A rapid review of the scalability of interventions targeting obesity prevention in infants.

ISSUE ADDRESSED: Obesity in children is one of the most significant public health issues globally. Given the high prevalence of overweight and obesity in children, there is a need to identify effective obesity prevention efforts that can be delivered at scale to improve child health. We aimed to (i) identify obesity prevention interventions targeted at children aged 0-2 that have been scaled-up, and their relative efficacy compared to their pre-scale trial, (ii) describe adaptations made, and the extent to which factors related to scalability have been reported. METHODS: We conducted a rapid review of pre-scale randomised controlled trials targeting nutrition, physical activity and obesity prevention in infants, and calculated the relative effect size for relevant outcomes in the corresponding scaled up trial. We documented adaptations made to the pre-scale trial for scale up, and explored how different components of scalability had been reported according to the Intervention Scalability Assessment Tool. RESULTS: Of the 14 identified pre-scale trials, only one formal evaluation of the scale-up trial was identified. For body mass index, <10% of the effect was retained, however for nutrition and behavioural outcomes, the proportion of effect retained varied from -11.1% to 144%. Significant adaptations to modality were made in the scaled up trial primarily to reduce cost and increase reach of the intervention. Reporting of scalability components varied across the 14 trials, with only one trial reporting information for all assessed components. CONCLUSIONS: The majority of effective interventions targeting obesity prevention in infants have not been evaluated in a scaled up form. The magnitude of effect retained for the single trial that was scaled up was variable. In general, reporting of components of scalability was sub-optimal. SO WHAT?: The findings suggest that there is substantial need for the development and rigorous evaluation of obesity prevention interventions in children aged 0-2 which are amenable for scale.

An audit of the dissemination strategies and plan included in international food-based dietary guidelines.

OBJECTIVE: Food-based dietary guidelines (FBDG) are an important resource to improve population health; however, little is known about the types of strategies to disseminate them. This study sought to describe dissemination strategies and content of dissemination plans that were available for FBDG. DESIGN: A cross-sectional audit of FBDG with a published English-language version sourced from the United Nations FAO repository. We searched for publicly available dissemination strategies and any corresponding plans available in English language. Two authors extracted data on strategies, which were grouped according to the Model for Dissemination Research Framework (including source, audience, channel and message). For guidelines with a dissemination plan, we described goals, audience, strategies and expertise and resources according to the Canadian Institute for Health Research guidance. SETTING: FBDG from fifty-three countries mostly from high-income (n 28, 52·8 %), and upper-middle income (n 18, 34 %) areas were included. PARTICIPANTS: n/a. RESULTS: The source of guidelines was most frequently health departments (79·2 %). The message included quantities and types of foods, physical activity recommendations and 88·7 % included summarised versions of main messages. The most common channels were infographics and information booklets, and the main end-users were the public. For twelve countries (22·6 %), we were able to source an English-language dissemination plan, where none met all recommendations outlined by the Canadian Institute for Health Research. CONCLUSIONS: The public was the most frequently identified end-user and thus most dissemination strategies and plans focused on this group. Few FBDG had formal dissemination plans and of those there was limited detailed provided.

Living a Healthy Life in Australia: Exploring Influences on Health for Refugees from Myanmar.

BACKGROUND: Humanitarian migrants from Myanmar represent a significant refugee group in Australia; however, knowledge of their health needs and priorities is limited. This study aims to explore the meaning and influencers of health from the perspectives of refugees from Myanmar. METHOD: Using a community-based participatory research (CBPR) design, a partnership was formed between the researchers, Myanmar community leaders and other service providers to inform study design. A total of 27 participants were recruited from a government-funded English language program. Data were collected using a short demographic survey and four focus groups, and were analysed using descriptive statistics and thematic analysis methods. RESULTS: Key themes identified included: (1) health according to the perspectives of Australian settled refugees from Myanmar, (2) social connections and what it means to be part of community, (3) work as a key influence on health, and (4) education and its links with work and health. CONCLUSIONS: This study outlined the inter-relationships between health, social connections, work and education from the perspectives of refugees from Myanmar. It also outlined how people from Myanmar who are of a refugee background possess strengths that can be used to manage the various health challenges they face in their new environment.

Free-Wilson Analysis of Comprehensive Data on Phosphoinositide-3-kinase (PI3K) Inhibitors Reveals Importance of N-Methylation for PI3Kδ Activity.

Phosphoinositide-3-kinase δ (PI3Kδ) is a critical regulator of cell growth and transformation and has been explored as a therapeutic target for a range of diseases. Through the exploration of the thienopyrimidine scaffold, we have identified a ligand-efficient methylation that leads to remarkable selectivity for PI3Kδ over the closely related isoforms. Interrogation through the Free-Wilson analysis highlights the innate selectivity the thienopyrimidine scaffold has for PI3Kδ and provides a predictive model for the activity against the PI3K isoforms.

Energetics of metamorphosis in Drosophila melanogaster.

We measured the energetic cost of metamorphosis in the fruitfly, Drosophila melanogaster. Metabolic rates decreased rapidly in the first 24h and remained low until shortly before eclosion, when the rates increased rapidly, thus creating a U-shaped metabolic curve. The primary fuel used during metamorphosis was lipid, which accounted for >80% of total metabolism. The total energy consumed during metamorphosis was lowest at 25°C, compared to 18 and 29°C, due to differences in metabolic rates and the length of pupal development. Temperature differentially affected metabolic rates during different stages of metamorphosis. Prepupal and late pupal stages exhibited typical increases in metabolic rate at high temperatures, whereas metabolic rates were independent of temperature during the first 2/3 of pupal development. We tested two hypotheses for the underlying cause of the U-shaped metabolic curve. The first hypothesis was that pupae become oxygen restricted as a result of remodeling of the larval tracheal system. We tested this hypothesis by exposing pupae to hypoxic and hyperoxic atmospheres, and by measuring lactic acid production during normoxic development. No evidence for oxygen limitation was observed. We also tested the hypothesis that the U-shaped metabolic curve follows changes in metabolically active tissue, such that the early decrease in metabolic rates reflects the histolysis of larval tissues, and the later increase in metabolic rates is associated with organogenesis and terminal differentiation of adult tissues. We assayed the activity of a mitochondrial indicator enzyme, citrate synthase, and correlated it with tissue-specific developmental events during metamorphosis. Citrate synthase activity exhibited a U-shaped curve, suggesting that the pattern of metabolic activity is related to changes in the amount of potentially active aerobic tissue.

Product variety in Australian snacks and drinks: how can the consumer make a healthy choice?

OBJECTIVE: To estimate the proportion of snack food and beverage choices available to an Australian consumer. DESIGN: A survey of product Nutrition Information Panels (NIP) and product labels on snack foods and beverages offered for sale. Data on nutrient content were compared with criteria from different nutrient profile systems to estimate the proportion of items conforming to a choice. SETTING: A large supermarket in metropolitan Melbourne, Australia. RESULTS: A consumer could choose from 1,070 different snack foods and 863 different drinks. Flavour variety was more common in snacks (maximum thirteen per product) while variation in container size was more common for drinks (up to ten per product). Recommended serving size for snacks varied greatly (1822 % of snack foods presented for sale could be deemed by multiple criteria. Similarly, only 14 healthy healthier' snack foods and beverages, e.g. by reformulation of many products by the food industry and their presentation in smaller, standardised portion-size packaging.