Scale-up of the Internet-based Professional Learning to help teachers promote Activity in Youth (iPLAY) intervention: a hybrid type 3 implementation-effectiveness trial

BACKGROUND

Whole-of-school programs have demonstrated success in improving student physical activity levels, but few have progressed beyond efficacy testing to implementation at-scale. The purpose of our study was to evaluate the scale-up of the 'Internet-based Professional Learning to help teachers promote Activity in Youth' (iPLAY) intervention in primary schools using the RE-AIM framework.

METHODS

We conducted a type 3 hybrid implementation-effectiveness study and collected data between April 2016 and June 2021, in New South Wales (NSW), Australia. RE-AIM was operationalised as: (i) Reach: Number and representativeness of students exposed to iPLAY; (ii) Effectiveness: Impact of iPLAY in a sub-sample of students (n = 5,959); (iii) Adoption: Number and representativeness of schools that received iPLAY; (iv) Implementation: Extent to which the three curricular and three non-curricular components of iPLAY were delivered as intended; (v) Maintenance: Extent to which iPLAY was sustained in schools. We conducted 43 semi-structured interviews with teachers (n = 14), leaders (n = 19), and principals (n = 10) from 18 schools (11 from urban and 7 from rural locations) to determine program maintenance.

RESULTS

Reach: iPLAY reached ~ 31,000 students from a variety of socio-economic strata (35% of students were in the bottom quartile, almost half in the middle two quartiles, and 20% in the top quartile).

EFFECTIVENESS

We observed small positive intervention effects for enjoyment of PE/sport (0.12 units, 95% CI: 0.05 to 0.20, d = 0.17), perceptions of need support from teachers (0.26 units, 95% CI: 0.16 to 0.53, d = 0.40), physical activity participation (0.28 units, 95% CI: 0.10 to 0.47, d = 0.14), and subjective well-being (0.82 units, 95% CI: 0.32 to 1.32, d = 0.12) at 24-months. Adoption: 115 schools received iPLAY.

IMPLEMENTATION

Most schools implemented the curricular (59%) and non-curricular (55%) strategies as intended. Maintenance: Based on our qualitative data, changes in teacher practices and school culture resulting from iPLAY were sustained.

CONCLUSIONS

iPLAY had extensive reach and adoption in NSW primary schools. Most of the schools implemented iPLAY as intended and effectiveness data suggest the positive effects observed in our cluster RCT were sustained when the intervention was delivered at-scale.

TRIAL REGISTRATION

ACTRN12621001132831.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Effects of classroom-based active breaks on cognition, sitting and on-task behaviour in children with intellectual disability: a pilot study

BACKGROUND

Classroom-based active breaks can help typically developing children reduce sitting, increase physical activity and improve cognitive functions and on-task behaviour. Yet, this strategy has not been tested in children with intellectual disability (ID) - a population who are insufficiently active. This study aimed to investigate the effects of a 5-week active breaks intervention on cognitive functions and on-task behaviour in schoolchildren with ID.

METHODS

Twenty-four children, aged between 8 and 12 years (37.5% girls), were recruited. Children's cognitive functions (response inhibition, lapses of attention, interference and working memory) were measured at baseline and end of trial using computer-based tests. Sitting, standing and movement patterns were assessed with inclinometers, and on-task behaviour was directly observed in the classroom before and after active breaks, at baseline, mid-trial and end of trial. Linear mixed models were used to investigate the intervention effects on cognitive functions and sedentary patterns; generalised linear mixed models were used to analyse on-task behaviour data.

RESULTS

A significant time × group interaction was found for working memory favouring the intervention (B = 11.56, 95% confidence interval [1.92, 21.21]). No significant effects were found in relation to the other measures of children's cognition or on-task behaviour. Stepping time and bouts of sitting were positively affected.

CONCLUSIONS

Classroom-based active breaks can increase physical activity and reduce sedentary behaviour in children with ID and might also benefit their working memory. Further research is required to clarify the effects on cognition and to investigate whether this strategy has other benefits in this population.

Workplace health beliefs concerning physical activity and sedentary behaviour

Background

Sedentary behaviour (SB) in the form of uninterrupted sitting constitutes a risk factor for chronic disease that is independent of the risks associated with insufficient physical activity (PA). However, little is known about employee and manager health beliefs concerning SB and PA.

Aims

We assess health beliefs of desk-based workers concerning PA and SB accrued at work versus during leisure. We ask whether recreational PA attenuates the perceived ill-health effects of prolonged occupational SB, and compare attitudes of employees and managers to interventions aimed at reducing/interrupting workplace sitting.

Methods

Two hundred and twenty-two desk-based employees and 121 managers located in Melbourne, Australia, rated the healthiness of vignettes describing combinations of uninterrupted sitting, sitting with breaks, light PA and moderate-to-vigorous PA accumulated at work and during leisure time. Participants also responded to open-ended questions concerning the implications of reducing workplace sitting.

Results

Mixed-model ANOVA revealed that the presence of leisure-time PA greatly diminished the perceived detrimental effects to health of workplace sitting. Subsequent thematic analysis of qualitative data further revealed that participants' concerns with SB were primarily musculoskeletal and workplace performance rather than chronic health.

Conclusions

Employees and their managers do not rate uninterrupted sitting as being unhealthy when it is presented to them in the form of an 'active couch potato' lifestyle (a person who meets minimum PA recommendations but spends much of their work time and non-PA time sitting). We recommend that interventions targeting workplace SB take into account the contextual nature of health beliefs.

Interventions to increase physical activity in children 0-5 years old: a systematic review, meta-analysis and realist synthesis

OBJECTIVE

The objective of the study is to evaluate the effectiveness of interventions to increase physical activity (PA) in 0-5 year olds and to determine what works, for whom, in what circumstances.

DESIGN

Systematic review, meta-analysis and realist synthesis.

DATA SOURCES

Embase and EBSCOhost (Academic Search Complete, CINAHL Complete, Global Health, MEDLINE Complete, PsycINFO, SPORTDiscus with full text), up to and including April 2017.

ELIGIBILITY CRITERIA

Published in a peer-reviewed English language journal; randomized or controlled trial design; aimed to increase children's PA levels; reported on objectively assessed PA in children between 0 and 5.9 years at baseline and post-intervention.

RESULTS

Thirty-four studies were included in the review, mostly conducted in the preschool/childcare setting. Meta-analyses showed an overall non-significant (Z = 0.04, p = 0.97) mean difference of 0.03 (95% CI = -1.57, 1.63) minutes/day for light-intensity PA (n = 11). The overall mean difference for moderate-intensity to vigorous-intensity PA (n = 21) was 2.88 (95% CI = 1.54, 4.23) minutes/day, indicating a small but significant overall positive effect (Z = 4.20, p < 0.001). The realist synthesis provided insights into the key contexts and mechanisms that appeared to be effective at changing children's PA.

CONCLUSION

Based on a quantitative and qualitative examination of the evidence, this review provides specific recommendations for effective early childhood PA interventions for practitioners and policymakers.

Inhibition du Purpura Thrombopénique Immunologique par l’Acide ε-aminocaproïque

L’acide ε-aminocaproïque inhibe le purpura thrombopénique immunologique. La pathogénie de ce dernier, que ne peut expliquer la seule thrombopénie, relève vraisemblablement de phénomènes fibrinolytiques, sinon d’une protéolyse non spécifique.

The Part Played by Platelets in the Formation of an Efficient Hemostatic Plug

The arrest of bleeding from small arteries or veins depends on the formation of a hemostatic plug made of platelets. In spite of recent information on the conditions required for platelet adhesion to various foreign surfaces, little is known about the precise mechanism of platelet adhesion to the lips of the vessel wound. The effectiveness of the hemostatic plug is due to the viscous metamorphosis of the agglutinated platelets.

Study protocol for a natural experiment in a lower socioeconomic area to examine the health-related effects of refurbishment to parks including built-shade (ShadePlus)

INTRODUCTION

Parks in disadvantaged suburbs often have low quality and few amenities, which is likely to result in them being underutilised for recreation and physical activity. Refurbishment of parks, including shade, walking paths and other amenities, may have broad health-related benefits.

METHODS AND ANALYSIS

The study design, methods and planned analyses for a natural experiment examining the effects of refurbishments including built-shade added to parks in disadvantaged outer suburbs of Melbourne are described. Three intervention parks and three comparison parks matched for equivalence of park and neighbourhood characteristics were selected. Using mixed methods, the outcomes will be assessed during three consecutive spring-summer periods (T1: 2013-2014; T2: 2014-2015: T3: 2015-2016). Primary outcomes included: observed park use, physical activity and shade use. Self-reported social connectedness, community engagement and psychological well-being were assessed as secondary outcomes.

ETHICS AND DISSEMINATION

This study was approved by Cancer Council Victoria's Human Research Ethics Committee. Studies such as ShadePlus can improve understanding of the broader effects of park refurbishments (including physical activity levels and sun protection behaviours, as well as social connectedness and psychological well-being). The study findings will be disseminated through established urban planning and parks and recreation networks, peer review publications and conference presentations.

Mediating effects of dietary intake on associations of TV viewing, body mass index and metabolic syndrome in adolescents

Objective

Evidence suggests that TV viewing is associated with body mass index (BMI) and metabolic syndrome (MetS) in adolescents. However, it is unclear whether dietary intake mediates these relationships.

Methods

A cross‐sectional analysis was conducted in adolescents (12–19 years) participating in the 2003–2006 United States National Health and Nutrition Examination Survey. BMI z scores (zBMI) (n = 3,161) and MetS (n = 1,379) were calculated using age‐ and sex‐specific criteria for adolescents. TV viewing (h/day) was measured via a self‐reported questionnaire, and dietary intake was assessed using two 24‐h recalls. Using the MacKinnon method, a series of mediation analyses were conducted examining five dietary mediators (total energy intake, fruit and vegetable intake, discretionary snacks, sugar‐sweetened beverages and diet quality) of the relationships between TV viewing and zBMI and MetS.

Results

Small positive relationships were observed between TV viewing and zBMI (β = 0.99, p < 0.001) and TV viewing and MetS (OR = 1.18, p = 0.046). No dietary element appeared to mediate the relationship between TV viewing and zBMI. However, sugar‐sweetened beverage consumption and fruit and vegetable intake partially mediated the relationship between TV viewing and MetS, explaining 8.7% and 4.1% of the relationship, respectively.

Conclusions

These findings highlight the complexity of the relationships between TV viewing, dietary intake and cardiometabolic health outcomes, and that TV viewing should remain a target for interventions.

New insights into complement: a mediator of injury and marker of disease activity in systemic lupus erythematosus

Studies performed during the past several decades have demonstrated a role for the complement system in both the etiology and pathogenesis of systemic lupus erythematosus (SLE). However the specifically defective molecular and cellular pathways responsible for the disease and its complications have generally not been identified. In this report, we describe two recent advances in complement pathobiology that highlight future directions for promising investigation toward enhancing our capacity to diagnose SLE, to monitor activity of the disease, and to identify molecular and cellular defects in SLE that can be targeted by therapeuticinhibitors of complement activation.In the first example, we describe recently developed assays to detect erythrocyte C4d and complement receptor1 for diagnosis and monitoring of disease activity in SLE. In the second example, we describe a recently discovered role for complement in mediating fetal loss in antiphospholipid syndrome and discuss the potential for this observation to facilitate identification and development of complement based biomarkers to predict poor fetal outcome in pregnant patients with SLE. These two examples are meant to underscore the importance of complement in the etiology and pathogenesis of SLE and its complications, and to stress the need for further investigation focused on the link between the complement system and SLE.

Associations of sedentary time patterns and TV viewing time with inflammatory and endothelial function biomarkers in children

OBJECTIVE

Investigate associations of TV viewing time and accelerometry-derived sedentary time with inflammatory and endothelial function biomarkers in children.

METHODS

Cross-sectional analysis of 164 7-10-year-old children. TV viewing time was assessed by parental proxy report and total and patterns of sedentary time accumulation (e.g. prolonged bouts) were assessed by accelerometry. C-reactive protein (CRP), homeostasis model assessment of insulin resistance, interleukin-2, -6, -8, -10, tumour necrosis factor alpha, adiponectin, resistin, brain-derived neurotrophic factor, soluble intercellular and vascular adhesion molecule 1, plasminogen activator inhibitor 1 and soluble E-selectin were assessed. Generalised linear models assessed the associations of TV viewing and sedentary time with biomarkers, adjusting for sex, waist circumference, moderate- to vigorous-intensity physical activity and diet density.

RESULTS

Each additional h week(-1) of TV viewing was associated with 4.4% (95% CI: 2.1, 6.7) greater CRP and 0.6% (0.2, 1.0) greater sVCAM-1 in the fully adjusted model. The association between frequency and duration of 5-10 min bouts of sedentary time and CRP was positive after adjustment for sex and waist circumference but attenuated after adjustment for diet density.

CONCLUSIONS

This study suggests that TV viewing was unfavourably associated with several markers of inflammation and endothelial dysfunction. The detrimental association between 5 and 10 min bouts of sedentary time and CRP approached significance, suggesting that further research with a stronger study design (longitudinal and/or experimental) is needed to better understand how the accumulation of sedentary time early in life may influence short and longer term health.

Objectively measured sedentary behaviour and health and development in children and adolescents: systematic review and meta-analysis

Sedentary behaviour has emerged as a unique determinant of health in adults. Studies in children and adolescents have been less consistent. We reviewed the evidence to determine if the total volume and patterns (i.e. breaks and bouts) of objectively measured sedentary behaviour were associated with adverse health outcomes in young people, independent of moderate-intensity to vigorous-intensity physical activity. Four electronic databases (EMBASE MEDLINE, Ovid EMBASE, PubMed and Scopus) were searched (up to 12 November 2015) to retrieve studies among 2- to 18-year-olds, which used cross-sectional, longitudinal or experimental designs, and examined associations with health outcomes (adiposity, cardio-metabolic, fitness, respiratory, bone/musculoskeletal, psychosocial, cognition/academic achievement, gross motor development and other outcomes). Based on 88 eligible observational studies, level of evidence grading and quantitative meta-analyses indicated that there is limited available evidence that the total volume or patterns of sedentary behaviour are associated with health in children and adolescents when accounting for moderate-intensity to vigorous-intensity physical activity or focusing on studies with low risk of bias. Quality evidence from studies with robust designs and methods, objective measures of sitting, examining associations for various health outcomes, is needed to better understand if the overall volume or patterns of sedentary behaviour are independent determinants of health in children and adolescents.

The contribution of antiphospholipid antibodies to organ damage in systemic lupus erythematosus

OBJECTIVES

The objective of this study was to assess the contribution of clinically significant antiphospholipid antibodies (aPL) to organ damage in systemic lupus erythematosus (SLE).

METHODS

Patients with disease duration of less than 10 years and at least 5 years of follow-up were identified from two SLE registries. A clinically significant antiphospholipid antibody (aPL) profile was defined as: positive lupus anticoagulant, anticardiolipin IgG/M ≥ 40 G phospholipid units (GPL)/M phospholipid units (MPL), and/or anti-β2-glycoprotein-I IgG/M ≥ 99th percentile on two or more occasions, at least 12 weeks apart. Organ damage was assessed by the Systemic Lupus International Collaborating Clinics Damage Index (SDI). Univariate and multivariate analysis compared SLE patients with and without SDI increase during a 15-year follow-up.

RESULTS

Among 262 SLE patients, 33% had a clinically significant aPL profile, which was associated with an increased risk of organ damage accrual during a 5-year follow-up in univariate analysis, and during a 15-year follow-up in the multivariate analysis adjusting for age, gender, race, disease duration at registry entry, and time. In the multivariate analysis, older age at diagnosis and male gender were also associated with SDI increase at each time point.

CONCLUSION

A clinically significant aPL profile is associated with an increased risk of organ damage accrual during a 15-year follow-up in SLE patients.

Is the relationship between sedentary behaviour and cardiometabolic health in adolescents independent of dietary intake? A systematic review

Screen time, but not overall sedentary behaviour, is consistently related to cardiometabolic health in adolescents. Because of the associations screen time has with dietary intake, diet may be an important factor in the screen time and health relationship; however, evidence has not previously been synthesized. Thus, the aim of this systematic review was to explore whether the associations between various sedentary behaviours and cardiometabolic risk markers are independent of dietary intake in adolescents. Online databases and personal libraries were searched for peer-reviewed original research articles published in English before March 2014. Included studies assessed associations between sedentary behaviour and cardiometabolic markers in 12- to 18-year-olds and adjusted for dietary intake. Twenty-five studies met the inclusion criteria. From the 21 studies examining sedentary behaviour and adiposity, the majority found significant positive associations between television viewing, screen time and self-reported overall sedentary behaviour with markers of adiposity, independent of dietary intake. No significant associations between screen time with blood pressure and cholesterol were reported. Sedentary behaviour appears to be associated with adiposity in adolescents, irrespective of dietary intake. However, the variability of dietary variables between studies suggests further work is needed to understand the role of dietary intake when examining these associations in youth.

Accretion of the Moon from non-canonical discs

Impacts that leave the Earth-Moon system with a large excess in angular momentum have recently been advocated as a means of generating a protolunar disc with a composition that is nearly identical to that of the Earth's mantle. We here investigate the accretion of the Moon from discs generated by such 'non-canonical' impacts, which are typically more compact than discs produced by canonical impacts and have a higher fraction of their mass initially located inside the Roche limit. Our model predicts a similar overall accretional history for both canonical and non-canonical discs, with the Moon forming in three consecutive steps over hundreds of years. However, we find that, to yield a lunar-mass Moon, the more compact non-canonical discs must initially be more massive than implied by prior estimates, and only a few of the discs produced by impact simulations to date appear to meet this condition. Non-canonical impacts require that capture of the Moon into the evection resonance with the Sun reduced the Earth-Moon angular momentum by a factor of 2 or more. We find that the Moon's semi-major axis at the end of its accretion is approximately 7R⊕, which is comparable to the location of the evection resonance for a post-impact Earth with a 2.5 h rotation period in the absence of a disc. Thus, the dynamics of the Moon's assembly may directly affect its ability to be captured into the resonance.

Television in the bedroom and increased body weight: potential explanations for their relationship among European schoolchildren

AIMS

A television in the bedroom is associated with measures of adiposity. We aimed to test if this association is mediated by any of (i) time spent watching television, (ii) sleep duration, (iii) physical activity level or (iv) consumption of soft drinks.

METHOD

Data were from 7234 boys and girls aged 10-12 years in European countries involved in the EuropeaN Energy balance Research to prevent excessive weight Gain among Youth project (Belgium, Greece, Hungary, the Netherlands, Norway, Slovenia and Spain). Waist circumference, height and weight were measured. The presence of a bedroom television, television viewing time, sleep duration, physical activity time and soft drink consumption were assessed by standardized questionnaires.

RESULTS

Almost 40% of schoolchildren had a bedroom television, with the highest percentage among Hungarian children (65%) and lowest for Belgian, Slovenian and Spanish children (all ≈28%). A television in the bedroom was positively associated with time spent watching television, soft drink consumption and overweight and obesity (all P < 0.001). The relationship between a television in the bedroom and measures of body size was partly mediated by total television viewing time (proportion mediated for waist circumference 8.9%; for body mass index 8.3%) but not sleep duration, physical activity time or soft drink consumption.

CONCLUSION

The strong association between a television in the bedroom and adiposity was at least partially mediated by television viewing time. The large proportion of European schoolchildren with a television in their bedroom is of concern. Parents should be aware of the potential consequences when placing a television in a child's bedroom and children should limit viewing time.

What helps children to be more active and less sedentary? Perceptions of mothers living in disadvantaged neighbourhoods

BACKGROUND

  Increasing children's participation in physical activity and decreasing time spent in sedentary behaviours is of great importance to public health. Despite living in disadvantaged neighbourhoods, some children manage to engage in health-promoting physical activity and avoid high levels of screen-based activities (i.e. watching TV, computer use and playing electronic games). Understanding how these children manage to do well and whether there are unique features of their home or neighbourhood that explain their success is important for informing strategies targeting less active and more sedentary children. The aim of this qualitative study was to gain in-depth insights from mothers regarding their child's resilience to low physical activity and high screen-time.

METHODS

  Semi-structured face-to-face interviews were conducted with 38 mothers of children who lived in disadvantaged neighbourhoods in urban and rural areas of Victoria, Australia. The interviews were designed to gain in-depth insights about perceived individual, social and physical environmental factors influencing resilience to low physical activity and high screen-time.

RESULTS

  Themes relating to physical activity that emerged from the interviews included: parental encouragement, support and modelling; sports culture in a rural town; the physical home and neighbourhood environment; child's individual personality; and dog ownership. Themes relating to screen-time behaviours encompassed: parental control; and child's individual preferences.

CONCLUSIONS

  The results offer important insights into potential avenues for developing 'resilience' and increasing physical activity and reducing screen-time among children living in disadvantaged neighbourhoods. In light of the negative effects of low physical activity and high levels of screen-time on children's health, this evidence is urgently needed.