Increasing Human Papillomavirus Vaccination in a Federally Qualified Health Center Organization Using a Systems-Based Intervention Integrating EHR and Statewide Immunization Information System.

Public acceptance of the HPV vaccine has not matched that of other common adolescent vaccines, and HPV vaccination rates remain below the Healthy People 2020 target of 80% compliance. The purpose of this study was to evaluate the capacity of nine pediatric clinics in a Federally Qualified Health Center organization to implement a systems-based intervention targeting office staff and providers using EHRs and a statewide immunization information system to increase HPV vaccination rates in girls and boys, ages 11 to 16 over a 16-month period. System changes included automated HPV prompts to staff, postcard reminders to parents when youths turned 11 or 12 years old, and monthly assessment of provider vaccination rates.During the intervention, 8960 patients (11-16 yo) were followed, with 48.8% girls (n = 4370) and 51.2% boys (n = 4590). For this study period, 80.5% of total patients received the first dose of the HPV vaccine and 47% received the second dose. For the first dose, 55.5% of 11 year old girls and 54.3% of 11 year old boys were vaccinated. For ages 12 to 16, first dose vaccination rates ranged from the lowest rate of 84.5% for 14 yo girls up to the highest rate of 90.5% for 13 yo boys. Logistic regression showed age was highly significantly associated with first dose completion (OR 1.565, 95% CI 1.501, 1.631) while males did not have a significant association with first dose completion compared to females. The intervention increased overall counts of first and second HPV vaccination rates.

Elevation of hepatic autophagy and antioxidative capacity by endurance exercise is associated with suppression of apoptosis in mice.

INTRODUCTION AND OBJECTIVES: Endurance exercise (EXE) has emerged as a potent inducer of autophagy essential in maintaining cellular homeostasis in various tissues; however, the functional significance and molecular mechanisms of EXE-induced autophagy in the liver remain unclear. Thus, the aim of this study is to examine the signaling nexus of hepatic autophagy pathways occurring during acute EXE and a potential crosstalk between autophagy and apoptosis. MATERIALS AND METHODS: C57BL/6 male mice were randomly assigned to sedentary control group (CON, n=9) and endurance exercise (EXE, n=9). Mice assigned to EXE were gradually acclimated to treadmill running and ran for 60min per day for five consecutive days. RESULTS: Our data showed that EXE promoted hepatic autophagy via activation of canonical autophagy signaling pathways via mediating microtubule-associated protein B-light chain 3 II (LC3-II), autophagy protein 7 (ATG7), phosphorylated adenosine mono phosphate-activated protein kinase (p-AMPK), CATHEPSIN L, lysosome-associated membrane protein 2 (LAMP2), and a reduction in p62. Interestingly, this autophagy promotion concurred with enhanced anabolic activation via AKT-mammalian target of rapamycin (mTOR)-p70S6K signaling cascade and enhanced antioxidant capacity such as copper zinc superoxide dismutase (CuZnSOD), glutathione peroxidase (GPX), and peroxiredoxin 3 (PRX3), known to be as antagonists of autophagy. Moreover, exercise-induced autophagy was inversely related to apoptosis in the liver. CONCLUSIONS: Our findings indicate that improved autophagy and antioxidant capacity, and potentiated anabolic signaling may be a potent non-pharmacological therapeutic strategy against diverse liver diseases.

Endurance Exercise Prevents Metabolic Distress-induced Senescence in the Hippocampus.

PURPOSE: Metabolic disorder such as obesity and type 2 diabetes caused by excess caloric intake is associated with an increased risk of neurodegenerative diseases. Endurance exercise (EXE) has been suggested to exert neuroprotective effects against the metabolic distress. However, the exact underlying molecular mechanisms responsible for the exercise-induced neuroprotection have not been fully elucidated. In this study, we investigated whether EXE-induced neuroprotection is associated with cellular senescence, neuroinflammation, and oxidative stress using a mouse model of obesity induced by a high-fat/high-fructose diet. METHODS: C57BL/6 female mice (10 wk old) were randomly divided to three groups: normal chow diet group (CON, n = 11), high-fat diet/high-fructose (HFD/HF) group (n = 11), and high-fat diet/high-fructose + endurance exercise (HFD/HF + EXE) group (n = 11). HFD/HF + EXE mice performed treadmill running exercise for 60 min·d, 5 d·wk for 12 wk. RESULTS: Our data showed that EXE ameliorated HFD/HF-induced weight gain, fasting blood glucose levels, and visceral fat gain. More importantly, HFD/HF diet promoted cellular senescence, whereas EXE reversed it, evidenced by a reduction in the levels of p53, p21, p16, beta-galactosidase (SA-ß-gal), and lipofuscin. Furthermore, EXE prevented HFD/HF-induced neuroinflammation (e.g., tumor necrosis factor-α and interleukin-1ß) by inhibiting toll-like receptor 2 downstream signaling cascades (e.g., tumor necrosis factor receptor-associated factor 6, c-Jun N-terminal kinase, and c-Jun) in parallel with reduced reactive glial cells. This anti-inflammatory effect of EXE was associated with the reversion of HFD/HF-induced cellular oxidative stress. CONCLUSION: Our study provides novel evidence that EXE-induced antisenescence against metabolic distress in the hippocampus may be a key neuroprotective mechanism, preventing neuroinflammation and oxidative stress.

Let's Wiggle with 5-2-1-0: Curriculum Development for Training Childcare Providers to Promote Activity in Childcare Settings.

Overweight and obesity are increasing in preschool children in the US. Policy, systems, and environmental change interventions in childcare settings can improve obesity-related behaviors. The aim of this study was to develop and pilot an intervention to train childcare providers to promote physical activity (PA) in childcare classrooms. An evidence scan, key informant (n = 34) and focus group (n = 20) interviews with childcare directors and staff, and environmental self-assessment of childcare facilities (n = 22) informed the design of the training curriculum. Feedback from the interviews indicated that childcare providers believed in the importance of teaching children about PA and were supportive of training teachers to incorporate PA into classroom settings. The Promoting Physical Activity in Childcare Setting Curriculum was developed and training was implemented with 16 teachers. Participants reported a positive experience with the hands-on training and reported acquiring new knowledge that they intended to implement in their childcare settings. Our findings highlight the feasibility of working with childcare staff to develop PA training and curriculum. Next steps include evaluating the curriculum in additional childcare settings and childcare staff implementation of the curriculum to understand the effectiveness of the training on PA levels of children.

Perceived value in food selection when dining out: comparison of African Americans and Euro-Americans.

This descriptive study compares African Americans' and Euro-Americans' perceived value of food selection pertaining to cost, portion size, and meal satisfaction when eating away from home. A stratified sample was drawn from a southern U.S. metropolitan area (N= 1,011; 486 African American, 525 Euro-American). Analysis showed no difference between African-American and Euro-American adults by sex or how often they dined out. These two groups significantly differed across years of education, age, and answering 14 of 18 rated statements on value perceptions. African-Americans' value perceptions were influenced more by lower cost foods and larger portion sizes than those of Euro-Americans. For meal satisfaction, African Americans were more likely to agree with statements that indicate preferring foods high in energy and low in essential micronutrient density. This study supports the need for more investigation.

Muscle cytokine mRNA changes after 2.5 h of cycling: influence of carbohydrate.

PURPOSE: To study the effect of carbohydrate compared to placebo ingestion on plasma cytokines and muscle cytokine mRNA following 2.5 h of intensive cycling in 15 trained cyclists. METHODS: Fifteen trained cyclists cycled for 2.5 h at 60% Wmax on two occasions while receiving 4 mL.kg.15 min carbohydrate (6%) (CHO) or placebo (PLA) beverages in a randomized, counterbalanced design. Blood and vastus lateralis muscle biopsy samples were collected before and after exercise and 12 h postexercise and compared to samples taken from five cyclists who rested in the lab during the exercise sessions. Blood cell counts were determined, and plasma was analyzed for interleukin (IL)-6, IL-10, IL-1 receptor antagonist (ra), IL-8, cortisol, epinephrine, glucose, and insulin. Muscle was analyzed for glycogen content and relative gene expression of four cytokines, IL-6, IL-8, tumor necrosis factor (TNF) alpha, and IL-1beta, using real-time quantitative reverse transcriptase polymerase chain reaction. RESULTS: Plasma glucose and insulin were higher, and epinephrine, cortisol, IL-6, IL-10, and IL-1ra, but not IL-8, were significantly lower postexercise in CHO versus PLA. Muscle glycogen content decreased 68% immediately postexercise and the pattern of change did not differ between CHO and PLA. Muscle IL-6, IL-8, TNF-alpha, but not IL-1beta mRNA increased immediately postexercise compared to controls, with no differences between CHO and PLA. CONCLUSION: CHO compared to PLA beverage ingestion attenuated the increase in plasma cortisol, epinephrine, IL-6, IL-10, and IL-1ra, but not muscle IL-6, IL-8, and TNF-alpha mRNA in athletes cycling 2.5 h at 60% Wmax.

Influence of carbohydrate and age on lymphocyte function following a marathon.

The influence of 6% carbohydrate ingestion and age on PHA-induced lymphocyte proliferation and in vitro cytokine production was studied in 48 runners following a competitive marathon. Runners were randomly assigned to carbohydrate (C; n = 23) and placebo (P; n= 25) groups, with blood samples taken before, immediately after, and 1.5 hr post-race. C versus P ingestion resulted in higher plasma glucose, lower plasma cortisol, reduced neutrophilia, and monocytosis during recovery, but had no effect on the post-exercise reduction in T-lymphocytes or NK cells, or on race times. No group differences were observed for PHA-induced lymphocyte proliferation or cytokine production. However, for all subjects combined, lymphocyte proliferation and IFN-gamma secretion decreased significantly below pre-race values by 1.5 hr of recovery, and these were negatively correlated with plasma cortisol. Young (<50 years; n = 36) and old (>or=50 years; n = 12) runners exhibited parallel post-race declines in lymphocyte proliferation and IFN-gamma secretion, with the older group exhibiting a 33-59% lower proliferation at each time point. In conclusion, PHA-induced lymphocyte proliferation and cytokine production decreased significantly following a marathon, and this decrease was strongly linked to cortisol and only partially linked to T-cell changes. This decrease occurred in both younger and older runners and was not influenced by carbohydrate.

Carbohydrate supplementation and perceived exertion during prolonged running.

PURPOSE: The purpose of this study was to investigate the relationship between carbohydrate energy substrate and hormonal regulation on the perception of exertion during prolonged running. METHODS: Sixteen experienced marathoners ran on treadmills for 3 h at approximately 70% VO2max on two occasions while receiving 1 L x h carbohydrate (C) or placebo (P) beverages. Blood and vastus lateralis muscle biopsy samples were collected before and after exercise. RESULTS: The pattern of change in ratings of perceived exertion (RPE) over time was significantly different between C and P ingestion (P < 0.01) with attenuated RPE responses found in the latter part of the 3 h run. The pattern of change in the respiratory exchange ratio and carbohydrate oxidation rates were significantly greater (P < 0.01) in the C than P condition. Change in muscle glycogen content did not differ between C and P (P = 0.246). C relative to P ingestion was associated with higher plasma levels of glucose, insulin, and lactate and lower levels plasma cortisol. CONCLUSIONS: These data indicate that a lower RPE was associated with a higher carbohydrate oxidation, plasma glucose, and insulin levels, and lower plasma cortisol during prolonged running after C supplementation as compared with P feeding despite no differences in muscle glycogen content. These findings support a physiological link between RPE and carbohydrate substrate availability as well as selected hormonal regulation during prolonged running.

Ratings of perceived exertion throughout an ultramarathon during carbohydrate ingestion.

Ratings of perceived exertion (RPE) and their relation to selected physiological mediators during endurance exercise have been limited to laboratory settings. The present study characterized the pattern of change in perceptual responses and examined the relation between RPE and selected physiological variables during a long competitive sporting event, i.e., an ultramarathon race (68 km). A single-group design was employed in which all of the 28 subjects provided their perceptual ratings 11.9 +/- 0.2) and heart rate (HR) (138 +/- 3) periodically (every 5 km) throughout the ultramarathon, and selected physiological responses were measured before, once during (32 km), and immediately after the race. Runners drank approximately 1,000 ml of carbohydrate beverage each hour (60 gm carbohydrate hr.(-1)) and ate 2 or 3 carbohydrate gel packs per hour (25 gm each(-1)). RPE increased significantly throughout the course of the ultramarathon. No significant correlations were found between RPE and HR at any time throughout the ultramarathon. RPE averaged 10.4 +/- 0.4 at the beginning of the race (6.4 km) and 15.4 +/- 0.4 at the conclusion of the race. Subjects maintained 76.9 +/- 1.1% of maximal heart rate; however, there was a tendency for heart rate to drop significantly after 32 km. Significant time main effects were found for serum glucose, insulin, and cortisol throughout the race. However, no significant correlations were found between RPE and any of these physiological mediators. These data indicate that during an ultramarathon race there is a progressive increase in RPE without an accompanying increase in HR or decrease in blood glucose. Therefore, during competitive self-paced exercise the perceptual responses may be mediated through other neurological and physiological mechanisms.

Influence of carbohydrate ingestion on oxidative stress and plasma antioxidant potential following a 3 h run.

Concentrations of reactive oxygen species (ROS) increase during exercise secondary to increased oxygen uptake, xanthine oxidase activity, and immune system activation. Carbohydrate compared to placebo beverage ingestion is associated with an attenuated cortisol and catecholamine response. Catecholamines can undergo autooxidation to form ROS. We hypothesized that during intense exercise, ingestion of carbohydrate compared to placebo would diminish oxidative stress. Sixteen experienced marathoners ran on treadmills for 3 h at approximately 70% VO2(max) on two occasions while receiving carbohydrate or placebo beverages (11/h, double-blinded) in a randomized, counterbalanced order. Blood samples were collected before and immediately after exercise, snap frozen in liquid nitrogen, and stored at -80 degrees C until analysis. Plasma samples were analyzed for F2-isoprostanes (FIP) and lipid hydroperoxides (ROOH) as measures for lipid peroxidation, ferric reducing ability of plasma (FRAP) as a measure of plasma antioxidant potential and for cortisol. The pattern of change in cortisol was significantly different between carbohydrate and placebo conditions (P = 0.024), with post-exercise levels higher in the placebo condition. Under both carbohydrate and placebo conditions, significant increases in FIP, ROOH, and FRAP were measured, but the pattern of increase was not different (FIP, interaction effect, P = 0.472; ROOH, P = 0.572; FRAP, P = 0.668). Despite an attenuation in the cortisol response, carbohydrate compared to placebo ingestion does not counter the increase in oxidative stress or modulate plasma antioxidant potential in athletes running 3 h at 70% VO2(max).

Influence of vitamin C supplementation on oxidative and salivary IgA changes following an ultramarathon.

This randomized study measured the influence of vitamin C ( N=15) compared to placebo ( N=13) supplementation on oxidative and salivary immunoglobulin A (sIgA) changes in runners competing in an ultramarathon race. Seven days prior to the race, subjects ingested in randomized, double-blind fashion three 500-mg tablets of vitamin C or placebo each day. On race day, blood and saliva samples were collected 1 h pre-race, after 32 km of running, and then again immediately post-race. During the race, runners received 1 l/h carbohydrate beverages (60 g/l) with vitamin C (150 mg/l) or without in a double-blinded fashion. The runners also ingested two to three carbohydrate gel packs per hour (25 g each). Subjects in both groups ran a mean of 69 km (range 48-80 km) in 9.8 h (range 5-12 h) and maintained an intensity of approximately 75% maximal heart rate (HR(max)) throughout the ultramarathon race. Plasma ascorbic acid was higher in the vitamin C compared to placebo group pre-race, and increased significantly in the vitamin C group during the race [post-race, 3.21 (0.29) and 1.28 (0.12) microg/100 microl, respectively, P<0.001]. No significant group or interaction effects were measured for lipid hydroperoxide and F(2)-isoprostane, but both oxidative measures rose significantly during the ultramarathon race. Saliva volume, sIgA concentration, sIgA secretion and sIgA:saliva protein ratio all decreased significantly (P<0.001) during the race, but the pattern of change in all saliva measures did not differ significantly between groups. No significant correlations were found between post-race plasma vitamin C, oxidative, and saliva measures, except for a positive correlation between post-race serum cortisol and serum vitamin C (r=0.50, P=0.006). These data indicate that vitamin C supplementation in carbohydrate-fed runners does not serve as a countermeasure to oxidative and sIgA changes during or following a competitive ultramarathon race.

Influence of vitamin C supplementation on oxidative and immune changes after an ultramarathon.

The purpose of this randomized study was to measure the influence of vitamin C (n = 15 runners) compared with placebo (n = 13 runners) supplementation on oxidative and immune changes in runners competing in an ultramarathon race. During the 7-day period before the race and on race day, subjects ingested in randomized, double-blind fashion 1,500 mg/day vitamin C or placebo. On race day, blood samples were collected 1 h before race, after 32 km of running, and then again immediately after race. Subjects in both groups maintained an intensity of approximately 75% maximal heart rate throughout the ultramarathon race and ran a mean of 69 km (range: 48-80 km) in 9.8 h (range: 5-12 h). Plasma ascorbic acid was markedly higher in the vitamin C compared with placebo group prerace and rose more strongly in the vitamin C group during the race (postrace: 3.21 +/- 0.29 and 1.28 +/- 0.12 microg/100 microl, respectively, P < 0.001). No significant group or interaction effects were measured for lipid hydroperoxide, F2-isoprostane, immune cell counts, plasma interleukin (IL)-6, IL-10, IL-1-receptor antagonist, or IL-8 concentrations, or mitogen-stimulated lymphocyte proliferation and IL-2 and IFN-gamma production. These data indicate that vitamin C supplementation in carbohydrate-fed runners does not serve as a countermeasure to oxidative and immune changes during or after a competitive ultramarathon race.