Benchmarking physical activity and nutrition policies in Europe: lessons from the CO-CREATE project

Background

Global research shows a strong link between physical activity, nutrition and the risk of developing non-communicable diseases. To increase physical activity and healthy eating, governments must design and implement a comprehensive set of policy actions across a range of areas. The MOVING and NOURISHING benchmarking tools were developed to identify gaps and assess the strength of actions taken by national governments in these complex policy areas.

Methods

The benchmarking tools value the strength of policy design based on policy attributes that are evidence-informed and aspirational. Both tools were applied to five countries participating in CO-CREATE, a European Commission-funded project: Netherlands, Norway, Poland, Portugal and UK. Physical activity and nutrition policies in each of these countries were identified based on a comprehensive country scan, with a set methodology.

Results

The benchmarks assessed the strengths and weaknesses in the design of policies across the NOURISHING and MOVING policy areas. They identified where there was scope for improvement within a policy area. For example, the tools helped evaluate the design of health related-food taxes in Norway, Poland, Portugal, and UK and allowed a cross-country comparison of these policies. When comparing the overall policy environment across all countries, we found an overall lack of policies promoting access to open/green spaces and weaknesses in designing restrictions on marketing unhealthy foods to children.

Conclusions

The benchmarking tools can inform the development and implementation of policies which promote physical activity and healthy eating. They were developed for the European context but are also being tested on relevant policies in South Africa. They can be used by governments, policymakers, researchers and civil society to identify areas of physical activity and nutrition policy that are weak and require government action.

Key messages

Benchmarking nutrition and physical activity policy can identify gaps and assess the strength of actions taken by national governments in these complex policy areas. The NOURISHING and MOVING benchmarking tools can be used by governments, policymakers, researchers and civil society various to inform policy-making in nutrition and physical activity.

Community engagement for paediatric MDR-TB clinical trials: principles to support ethical trial implementation

The paediatric tuberculosis (TB) prevention and treatment landscape is moving into a new and exciting era, with knowledge from clinical trials offering real benefit to children. Community engagement is key to optimising the success of these trials. However, the clinical profile, epidemiology and social perceptions for paediatric multidrug-resistant TB (MDR-TB) complicate the operationalisation of this community engagement. We reflect on a diversity of recent experiences attempting to implement this type of research and the community engagement around it. We describe four recommendations and argue that these should guide the implementation of the community engagement agenda in the new landscape of paediatric MDR-TB clinical trials. Specifically, we argue for 1) dynamic, long-term continuity in community engagement platforms; 2) tiers of TB and research literacy; 3) multiple separate and joint platforms for holding 'stakes'; and 4) addressing the social/structural implications of family participation. We conclude that community-level stakeholders, such as health workers, parents and children, are willing to collaborate in paediatric MDR-TB clinical trials. Using these recommendations, there is considerable opportunity for effective community engagement in this new era of paediatric MDR-TB research.

Expression of adiponectin and its receptors in avian species

Adipose tissue is a dynamic endocrine organ secreting a variety of hormones that affect physiological functions within the central nervous system, cardiovascular system, reproductive, and immune systems. The endocrine role of avian adipose tissue remains enigmatic as many of the classical hormones found in mammalian adipose tissue have not been found in avians. This mini-review summarizes our current knowledge on avian adiponectin, one of the most abundant adipose tissue hormones, and its receptors. We cloned the genes encoding chicken adiponectin and its receptors, AdipoR1 and AdipoR2. Using anti-chicken adiponectin antibody, we found that chicken adipose tissue and plasma predominantly contain a unique polymer of adiponectin with a mass greater than 669kDa, unlike mammalian adiponectin which is found as three distinct oligomers. Mass spectrometric analyses of chicken adiponectin revealed certain post-translational modifications that are likely to favor the unique multimerization of adiponectin in chickens. Unlike adiponectin, the nucleotide sequences of chicken AdipoR1- and AdipoR2 cDNA are highly similar to that of mammalian adiponectin receptors. Both adiponectin and adiponectin receptors are widely expressed in several tissues in the chicken. Herein, we review the unique biochemistry of adiponectin as well as expression of adiponectin and its receptors in the chicken. Future studies should focus on elucidating the role of adiponectin, AdipoR1, and AdipoR2 on metabolism, steroidogenesis, and adipose tissue remodeling during growth and reproduction in birds.

Adiponectin gene is expressed in multiple tissues in the chicken: food deprivation influences adiponectin messenger ribonucleic acid expression

Adiponectin is a cytokine hormone originally found to be secreted exclusively by white adipose tissue. However, recent evidences suggest that adiponectin is also produced in brown adipose tissue and skeletal muscle. The present study investigated the expression of adiponectin mRNA in various tissues in the chicken. We also studied the effect of food deprivation on adiponectin gene expression in adipose tissue, liver, anterior pituitary gland, and diencephalon in the chicken. The open reading frame of chicken adiponectin cDNA consists of 735 nucleotides that were 65-68% homologous to various mammalian adiponectin cDNAs. The deduced amino acid sequence of chicken adiponectin contains 22 glycine-X-Y repeats (in which X and Y represent any amino acid) at the N-terminal end as found in the mammalian adiponectin. By RT-PCR and Northern analysis, we detected chicken adiponectin mRNA transcript in adipose tissue, liver, anterior pituitary gland, diencephalon, skeletal muscle, liver, kidney, ovary, and spleen but not in blood. Adiponectin mRNA expression in various tissues was quantitated using real-time quantitative PCR and found to be the highest in adipose tissue, followed by liver, anterior pituitary, diencephalon, kidney, and skeletal muscle. We also found that adiponectin mRNA quantity was significantly decreased after a 48-h food deprivation in adipose tissue, liver, and anterior pituitary gland but not in diencephalon. Our results provide novel evidence that, unlike mammals, adiponectin gene is expressed in several tissues in the chicken and that its expression is influenced by food deprivation.

The role of neuroendocrine immune interactions in the initiation of humoral immunity in chickens

The presence of neuroendocrine immune interaction in mammalian species has been studied extensively and has been established. However, such an interaction is not as well established in avian species. Furthermore, the role of such an interaction in the initiation of humoral immunity is not well understood. Therefore, the present studies were conducted to determine mechanisms involved in the initiation of humoral immunity in chickens. Cornell K-strain White Leghorn immature male chickens were used for all the experiments. Changes in hormonal and leukocyte profiles after antigen stimulation were studied. The ability of different leukocytes to produce ACTH was also investigated. It was concluded that the first step in the initiation of humoral immunity after antigen exposure is the release of interleukin-1 by macrophages, which in turn stimulates the production of CRF by hypothalamus and/or leukocytes. It is important to mention that CRF production could also be a direct effect of antigen stimulation. The CRF will then stimulate ACTH production by anterior pituitary and/or leukocytes. In addition, CRF will directly enhance lymphocyte activities in the spleen. Corticosteroid production will be stimulated by ACTH and will cause redistribution of lymphocytes from circulation to secondary lymphoid organs such as the spleen for antigen processing and eventual production of antibodies against the invading antigens. Finally, both ACTH and corticosteroids will later act in a negative feedback manner to regulate and control the process of antibody production by inhibiting lymphocyte activities and/or reducing the responsiveness to different stimuli.

Cytologic diagnosis of cat scratch disease (CSD) by fine-needle aspiration

Cat scratch disease (CSD) is usually a benign, self-limited lymphadenitis, characterized by suppurative granulomas. It can, however, produce a wide spectrum of clinical symptoms and cytologic changes and be the source of diagnostic dilemmas. Identification of pleomorphic bacilli (PB) with silver impregnation stains aids in the diagnosis, but this has not been well documented in cytologic preparations or in cases without the classic morphologic changes. We reviewed 13 aspirations from eight patients (aged 13-36 yr) occurring over a 15 mo time period, all clinically or cytologically suspicious for CSD. Sites included: axilla (6), parotid (3), epitrochlear (1), neck (1), submental (1), and intraclavicular (1) nodes. Neoplasia was initially suspected clinically in 38% of the cases. All but two patients had cat exposure on subsequent interview. The cytologic differential included bacterial abscess and lymphoproliferative disorders in 31%. Neither granulomas nor suppurative inflammation were seen in all cases. Changes included: granulomas (77%), PMNs (62%), dispersed epithelioid histiocytes (46%), and suppurative granulomas (38%). A modified silver stain (Modified Steiner, Sigma Diagnostics, St. Louis, MO) was performed on all specimens. Silver positive organisms were seen in 69% of cases and were not limited to those preparations with suppurative granulomas. Fine-needle aspiration biopsy (FNAB) is an effective method for diagnosing CSD despite its heterogeneous appearance; and, when combined with clinical information and silver staining, may obviate the need for excision.