Cross-sectional survey of child weight management service provision by acute NHS trusts across England in 2020/2021.

OBJECTIVE: With one in five children in England living with obesity, we mapped the geographical distribution and format of child weight management services provided by acute National Health Service (NHS) trusts across England, to identify breadth of service provision. DESIGN: A cross-sectional survey. SETTING: The survey was sent to acute NHS trusts (n=148) in England in 2020, via a freedom of information request. PARTICIPANTS: Responses were received from 139 of 148 (94%) acute NHS trusts, between March 2020 to March 2021. OUTCOME MEASURES: The survey asked each acute NHS trust whether they provide a weight management service for children living with obesity. For those trusts providing a service, data were collected on eligibility criteria, funding source, personnel involved, number of new patients seen per year, intervention duration, follow-up length and outcome measures. Service characteristics were reported using descriptive statistics. Service provision was analysed in the context of ethnicity and Index of Multiple Deprivation score of the trust catchment area. RESULTS: From the 139 survey respondents, 23% stated that they provided a weight management service for children living with obesity. There were inequalities in the proportion of acute NHS trusts providing a service across the different regions of England, ranging from 4% (Midlands) to 36% (London). For trusts providing a service, there was variability in the number of new cases seen per year, eligibility criteria, funding source, intervention format and outcome measures collected. A multidisciplinary approach was not routinely provided, with only 41% of services reporting ≥3 different staff disciplines. CONCLUSION: In 2020/2021, there were geographical inequalities in weight management service provision by acute NHS trusts for children living with obesity. Services provided lacked standardisation, did not routinely offer children multidisciplinary care and were insufficient in size to meet need.

Exploring how lifestyle weight management programmes for children are commissioned and evaluated in England: a mixed methodology study.

OBJECTIVE: To assess how lifestyle weight management programmes for children aged 4-16 years in England are commissioned and evaluated at the local level. DESIGN: This was a mixed-methods study comprising an online survey and semistructured telephone interviews. SETTING: An online survey was sent to all local authorities (LAs) in England regarding lifestyle weight management services commissioned for children aged 4-16 years. Online survey data were collected between February and May 2016 and based on services commissioned between April 2014 and March 2015. Semistructured telephone interviews with LA staff across England were conducted between April and June 2016. PARTICIPANTS: Commissioners or service providers working within the public health department of LAs. MAIN OUTCOME MEASURES: The online survey collected information on the evidence base, costs, reach, service usage and evaluation of child lifestyle weight management services. The telephone interviews explored the nature of child weight management contracts commissioned by LAs, the type of outcome data collected and whether these data were shared with other LAs or organisations, the challenges faced by these services, and the perceived 'markers of success' for a programme. RESULTS: The online survey showed that none of the participating LAs was aware of any peer-reviewed evidence supporting the effectiveness of their specific commissioned service. Despite this, the telephone interviews revealed that there was no national formal sharing of data to enable oversight of the effectiveness of commissioned services across LAs in England to help inform future commissioning decisions. Challenges with long-term data collection, service engagement, funding and the pressure to reduce the prevalence of obesity were frequently mentioned. CONCLUSIONS: Robust, independent, cost-effectiveness analyses of obesity strategies are needed to determine the appropriate allocation of funding to lifestyle weight management treatment services, population-level preventative approaches or development of whole system approaches by an LA.

Effectiveness of after-school interventions at increasing moderate-to-vigorous physical activity levels in 5- to 18-year olds: a systematic review and meta-analysis.

AIM: Physical activity in children improves cardiovascular, mental, metabolic and skeletal health. Many children fail to meet the national recommendation of at least 60 min per day of moderate-to-vigorous physical activity (MVPA). After-school programmes provide an opportunity to engage children in physical activity. This systematic review and meta-analysis examine the effectiveness of after-school interventions at increasing MVPA levels in children and adolescents. DESIGN: Systematic review and meta-analyses. DATA SOURCES: A literature search was conducted using MEDLINE, EMBASE and PsychINFO databases from January 1950 to April 2015. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Inclusion criteria-Population: participants aged 5-18 years. INTERVENTION: an after-school programme in a school-based setting as the main component of an intervention to increase physical activity levels. OUTCOMES: individual-level measure of time spent in MVPA. STUDY DESIGN: quasi-experimental, pilot, non-randomised or randomised trials. EXCLUSION CRITERIA: conference abstracts, unpublished articles, dissertations and non-English language papers. RESULTS: 1387 records were identified through database searching. After removal of duplicates, there were 748 records. 15 articles met the inclusion criteria for the systematic review. 6 studies were eligible for meta-analysis and the pooled intervention effect at end point follow-up was 4.84 min/day of MVPA (95% CI -0.94 to 10.61). The effectiveness of after-school interventions varied considerably and comparisons between studies limited by different methodological study designs. Subgroup analyses within a small minority of studies revealed significant benefits in overweight/obese children and boys. There was a lack of convincing evidence that interventions based on theories of behaviour change were more effective than those with no underlying theory. CONCLUSIONS: After-school physical activity interventions to date have had mixed effectiveness on increasing MVPA levels. More robust evaluations of extracurricular physical activity interventions are required, particularly studies that use objective assessment of physical activity.

Cysteine residue 911 in C-terminal tail of human BK(Ca)α channel subunit is crucial for its activation by carbon monoxide.

The large conductance, voltage- and calcium-activated potassium channel, BK(Ca), is a known target for the gasotransmitter, carbon monoxide (CO). Activation of BK(Ca) by CO modulates cellular excitability and contributes to the physiology of a diverse array of processes, including vascular tone and oxygen-sensing. Currently, there is no consensus regarding the molecular mechanisms underpinning reception of CO by the BK(Ca). Here, employing voltage-clamped, inside-out patches from HEK293 cells expressing single, double and triple cysteine mutations in the BK(Ca) α-subunit, we test the hypothesis that CO regulation is conferred upon the channel by interactions with cysteine residues within the RCK2 domain. In physiological [Ca(2+)](i), all mutants carrying a cysteine substitution at position 911 (C911G) demonstrated significantly reduced CO sensitivity; the C911G mutant did not express altered Ca(2+)-sensitivity. In contrast, histidine residues in RCK1 domain, previously shown to ablate CO activation in low [Ca(2+)](i), actually increased CO sensitivity when [Ca(2+)](i) was in the physiological range. Importantly, cyanide, employed here as a substituent for CO at potential metal centres, occluded activation by CO; this effect was freely reversible. Taken together, these data suggest that a specific cysteine residue in the C-terminal domain, which is close to the Ca(2+) bowl but which is not involved in Ca(2+) activation, confers significant CO sensitivity to BK(Ca) channels. The rapid reversibility of CO and cyanide binding, coupled to information garnered from other CO-binding proteins, suggests that C911 may be involved in formation of a transition metal cluster which can bind and, thereafter, activate BK(Ca).

Enzyme-linked oxygen sensing by potassium channels.

The ability of ion channels to respond to an acute perturbation in oxygen tension is a widespread phenomenon, which encompasses many of the major ion channel families. Integral to the ability of several ion channels to respond to acute hypoxic challenge is modulation by upstream enzymatic reactions, suggesting that many ion channels sense oxygen via enzyme-linked processes. Several enzyme-linked oxygen sensing systems have been proposed, including nicotinamide adenine dinucleotide phosphate (NADPH) oxidase-dependent production of hydrogen peroxide, hemoxygenase-dependent generation of carbon monoxide, adenosine monophosphate (AMP) kinase-dependent channel phosphorylation, and src-Lck protein tyrosine kinase, via a currently undetermined mechanism. Each of these enzymes has been shown to endow specific ion channels with the ability to respond to changes in oxygen, with hypoxia exclusively evoking channel inhibition. This article reviews these proposed mechanisms and presents new insights into how one system, hemeoxygenase-2, confers oxygen sensitivity to large conductance, voltage- and calcium-activated potassium channels.