Measurement and prevalence of adult physical activity levels in Arab countries.

OBJECTIVES: This study aims to examine the reported prevalence of sufficient physical activity among adults in Arab countries and to determine the use of validated instruments for assessing physical activity. STUDY DESIGN: This is a systematic literature review. METHODS: This review follows recommendations outlined in the Meta-Analysis of Observational Studies in Epidemiology guidelines. The protocol for this study was preregistered with PROSPERO. Cross-sectional, cohort and intervention studies with a minimum of 300 adults aged ≥18 years assessing physical activity using a questionnaire or other self-report measure in the Arabic language were identified from seven electronic databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, PsycINFO, SPORTDiscu and PubMed). Databases were searched from 1st January 2008 to 17th September 2018. Descriptive analysis was performed using frequency and percentages. The prevalence of physical activity was calculated as the average prevalence for the reported percentages from the studies with similar tools. RESULTS: Fifty studies involving 298,242 participants were included in this review. The mean (range) sample size was 5964.8.1 (323-197,681). Data were collected from participants in 16 of the 22 Arab countries. Great variation exists across the studies in determining whether adults were sufficiently active or not. Twenty studies reported usable data from the Global Physical Activity Questionnaire and the International Physical Activity Questionnaire (moderate & high categories). In these studies, prevalence of physical activity ranged from 34.2 to 96.9%. It was not possible to compare the other studies owing to variation in instruments used to assess physical activity and in the case definition used for 'physically active'. CONCLUSIONS: This study highlights the need for wider reporting of physical activity and the adoption of valid and reliable instruments to support the development of evidence-informed policy and programmes at both country and regional level. International tools need to be correctly validated, or context-specific tools must be developed to accurately measure physical activity.

Global Matrix 3.0 physical activity report card for children and youth: a comparison across Europe.

OBJECTIVES: The Global Matrix of report card grades on physical activity serves as a public health awareness tool by summarising the status of child and youth physical activity prevalence and action. The objectives were to: (1) provide a detailed examination of the evidence informing the 'School' and 'Community and Environment' indicators across all participating European Global Matrix 3.0 countries; (2) explore the comparability of the grades for these two indicators across Europe; (3) detail any limitations or issues with the methods used to assign grades; and (4) provide suggestions on how future grading of the indicators could be improved. STUDY DESIGN: A comparative review of published methods on the grading of Global Matrix 3.0 indicators across European countries. METHODS: Key documents relating to the European countries involved in the 2018 Global Matrix 3.0 were collated and a template used to extract data for both the 'School' and 'Community and Environment' indicators. RESULTS: Seventeen of the 20 European Report Card countries (85%) had a grade for schools, and 15 countries (75%) had a grade for community and environment. All countries considered between one and five factors when assigning the grade for these indicators. There were wide disparities in the number and sources of evidence used to assign the grades for both indicators, limiting the comparability of the evidence between different countries. CONCLUSION: To enable comparability, the authors recommend moving towards an agreed standardised set of metrics for grading each indicator. Furthermore, it would be useful to develop and share common tools, methods and instruments to collect data in a uniform way across countries, where possible. Such action will ultimately make the Global Matrix a more robust and useful tool for the future.

Mothers and teenage daughters walking to health: using the behaviour change wheel to develop an intervention to improve adolescent girls' physical activity.

OBJECTIVES: The majority of adolescent girls fail to meet public health guidelines for physical activity. Engaging mothers in the promotion of physical activity for their daughters may be an important strategy to facilitate behaviour change. The aim of this study was to use the behaviour change wheel (BCW) framework to design the components of an intervention to improve adolescent girls' physical activity. STUDY DESIGN: Cross-sectional study to inform intervention development. METHODS: The BCW framework was used to (1) understand the behaviour, (2) identify intervention functions and (3) select content and implementation options. A circular development process was undertaken by the research team to collectively design the intervention in accordance with the steps recommended by the BCW. RESULTS: The BCW design process resulted in the selection of six intervention functions (education, persuasion, incentivization, training, modelling, enablement) and 18 behaviour change techniques delivered via group-based, face-to-face mode. Behaviour change technique groupings include: goals and planning; feedback and monitoring; social support; shaping knowledge; natural consequences; comparison of behaviour; associations; comparison of outcomes; reward and threat; identity; and, self-belief. CONCLUSIONS: The BCW process allowed an in-depth consideration of the target behaviours and provided a systematic framework for developing the intervention. The feasibility and preliminary efficacy of the programme will be examined.

Auditing a new lung cancer service.

The Adelaide and Meath Hospital (AMNCH) is a new hospital, with the respiratory service established in 1999. We report on our experience with lung cancer in this short time. We conducted a retrospective chart audit, identifying patients from the Oncology Nurse patient list, of lung cancer cases diagnosed in 2001-2002. In 2001, 47 cases were diagnosed, with 71 cases diagnosed in 2002. Time to tissue diagnosis was 14.8, 2-46 (mean, range, one subject skewing the data) days. Diagnosis by tissue type was as follows: non-small cell carcinoma (NSCLC) n=92 (77.9%), small cell lung carcinoma (SCLC) n=17 (14.4%), mesothelioma n=2 (17%), carcinoid n=1 (0.8%) and no tissue diagnosis n=6 (5.1%). Staging of NSCLC: stage 1a n=3 (3.2%), stage 1b n=6 (6.5%), stage 2a n=5 (5.4%), stage 2b n=2 (2.2%), stage 3a n=10 (10.9%), stage 3b n=22 (23.9%) and stage 4 n=44 (47.8%). Staging of SCLC: limited stage n=5 (29.4%), extensive stage n=12 (70.6%). Positive emission tomography (PET) was employed in the staging of 22 patients. In these patients PET up-staged the disease in 8 patients, and management was unchanged in 8 patients. We conclude that 1. the relatively new respiratory service in AMNCH is handling increasing numbers of lung cancer cases, 2. cases are diagnosed within an acceptable time-frame, 3. rate of tissue diagnosis is comparable to national figures, 4. most patients present with advanced disease and 5. PET is a useful imaging modality for detection of cancer spread in selected patients.

Assessment of the quality of neonatal echocardiographic images transmitted by ISDN telephone lines.

OBJECTIVE: To assess the quality of echocardiographic images from neonates transmitted over Integrated Service Digital Network 2 (ISDN2) channels. DESIGN: Echocardiographic images were viewed live in real time either by a direct video link or by transmission over the commercial network, using one, two, or three ISDN2 channels. The order of the viewing formats was random and four observers marked each view for potential for provision of complete diagnostic information and quality. SETTING: Cardiology department of tertiary referral centre for paediatric cardiac services. ISDN lines were positioned in two nearby rooms. Telephone connection was through the commercial network and video connection by a direct video cable. PATIENTS: 10 neonates were studied (weight 2600 to 3900 g). In each, nine echocardiographic studies were undertaken to assess imaging (M mode and cross sectional) and Doppler (spectral and colour) quality. RESULTS: No significant differences were found in diagnostic ability between the different formats for M mode, colour, or spectral Doppler studies. For cross sectional imaging the diagnostic information and image quality increased with increasing numbers of ISDN channels. With six channels there was little difference from the directly connected images. CONCLUSIONS: In echocardiographic assessment of the newborn, one or two ISDN2 channels will transmit images of satisfactory quality in many situations but three or more channels are necessary to ensure minimum degradation of the live image.

Intermittent ductal patency in healthy newborn infants: demonstration by colour Doppler flow mapping.

Colour Doppler flow mapping was used to determine the time of closure of the arterial duct in 51 healthy newborn infants. Initial time of closure corresponded with previous reports: 20% on the first day, 82% by the second day, 96% by the third day, and 100% by the fourth day. Twenty infants were delivered by caesarean section and followed up for seven days even if the duct had apparently closed; in six intermittent patency was demonstrated with flow in the third, fourth or fifth day, although earlier functional closure had been observed. All were found to be closed on the sixth and seventh days. It is necessary to be aware of the phenomenon of intermittent closure in any study determining or assessing the effect of any intervention on ductal patency.

Influence of colour Doppler echocardiography on the ultrasonic assessment of congenital heart disease: a prospective study.

OBJECTIVE: To evaluate the additional information provided by colour Doppler in the ultrasonic assessment of congenital heart disease. PATIENTS AND METHODS: A prospective study of 215 children (age range 1 day-16 years) presenting with clinical signs of congenital heart disease. RESULTS: Colour Doppler was essential for the diagnosis of an anomalous left coronary artery and altered the management of a patient initially diagnosed as having cardiomyopathy. Colour Doppler provided extra information, but without major impact on management, in the following: the diagnosis of ventricular septal defects associated with other defects, of multiple ventricular septal defects, of anomalous pulmonary venous drainage, and of mild mitral regurgitation; the demonstration of site of coarctation, of stenotic or hypoplastic pulmonary artery branches, of unobstructed flow through a right atrial membrane, and of left ventricle to right atrium regurgitation; the assessment of the width of the duct and of flow through the patent foramen ovale in transposition and tricuspid atresia; the differentiation of pulmonary atresia from critical pulmonary stenosis and the measurement of maximum velocity of tricuspid regurgitation. CONCLUSIONS: Ideally all patients should undergo colour Doppler studies before cardiac surgery to ensure a more accurate diagnosis. However, since the additional information provided does not affect the management in most patients, machines without colour Doppler can provide a satisfactory service in paediatric cardiology centres in countries where resources are limited.

Balloon atrial septostomy under echocardiographic control: six years' experience and evaluation of the practicability of cannulation via the umbilical vein.

Balloon atrial septostomy was undertaken under cross sectional echocardiographic control in 63 consecutive infants: in no case was fluoroscopic imaging required. The procedure was performed in the cardiac catheterisation laboratory, ward side room, or at the bedside in the neonatal intensive care unit. Catheterisation via the umbilical vein was attempted in 37 infants aged less than 48 hours old and was successful in 27. No complication was clearly attributable to the procedure though two infants died. A nine day old child died from disseminated intravascular coagulation the day after septostomy by the iliofemoral route and another, aged nine days, died of necrotising enterocolitis which had developed when he was eight days old, after umbilical catheterisation at eight hours. Balloon atrial septostomy is a safe and easy procedure under cross sectional echocardiographic imaging control. Catheterisation via the umbilical vein was safe, easy to perform, and is appropriate in infants aged less than 48 hours.

Anomalous origin of the left coronary artery from the pulmonary trunk: elucidation with colour Doppler flow mapping.

Four infants and children with anomalous connection of the left coronary artery to the pulmonary trunk were studied with colour Doppler flow mapping. In three the diagnosis was only suspected when the colour Doppler study showed dilated intraseptal and epicardial vessels and an abnormal flow signal into the pulmonary artery in diastole; this latter signal localised the exact site of communication, which was not apparent on angiocardiography. Two of these patients had previously had operations for severe mitral regurgitation, the diagnosis of anomalous left coronary artery having been previously considered in one but missed despite aortic root angiography. The colour study in the fourth was largely confirmatory, operation without catheterisation being undertaken on the basis of the echocardiographic images. By contrast in two infants subsequently seen with congestive cardiomyopathy the demonstration of flow direction in the left coronary artery confirmed that it was normally connected to the aorta. Colour Doppler flow mapping can show flow direction in the left coronary artery and from the mouth of an anomalous coronary artery into the pulmonary artery, thus simplifying the diagnosis and allowing the site of the connection of the left coronary artery to the pulmonary artery to be determined with precision.

Variability of the Doppler gradient in pulmonary valve stenosis before and after balloon dilatation.

The variability of the valve gradient measured by Doppler in pulmonary stenosis was compared with the variability of the gradient measured at catheterisation in 42 infants and children undergoing catheterisation with a view to balloon dilatation of the pulmonary valve. The maximum value measured by Doppler when the patient was unsedated was significantly higher than that measured when the patient was sedated for catheterisation, and the maximum gradient was significantly higher shortly after than several days later. In a patient with pronounced infundibular obstruction after dilatation the Doppler signal clearly showed that the obstruction was dynamic, with a superimposed lower fixed signal that correctly predicted the final low gradient. The Doppler gradient in an alert and unsedated patient may be a better measure of the true physiological value. The highest Doppler value so obtained is a more appropriate indicator of the need for balloon dilatation than a single catheter measurement. The result of dilatation is best assessed by Doppler measurement at least a day after the procedure.

Two-dimensional echocardiography in infants with persistent truncus arteriosus.

Two-dimensional echocardiography was used to study a consecutive series of 13 infants with persistent truncus arteriosus. In all a single great artery with the long upward course characteristic of the aorta was shown. This great artery could be identified as a persistent truncus arteriosus by the recognition of a branch arising from its ascending part (10 out of 13) or of more than three semilunar valve cusps (5/13). These criteria allowed the correct diagnosis to be reached in 12 of the 13 infants.