Association between multi-component initiatives and physical activity-related behaviors: interim findings from the Healthy Schools Healthy Communities initiative.

BACKGROUND: Although successful, assessment of multi-component initiatives (MCIs) prove to be very challenging. Further, rigorous evaluations may not be viable, especially when assessing the impact of MCIs on long-term population-level behavior change (e.g., physical activity (PA) and health outcomes (e.g., childhood obesity). The purpose of this study was to use intensity scoring, to assess whether higher intensity MCIs implemented as part of Healthy Schools Healthy Communities (HSHC) were associated with improved physical activity and reduced sedentary behaviors among youth (dependent variables). METHODS: PA-related interventions were assigned point values based on three characteristics: 1) purpose of initiative; 2) duration; and 3) reach. A MCI intensity score of all strategies was calculated for each school district and its respective community. Multivariate longitudinal regressions were applied, controlling for measurement period, Cohort, and student enrollment size. RESULTS: Strategy intensity scores ranged from 0.3 to 3.0 with 20% considered "higher-scoring" (score > 2.1) and 47% considered "lower-scoring" (< 1.2). Average MCI intensity scores more than tripled over the evaluation period, rising from 14.8 in the first grant year to 32.1 in year 2, 41.1 in year 3, and 48.1 in year 4. For each additional point increase in average MCI intensity score, the number of days per week that students reported PA for at least 60 min increased by 0.010 days (p < 0.01), and the number of hours per weekday that students reported engaging in screen time strategies decreased by 0.006 h (p < 0.05). An increase of 50 points in MCI intensity score was associated with an average 0.5 day increase in number of weekdays physically active and an increase of 55 points was associated with an average decrease of 20 min of sedentary time per weekday. CONCLUSIONS: We found a correlation between intensity and PA and sedentary time; increased PA and reduced sedentary time was found with higher-intensity MCIs. While additional research is warranted, practitioners implementing MCIs, especially with limited resources (and access to population-level behavior data), may consider intensity scoring as a realistic and cost effective way to assess their initiatives. At a minimum, the use of intensity scoring as an evaluation method can provide justification for, or against, the inclusion of an individual strategy into an MCI, as well as ways to increase the likelihood of the MCI impacting population-health outcomes.

Overcoming Challenges Resulting From COVID-19: New York State's Creating Healthy Schools and Communities Initiative.

"Upstream" interventions that increase access or reduce barriers to healthy foods and opportunities for physical activity - referred to as policy, systems, or environmental strategies - are central to encouraging and supporting healthy behaviors that prevent chronic disease at a population level. However, they are complex and challenging to execute, especially during coronavirus disease 2019 (COVID-19), and efforts to build practitioner capacity are warranted. In this commentary, we describe a user or human-centered design (HCD) capacity-building approach to support practitioners in accomplishing the goals of the New York State Creating Healthy Schools and Communities (CHSC) initiative. This approach has been especially helpful during COVID-19, as it enables support to be responsive to practitioners' constantly changing needs. Given that CHSC is a project specific to New York State and that the efforts of the Obesity Prevention Center for Excellence were tailored to obesity prevention, more research and evaluations should be conducted to better understand how the use of HCD could support practitioners addressing other complex public health issues in the United States.

Very early onset of autoimmune thyroiditis in a toddler with severe hypothyroidism presentation: a case report.

BACKGROUND: In infants under 3 years of age acquired primary hypothyroidism caused by autoimmune thyroiditis is very rare. Hypothyroidism can manifest with different signs and symptoms and has a wide range of presentations from subclinical hypothyroidism to overt form. We describe a child with acquired autoimmune thyroiditis during a very early period of life and with a severe hypothyroidism presentation. CASE PRESENTATION: A 22-month-old white male patient with normal neonatal screening presented with a six-month history of asthenia and cutaneous pallor. At general clinical and biochemical exams he showed weight gain, statural growth deceleration, poor movements, sleepy expression, instability while walking, myxoedema, bradycardia, open anterior fontanelle, changes in the face habitus, macrocytic anaemia, ascites, and high CPK, creatinine and cholesterol levels. Acquired autoimmune thyroiditis was the final diagnosis. The thyroxine replacement therapy normalized all the clinical and biochemical abnormalities but at the age of 30 months his mental age showed a delay of 6 months. CONCLUSIONS: Our case could give useful learning points: i) although the screening for congenital hypothyroidism is routinely performed, a severe hypothyroidism (for example due to autoimmune thyroiditis) can anyway occur early in life and the clinicians should consider this possibility; ii) hypothyroidism can have a misleading and multi-face clinical presentation; iii) anemia, rhabdomyolysis and high creatinine levels should always include the hypothyroidism in the differential diagnosis; iv) thyroxine replacement therapy is able to revert all the clinical manifestations related to the hypothyroidism; v) evaluating the patient's previous pictures could play an important role in resolving a diagnostic conundrum.

Long-Term Provision of Environmental Resources Alters Behavior but not Physiology or Neuroanatomy of Male and Female BALB/c and C57BL/6 Mice.

Few studies have evaluated the long-term effects of providing environmental resources to mice. This consideration is important given that mice are often maintained in vivaria for months. We evaluated the effects of providing simple cage resources (wood wool, cotton nesting material, a plastic tunnel, and oat cereal) compared with standard housing (solid-bottom cage with hardwood chips) to group-housed adult male and female C57BL/6 and BALB/c mice (n = 20/sex/strain/group) over 6 mo to determine whether these resources had a lasting effect on animal physiology, anatomy, and behavior. Body weights increased in all groups over time but were proportionately higher in male and female BALB/c mice housed in resource-supplemented environments. Throughout the study, adding environmental resources had no effect on hematology and lymphocyte subsets, fecal corticoid metabolite levels, response to LPS injection, or dendritic spine length or density. Strain- or sex×environmentspecific changes occurred in dark-light activity and thermal nociceptive responses. Dominant agonistic behaviors, abnormal conspecific sexual behaviors, and social nonagonistic behaviors demonstrated sex and strain×environment interactions such that fewer maladaptive social behaviors were noted in mice that were provided with environmental resources. This association was particularly evident in male mice of both strains in resource-supplemented environments. A small but significant increase in brain weight:body weight ratios occurred in mice in resource-supplemented environments. Under the conditions evaluated here, consistent use of simple environmental resources had a positive long-term effect on the behavioral wellbeing of male and female BALB/c and C57BL/6 mice yet minimally affected other aspects of murine physiology and neuroanatomy.

Bioavailable Vitamin D in Obese Children: The Role of Insulin Resistance.

CONTEXT: Studies examining vitamin D levels in association with childhood obesity usually do not consider the effect of insulin on vitamin D-binding protein and do not calculate the unbound, bioavailable vitamin D. OBJECTIVE: This study aimed to evaluate in a group of children 1) the concentrations of both total 25-hydroxyvitamin D and bioavailable fraction, and 2) the potential role of insulin resistance in modulating the concentrations of bioavailable vitamin D. Design, Setting, and Patients or Other Participants: This was a cross-sectional study at a University Pediatric Department in which 63 obese children and 21 lean controls were enrolled. MAIN OUTCOME MEASURES: Total 25-hydroxyvitamin D and vitamin D-binding protein were measured, two single-nucleotide polymorphisms in the coding region of the vitamin D-binding protein (rs4588 and rs7041) were studied, and the vitamin D bioavailable fraction was calculated. RESULTS: Obese children showed total 25-hydroxyvitamin D levels lower compared with nonobese children (21.3 ± 6.7 ng/mL vs 29.6 ± 11.7 ng/mL; P = .0004). Bioavailable 25-hydroxyvitamin D levels were not different among the two groups (3.1 ± 1.6 ng/mL vs 2.6 ± 1.2 ng/mL; P > .05). Insulin-resistant children showed higher bioavailable levels of 25-hydroxyvitamin D compared with noninsulin-resistant children (3.4 ± 1.4 ng/mL vs 2.0 ± 0.9 ng/mL; P = .013) and an inverse correlation between insulin resistance and vitamin D-binding protein was found (r:= -0.40; P = .024). CONCLUSIONS: Obese children present levels of bioavailable 25-hydroxyvitamin D similar to those of normal-weight children due to reduced concentration of vitamin D-binding protein. The insulin resistance could play a role in this reduced concentration.

Chronic HCV infection is a risk of atherosclerosis. Role of HCV and HCV-related steatosis.

OBJECTIVES: HCV and NAFLD are associated with atherosclerosis in general population. The prevalence of atherosclerosis in chronic hepatitis C (CHC) patients is unknown. We hypothesized that HCV per se and HCV-related steatosis could favour atherosclerosis. Thus, in CHC patients we assessed: (a) the prevalence of atherosclerosis; (b) the role of HCV, cardio-metabolic risk factors and hepatic histology. METHODS: Overall, 803 subjects were enrolled: (A) 326 patients with liver biopsy-proven treatment naive CHC (175 with and 151 without steatosis); (B) 477 age and gender matched controls, including 292 healthy subjects without steatosis (B1) and 185 with NAFLD (B2). Carotid atherosclerosis (CA), assessed by high-resolution B-mode ultrasonography, was categorized as either intima-media thickness (IMT: >1mm) or plaques (≥ 1.5mm). RESULTS: CHC patients had a higher prevalence of CA than controls (53.7% vs 34.3%; p<0.0001). Younger CHC (<50 years) had a higher prevalence of CA than controls (34.0% vs 16.0%; p<0.04). CHC patients without steatosis had a higher prevalence of CA than B1 controls (26.0% vs 14.8%; p<0.02). CHC with steatosis had a higher prevalence of CA than NAFLD patients (77.7% vs 57.8%, p<0.0001). Viral load was associated with serum CRP and fibrinogen levels; steatosis with metabolic syndrome, HOMA-IR, hyperhomocysteinemia and liver fibrosis. Viral load and steatosis were independently associated with CA. Diabetes and metabolic syndrome were associated with plaques. CONCLUSION: HCV infection is a risk factor for earlier and facilitated occurrence of CA via viral load and steatosis which modulate atherogenic factors such as inflammation and dysmetabolic milieu.