Publications by authors named "Caroline Brand"

147 Publications

A Multicomponent Intervention Program With Overweight and Obese Adolescents Improves Body Composition and Cardiorespiratory Fitness, but Not Insulin Biomarkers.

Front Sports Act Living 2021 22;3:621055. Epub 2021 Feb 22.

Postgraduate Program Master and Doctorate in Health Promotion, University of Santa Cruz do Sul, Santa Cruz do Sul, Brazil.

To verify the effect of a multicomponent intervention with overweight/obese adolescents on physical fitness, body composition, and insulin biomarkers. A quasi-experimental study with 37 adolescents, aged 10 to 17 years, of both sexes, overweight and obese, allocated in two groups (Intervention-IG Group, = 17; Control-GC Group, = 20). The IGs were submitted to a multicomponent intervention for 6 months (three weekly sessions) consisting of physical exercises (sports, functional circuit, recreational, and water activities) and nutritional and psychological guidance. Participants were assessed before and after intervention on body composition [body mass index (BMI), body fat, waist circumference, and waist-to-hip ratio (WHR)], physical fitness [cardiorespiratory fitness (CRF) and abdominal strength], and biomarkers of insulin (glucose, insulin, evaluation of the homeostasis model of insulin, and resistin resistance). The prevalence of responders in both groups was obtained according to the theoretical model applied in previous studies similar to this one to determine the cutoff points for response to intervention. Poisson regression was used to verify the difference in the prevalence ratio (PR) of the interviewees between the groups. The responders' prevalence between groups CG and IG showed significant differences for body fat (CG = 30.0%; IG = 70.6%; PR = 1.396; < 0.001), WHR (CG = 30.0%; IG = 76.5%; PR = 1.730; < 0.001), and CRF (CG = 15.0%; IG = 52.5%; PR = 1.580; < 0.001). A 6-month multicomponent intervention program improved certain body composition parameters and the CRF of overweight and obese adolescents but did not improve insulin biomarkers. Clinical Trials under Protocol ID: 54985316.0.0000.5343.
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http://dx.doi.org/10.3389/fspor.2021.621055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937702PMC
February 2021

Choose Where You Live Carefully: Built Environment Differences in Children's Cardiorespiratory Fitness and Cardiometabolic Risk.

Sports (Basel) 2021 Feb 21;9(2). Epub 2021 Feb 21.

Sport, Exercise and Life Sciences Research Centre, Coventry University, Coventry CV1 5FB, UK.

Information regarding urban-rural differences in health indicators are scarce in Brazil. This study sought to identify rural-urban differences in cardiorespiratory fitness (CRF) and cardiometabolic risk (CMR) in Brazilian children and adolescents whilst controlling for the important confounding variables including social economic status (SES). This is a cross-sectional study developed with children and adolescents (n = 2250, age 11.54 ± 2.76) selected from a city in the south of Brazil. CRF was estimated using a 6-minute run/walk test. CMR scores were calculated by summing different cardiometabolic risk indicators. CRF was analysed assuming a multiplicative model with allometric body-size components. CMR differences in residential locations was assessed using Analysis of caovariance (ANCOVA) adopting SES, Body Mass Index (BMI), waist circumference (WC), age and fitness as covariates. Results indicated a main effect of location ( < 0.001) with children living a rural environment having the highest CRF, and children living in the periphery of towns having the lowest. Analysis also revealed significant main effects of location ( < 0.001) with children living a rural environment having the lowest CMR and children living in the centre of towns having the highest. Therefore, Brazilian children living in a rural environment appear to have superior health benefits.
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http://dx.doi.org/10.3390/sports9020031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924861PMC
February 2021

24-hour movement behaviors and fitness in preschoolers: A compositional and isotemporal reallocation analysis.

Scand J Med Sci Sports 2021 Feb 18. Epub 2021 Feb 18.

Associate Graduate Program in Physical Education UPE/UFPB, Federal University of Paraíba, João Pessoa, Brazil.

This study analyzed the associations between the 24-hour movement behaviors composition and fitness in preschoolers and investigated predicted changes in fitness when time in active behaviors is reallocated. This cross-sectional study was carried out with 270 preschoolers (132 boys; 3.97 ± 0.80 years-old). Light and moderate-to-vigorous physical activity (LPA and MVPA), and sedentary behavior (SB) were verified using an accelerometer. Sleep time was obtained through interviews with parents. Components of physical fitness (cardiorespiratory fitness-CRF, speed-agility, and lower-body muscular strength) were assessed using the PREFIT Battery. To verify the association between 24-hour movement behaviors and physical fitness, the compositional analysis was used, and for the time reallocation, the compositional isotemporal substitution analysis was used for active behaviors (LPA and MVPA). The daily composition, adjusted for body mass index, sex, and age, was significantly associated with CRF (P = .007; r  = 0.29), speed-agility (P < .001; r  = 0.14), and lower-body muscular strength (P = .01; r  = 0.07). For CRF, the addition of MVPA, at the expense of any other behavior, was associated with significant improvements. For speed-agility and lower-body muscular strength, only reallocations between sleep and LPA yielded significant associations. The variation in CRF, speed-agility, and lower-body muscular strength was associated with the 24 hours movement composition, and reallocating 5, 10 or 15 minutes of SB or sleep for MVPA was significantly positive for CRF (P < .05). The present findings highlight the relevance of decreasing SB and increasing physical activity practice, particularly at high intensities, to promote a better CRF profile for preschoolers.
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http://dx.doi.org/10.1111/sms.13938DOI Listing
February 2021

Relationship between rs9939609 FTO polymorphism with waist circumference and body fat is moderated by ponderal index at birth in youth.

Am J Hum Biol 2021 Feb 15:e23575. Epub 2021 Feb 15.

Department of Life Sciences. Graduate Program in Health Promotion, University of Santa Cruz do Sul, Santa Cruz do Sul, Rio Grande do Sul, Brazil.

Objective: The goal of this study was to analyze whether the relationship between the rs9939609 polymorphism of the fat mass and obesity-associated gene (FTO) with nutritional status is moderated by the ponderal index (PI) at birth in children and adolescents.

Methods: A cross-sectional study evaluated 382 schoolchildren aged 6-17 years. Anthropometric variables such as waist circumference (WC), body mass index (BMI) and body fat percentage (BF%) were used to assess nutritional status. Weight and height at birth were used for the PI calculation, which was divided into tertiles (lower, middle and upper). To compare the continuous variables between genotypes of the rs9939609 polymorphism, a recessive model (TT/AT vs. AA) and covariance analysis (ANCOVA) were used.

Results: The AA genotype of the rs9939609 polymorphism was associated with higher WC in schoolchildren born with lower PI (β = 4.40; p = .048). However, for BF%, the genotype association was found in the upper PI tertile (β = 7.35; p = .040).

Conclusion: The relationship between WC and BF% with rs9939609 polymorphism (FTO) seems to be moderated by PI at birth. This is an important insight, since the data for intrauterine growth, genetic factors and the presence of obesity in children and adolescents are still contradictory.
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http://dx.doi.org/10.1002/ajhb.23575DOI Listing
February 2021

Combination of sleep duration, TV time and body mass index is associated with cardiometabolic risk moderated by age in youth.

J Pediatr Endocrinol Metab 2021 Jan 16;34(1):51-58. Epub 2020 Nov 16.

Graduate Program in Health Promotion, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil.

Objectives: The combination of sleep duration, television (TV) time and body mass index (BMI) may be related to the alteration of cardiometabolic risk. However, there are few studies that use these variables grouped, and showing the moderating role of age. This study aimed to verify if the combination of sleep duration, TV time and BMI is associated with cardiometabolic risk and the moderating role of age in this relationship in youth.

Methods: Cross-sectional study conducted with 1411 adolescents (611 male), aged 10-17 years. Sleep duration, TV time and BMI were assessed and grouped into eight categories. Cardiometabolic risk was assessed by a continuous metabolic risk score, including the following variables: low HDL-cholesterol, elevated triglycerides, dysglycemia, high systolic blood pressure, high waist circumference and low cardiorespiratory fitness. Generalized linear models were used to test moderation of age in the relationship between the eight categories of sleep duration/television time/BMI with cardiometabolic risk.

Results: Cardiometabolic risk factor showed association with all overweight or obesity independent of sleep time and TV time. Age moderated the relationship between sleep duration/television time/BMI with cardiometabolic risk. This association was stronger in younger adolescents (11 and 13 years), indicating that individuals with inadequate sleep, prolonged TV time and overweight/obesity present higher cardiometabolic risk values when compared to 15-year-old adolescents.

Conclusion: Overweight/obesity, independently of sleep duration and TV time, is the main risk factor for cardiometabolic disorders in adolescence. When moderated by age, younger adolescents that presented the combination of risk factors had higher cardiometabolic risk.
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http://dx.doi.org/10.1515/jpem-2020-0399DOI Listing
January 2021

Validation of the responding to urgency of need in palliative care (RUN-PC) triage tool.

Palliat Med 2021 Apr 21;35(4):759-767. Epub 2021 Jan 21.

Department of Public Health, La Trobe University, Melbourne, VIC, Australia.

Background: The Responding to Urgency of Need in Palliative Care (RUN-PC) Triage Tool is a novel, evidence-based tool by which specialist palliative care services can manage waiting lists and workflow by prioritising access to care for those patients with the most pressing needs in an equitable, efficient and transparent manner.

Aim: This study aimed to establish the intra- and inter-rater reliability, and convergent validity of the RUN-PC Triage Tool and generate recommended response times.

Design: An online survey of palliative care intake officers applying the RUN-PC Triage Tool to a series of 49 real clinical vignettes was assessed against a reference standard: a postal survey of expert palliative care clinicians ranking the same vignettes in order of urgency.

Setting/participants: Intake officers ( = 28) with a minimum of 2 years palliative care experience and expert clinicians ( = 32) with a minimum of 10 years palliative care experience were recruited from inpatient, hospital consultation and community palliative care services across metropolitan and regional Victoria, Australia.

Results: The RUN-PC Triage Tool has good intra- and inter-rater reliability in inpatient, hospital consultation and community palliative care settings (Intraclass Correlation Coefficients ranged from 0.61 to 0.74), and moderate to good correlation to expert opinion used as a reference standard (Kendall's Tau rank correlation coefficients ranged from 0.68 to 0.83).

Conclusion: The RUN-PC Triage Tool appears to be a reliable and valid tool for the prioritisation of patients referred to specialist inpatient, hospital consultation and community palliative care services.
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http://dx.doi.org/10.1177/0269216320986730DOI Listing
April 2021

Physical fitness attenuates the genetic predisposition to obesity in children and adolescents.

Scand J Med Sci Sports 2021 Apr 11;31(4):894-902. Epub 2020 Dec 11.

Graduate Program in Health Promotion, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil.

Obesity is an important risk factor associated with non-communicable cardiometabolic diseases. Previous studies have indicated that children and adolescents with a predisposed genetic risk for obesity could benefit from an active lifestyle, but there are no studies investigating whether physical fitness moderates the association of genetics and obesity. The aim of this study was to verify the moderating role of physical fitness in the relationship between genetic risk score (GRS) and body mass index (BMI) in children and adolescents. This cross-sectional study was carried out with 1471 children and adolescents, aged between 6 and 17 years from Santa Cruz do Sul, Brazil. Weight and height were assessed to determine BMI. Physical fitness components (cardiorespiratory fitness [CRF], lower limb strength [LLS], upper limb strength, and abdominal strength) were evaluated. The GRS was based on previously associated obesity single-nucleotide polymorphism rs9939609 (FTO), rs6548238 (TMEM18), and rs16835198 (FNDC5). Moderation analyses were tested using linear regression models, and the interactions were represented by physical fitness components X GRS (categorical variable). All analyses were adjusted for skin color/ethnicity, sex, and sexual maturation. Significant interactions for CRF (P = 0.041), LLS (P = 0.041), and abdominal strength (P = 0.046) X 5 and 6 risk alleles with BMI were found only in adolescents. In addition, there was evidence that fitness components attenuated the high genetic predisposition to high BMI. Physical fitness components are moderators in the relationship between GRS and BMI in adolescents. These findings highlight the need for interventions targeting to improve this aspect, which is an important health indicator in all ages.
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http://dx.doi.org/10.1111/sms.13899DOI Listing
April 2021

Animal Safety, Toxicology, and Pharmacokinetic Studies According to the ICH S9 Guideline for a Novel Fusion Protein tTF-NGR Targeting Procoagulatory Activity into Tumor Vasculature: Are Results Predictive for Humans?

Cancers (Basel) 2020 Nov 26;12(12). Epub 2020 Nov 26.

Department of Medicine A Hematology and Oncology, University Hospital Muenster, D-48149 Muenster, Germany.

Background: CD-13 targeted tissue factor tTF-NGR is a fusion protein selectively inducing occlusion of tumor vasculature with resulting tumor infarction. Mechanistic and pharmacodynamic studies have shown broad anti-tumor therapeutic effects in xenograft models.

Methods: After successful Good Manufacturing Practice (GMP) production and before translation into clinical phase I, ICH S9 (S6) guideline-conforming animal safety, toxicology, and pharmacokinetic (PK) studies were requested by the federal drug authority in accordance with European and US regulations.

Results: These studies were performed in mice, rats, guinea pigs, and beagle dogs. Results of the recently completed clinical phase I trial in end-stage cancer patients showed only limited predictive value of these non-clinical studies for patient tolerability and safety in phase I.

Conclusions: Although this experience cannot be generalized, alternative pathways with seamless clinical phase 0 microdosing-phase I dose escalation studies are endorsed for anticancer drug development and translation into the clinic.
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http://dx.doi.org/10.3390/cancers12123536DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759859PMC
November 2020

Do family meetings for hospitalised palliative care patients improve outcomes and reduce health care costs? A cluster randomised trial.

Palliat Med 2021 Jan 31;35(1):188-199. Epub 2020 Oct 31.

Austin Health, Heidelberg, Victoria, Australia.

Background: Family meetings facilitate the exploration of issues and goals of care however, there has been minimal research to determine the benefits and cost implications.

Aims: To determine: (1) if family caregivers of hospitalised patients referred to palliative care who receive a structured family meeting report lower psychological distress (primary outcome), fewer unmet needs, improved quality of life; feel more prepared for the caregiving role; and receive better quality of end-of-life care; (2) if outcomes vary dependant upon site of care and; (3) the cost-benefit of implementing meetings into routine practice.

Design: Pragmatic cluster randomised trial involving palliative care patients and their primary family caregivers at three Australian hospitals. Participants completed measures upon admission (Time 1); 10 days later (Time 2) and two months after the patient died (Time 3). Regression analyses, health utilisation and process evaluation were conducted.

Results: 297 dyads recruited; control ( = 153) and intervention ( = 144). The intervention group demonstrated significantly lower psychological distress (Diff: -1.68,  < 0.01) and higher preparedness (Diff: 3.48,  = 0.001) at Time 2. No differences were identified based on quality of end of life care or health utilisation measures.

Conclusions: Family meetings may be helpful in reducing family caregiver distress and enhancing their preparedness for the caregiving role and it appears they may be conducted without increased hospital health utilisation impacts; although opportunity costs need to be considered in order to routinely offer these as a standardised intervention. Additional health economic examination is also advocated to comprehensively understand the cost-benefit implications.

Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12615000200583.
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http://dx.doi.org/10.1177/0269216320967282DOI Listing
January 2021

Association between cardiorespiratory fitness and cardiometabolic risk factors in Brazilianchildren and adolescents: the mediating role of obesity parameters.

Paediatr Int Child Health 2020 Oct 28:1-10. Epub 2020 Oct 28.

Graduate Program in Health Promotion, University of Santa Cruz do Sul , Santa Cruz do Sul, Brasil.

Background: There is a lack of clarity as to which obesity parameters may be more important in the association between cardiorespiratory fitness (CRF) and cardiometabolic risk factors (CMRF).

Aim: To verify the mediating role of different obesity parameters on the association between CRF and CMRF in normal weight and overweight/obese children and adolescents.

Methods: This cross-sectional study comprised 999 children and adolescents (534 boys) aged 7-14 years from the south of Brazil. Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and percentage of body fat were assessed. Participants were classified as normal weight, overweight and obese according to BMI. CRF was evaluated by the 6-minute run/walk test. . A continuous CMRF score was calculated by summing the Z-scores of the following variables: systolic and diastolic blood pressure, glucose, total cholesterol, high-density lipoprotein cholesterol and triglycerides. Data analysis was performed using partial correlation and linear regression models.

Results: BMI, WC, WHtR and percentage of body fat mediated the relationship between CRF and CMRF in overweight/obese boys and girls but not those of normal weight. Additionally, the percentage of the influence of each obesity parameter was 20% for BMI and WC, 16% for percentage of body fat and 18% for WHtR in girls. For boys, the mediation effect was 25% for BMI, 26% for WC, 28% for percentage of body fat and 25% for WHtR.

Conclusion: Adiposity plays a central role in CMRF; therefore, maintaining an adequate weight status should be an important objective of health-promoting programmes in early age.

: CMRF, cardiometabolic risk factors; CRF, cardiorespiratory fitness; BMI. body mass index; HDL-c, high-density lipoprotein cholesterol, PROCESS PROESP-Br, Projeto Esporte Brasil; SPSS, Package for Social Sciences; TC, total cholesterol; TG, triglycerides; WC, waist circumference; WHtR, waist-to-height ratio; %BF, percentage of body fat.
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http://dx.doi.org/10.1080/20469047.2020.1838758DOI Listing
October 2020

Child's body mass index and mother's obesity: the moderating role of physical fitness.

Eur J Pediatr 2021 Mar 17;180(3):843-850. Epub 2020 Sep 17.

Roya Kelishadi. Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan Province, Isfahan, Iran.

The aim of this study was to verify the association between children's body mass index and their mother's obesity, considering children's physical fitness as a possible moderator. Cross-sectional study developed with 1842 children and adolescents, aged seven to 17 years, from Santa Cruz do Sul-RS, Brazil. Body weight and height were assessed to determine body mass index. Cardiorespiratory fitness was determined by the 6-min walk/run test and muscular strength through the lower limb strength test. Mother's perception of obesity was self-assessed. Moderation was tested through a SPSS program extension. Results indicated that higher children's body mass index (p < 0.001) and lower levels of cardiorespiratory fitness (p = 0.001) and muscular strength (p = 0.035) were associated with mother's obesity. Likewise, higher body mass index (p < 0.001) and lower cardiorespiratory fitness (p < 0.001) in adolescents were associated with maternal obesity. Moreover, physical fitness moderates the relationship between body mass index and mother's obesity in children (cardiorespiratory fitness: β = - 0.006; 95% CI = (- 0.010, - 0.001); muscular strength: β = - 8.415; 95% CI = (- 12.526, - 4.304)) and in adolescents (cardiorespiratory fitness: β = - 0.004; 95% CI = (- 0.008, - 0.0008); muscular strength: β - 2.958; 95% CI = (- 5.615, - 0.030)).Conclusion: increasing physical fitness is an important strategy to protect youths from high body mass index, when their mothers are obese. What is Known: • Mother's obesity is associated with their children's body mass index. • Parents' obesity is associated with their children's physical fitness What is New: • Cardiorespiratory fitness and muscular strength are moderators in the relationship between mother's obesity and BMI of their children. • Children and adolescents with high cardiorespiratory fitness and muscular strength levels are protected against elevated body mass index, considering mother's obesity.
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http://dx.doi.org/10.1007/s00431-020-03810-5DOI Listing
March 2021

Relationship between sleep duration and TV time with cardiometabolic risk in adolescents.

Environ Health Prev Med 2020 Aug 21;25(1):42. Epub 2020 Aug 21.

Graduate Program in Health Promotion, Department of Health Sciences, University of Santa Cruz do Sul (UNISC), Av. Independência, 2293, Santa Cruz do Sul, RS, 96815-900, Brazil.

Objective: To verify the association between sleep duration and television time with cardiometabolic risk and the moderating role of age, gender, and skin color/ethnicity in this relationship among adolescents.

Methods: Cross-sectional study with 1411 adolescents (800 girls) aged 10 to 17 years. Television time, sleep duration, age, gender, and skin color/ethnicity were obtained by self-reported questionnaire. Cardiometabolic risk was evaluated using the continuous metabolic risk score, by the sum of the standard z-score values for each risk factor: high-density lipoprotein cholesterol, triglycerides, glycemia, cardiorespiratory fitness, systolic blood pressure, and waist circumference. Generalized linear regression models were used.

Results: There was an association between television time and cardiometabolic risk (β, 0.002; 95% CI, 0.001; 0.003). Short sleep duration (β, 0.422; 95% CI, 0.012; 0.833) was positively associated with cardiometabolic risk. Additionally, age moderated the relationship between television time and cardiometabolic risk (β, - 0.009; 95% CI, - 0.002; - 0.001), suggesting that this relationship was stronger at ages 11 and 13 years (β, 0.004; 95% CI, 0.001; 0.006) compared to 13 to 15 years (β, 0.002; 95% CI, 0.001; 0.004). No association was found in older adolescents (β, 0.001; 95% CI, - 0.002; 0.002).

Conclusions: Television time and sleep duration are associated with cardiometabolic risk; adolescents with short sleep have higher cardiometabolic risk. In addition, age plays a moderating role in the relationship between TV time and cardiometabolic risk, indicating that in younger adolescents the relationship is stronger compared to older ones.
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http://dx.doi.org/10.1186/s12199-020-00880-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442988PMC
August 2020

Food Consumption is Associated with Hyperuricemia in Boys.

High Blood Press Cardiovasc Prev 2020 Oct 9;27(5):409-415. Epub 2020 Aug 9.

Graduate Program in Health Promotion, University of Santa Cruz do Sul, Santa Cruz do Sul, Rio Grande do Sul, Brazil.

Introduction: Hyperuricemia is related to health issues among children and adolescents, once the uric acid concentration is associated with metabolic syndrome, hypertension, insulin resistance, obesity, and dyslipidemia. However, few studies are addressing uric acid levels and food uptake in this age group.

Aim: To verify the association between food consumption and uric acid in children and adolescents.

Methods: This is a cross-sectional study developed with 2335 children and adolescents of both genders aged 6-17 years old. Blood collection was performed after 12 h of fasting. Uric acid values were classified according to tertiles, in which the highest tertile was considered as hyperuricemia. Food consumption was evaluated by weekly consumption frequency questionnaire. Pearson correlation and logistic binary regressions were used for statistical analysis. Models were adjusted for age, systolic blood pressure, body mass index (BMI), and skin color/ethnicity.

Results: It was found an association between red meat consumption and hyperuricemia only in boys in the crude model (OR = 1.56; 95% CI 1.12; 2.18). Also, there was an association between pasta (OR = 1.52; 95% CI 1.11; 2.10) with hyperuricemia in boys, when adjusted age, systolic blood pressure, BMI, and skin color/ethnicity.

Conclusion: The knowledge of food patterns which are predisposing factors for the increase in serum uric acid levels is important for the implementation of strategies and public health policies for health promotion among children and adolescents.
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http://dx.doi.org/10.1007/s40292-020-00406-wDOI Listing
October 2020

Physical fitness as a moderator in the relationship between adiposity and cardiometabolic risk factors in children and adolescents.

J Sports Med Phys Fitness 2020 Dec 1;60(12):1567-1575. Epub 2020 Jul 1.

Graduate Program in Health Promotion, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil.

Background: The aim of this study was to verify the moderator role of physical fitness in the relationship between adiposity and cardiometabolic risk factors in normal weight and overweight/obese children and adolescents.

Methods: Cross-sectional study comprising 2482 children and adolescents, aged 7-17 years. Physical fitness was evaluated according the procedures of Projeto Esporte Brazil, and waist circumference (WC) with an inelastic tape. Cardiometabolic risk score was defined by the z-score sum of glucose, total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol. Moderation analysis was done through linear regression models.

Results: Significant interaction term for cardiorespiratory fitness (CRF)×WC with cardiometabolic risk factors (P<0.001), as well as for lower limbs strength (LLS)×WC (P<0.001) and agility × WC (P=0.01) in normal weight girls. For normal weight boys it was found a significant interaction term for CRF×WC with cardiometabolic risk factor (P=0.007), and also for agility × WC (P=0.003), while overweight/obese boys showed a significant interaction term only for agility × WC with cardiometabolic risk factor (P=0.001).

Conclusions: CRF, LLS and agility are moderators in the relationship between WC and cardiometabolic risk factors in normal weight girls, while CRF and agility were moderators for normal weight boys and only agility for overweight/obese boys.
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http://dx.doi.org/10.23736/S0022-4707.20.11130-7DOI Listing
December 2020

Neighborhood environmental factors associated with leisure walking in adolescents.

Rev Saude Publica 2020 1;54:61. Epub 2020 Jun 1.

Programa de Pós-Graduação em Ciências do Movimento Humano, Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.

OBJECTIVE To verify the associations of leisure walking with perceived and objective measures of neighborhood environmental factors stratified by gender and socioeconomic status (SES) in Brazilian adolescents. METHODS Cross-sectional study with a random sample of 1,130 high school students (47.3% girls; aged 14 to 20 years old) from Porto Alegre, Brazil. Leisure walking and SES were self-reported by the adolescents. Perceived environmental factors were assessed through Neighborhood Environment Walkability Scale for Youth (NEWS-Y). Objective measures were evaluated using Geographic Information Systems, with road network calculated around the adolescent's residential address, using 0.5km and 1.0km buffers. Data collection was carried out in 2017 and generalized linear regression models were used. RESULTS Leisure walking was positively associated with access to services (0.5 km buffers [Odds ratio (OR) = 2.22] 1.0 km buffers [OR = 2.17]) and lower distance to parks and squares (0.5 km [OR=2.80] 1.0 km [OR = 2.73]) in girls from low SES. Residential density (0.5 km [OR = 1.57] 1.0 km [OR = 1.54]) and walkability index (0.5 km [OR = 1.17] 1.0 km [OR = 1.20]) were associated with leisure walking in girls from middle SES. Boys from low SES showed an inverse association between crime safety and leisure walking (0.5 km [OR = 0.59] 1.0 km [OR = 0.63]). Neighborhood recreation facilities was positively associated with leisure walking in middle SES (0.5 km [OR = 1.55] 1.0 km [OR = 1.60]). Land use mix (0.5 km [OR = 1.81] 1.0 km [OR = 1.81]), neighborhood recreation facilities (0.5 km [OR = 2.32] 1.0 km [OR = 2.28]) and places for walking (0.5 km [OR=2.07] 1.0 km [OR=2.22]) were positively associated with leisure walking in high SES. CONCLUSION Environmental factors (objectively and subjectively measured) and leisure walking show association in boys and girls of different SES.
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http://dx.doi.org/10.11606/s1518-8787.2020054002222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263801PMC
June 2020

Relationship between insulin resistance and adipocytokines: the mediator role of adiposity in children.

Ann Hum Biol 2020 May 13;47(3):244-249. Epub 2020 Apr 13.

School of Physical Education, Physiotherapy and Dance, Post-Graduation Program in Human Movement Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.

Leptin and adiponectin interact with each other in the modulation of obesity and insulin resistance (IR) and it is also important to consider the role of cardiorespiratory and muscular fitness in these relationships.: To analyse the relationship between IR with adipocytokines in children, and to test the mediation effect of %BF (percentage of body fat) in the association of IR with leptin, adiponectin, and L/A ratio. This cross-sectional study comprised a sample of 150 schoolchildren, aged 6-11 years, from school in Porto Alegre, Brazil. The following variables were evaluated: cardiorespiratory fitness (CRF), muscular fitness (MF), percentage of body fat (%BF), and biochemical variables (leptin, adiponectin, glucose, and insulin). IR was associated with leptin and L/A ratio, after adjustments for age, sex, sexual maturation, and CRF. When adjusted for age, sex, sexual maturation, and MF, an association was found between IR with leptin and L/A ratio. Moreover, %BF was a mediator in the association between IR and leptin, as well as IR and L/A ratio, explaining 54% and 57% of these associations, respectively. Leptin and L/A ratio are positively associated with IR after adjustments. Also, %BF is a mediator in the associations between IR and leptin and L/A ratio.
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http://dx.doi.org/10.1080/03014460.2020.1740320DOI Listing
May 2020

Radiation synergizes with antitumor activity of CD13-targeted tissue factor in a HT1080 xenograft model of human soft tissue sarcoma.

PLoS One 2020 21;15(2):e0229271. Epub 2020 Feb 21.

Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Muenster, Germany.

Background: Truncated tissue factor (tTF) retargeted by NGR-peptides to aminopeptidase N (CD13) in tumor vasculature is effective in experimental tumor therapy. tTF-NGR induces tumor growth inhibition in a variety of human tumor xenografts of different histology. To improve on the therapeutic efficacy we have combined tTF-NGR with radiotherapy.

Methods: Serum-stimulated human umbilical vein endothelial cells (HUVEC) and human HT1080 sarcoma cells were irradiated in vitro, and upregulated early-apoptotic phosphatidylserine (PS) on the cell surface was measured by standard flow cytometry. Increase of cellular procoagulant function in relation to irradiation and PS cell surface concentration was measured in a tTF-NGR-dependent Factor X activation assay. In vivo experiments with CD-1 athymic mice bearing human HT1080 sarcoma xenotransplants were performed to test the systemic therapeutic effects of tTF-NGR on tumor growth alone or in combination with regional tumor ionizing radiotherapy.

Results: As shown by flow cytometry with HUVEC and HT1080 sarcoma cells in vitro, irradiation with 4 and 6 Gy in the process of apoptosis induced upregulation of PS presence on the outer surface of both cell types. Proapoptotic HUVEC and HT1080 cells both showed significantly higher procoagulant efficacy on the basis of equimolar concentrations of tTF-NGR as measured by FX activation. This effect can be reverted by masking of PS with Annexin V. HT1080 human sarcoma xenografted tumors showed shrinkage induced by combined regional radiotherapy and systemic tTF-NGR as compared to growth inhibition achieved by either of the treatment modalities alone.

Conclusions: Irradiation renders tumor and tumor vascular cells procoagulant by PS upregulation on their outer surface and radiotherapy can significantly improve the therapeutic antitumor efficacy of tTF-NGR in the xenograft model used. This synergistic effect will influence design of future clinical combination studies.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0229271PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034830PMC
May 2020

Effects and prevalence of responders after a multicomponent intervention on cardiometabolic risk factors in children and adolescents with overweight/obesity: Action for health study.

J Sports Sci 2020 Mar 12;38(6):682-691. Epub 2020 Feb 12.

Projeto Esporte Brasil (PROESP-Br). School of Physical Education, Physiotherapy and Dance, Post-graduation Program in Human Movement Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.

This study aimed to verify the effect of a multicomponent intervention on cardiometabolic risk factors (CMRF), and to determine the prevalence of responders on CMRF among children and adolescents with overweight/obesity. This is a quasi-experimental study, developed with 35 children and adolescents with overweight/obesity (control group (CG) = 18; intervention group (IG) = 17), aged between 7 and 13 years. Participants in IG underwent a multicomponent intervention for 12 weeks. The following variables were evaluated: anthropometric measures, maturational stages and CMRF (body fatness, HOMA-IR, triglycerides, high-density and low-density lipoprotein) (HDL-C, LDL-C), total cholesterol (TC), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and AST/ALT ratio. Mixed analysis of variance and the prevalence of responders were used for statistical analysis. There was a significant time x group interaction on body fatness (p < 0.001), HOMA-IR (p = 0.01), HDL-C (p < 0.001), LDL-C (p = 0.009) and TC (p < 0.001). The prevalence of responders for CMRF in IG and CG was respectively: body fatness (47%; 0%; p = 0.04), HOMA-IR (58.8%; 16.6%; p = 0.04); triglycerides (17.6%; 5.5%; p = 0.31); HDL-C (76.4%; 5.5%; p = 0.01), LDL-C (35.3%; 5%; p = 0.08), TC (64.7%; 5%; p = 0.01), AST (5.8%; 0%; p = 0.87), ALT (29.4%; 11.1%; p = 0.24) and AST/ALT ratio (24.4%; 22.2%; p = 0.67). Multicomponent intervention induced positive changes on CMRF along with a higher prevalence of positive adaptations in IG than the CG in some of the cardiometabolic outcomes assessed.
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http://dx.doi.org/10.1080/02640414.2020.1725384DOI Listing
March 2020

Adherence to Southern European Atlantic Diet and physical fitness on the atherogenic index of plasma in adolescents.

Cad Saude Publica 2019 28;35(12):e00200418. Epub 2019 Nov 28.

Faculdade de Desporto, Universidade do Porto, Porto, Portugal.

We sought (i) to evaluate the associations of cardiorespiratory fitness (CRF), muscular fitness (MF) and Southern European Atlantic Diet (SEADiet) with atherogenic index of plasma (AIP) and (ii) to investigate de combined association of MF, CRF and SEADiet on AIP in adolescents. A cross-sectional school-based study was conducted on 493 adolescents (285 girls and 208 boys) aged 15-18 years, from the Portuguese Azorean Archipelago. CRF was measured by shuttle run test and MF by curl up and push up tests. Adherence to SEADiet was assessed with a semi-quantitative food frequency questionnaire (FFQ). The AIP was estimated as log (TG/HDL-C). Measures of pubertal stage and socioeconomic status were assessed. Linear regression showed a significant inverse association between MF (standardized β = -0.165; p < 0.001), CRF (standardized β = -0.081; p < 0.030) and SEADiet (standardized β = -0.081; p < 0.045) with AIP, after adjustments for age, sex, pubertal stage and parental education. Furthermore, participants classified with an optimal as well as those with low adherence to a SEADiet but with LowMF/LowCRF had on average the highest AIP (F(7.482) = 3.270; p = 0.002). Moreover, optimal SEADiet with HighMF/HighCRF group showed the lowest AIP when compared with those with low adherence to a SEADiet with HighMF/HighCRF group (p = 0.03). AIP is inversely associated with MF, CRF and SEADiet. The low MF combined with a low CRF levels seems to overcome the potential healthy effect of having an optimal adherence to the SEADiet on AIP. However, an optimal adherence to SEADiet seems to improve the AIP in those adolescents with high fitness levels.
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http://dx.doi.org/10.1590/0102-311X00200418DOI Listing
June 2020

A mixed methods process evaluation of a person-centred falls prevention program.

BMC Health Serv Res 2019 Nov 28;19(1):906. Epub 2019 Nov 28.

School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

Background: RESPOND is a telephone-based falls prevention program for older people who present to a hospital emergency department (ED) with a fall. A randomised controlled trial (RCT) found RESPOND to be effective at reducing the rate of falls and fractures, compared with usual care, but not fall injuries or hospitalisations. This process evaluation aimed to determine whether RESPOND was implemented as planned, and identify implementation barriers and facilitators.

Methods: A mixed-methods evaluation was conducted alongside the RCT. Evaluation participants were the RESPOND intervention group (n = 263) and the clinicians delivering RESPOND (n = 7). Evaluation data were collected from participant recruitment and intervention records, hospital administrative records, audio-recordings of intervention sessions, and participant questionnaires. The Rochester Participatory Decision-Making Scale (RPAD) was used to evaluate person-centredness (score range 0 (worst) - 9 (best)). Process factors were compared with pre-specified criteria to determine implementation fidelity. Six focus groups were held with participants (n = 41), and interviews were conducted with RESPOND clinicians (n = 6). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the 'Capability, Opportunity, Motivation - Behaviour' (COM-B) behaviour change framework.

Results: RESPOND was implemented at a lower dose than the planned 10 h over 6 months, with a median (IQR) of 2.9 h (2.1, 4). The majority (76%) of participants received their first intervention session within 1 month of hospital discharge with a median (IQR) of 18 (12, 30) days. Clinicians delivered the program in a person-centred manner with a median (IQR) RPAD score of 7 (6.5, 7.5) and 87% of questionnaire respondents were satisfied with the program. The reports from participants and clinicians suggested that implementation was facilitated by the use of positive and personally relevant health messages. Complex health and social issues were the main barriers to implementation.

Conclusions: RESPOND was person-centred and reduced falls and fractures at a substantially lower dose, using fewer resources, than anticipated. However, the low dose delivered may account for the lack of effect on falls injuries and hospitalisations. The results from this evaluation provide detailed information to guide future implementation of RESPOND or similar programs.

Trial Registration: This study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000336684 (27 March 2014).
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http://dx.doi.org/10.1186/s12913-019-4614-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883679PMC
November 2019

A screen-based simulation training program to improve palliative care of people with advanced dementia living in residential aged care facilities and reduce hospital transfers: study protocol for the IMproving Palliative care Education and Training Using Simulation in Dementia (IMPETUS-D) cluster randomised controlled trial.

BMC Palliat Care 2019 Oct 23;18(1):86. Epub 2019 Oct 23.

Department of Medicine and Aged Care, Melbourne Health and Department of Medicine - Royal Melbourne Hospital, University of Melbourne, 300 Grattan Street, Parkville, VIC, 3050, Australia.

Background: Many people with advanced dementia live in residential aged care homes. Care home staff need the knowledge and skills to provide high-quality end-of-life (EOL) dementia care. However, several studies have found EOL dementia care to be suboptimal, and care staff have reported they would benefit from training in palliative care and dementia. Simulation offers an immersive learning environment and has been shown to improve learners' knowledge and skills. However, there is little research on simulation training for residential care staff. This article presents the development and evaluation protocol of IMproving Palliative care Education and Training Using Simulation in Dementia (IMPETUS-D) - a screen-based simulation training program on palliative dementia care, targeted at residential care staff. IMPETUS-D aims to improve the quality of palliative care provided to people living with dementia in residential care homes, including avoiding unnecessary transfers to hospital.

Methods: A cluster RCT will assess the effect of IMPETUS-D. Twenty-four care homes (clusters) in three Australian cities will be randomised to receive either the IMPETUS-D intervention or usual training opportunities (control). The primary outcome is to reduce transfers to hospital and deaths in hospital by 20% over 6-months in the intervention compared to the control group. Secondary outcomes include uptake of goals of care plans over 6 and 12 months, change in staff knowledge and attitudes towards palliative dementia care over 6 months, change in transfers to hospital and deaths in hospital over 12 months. For the primary analysis logistic regression models will be used with standard errors weighted by the cluster effects. A mixed methods process evaluation will be conducted alongside the cluster RCT to assess the mechanisms of impact, the implementation processes and contextual factors that may influence the delivery and effects of the intervention.

Discussion: In Australia, the need for high-quality advanced dementia care delivered in residential aged care is growing. This study will assess the effect of IMPETUS-D a new simulation-based training program on dementia palliative and EOL care. This large multisite trial will provide robust evidence about the impact of the intervention. If successful, it will be distributed to the broader residential care sector.

Trial Registration: ANZCTR, ACTRN12618002012257 . Registered 14 December 2018.
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http://dx.doi.org/10.1186/s12904-019-0474-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813113PMC
October 2019

Triaging the Terminally Ill-Development of the Responding to Urgency of Need in Palliative Care (RUN-PC) Triage Tool.

J Pain Symptom Manage 2020 01 14;59(1):95-104.e11. Epub 2019 Aug 14.

Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Public Health, La Trobe University, Bundoora, Australia.

Context: Evidence-based resource allocation is receiving increasing attention as we strive for equity, transparency, and cost-effectiveness across health care. In the context of finite resources, which of our patients with terminal illness should be prioritized for urgent palliative care?

Objectives: To develop the scoring system for the novel Responding to Urgency of Need in Palliative Care triage tool.

Methods: Online international discrete choice experiment involving palliative care clinicians to establish the relative importance of seven key attributes of palliative care triage identified during an earlier qualitative study.

Results: Participants (n = 772) were mainly female (79.9%) with a decade of clinical experience. All attributes contributed significantly (all P-values < 0.001) and independently to clinician assessment of urgency. This study found physical suffering (coefficient 3.45; 95% confidence interval: 3.24 to 3.66) was the most important determinant of urgency, followed by imminent dying (coefficient 1.56; 1.43 to 1.69), psychological suffering (coefficient 1.49; 1.37 to 1.60), caregiver distress (coefficient 1.47; 1.35 to 1.59), discrepancy between care needs and care arrangements (coefficient 1.14; 1.02 to 1.26), mismatch between current and desired site of care (coefficient 0.94; 0.85 to 1.03), and unmet communication needs (coefficient 0.84; 0.76 to 0.92).

Conclusion: Palliative care triage, which is complex and contextual, has been made more transparent through this discrete choice experiment. The Responding to Urgency of Need in Palliative Care triage tool provides an important step toward evidence-based assessment of priority for palliative care. Further research is underway to determine the validity of the tool in clinical practice and its impact on patient and caregiver outcomes.
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http://dx.doi.org/10.1016/j.jpainsymman.2019.08.009DOI Listing
January 2020

Evaluation of RESPOND, a patient-centred program to prevent falls in older people presenting to the emergency department with a fall: A randomised controlled trial.

PLoS Med 2019 05 24;16(5):e1002807. Epub 2019 May 24.

School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.

Background: Falls are a leading reason for older people presenting to the emergency department (ED), and many experience further falls. Little evidence exists to guide secondary prevention in this population. This randomised controlled trial (RCT) investigated whether a 6-month telephone-based patient-centred program-RESPOND-had an effect on falls and fall injuries in older people presenting to the ED after a fall.

Methods And Findings: Community-dwelling people aged 60-90 years presenting to the ED with a fall and planned for discharge home within 72 hours were recruited from two EDs in Australia. Participants were enrolled if they could walk without hands-on assistance, use a telephone, and were free of cognitive impairment (Mini-Mental State Examination > 23). Recruitment occurred between 1 April 2014 and 29 June 2015. Participants were randomised to receive either RESPOND (intervention) or usual care (control). RESPOND comprised (1) home-based risk assessment; (2) 6 months telephone-based education, coaching, goal setting, and support for evidence-based risk factor management; and (3) linkages to existing services. Primary outcomes were falls and fall injuries in the 12-month follow-up. Secondary outcomes included ED presentations, hospital admissions, fractures, death, falls risk, falls efficacy, and quality of life. Assessors blind to group allocation collected outcome data via postal calendars, telephone follow-up, and hospital records. There were 430 people in the primary outcome analysis-217 randomised to RESPOND and 213 to control. The mean age of participants was 73 years; 55% were female. Falls per person-year were 1.15 in the RESPOND group and 1.83 in the control (incidence rate ratio [IRR] 0.65 [95% CI 0.43-0.99]; P = 0.042). There was no significant difference in fall injuries (IRR 0.81 [0.51-1.29]; P = 0.374). The rate of fractures was significantly lower in the RESPOND group compared with the control (0.05 versus 0.12; IRR 0.37 [95% CI 0.15-0.91]; P = 0.03), but there were no significant differences in other secondary outcomes between groups: ED presentations, hospitalisations or falls risk, falls efficacy, and quality of life. There were two deaths in the RESPOND group and one in the control group. No adverse events or unintended harm were reported. Limitations of this study were the high number of dropouts (n = 93); possible underreporting of falls, fall injuries, and hospitalisations across both groups; and the relatively small number of fracture events.

Conclusions: In this study, providing a telephone-based, patient-centred falls prevention program reduced falls but not fall injuries, in older people presenting to the ED with a fall. Among secondary outcomes, only fractures reduced. Adopting patient-centred strategies into routine clinical practice for falls prevention could offer an opportunity to improve outcomes and reduce falls in patients attending the ED.

Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12614000336684).
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http://dx.doi.org/10.1371/journal.pmed.1002807DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534288PMC
May 2019

Relationship between Dyslipidemia, Cultural Factors, and Cardiorespiratory Fitness in Schoolchildren.

Arq Bras Cardiol 2019 06 8;112(6):729-736. Epub 2019 Apr 8.

Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS - Brazil.

Background: The presence of dyslipidemia and behavioral aspects are determinants of cardiovascular risk, especially in childhood and adolescence.

Objective: To verify possible relationships between dyslipidemia, cultural factors, and cardiorespiratory fitness (CRF) in schoolchildren.

Methods: This cross-sectional study evaluated a sample of 1,254 children and adolescents between the ages of 7 and 17 from the South of Brazil, 686 of whom were female. Dyslipidemia was defined as increased levels of at least one of the following lipid profile parameters: triglycerides (TG), total cholesterol (TC) and fractions of high (HDL-c) and low-density lipoprotein (LDL-c). Cultural aspects were evaluated by a self-reported questionnaire. Data were analyzed by logistic regression, considering the odds ratios (OR) and confidence intervals (CI) at 95%.

Results: The results revealed a high prevalence of dyslipidemia (41.9%), which was associated with female sex (OR: 1.56; IC: 1.24-1.96) and overweight/obese status (OR: 1.55; IC: 1.20-2.00). When lipid profile parameters were evaluated separately, high levels of LDL-c were observed to be associated with sedentary school transport (OR: 1.59; IC: 1.20-2.09). Schoolchildren who were overweight/obese had higher chances of elevated levels of TC (OR: 1.40; IC: 1.07-1.84) and TG (OR: 3.21; IC: 1.96-5.26). HDL-c was shown to be related to high television time (OR: 1.59; IC: 1.00-2.54).

Conclusion: Alterations in lipid parameters are associated with cultural factors, especially those related to sedentary lifestyle and low levels of CRF.
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http://dx.doi.org/10.5935/abc.20190068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636371PMC
June 2019

A randomised phase II trial to examine feasibility of standardised, early palliative (STEP) care for patients with advanced cancer and their families [ACTRN12617000534381]: a research protocol.

Pilot Feasibility Stud 2019 14;5:44. Epub 2019 Mar 14.

9Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Australia.

Background: Current international consensus is that 'early' referral to palliative care services improves cancer patient and family carer outcomes; however, in practice, these referrals are not routine. Uncertainty about the 'best time' to refer has been highlighted as contributing to care variation. Previous work has identified clear disease-specific transition points in the cancer illness which heralded subsequent poor prognosis (less than 6 months) and which, we contest, represent times when palliative care should be routinely introduced as a standardised approach, if not already in place, to maximise patient and carer benefit. This protocol details a trial that will test the feasibility of a novel standardised outpatient model of early palliative care [Standardised Early Palliative Care (STEP Care)] for advanced cancer patients and their family carers, with referrals occurring at the defined disease-specific evidence-based transition points.The aims of this study are to (1) determine the feasibility of conducting a definitive phase 3 randomised trial, which evaluates effectiveness of STEP Care (compared to usual best practice cancer care) for patients with advanced breast or prostate cancer or high grade glioma; (2) examine preliminary efficacy of STEP Care on patient/family caregiver outcomes, including quality of life, mood, symptoms, illness understanding and overall survival; (3) document the impact of STEP Care on quality of end-of-life care; and (4) evaluate the timing of palliative care introduction according to patients, families and health care professionals.

Methods: Phase 2, multicenter, open-label, parallel-arm, randomised controlled trial (RCT) of STEP Care plus standard best practice cancer care versus standard best practice cancer care alone.

Discussion: The research will test the feasibility of standardised palliative care introduction based on illness transitions and provide guidance on subsequent development of phase 3 studies of integration. This will directly address the current uncertainty about palliative care timing.

Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000534381.
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http://dx.doi.org/10.1186/s40814-019-0424-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417202PMC
March 2019

Adiposity and adipocytokines: the moderator role of cardiorespiratory fitness and pubertal stage in girls.

J Pediatr Endocrinol Metab 2019 Mar;32(3):239-246

Project Sport Brazil (PROESP-Br), Post Graduation Program in Human Movement Sciences, School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.

Background Cardiorespiratory fitness (CRF) and pubertal stages have been related to many health outcomes, including obesity and adipocytokines. Thus, the present study aimed to analyze the moderator role of CRF and pubertal stage in the relationship between adiposity and adipocytokines in girls. Method This cross-sectional study was performed with 42 pre-pubertal girls aged from 7 to 11 years and 54 post-pubertal girls aged from 13 to 17 years. Blood samples were collected to determine the serum levels of leptin and adiponectin, and then the leptin/adiponectin ratio (L/A ratio) was calculated. CRF, anthropometric and body composition indicators were assessed. For statistical analysis, descriptive statistics and several linear regression models were used. The moderation analysis was tested using the PROCESS macro. Results An interaction between body mass index (BMI) and CRF (β: -0.70; confidence interval [CI]: -1.29, -0.12), as well as between BMI and pubertal stage (β: 0.79; CI: 0.28, 1.30) with leptin, was found. Regarding the L/A ratio, an interaction was found only in BMI × CRF (β: -0.56; CI: -1.06, -0.06). Using a combined interaction (CRF and pubertal stage), the results showed a positive association between BMI with leptin and L/A ratio only in low CRF, pre-pubertal and post-pubertal stages. Conclusion This study suggests a protective role of high levels of CRF in the relationship between BMI and adipocytokines. Despite the effect of pubertal stage, the results suggest that youth should be engaged in physical activity in order to improve CRF levels and consequently improve cardiometabolic health.
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http://dx.doi.org/10.1515/jpem-2018-0407DOI Listing
March 2019

The Ethics of Prioritizing Access to Palliative Care: A Qualitative Study.

Am J Hosp Palliat Care 2019 Jul 25;36(7):577-582. Epub 2019 Feb 25.

3 Department of Medicine, University of Melbourne, Victoria, Australia.

Objective: This article sought to explore ethical issues associated with prioritization decisions in palliative care.

Methods: As part of a broader series of studies of triage in palliative care, this qualitative substudy was conducted via semi-structured focus groups and individual interviews. Transcripts were subjected to thematic analysis.

Setting/participants: Twenty health professionals working across disciplines (primary, specialist; medicine, nursing, and allied health), service types (inpatient, hospital liaison, and community), and locations (metropolitan and rural) in Victoria, Australia.

Results: Four themes emerged from the data: (1) Clinicians understood the tension between maintaining service quality with the delivery of a compromised service that sought to respond to demand. (2) They were aware of the influences of relationships and responsibilities upon patient waiting list prioritization, and (3) reported a hierarchy of suffering with certain types of clinical problems viewed as more urgent than others, for example, pain being more urgent than existential distress. (4) Clinicians noted a lack of transparency around waiting lists as they currently exist.

Conclusions: This study revealed key ethical decision-making issues associated with prioritizing access to palliative care services. Making explicit the processes and influences upon decision-making provides greater transparency of health-care utilization at the end of life.
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http://dx.doi.org/10.1177/1049909119833333DOI Listing
July 2019

The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030.

BMC Musculoskelet Disord 2019 Feb 23;20(1):90. Epub 2019 Feb 23.

Department of Surgery, Epworth HealthCare, The University of Melbourne, 89 Bridge Road, Richmond, Victoria, 3121, Australia.

Background: Comprehensive national joint replacement registries with well-validated data offer unique opportunities for examining the potential future burden of hip and knee osteoarthritis (OA) at a population level. This study aimed to forecast the burden of primary total knee (TKR) and hip replacements (THR) performed for OA in Australia to the year 2030, and to model the impact of contrasting obesity scenarios on TKR burden.

Methods: De-identified TKR and THR data for 2003-2013 were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Population projections and obesity trends were obtained from the Australian Bureau of Statistics, with public and private hospital costs sourced from the National Hospital Cost Data Collection. Procedure rates were projected according to two scenarios: (1) constant rate of surgery from 2013 onwards; and (2) continued growth in surgery rates based on 2003-2013 growth. Sensitivity analyses were used to estimate future TKR burden if: (1) obesity rates continued to increase linearly; or (2) 1-5% of the overweight or obese population attained a normal body mass index.

Results: Based on recent growth, the incidence of TKR and THR for OA is estimated to rise by 276% and 208%, respectively, by 2030. The total cost to the healthcare system would be $AUD5.32 billion, of which $AUD3.54 billion relates to the private sector. Projected growth in obesity rates would result in 24,707 additional TKRs totalling $AUD521 million. A population-level reduction in obesity could result in up to 8062 fewer procedures and cost savings of up to $AUD170 million.

Conclusions: If surgery trends for OA continue, Australia faces an unsustainable joint replacement burden by 2030, with significant healthcare budget and health workforce implications. Strategies to reduce national obesity could produce important TKR savings.
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http://dx.doi.org/10.1186/s12891-019-2411-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387488PMC
February 2019

Novel application of discrete choice experiment methodology to understand how clinicians around the world triage palliative care needs: A research protocol.

Palliat Support Care 2019 02 3;17(1):66-73. Epub 2019 Jan 3.

Centre for Palliative Care, St Vincent's Hospital Melbourne,Victoria,Australia.

Objective: As referrals to specialist palliative care (PC) grow in volume and diversity, an evidence-based triage method is needed to enable services to manage waiting lists in a transparent, efficient, and equitable manner. Discrete choice experiments (DCEs) have not to date been used among PC clinicians, but may serve as a rigorous and efficient method to explore and inform the complex decision-making involved in PC triage. This article presents the protocol for a novel application of an international DCE as part of a mixed-method research program, ultimately aiming to develop a clinical decision-making tool for PC triage.

Method: Five stages of protocol development were undertaken: (1) identification of attributes of interest; (2) creation and (3) execution of a pilot DCE; and (4) refinement and (5) planned execution of the final DCE.ResultSix attributes of interest to PC triage were identified and included in a DCE that was piloted with 10 palliative care practitioners. The pilot was found to be feasible, with an acceptable cognitive burden, but refinements were made, including the creation of an additional attribute to allow independent analysis of concepts involved. Strategies for recruitment, data collection, analysis, and modeling were confirmed for the final planned DCE.Significance of resultsThis DCE protocol serves as an example of how the sophisticated DCE methodology can be applied to health services research in PC. Discussion of key elements that improved the utility, integrity, and feasibility of the DCE provide valuable insights.
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http://dx.doi.org/10.1017/S1478951518000913DOI Listing
February 2019

Aminopeptidase N (CD13): Expression, Prognostic Impact, and Use as Therapeutic Target for Tissue Factor Induced Tumor Vascular Infarction in Soft Tissue Sarcoma.

Transl Oncol 2018 Dec 17;11(6):1271-1282. Epub 2018 Aug 17.

Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Muenster, Germany.

Aminopeptidase N (CD13) is expressed on tumor vasculature and tumor cells. It represents a candidate for targeted therapy, e.g., by truncated tissue factor (tTF)-NGR, binding to CD13, and causing tumor vascular thrombosis. We analyzed CD13 expression by immunohistochemistry in 97 patients with STS who were treated by wide resection and uniform chemo-radio-chemotherapy. Using a semiquantitative score with four intensity levels, CD13 was expressed by tumor vasculature, or tumor cells, or both (composite value, intensity scores 1-3) in 93.9% of the STS. In 49.5% tumor cells, in 48.5% vascular/perivascular cells, and in 58.8%, composite value showed strong intensity score 3 staining. Leiomyosarcoma and synovial sarcoma showed low expression; fibrosarcoma and undifferentiated pleomorphic sarcoma showed high expression. We found a significant prognostic impact of CD13, as high expression in tumor cells or vascular/perivascular cells correlated with better relapse-free survival and overall survival. CD13 retained prognostic significance in multivariable analyses. Systemic tTF-NGR resulted in significant growth reduction of CD13-positive human HT1080 sarcoma cell line xenografts. Our results recommend further investigation of tTF-NGR in STS patients. CD13 might be a suitable predictive biomarker for patient selection.
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http://dx.doi.org/10.1016/j.tranon.2018.08.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6113655PMC
December 2018