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IntroductionChildhood obesity and physical inactivity are two of the most significant modifiable risk factors for the prevention of non-communicable diseases (NCDs). Yet, a third of children in Wales and Australia are overweight or obese, and only 20% of UK and Australian children are sufficiently active. The purpose of the Built Environments And Child Health in WalEs and AuStralia (BEACHES) study is to identify and understand how complex and interacting factors in the built environment influence modifiable risk factors for NCDs across childhood.Methods and analysisThis is an observational study using data from five established cohorts from Wales and Australia: (1) Wales Electronic Cohort for Children; (2) Millennium Cohort Study; (3) PLAY Spaces and Environments for Children’s Physical Activity study; (4) The ORIGINS Project; and (5) Growing Up in Australia: the Longitudinal Study of Australian Children. The study will incorporate a comprehensive suite of longitudinal quantitative data (surveys, anthropometry, accelerometry, and Geographic Information Systems data) to understand how the built environment influences children’s modifiable risk factors for NCDs (body mass index, physical activity, sedentary behaviour and diet).Ethics and disseminationThis study has received the following approvals: University of Western Australia Human Research Ethics Committee (2020/ET000353), Ramsay Human Research Ethics Committee (under review) and Swansea University Information Governance Review Panel (Project ID: 1001). Findings will be reported to the following: (1) funding bodies, research institutes and hospitals supporting the BEACHES project; (2) parents and children; (3) school management teams; (4) existing and new industry partner networks; (5) federal, state and local governments to inform policy; as well as (6) presented at local, national and international conferences; and (7) disseminated by peer-reviewed publications.

The health benefits of individual and group participation in sports are well-known. While a positive association between participation in sport and self-assessed health has been reported for England and Scotland, research has been limited in Wales. In addition, research examining the relationship between levels of physical activity and the accessibility of sport facilities give inconsistent findings. This research project proposes to explore the potential association between the accessibility of sports facilities, sport participation and health. In particular, we will examine whether: Accessibility to sport facilities contributes to participation in sporting activities. Sports participation mediates the association between accessibility to sport facilities and health outcomes (as recorded in routine-health-records). The association between participation in sports and health is independent of individual characteristics such as gender, socio-economic characteristics. The data-sets used were: the Welsh Demographic Service Data (WDSD), the Patient Episode Database for Wales (PEDW), the Sport Wales Active Adults Survey (AAS) and Enhanced Recreational Database (ERD). Accessibility measures were derived from the SWERD, while the Charlson Comorbidity Index (CCI) was estimated as an indicator of general health based on PEDW data. The AAS was then linked to PEDW and the ERD. Appropriate regression analysis was applied based on the type of outcome explored. Preliminary results showed that 72% of the adults participated in sports in the 4 weeks prior to interview and 39% of them participated 3 or more times. Accessibility to sport facilities was significantly associated with outdoor sport activities rather than indoor activities. Distance to a sports hall was significantly associated with sport participation. Adults with a chronic condition based on CCI were less likely to participate in sports. The study provided a unique opportunity to explore the benefits of analysing linked administrative and survey data, therefore contributing to current research on sport participation/accessibility and health.

Adolescents' engage in new behaviours such as substance use and change others, such as reducing physical activity. Risks to health from these tend to be considered separately. We examined the association between multiple risk behaviours at age 16 years and outcomes in early adulthood. 5591 young people enrolled in the Avon Longitudinal Study of Parents and Children provided data on at least one of seven adverse outcomes at age ~18 years. We used logistic regression to examine associations between total number of risk behaviours and rates of depression, anxiety, problem gambling, getting into trouble with the police, harmful drinking, obesity and not in education, employment or training (NEET) at age 18 years. We found strong associations between multiple risk behaviours and all seven adverse outcomes. For each additional risk behaviour engaged in the odds of harmful drinking increased by OR = 1.58[95%CI:1.48,1.69], getting into trouble with the police OR = 1.49[95%CI:1.42,1.57], having depression OR = 1.24[95%CI:1.17,1.31], problem gambling OR = 1.20[95%CI:1.13,1.27], NEET OR = 1.19[95%CI:1.11,1.29], anxiety OR = 1.18[95%CI:1.12,1.24] and obesity OR = 1.09[95%CI:1.03,1.15]. Neither adjustment for sex, parental socio-economic position and maternal risk behaviours, nor confining analyses to adolescents with no previous presentation of these adverse outcomes, resulted in any notable reductions in the odds ratios. Investment in interventions and environments that effectively prevent multiple risk behaviour is likely to improve a range of health outcomes in young adults., Highlights • MRB in adolescence was associated with adverse health outcomes in early adulthood. • For each additional risk behaviour odds of an adverse outcome ranged from 1.09–1.58. • Adjustments for potential confounders did not alter the odds of an adverse outcome. • Association between MRB and adverse outcomes was not due to reverse causality.

Objective: To describe levels of physical activity, sedentary time and adherence to Chief Medical Officers (CMO) physical activity guidelines among primary school-aged children across the UK using objective accelerometer-based measurements. Design: Nationally representative prospective cohort study. Setting: Children born across the UK, between 2000 and 2002. Participants: 6497 7-year-old to 8-year-old singleton children for whom reliable accelerometer data were available for at least 10 h a day for at least 2 days. Main outcome measures: Physical activity in counts per minute (cpm); time spent in sedentary and moderate-to-vigorous intensity physical activity (MVPA); proportion of children meeting CMO guidelines (≥60 min/day MVPA); average daily steps. Explanatory measures: Gender, ethnicity, maternal current/most recent occupation, lone parenthood status, number of children in the household and country/region of residence. Results: The median daily physical activity level was 595 cpm (IQR 507, 697). Children spent a median of 60 min (IQR 47-76) in MVPA/day and were sedentary for a median of 6.4 h/day (IQR 6-7). Only 51% met CMO guidelines, with girls (38%) less active than boys (63%). Children took an average of 10 229 (95% CI (8777 to 11 775)) steps each day. Children of Indian ethnicity were significantly less active overall than all other ethnic groups. Children of Bangladeshi origin and those living in Northern Ireland were least likely to meet CMO guidelines. Conclusions: Only half of 7-year-old children in the UK achieve recommended levels of physical activity, with significant gender, ethnic and geographic variations. Longitudinal studies are needed to better understand the relevance of these (in)activity patterns for long-term health and well-being. In the meantime population-wide efforts to boost physical activity among young people are needed which are likely to require a broad range of policy interventions.

Objectives To investigate whether physical activity or sedentary behaviour at different life stages is associated with blood pressure (BP) in mid-adulthood; activity levels have accumulative associations with BP; and adult body mass index (BMI) mediates associations. Methods Information on activity and television-viewing was available at several ages (23, 33, 42, 45 years) and BP at 45 years for the 1958 British birth cohort (n = 9927). Associations were examined with and without adjustment for covariates. Results Active adults, generally, had lower mean systolic and diastolic BP and risk of hypertension than nonactive, although varying by age. After adjustment for covariates, systolic and diastolic BP for active men at 23 years or at 45 years were 1-2 mmHg lower; similar associations were seen for women active at 33 years. Some but not all associations attenuated with further adjustment for BMI: odds ratio (OR) for hypertension associated with 23 years activity changed from 0.82 [95% confidence interval (CI) 0.74, 0.91] to 0.79 (0.70, 0.90) after BMI adjustment. Independent associations of activity at more than one age were found, such that prevalence of hypertension was higher in men active at 23 years but not at 45 years, than men sustaining activity (39 vs. 31%). Sitting at work was unrelated to BP, but there was a trend of higher BP with greater television-viewing: for example risk of hypertension was higher by 10-12% per h/day television-viewing at 45 years after adjustment for covariates, attenuating after allowance for BMI. Conclusion Our study suggests that there are benefits to BP of becoming and sustaining active lifestyles and minimizing television-viewing over many years of adulthood, with a mediating role for BMI.

Overweight/obesity represent a significant public health problem in Canada and abroad. The objective of this paper is to identify potential associations between overweight/obesity and individual as well as socio-environmental determinants. The data sources used are the 2003 Canadian Community Health Survey and the Desktop Mapping Technologies Incorporated database. Geographical Information Systems are first employed to create neighbourhood-level variables such as neighbourhood walkability and fast food accessibility. Multivariate analysis is then applied to estimate the relative effects of individual- and neighbourhood-level risk-factors of overweight/obesity. Results demonstrate the important role of the built-environment after adjustment for demographic, socio-economic and behavioural characteristics. Findings support the rationale that reversing current trends will require a multifaceted public health approach where interventions are developed from the individual- to the neighbourhood-level, with a particular focus on altering obesogenic environments.

Maternal sun exposure in gestation and throughout the lifetime is necessary for vitamin D synthesis, and living near the sea is a population level index of seafood consumption. The aim of this study was to estimate the incidence rate of multiple sclerosis (MS) in Wales and examine its association with sun exposure, coastal living, and latitude. The study used a database of MS hospital visits and admissions in Wales between 2002 and 2013. For the 1,909 lower layer super output areas (LSOAs) in Wales, coastal status, population, longitude/latitude, and average sunshine hours per day were obtained. Age-specific and age-standardised MS incidence were calculated and modelled using Poisson regression. The distribution of births by month was compared between MS cases and the combined England and Wales population. There were 3,557 new MS cases between 2002 and 2013, with an average annual incidence of 8.14 (95% CI: 7.69–8.59) among males and 12.97 (95% CI: 12.44–13.50) among females per 100,000 population. The female-to-male ratio was 1.86:1. For both sexes combined, the average annual incidence rate was 9.10 (95% CI: 8.80–9.40). All figures are age-standardized to the 1976 European standard population. Compared to the combined England and Wales population, more people with MS were born in April, observed-to-expected ratio: 1.21 (95% CI: 1.08–1.36). MS incidence varied directly with latitude and inversely with sunshine hours. Proximity to the coast was associated with lower MS incidence only in easterly areas. This study shows that MS incidence rate in Wales is comparable to the rate in Scotland and is associated with environmental factors that probably represent levels of vitamin D.

Background This paper aims to assess whether 7-year-olds’ physical activity is associated with family and area-level measures of the physical and socioeconomic environments. Methods We analysed the association of environments with physical activity in 6497 singleton children from the UK Millennium Cohort Study with reliable accelerometer data (≥2 days and ≥10 h/day). Activity levels were assessed as counts per minute; minutes of moderate to vigorous activity (MVPA); and whether meeting recommended guidelines (≥60 min/day MVPA). Results Higher levels of children's physical activity were associated with households without use of a car and with having a television in a child's bedroom (for counts per minute only). Aspects of the home socioeconomic environment that were associated with more children's physical activity were lone motherhood, lower maternal socioeconomic position and education, family income below 60% national median, and not owning the home. Children's activity levels were higher when parents perceived their neighbourhood as poor for bringing up children and also when families were living in the most deprived areas. Relationships were independent of characteristics such as child's body mass index and ethnic group. When adjusted for physical and socioeconomic correlates, the factors remaining significant in all outcomes were: household car usage and maternal education. Conclusions Although physical and socioeconomic environments are associated with children’s physical activity, much of the variation appears to be determined by the child's home socioeconomic circumstances rather than the wider environment where they live.

Background Healthy children achieve better educational outcomes which, in turn, are associated with improved health later in life. The World Health Organization’s Health Promoting Schools (HPS) framework is a holistic approach to promoting health and educational attainment in school. The effectiveness of this approach has not yet been rigorously reviewed. Methods We searched 20 health, education and social science databases, and trials registries and relevant websites in 2011 and 2013. We included cluster randomised controlled trials. Participants were children and young people aged four to 18 years attending schools/colleges. HPS interventions had to include the following three elements: input into the curriculum; changes to the school’s ethos or environment; and engagement with families and/or local communities. Two reviewers identified relevant trials, extracted data and assessed risk of bias. We grouped studies according to the health topic(s) targeted. Where data permitted, we performed random-effects meta-analyses. Results We identified 67 eligible trials tackling a range of health issues. Few studies included any academic/attendance outcomes. We found positive average intervention effects for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small. On average across studies, we found little evidence of effectiveness for zBMI (BMI, standardized for age and gender), and no evidence for fat intake, alcohol use, drug use, mental health, violence and bullying others. It was not possible to meta-analyse data on other health outcomes due to lack of data. Methodological limitations were identified including reliance on self-reported data, lack of long-term follow-up, and high attrition rates. Conclusion This Cochrane review has found the WHO HPS framework is effective at improving some aspects of student health. The effects are small but potentially important at a population level.

BACKGROUND: The World Health Organization's (WHO's) Health Promoting Schools (HPS) framework is an holistic, settings-based approach to promoting health and educational attainment in school. The effectiveness of this approach has not been previously rigorously reviewed. OBJECTIVES: To assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well-being of students and their academic achievement. SEARCH METHODS: We searched the following electronic databases in January 2011 and again in March and April 2013: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, Campbell Library, ASSIA, BiblioMap, CAB Abstracts, IBSS, Social Science Citation Index, Sociological Abstracts, TRoPHI, Global Health Database, SIGLE, Australian Education Index, British Education Index, Education Resources Information Centre, Database of Education Research, Dissertation Express, Index to Theses in Great Britain and Ireland, ClinicalTrials.gov, Current controlled trials, and WHO International Clinical Trials Registry Platform. We also searched relevant websites, handsearched reference lists, and used citation tracking to identify other relevant articles. SELECTION CRITERIA: We included cluster-randomised controlled trials where randomisation took place at the level of school, district or other geographical area. Participants were children and young people aged four to 18 years, attending schools or colleges. In this review, we define HPS interventions as comprising the following three elements: input to the curriculum; changes to the school's ethos or environment or both; and engagement with families or communities, or both. We compared this intervention against schools that implemented either no intervention or continued with their usual practice, or any programme that included just one or two of the above mentioned HPS elements. DATA COLLECTION AND ANALYSIS: At least two review authors identified relevant trials, extracted data, and assessed risk of bias in the trials. We grouped different types of interventions according to the health topic targeted or the approach used, or both. Where data permitted, we performed random-effects meta-analyses to provide a summary of results across studies. MAIN RESULTS: We included 67 eligible cluster trials, randomising 1443 schools or districts. This is made up of 1345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand-washing (2), multiple risk behaviours (7), cycle-helmet use (1), eating disorders (1), sun protection (1), and oral health (1). The quality of evidence overall was low to moderate as determined by the GRADE approach. 'Risk of bias' assessments identified methodological limitations, including heavy reliance on self-reported data and high attrition rates for some studies. In addition, there was a lack of long-term follow-up data for most studies.We found positive effects for some interventions for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small but have the potential to produce public health benefits at the population level. We found little evidence of effectiveness for standardised body mass index (zBMI) and no evidence of effectiveness for fat intake, alcohol use, drug use, mental health, violence and bullying others; however, only a small number of studies focused on these latter outcomes. It was not possible to meta-analyse data on other health outcomes due to lack of data. Few studies provided details on adverse events or outcomes related to the interventions. In addition, few studies included any academic, attendance or school-related outcomes. We therefore cannot draw any clear conclusions as to the effectiveness of this approach for improving academic achievement. AUTHORS' CONCLUSIONS: The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well-designed research is required to establish the effectiveness of this approach for other health topics and academic achievement.

Η ραγδαία πρόοδος των τελευταίων χρόνων στον τομέα της Νεογνολογίας και της Εντατικής Νοσηλείας είχε ως αποτέλεσμα τη σημαντική αύξηση της επιβίωσης των πρόωρων και χαμηλού βάρους γέννησης νεογνών. Ένα από τα προβλήματα που απασχολούν τους νεογνολόγους κατά τη διάρκεια της νοσηλείας των νεογνών αυτών, είναι η «αναιμία της προωρότητας», η οποία είναι ορθόχρωμη, ορθοκυτταρική και χαρακτηρίζεται από δικτυοερυθροκυτταροπενία, υποπλασία του μυελού των οστών και επίπεδα ερυθροποιητίνης πολύ χαμηλά συγκριτικά με το βαθμό της αναιμίας. Τα πρόωρα νεογνά, και ιδιαίτερα αυτά που παρουσιάζουν σοβαρά προβλήματα, υφίστανται μεγάλες απώλειες αίματος για τη διενέργεια εργαστηριακών εξετάσεων τις πρώτες εβδομάδες της ζωής και υποβάλλονται σε συχνές μεταγγίσεις για την αντιμετώπιση της αναιμίας της προωρότητας και της ιατρογενούς αναιμίας. Οι μεταγγίσεις, όμως, των ερυθρών αιμοσφαιρίων ενέχουν κινδύνους, όπως μετάδοση λοιμώξεων, ευαισθητοποίηση σε αντιγόνα του αίματος, αντίδραση απόρριψης μοσχεύματος, υποθερμία, άπνοια, υπόταση, μεταβολικές διαταραχές καθώς και αύξηση του κινδύνου για ΑΤΠ. Οι κίνδυνοι αυτοί αυξάνονται καθώς τα νεογνά που υποβάλλονται σε πολλαπλές μεταγγίσεις δέχονται αίμα και παράγωγα αυτού από πολλούς δότες. Δεδομένου ότι η αναιμία της προωρότητας χαρακτηρίζεται από χαμηλά επίπεδα ερυθροποιητίνης και άφθονες μορφές προγονικών ερυθροκυττάρων που ανταποκρίνονται στην ανασυνδυασμένη ανθρώπινη ερυθροποιητίνη (rHu-EPO) in vitro, πολλές κλινικές μελέτες έχουν διερευνήσει το ρόλο της στην πρόληψη και θεραπεία της αναιμίας της προωρότητας. Έτσι, το ενδιαφέρον των ερευνητών έχει στραφεί στη χορήγηση της rHu-EPO ως εναλλακτικής θεραπείας για την πρόληψη και αντιμετώπιση της αναιμίας της προωρότητας. Τα αποτελέσματα, όμως, των κλινικών μελετών είναι ποικίλα και μερικές φορές αντικρουόμενα, ώστε η αξιολόγηση της δράσης της ερυθροποιητίνης στις μετα-αναλύσεις να είναι ανεπαρκής. Ο πρώτος και κύριος σκοπός της μελέτης ήταν να διερευνηθεί η αποτελεσματικότητα και ασφάλεια της πρώιμης χορήγησης (1η–7η μέρα ζωής) της rHu-EPO σε πολύ χαμηλού βάρους πρόωρα νεογνά (ΠΧΒΝ) με ΔΚ≤32 εβδ. και ΒΣ≤1250γρ, όσον αφορά την πορεία της αναιμίας και τη διέγερση της ερυθροποίησης. Ο δεύτερος σκοπός της μελέτης ήταν να καταγραφούν οι πιθανές ανεπιθύμητες ενέργειες της rHu-EPO, να διερευνηθούν οι μακροχρόνιες επιδράσεις της στην ερυθροποίηση μετά το τέλος της θεραπείας καθώς και η πιθανή συσχέτισή της με την εμφάνιση των πρώιμων επιπλοκών της προωρότητας και την όψιμη νευροαναπτυξιακή εξέλιξη. Για το σκοπό αυτό μελετήθηκαν προγραμματισμένα 129 πρόωρα νεογνά με ΔΚ≤32εβδ. και ΒΣ≤1250γρ, τα οποία νοσηλεύτηκαν στην Α΄ Νεογνολογική Κλινική και Εντατική Νοσηλεία Νεογνών του Αριστοτέλειου Πανεπιστημίου Θεσσαλονίκης, κατά τη χρονική περίοδο 2001-2004. Τα νεογνά που πληρούσαν τα κριτήρια εισαγωγής στη μελέτη, ταξινομήθηκαν τυχαία σε δύο ομάδες, από τα οποία 67 νεογνά αποτέλεσαν την ομάδα rHu-EPO και 62 νεογνά την ομάδα ελέγχου. Στα νεογνά της ομάδας rHu-EPO χορηγήθηκε ανασυνδυασμένη ανθρώπινη ερυθροποιητίνη (rHu-EPO) σε δόση 250IU/kg, μέρα παρά μέρα, υποδόρια με έναρξη μέσα στις πρώτες 96 ώρες της ζωής. Τόσο τα νεογνά της ομάδας rHu-EPO όσο και αυτά της ομάδος ελέγχου έλαβαν συμπληρωματικά σίδηρο και φυλλικό οξύ από το στόμα, όταν τα 2/3 του συνόλου των ημερήσιων αναγκών των νεογνών χορηγούνταν από το στόμα και μέχρι την έξοδό τους από την κλινική. Για τα νεογνά της ομάδας rHu-EPO, η αρχική δόση του σιδήρου ήταν 4mg/kgΒΣ ημερησίως, σε 2-3 δόσεις, με προοδευτική αύξηση στα 12mg/kgΒΣ ημερησίως σε διάστημα 14 ημερών. Για τα νεογνά της ομάδας ελέγχου, η δόση του σιδήρου ήταν 4mg/kg ΒΣ ημερησίως. Παρακολουθήθηκαν οι δύο ομάδες κλινικά και εργαστηριακά. Έγιναν διαδοχικές μετρήσεις των αιματολογικών παραμέτρων, Hct, Hb, ΔΕΚ, δείκτες ερυθρών αιμοσφαιρίων, αριθμός λευκοκυττάρων και αιμοπεταλίων, και των βιοχημικών παραμέτρων, επίπεδα φερριτίνης, ερυθροποιητίνης, sTfR του ορού στην είσοδο και κάθε 14η μέρα μέχρι την έξοδο των νεογνών από την κλινική καθώς και στον 4ο, 6ο και 12ο μήνα της ζωής. Ταυτόχρονα, καταγράφηκαν ο αριθμός των μεταγγίσεων και ο όγκος του μεταγγιζόμενου αίματος, οι πρώιμες επιπλοκές της προωρότητας (ΣΑΔ, ΝΕΚ, ΑΤΠ, ΒΠΔ, σηψαιμία, εγκεφαλική αιμορραγία) καθώς και η όψιμη νευροαναπτυξιακή εξέλιξη των νεογνών. Η ανάλυση των αποτελεσμάτων έδειξε ότι ο αριθμός των μεταγγίσεων στα νεογνά στα οποία χορηγήθηκε rHu-EPO ήταν σημαντικά μικρότερος, σε σύγκριση με εκείνον στην ομάδα ελέγχου. Το ποσοστό των ασθενών που δεν χρειάστηκαν μετάγγιση κατά τη διάρκεια της μελέτης ήταν 29,8% για την ομάδα rHu-EPO και 12,9% για την ομάδα ελέγχου. Από τα νεογνά με ΔΚ≤28εβδ., ο όγκος αίματος των μεταγγίσεων ήταν σημαντικά μικρότερος στην ομάδα rHu-EPO συγκριτικά με τους αντίστοιχους μάρτυρες, παρόλο που δεν υπήρχε διαφορά στην ποσότητα αίματος που αφαιρέθηκε με τις αιμοληψίες κατά τη διάρκεια της μελέτης μεταξύ των δύο ομάδων. Τα ίδια ευρήματα παρατηρήθηκαν και στα νεογνά με μεγάλη διάρκεια μηχανικού αερισμού. Ο όγκος του αίματος που αφαιρέθηκε κατά τη διάρκεια νοσηλείας των ασθενών για τη διενέργεια εργαστηριακών εξετάσεων είναι μεγάλος. Ιδιαίτερα, στην υπο-ομάδα των ασθενών με ΔΚ≤28εβδ., αφαιρέθηκε διπλάσιος όγκος αίματος, από ότι στην υπο-ομάδα των νεογνών με ΔΚ≥29εβδ. Η μέτρηση του διαλυτού υποδοχέα της τρανσφερρίνης (sTfR) έδειξε ότι τα επίπεδά του και στις δύο ομάδες ήταν σημαντικά υψηλότερα στη γέννηση σε σύγκριση με εκείνα που παρατηρήθηκαν στη διάρκεια νοσηλείας, γεγονός που αντανακλά την έντονη ερυθροποιητική δραστηριότητα στο τρίτο τρίμηνο της κύησης. Στη συνέχεια, μετά από μια αρχική ελάττωση και στις δύο ομάδες, τα επίπεδα του sTfR παρέμειναν σημαντικά υψηλότερα στην ομάδα rHu-EPO σε όλη τη διάρκεια της θεραπείας, γεγονός ενδεικτικό έντονης ερυθροποίησης. Τα επίπεδα της φερριτίνης στην ομάδα rHu-EPO ελαττώθηκαν σταδιακά συγκριτικά με την ομάδα ελέγχου. Το εύρημα αυτό είναι ενδεικτικό της ταχείας κινητοποίησης των αποθεμάτων σιδήρου κατά τη διάρκεια της ερυθροποίησης. Μετά τη διακοπή της χορήγησης της rHu-EPO δεν παρατηρήθηκαν διαταραχές στα επίπεδα του αιματοκρίτη, αιμοσφαιρίνης και της ερυθροποιητίνης του ορού στον 4ο, 6ο και 12ο μήνα της ζωής. Η ανάλυση των αποτελεσμάτων σχετικά με τις ανεπιθύμητες ενέργειες της rHu-EPO έδειξε ότι κανένα νεογνό δεν παρουσίασε ουδετεροπενία, διαταραχές του αριθμού των αιμοπεταλίων ή υπέρταση. Επίσης, σε κανένα από τα νεογνό της μελέτης δεν παρατηρήθηκαν αγγειακές δυσπλασίες. Όσον αφορά τις επιπλοκές της προωρότητας (ΣΑΔ, ΒΠΔ, ΝΕΚ, ΑΤΠ, σηψαιμία, εγκεφαλική αιμορραγία), η συχνότητα εμφάνισης δεν φάνηκε να επηρεάζεται από τη χορήγηση της rHu-EPO. Η συχνότητα της σοβαρής ΑΤΠ, που χρειάστηκε κρυοπηξία, ήταν χαμηλότερη στην ομάδα rHu-EPO, χωρίς όμως η διαφορά να είναι στατιστικά σημαντική. Η συχνότητα της εγκεφαλικής αιμορραγίας οποιουδήποτε βαθμού ήταν σημαντικά μικρότερη στην ομάδα rHu-EPO, σε σύγκριση με την ομάδα ελέγχου, χωρίς όμως να υπάρχει διαφορά στη συχνότητα της σοβαρής εγκεφαλικής αιμορραγίας. Τέλος, η νευροαναπτυξιακή εξέλιξη στους 18-24 μήνες της ζωής δεν παρουσίαζε διαφορά μεταξύ των δύο ομάδων, ενώ από την επιμέρους ανάλυση των αποτελεσμάτων φάνηκε ότι τα υψηλά επίπεδα της ερυθροποιητίνης στη γέννηση σχετίζονται με σημαντικά καλύτερη πρώιμη νευρολογική έκβαση. Είναι πιθανό ότι τα αυξημένα επίπεδα ερυθροποιητίνης στη γέννηση, που μπορούν να αποδοθούν σε χρόνια ενδομήτρια υποξία, επάγουν τους ενδογενείς προστατευτικούς μηχανισμούς και πιθανόν να προλαμβάνουν επακόλουθη νευρολογική βλάβη. Συμπερασματικά, φαίνεται ότι η χορήγηση της ερυθροποιητίνης στη δόση των 250IU/kgΒΣ, μέρα παρά μέρα, όταν χορηγείται από την 1η εβδομάδα της ζωής στα νεογνά με ΔΚ≤29εβδ και ΒΓ≤1000γρ προλαμβάνει την αναιμία της προωρότητας που εμφανίζεται μετά τη 2η εβδομάδα της ζωής, αλλά όχι την ιατρογενή αναιμία των ΠΧΒΝ και σοβαρά άρρωστων νεογνών. Έτσι, δεν είναι δυνατόν να υποκαταστήσει πλήρως τις μεταγγίσεις των ερυθρών στα πρόωρα και χαμηλού βάρους νεογνά. Επιπλέον, η rHu-EPO διεγείρει αποτελεσματικά την ερυθροποίηση, όπως φαίνεται από τη σημαντική αύξηση του αριθμού των ΔΕΚ, του αιματοκρίτη και της αιμοσφαιρίνης στα νεογνά στα οποία χορηγήθηκε. Ωστόσο, για την επιτυχή διέγερση της ερυθροποίησης, ιδιαίτερα μετά από τη χορήγηση της rHu-EPO, είναι απαραίτητη η επαρκής συμπληρωματική χορήγηση του σιδήρου. Τέλος, η θεραπεία με ερυθροποιητίνη για την αντιμετώπιση της αναιμίας της προωρότητας είναι ασφαλής για τα νεογνά, καθώς δεν συνδυάζεται με ανεπιθύμητες ενέργειες ούτε επηρεάζει την παραγωγή των άλλων κυτταρικών σειρών του μυελού των οστών ή την ενδογενή ερυθροποίηση μετά τη διακοπή της θεραπείας. Επίσης, φαίνεται ότι δεν επηρεάζει την πορεία και συχνότητα των επιπλοκών της προωρότητας, ενώ με τη συνήθη δοσολογία που χρησιμοποιείται για την αιμοποιητική της δράση δεν εκδηλώνονται οι πιθανές νευροπροστατευτικές της ιδιότητες. Το θετικό αποτέλεσμα από τη δράση της ανασυνδυασμένης ανθρώπινης ερυθροποιητίνης θα μπορούσε να μεγιστοποιηθεί, αν στις μονάδες εντατικής νοσηλείας νεογνών περιοριστούν οι ποσότητες αίματος που λαμβάνονται για τη διενέργεια εργαστηριακών εξετάσεων, με τη χρήση μικρομεθόδων, και εφαρμοστούν αυστηρότερα κριτήρια μετάγγισης στα ΠΧΒΝ. Η ερυθροποιητίνη, με την πλειοτροπική της δράση, είναι ένα πολλά υποσχόμενο φάρμακο, διότι, εκτός από τη θετική επίδρασή της στην ερυθροποίηση, μπορεί να ελαττώσει τη νοσηρότητα και ενδεχόμενα να βελτιώσει τη νευροαναπτυξιακή εξέλιξη των ΠΧΒΝ.

Objectives To investigate associations between physical (in)activity at different life-stages and lipids in mid-adulthood, examining the role of potential confounding and mediating factors, such as adiposity. Methods Data from the 1958 British birth cohort ( n =7824) were examined. Using linear regression, we analysed prospectively reported frequency of activity and TV-viewing (23, 33, 42 and 45y) in relation to total, LDL-, HDL-cholesterol and triglycerides, at 45y. Results Activity at different ages was associated with HDL-cholesterol and triglycerides at 45y: e.g. in men, a 1 day/week greater activity frequency at 42y was associated with 0.006mmol/L higher HDL-cholesterol and 1.4% lower triglycerides. Most associations attenuated, but were not entirely explained by adjustment for covariates (life-styles and socio-economic factors): e.g. among men, the estimated 2.0% lower triglycerides per 1 day/week greater frequency at 33y reduced to 1.8% after adjustment. Among women, though not men, activity at both 23 and 45y contributed cumulatively to HDL-cholesterol. For sedentary behaviour, associations were found for sitting at work: a 1h/day greater sitting among men was associated with a 0.012mmol/L lower HDL-cholesterol after adjustment for covariates. Associations were seen for TV-viewing: e.g. in men, a 0.04mmol/L lower HDL-cholesterol and 5.9% higher triglycerides per hour/day greater TV-viewing at 45y, attenuated, respectively, to 0.03mmol/L and 4.6% after adjustment for covariates. Associations attenuated further after adjustment for current BMI. Associations for total and LDL-cholesterol were less consistent. Conclusion Activity and sedentary behaviour at different adult ages were associated with HDL-cholesterol and triglycerides in mid-adulthood. Associations were partly mediated by other life-style factors and by BMI.

Parent-offspring adiposity associations are well-established: offspring of obese parents have elevated risks of overweight/obesity. The aim of studies based on the 1958 British birth cohort has been to gain insights into explanations of these associations, such as whether parent-offspring BMI associations are due to offspring lifestyles or depend on socio-economic conditions.All major studies on intergenerational adiposity associations in the three generations of the 1958 birth cohort were reviewed. In addition, BMI data for parents (G1) and the cohort (G2) were analysed stratified by social class.BMI of G1 and G2 were correlated both when offspring were children and in mid-adulthood: a 1 kg/m(2) higher parental BMI was associated with an average 0.24-0.35 kg/m(2) higher offspring (mothers/fathers vs sons/daughters) BMI at 45 years. Associations were little affected by adjustment for lifestyle and socio-economic factors, but varied by social class: average BMI gain in offspring relative to parents was greater in lower classes, e.g. for males vs fathers by 3.6 and 2.5 kg/m(2) in classes IVV and III, respectively. Parent-offspring BMI associations were stronger for recent (G2 and G3) than older (G1 and G2) generations.Parent-offspring associations in BMI were not explained by offspring lifestyles, but varied over successive generations and by social class, suggesting that intergenerational transmission of adiposity at a population level is modifiable rather than immutable.

To examine school-level opportunity structures of the built environment and student characteristics associated with being overweight. Multi-level logistic regression analysis were used to examine the school- and student-level characteristics associated with the odds of a student being overweight among grade 5–8 students attending 30 elementary schools in Ontario, Canada, as part of the Play-Ontario (PLAY-ON) study. Significant between school random variation in overweight was identified [σ μ0 2 = 0.187 (0.084), P

Objective The identification of spatial clusters of overweight and obesity can be a key indicator for targeting scarce public health resources. This paper examines sex-specific spatial patterns of overweight/obesity in Canada as well as investigates the presence of spatial clusters. Methods Using data on Body Mass Index (BMI) from the 2005 Canadian Community Health Survey (20 years and older) cycle 3.1, a cross-sectional ecological-level study was conducted. Sex-specific prevalence of overweight and obesity were first mapped to explore spatial patterns. In order to assess the degree of spatial dependence, exploratory spatial data analysis was performed using the Moran's I statistic and the Local Indicator of Spatial Association (LISA). Results Results revealed marked geographical variation in overweight/obesity prevalence with higher values in the Northern and Atlantic health-regions and lower values in the Southern and Western health-regions of Canada. Significant positive spatial autocorrelation was found for both males and females, with significant clusters of high values or ‘hot spots’ of obesity in the Atlantic and Northern health-regions of Alberta, Saskatchewan, Manitoba and Ontario. Conclusions Findings reveal overweight/obesity clusters and underscore the importance of geographically focused prevention strategies informed by population-specific needs.

The objective of this paper was to reassess children's exposure to air pollution as well as investigate the importance of other covariates of respiratory health. We re-examined the Hamilton Children's Cohort (HCC) dataset with enhanced spatial analysis methods, refined in the approximately two decades since the original study was undertaken. Children's exposure to air pollution was first re-estimated using kriging and land-use regression. The land-use regression model performed better, compared to kriging, in capturing local variation of air pollution. Multivariate linear and logistic regression analysis was then applied for the study of potential risk factors for respiratory health. Findings agree with the HCC study-results, confirming that children's respiratory health was associated with maternal smoking, hospitalization in infancy and air pollution. However, results from this study reveal a stronger association between children's respiratory health and air pollution. Additionally, this study demonstrated associations with low-income, household crowding and chest illness in siblings.

A prospective study was conducted to determine risk factors for fungal colonization, drug susceptibility, and association with invasive fungal infections (IFIs) in a neonatal unit. On admission and weekly thereafter, surveillance fungal cultures were taken from mouth, rectum, and trachea of neonates with expected stays of > 1 week. Fungal colonization was detected in 72 (12.1%) of 593 neonates during 12 months. CANDIDA ALBICANS was isolated from 42% of colonized neonates. Although early colonization (age 1.3 +/- 0.2 days) was found in 2.5% of the neonates, late colonization (age 17.6 +/- 1.4 days) was noted in 14.2% of neonates hospitalized for > 5 days. Neonates born vaginally were at higher risk for early colonization than those delivered after cesarean section ( P = 0.01). By multivariate logistic regression, very low birthweight was the only independent risk factor for late colonization. Ten IFIs (nine candidemias) were diagnosed, yielding a rate of 1.1%. These episodes occurred in 6.9% of colonized neonates, compared with 0.76% of noncolonized neonates ( P = 0.002). C. ALBICANS was susceptible to azoles, but some non- ALBICANS CANDIDA spp. exhibited decreased susceptibility to these drugs.

Background Recent studies show TV-viewing time being related to mortality independent to physical activity (PA). However, the mechanism behind this association is unclear. Aim We investigate cross-sectional associations between sedentary behaviour and preclinical variations in markers for cardiovascular disease (CVD) and diabetes. Methods Using data from the 1958 British birth cohort, we analysed associations between (1) television (TV)-viewing and (2) sitting at work with blood pressure (BP), total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), glycated haemoglobin (HbA1c), C-reactive protein (CRP), fibrinogen, tissue plasminogen activator (tPA), D-dimer and von Willebrand factor (vWF) at 45 years. TV-viewing was measured in six categorises from none to >4 h /day. Sitting at work was measured as a continuous variable. Analysis adjusted for confounding factors (birth-weight, long-term illness, smoking, drinking, diet, social class and concurrent moderate/vigorous leisure-time PA). We assessed whether associations were mediated by body mass index (BMI). Inverse probability weights were used to account for attrition. Analysis was separate for males (n=4632) and females (n=4665). Results Men had higher total cholesterol, LDL, triglycerides, BP, HbA1c, tPA and vWF compared to women. Both genders had similar TV-viewing patterns, but men spent more time sitting at work. Preliminary analysis suggests that TV-viewing was consistently associated with adverse biomarker levels, usually with a stronger trend in women than men. For example increasing by a category of TV-viewing was linked to an unadjusted 11.0% (95% CI: 6.9% to 15.1%) increase in CRP in men and a 22.3% (95% CI: 18.0% to 26.6%) increase in women. Adjustment attenuated the relationships slightly to a 5.5% (95% CI: 1.3% to 9.8%) increase in men and a 18.1% (95% CI: 13.6% to 22.6%) increase in women. Associations with sitting were less consistent. After adjustment, sitting at work for 1–2, 2–3 and >3 h/day compared to Conclusions Two indicators of sedentary behaviour show inconsistent associations with CVD biomarkers: TV-viewing shows strong trends, whereas trends for sitting at work are less consistent. The contrast between the two markers of sedentary behaviour brings into question the role of sedentary behaviour and its measurement in relation to CVD risk.

Background There is growing evidence of the health benefits of physical activity for young people, including reduced risk of obesity and improved psychological wellbeing. Conversely, sedentary behaviour is now recognised to increase the risk of later poor health. Patterns of physical activity and sedentary behaviour are established in early childhood. In July, 2011, the UK Chief Medical Officers released new guidelines for all young people, recommending engagement in moderate to vigorous intensity physical activity for at least 60 min every day, incorporation of vigorous intensity activities on at least 3 days each week, and minimising time spent being sedentary for extended periods. Information about the extent to which UK children of primary school age are meeting these recommendations is sparse. We measured time spent in different intensities of physical activity, and assessed adherence to guidelines, in a UK-wide representative sample of children of primary school age taking part in a longitudinal cohort study. We used accelerometer-based activity monitors because this approach allowed the frequency, intensity, and duration of free-living activity to be objectively measured. Methods Nearly 13 000 7-year-old children taking part in the UK Millennium Cohort Study consented to wear an Actigraph activity monitor during all waking hours for 7 days, apart from during bathing or other aquatic activities (eg, swimming). Valid accelerometer data (≥2 days, ≥6 h wear each day) were obtained from nearly 7000 singletons. For each child several variables were produced: mean daily min of sedentary (defined as 3841 cpm) activity. Time spent in moderate and vigorous activity was combined to establish adherence to activity guidelines. We fitted logistic regression models to compare adherence to guidelines according to individual (sex, ethnicity) and family (maternal social class, numbers of children in household, lone parenthood) factors, and country or region of residence. Findings On average, children accumulated 27 and 11 min per day of moderate and vigorous activity, respectively, and were sedentary for 5 h per day. Only 15% of all children achieved 60 min or more of daily moderate to vigorous intensity physical activity. Activity varied by ethnic group, with those of Indian and Bangladeshi origin the least active and black children the most active. Within adjusted analyses, significant differences were reported in adherence to activity guidelines between girls and boys (p Interpretation Only a small proportion of children of primary school age in the UK meet guidelines and are sufficiently active. A substantial part of their day is spent in sedentary behaviour and striking differences in activity are evident between boys and girls, different ethnic or social groups, and UK countries. Although we recognise the importance of some sedentary pursuits, such as reading and homework, measures to increase children's engagement in physical activity are needed for social and health benefits. Funding The Wellcome Trust (grant 084686/Z/08/A).