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Li C, Islam N, Gutierrez JP, Gutiérrez-Barreto SE, Castañeda Prado A, Moolenaar RL, Lacey B, Richter P. Associations of diabetes, hypertension and obesity with COVID-19 mortality: a systematic review and meta-analysis. BMJ Glob Health 2023; 8:e012581. [PMID: 38097276 PMCID: PMC10729095 DOI: 10.1136/bmjgh-2023-012581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/04/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Despite a growing body of scholarly research on the risks of severe COVID-19 associated with diabetes, hypertension and obesity, there is a need for estimating pooled risk estimates with adjustment for confounding effects. We conducted a systematic review and meta-analysis to estimate the pooled adjusted risk ratios of diabetes, hypertension and obesity on COVID-19 mortality. METHODS We searched 16 literature databases for original studies published between 1 December 2019 and 31 December 2020. We used the adapted Newcastle-Ottawa Scale to assess the risk of bias. Pooled risk ratios were estimated based on the adjusted effect sizes. We applied random-effects meta-analysis to account for the uncertainty in residual heterogeneity. We used contour-funnel plots and Egger's test to assess possible publication bias. RESULTS We reviewed 34 830 records identified in literature search, of which 145 original studies were included in the meta-analysis. Pooled adjusted risk ratios were 1.43 (95% CI 1.32 to 1.54), 1.19 (95% CI 1.09 to 1.30) and 1.39 (95% CI 1.27 to 1.52) for diabetes, hypertension and obesity (body mass index ≥30 kg/m2) on COVID-19 mortality, respectively. The pooled adjusted risk ratios appeared to be stronger in studies conducted before April 2020, Western Pacific Region, low- and middle-income countries, and countries with low Global Health Security Index scores, when compared with their counterparts. CONCLUSIONS Diabetes, hypertension and obesity were associated with an increased risk of COVID-19 mortality independent of other known risk factors, particularly in low-resource settings. Addressing these chronic diseases could be important for global pandemic preparedness and mortality prevention. PROSPERO REGISTRATION NUMBER CRD42021204371.
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Affiliation(s)
- Chaoyang Li
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nazrul Islam
- Faculty of Medicine, University of Southampton, Southampton, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Juan Pablo Gutierrez
- Center for Policy, Population & Health Research, Universidad Nacional Autónoma de México, Coyoacan, Mexico
| | | | - Andrés Castañeda Prado
- Center for Policy, Population & Health Research, Universidad Nacional Autónoma de México, Coyoacan, Mexico
| | - Ronald L Moolenaar
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ben Lacey
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Patricia Richter
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Kipping R, Pallan M, Hannam K, Willis K, Dobell A, Metcalfe C, Jago R, Johnson L, Langford R, Martin CK, Hollingworth W, Cochrane M, White J, Blair P, Toumpakari Z, Taylor J, Ward D, Moore L, Reid T, Pardoe M, Wen L, Murphy M, Martin A, Chambers S, Simpson SA. Protocol to evaluate the effectiveness and cost-effectiveness of an environmental nutrition and physical activity intervention in nurseries (Nutrition and Physical Activity Self Assessment for Child Care - NAP SACC UK): a multicentre cluster randomised controlled trial. BMC Public Health 2023; 23:1475. [PMID: 37532982 PMCID: PMC10398919 DOI: 10.1186/s12889-023-16229-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/01/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND One in seven UK children have obesity when starting school, with higher prevalence associated with deprivation. Most pre-school children do not meet UK recommendations for physical activity and nutrition. Formal childcare settings provide opportunities to deliver interventions to improve nutritional quality and physical activity to the majority of 3-4-year-olds. The nutrition and physical activity self-assessment for childcare (NAP SACC) intervention has demonstrated effectiveness in the USA with high acceptability in the UK. The study aims to evaluate the effectiveness and cost-effectiveness of the NAP SACC UK intervention to increase physical activity, reduce sedentary time and improve nutritional intake. METHODS Multi-centre cluster RCT with process and economic evaluation. Participants are children aged 2 years or over, attending UK early years settings (nurseries) for ≥ 12 h/week or ≥ 15 h/week during term time and their parents, and staff at participating nurseries. The 12-month intervention involves nursery managers working with a Partner (public health practitioner) to self-assess policies and practices relating to physical activity and nutrition; nursery staff attending one physical activity and one nutrition training workshop and setting goals to be achieved within 6 months. The Partner provides support and reviews progress. Nursery staff receive a further workshop and new goals are set, with Partner support for a further 6 months. The comparator is usual practice. Up to 56 nurseries will be stratified by area and randomly allocated to intervention or comparator arm with minimisation of differences in level of deprivation. PRIMARY OUTCOMES accelerometer-assessed mean total activity time on nursery days and average total energy (kcal) intake per eating occasion of lunch and morning/afternoon snacks consumed within nurseries. SECONDARY OUTCOMES accelerometer-assessed mean daily minutes of moderate-to-vigorous physical activity and sedentary time per nursery day, total physical activity on nursery days compared to non-nursery days, average serving size of lunch and morning/afternoon snacks in nursery per day, average percentage of core and non-core food in lunch and morning/afternoon snacks, zBMI, proportion of children who are overweight/obese and child quality-of-life. A process evaluation will examine fidelity, acceptability, sustainability and context. An economic evaluation will compare costs and consequences from the perspective of the local government, nursery and parents. TRIAL REGISTRATION ISRCTN33134697, 31/10/2019.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jodi Taylor
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Dianne Ward
- University of North Carolina, Chapel Hill, USA
| | - Laurence Moore
- MRC / CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Tom Reid
- University of Bristol, Bristol, UK
| | | | | | | | - Anne Martin
- MRC / CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Stephanie Chambers
- School of Social and Political Sciences and MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Sharon Anne Simpson
- MRC / CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Ellmers TJ, Freiberger E, Hauer K, Hogan DB, McGarrigle L, Lim ML, Todd C, Martin F, Delbaere K. Why should clinical practitioners ask about their patients' concerns about falling? Age Ageing 2023; 52:7136743. [PMID: 37097766 DOI: 10.1093/ageing/afad057] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Indexed: 04/26/2023] Open
Abstract
Concerns (or 'fears') about falling (CaF) are common in older adults. As part of the 'World Falls Guidelines Working Group on Concerns about Falling', we recommended that clinicians working in falls prevention services should regularly assess CaF. Here, we expand upon these recommendations and argue that CaF can be both 'adaptive' and 'maladaptive' with respect to falls risk. On the one hand, high CaF can lead to overly cautious or hypervigilant behaviours that increase the risk of falling, and may also cause undue activity restriction ('maladaptive CaF'). But concerns can also encourage individuals to make appropriate modifications to their behaviour to maximise safety ('adaptive CaF'). We discuss this paradox and argue that high CaF-irrespective of whether 'adaptive' or 'maladaptive'-should be considered an indication that 'something is not right', and that is represents an opportunity for clinical engagement. We also highlight how CaF can be maladaptive in terms of inappropriately high confidence about one's balance. We present different routes for clinical intervention based on the types of concerns disclosed.
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Affiliation(s)
- Toby Jack Ellmers
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, UK
| | - Ellen Freiberger
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute for Biomedicine of Aging, Nürnberg, Germany
| | - Klaus Hauer
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg/Geriatric Centre of the University of Heidelberg, Heidelberg, Germany
| | - David B Hogan
- Brenda Strafford Centre on Aging, Cumming School of Medicine, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Lisa McGarrigle
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Mae Ling Lim
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Finbarr Martin
- Population Health Sciences, Faculty of Life Sciences and Medicine King's College London, London, UK
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
- Medicine & Health, School of Population Health, University of New South Wales, Kensington, NSW, Australia
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