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Purpose: The purpose of this study was to evaluate a weekly school-based fruit and vegetable delivery via a mobile market on urban middle schoolers' nutrition behaviors. Design: One-group, pretest-posttest design, quasi-experimental intervention in middle schoolers (6th-8th graders, N = 158) in Kansas City, MO Intervention: Weekly delivery of free produce via a mobile market over 12 weeks. Measures: A self-administered survey to assess self-report consumption of fruits, vegetables, soda, and sports drinks. Analysis: Univariate and bivariate analyses were used. Proportions were compared and chi-square tests were conducted to compare youth at baseline and 12 weeks. Results: More youth reported consuming fresh fruit (73.8% to 83.3%; χ2 = 7.76, P =.005) and vegetables (66.4% to 71.3%; χ2 = 13.55, P = <.001) from baseline to follow-up. Less youth reported soda (49.0% to 52.8%; χ2= 6.33, P =.012) and sports drinks (41.8% to 38.2%; χ2= 12.32, P <.001) from baseline to follow-up. Conclusions: A mobile produce delivery intervention, like the Healthy Harvest Mobile Market, may be an effective strategy to increase fruit and vegetable consumption for adolescents. [ABSTRACT FROM AUTHOR]

Background: Social integration has been shown to predict physical activity (PA), diet, and sleep in adults. However, these associations have not been well-studied in youth samples. Using a life course perspective, it is imperative to study this in youths as social and health behaviors are established early in life. Objective: The purpose of this study was to understand the relationship between social integration and PA, diet, and sleep for urban, middle-school youth. Methods: Cross-sectional baseline data from middle-school youths (N=73) who participated in an afterschool health behavior intervention were included in this study. Results: Time with friends significantly predicted moderate to vigorous intensity PA (ß=.33, P=.02). Time spent with family was significantly related to fruit consumption (t66=1.38, P=.005) and vegetable consumption (t72=1.96, P=.01). Conclusions: Social integration appears to be related to both PA and nutrition behaviors in youths. Future research should expand on our findings to explain how different domains of social integration may impact youths' health behaviors. [ABSTRACT FROM AUTHOR]

Evans syndrome is a rare but challenging disorder in children; and despite rapidly growing evidence for targetable systemic immune dysregulation driving these "idiopathic" autoimmune cytopenias, precision diagnosis and management remains sub‐optimal among these patients. We analyzed retrospective clinical data for 60 pediatric ES patients followed at 3 large tertiary referral centers in the United States over a recent 6‐year period and found that definable underlying systemic immune dysregulation was identified in only 42% of these patients throughout the course of clinical care. Median time from ES diagnosis to identification of the underlying systemic immune dysregulation disorder was 1.3 years (<1 month for rheumatologic disease, 2.3 years for CVID, 3.4 years for ALPS, and 7.4 years for monogenic disorders of immune regulation). Notably, a significantly higher percentage of patients in whom a definitive immune dysregulation disorder was ultimately identified required ≥3 cytopenia‐directed therapies (92%) and also second‐ and third‐line immunomodulatory agents (84%), vs those in whom no unifying immune dysregulation was diagnosed (65%, and 35%, respectively)—indicating that autoimmune cytopenias as a manifestation of systemic immune dysregulation are more treatment‐refractory and severe. These data underline the importance of identifying the underlying systemic immune dysregulation and providing targeted therapy in pediatric ES. [ABSTRACT FROM AUTHOR]

Immune thrombocytopenia (ITP) is an immune-mediated disorder resulting in platelet destruction and subsequent thrombocytopenia. Bleeding symptoms range from mild cutaneous bleeding to life-threatening hemorrhage. Romiplostim, a peptide-antibody fusion product, is a thrombopoietin receptor agonist (TPO-RA) indicated for use in patients with ITP. Romiplostim is US Food and Drug Administration (FDA) approved in children ≥ 1 year of age with ITP of > 6 months' duration who have had an inadequate response to first-line therapies or splenectomy. FDA approval in adults with chronic ITP was expanded in October 2019 to include adults with newly diagnosed (< 3 months' duration) and persistent (3– 12 months' duration) ITP who demonstrated an inadequate response to first-line therapies, including corticosteroids and immunoglobulins, or splenectomy. The newly published 2019 American Society of Hematology ITP Guidelines place TPO-RAs, including romiplostim, as second-line therapies in both children and adults. Here, we review the use of romiplostim as second-line therapy with a spotlight on health-related quality of life, ease of use, and patient preference. [ABSTRACT FROM AUTHOR]

The article discusses the study regarding the efficacy of using hydroxyurea (HU) as treatment for Langerhans cell histiocytosis (LCH), a disorder caused by lesions arising from myeloid dendritic cells. HU was found to be effective in treating LCH and well tolerated and safe for prolonged use in treating sickle disease in children. HU toxicity profile was also noted to be favorable compared to alternative salvage therapies.

Transgender individuals face stigma, discrimination, and other barriers impacting their ability to engage in physical activity (PA). We aim to review current literature on PA among transgender individuals. A systemic literature search of research studies from 2010–2023 was conducted. Studies must have reported a measure of PA and gender, be original research, and focus on transgender participants' PA. Rates of PA for transgender individuals were lower compared to cisgender or sexual minority individuals. Transgender women were less likely to engage in PA than other groups. Qualitative results suggest transgender oppression, stigma, discrimination, body image, unwelcoming environments (gyms, locker rooms, swimming pools), and the dichotomous structure of sport contribute to lower rates of PA among transgendered individuals. Disparities in PA for transgender individuals exist. Policy, environment, and system changes are needed to reduce transgender stigma in sport and PA settings. Current legislation is being developed and implemented in the United States regarding the place of transgender individuals in sport and PA. These results should inform public discourse on the topic. [ABSTRACT FROM AUTHOR]

In this study, we investigated students 'attitudes toward physical activity (PA) when including a required PA component in a university-required personal wellness class. The study included (a) an experimental group of students enrolled in a personal wellness course in which there was a required PA requirement and (b) a control group of students enrolled in a personal wellness course in which there was no PA requirement. Subjects were tested using the Corbin Attitude Test. The students in the experimental group were exposed to an additional PA requirement in which they were to exercise at least twice per week at a perceived exertion level of 4 or above on the modified 1 to 10 scale. Students in the control group were only required to complete the university-required personal wellness course, which did not include a required PA component. A repeated measures ANOVA was used to determine if adding the PA component had an effect on students' attitudes and perceptions toward their personal health and to check for significance between gender and attitude toward physical activity. The analysis of the data showed no significant gain or decline in attitude for either group, suggesting that although specific required PA does not significantly improve attitude, it does not hurt it either. It could be surmised from this study and similar studies that choice of activity is the most important factor for improving attitude toward PA. [ABSTRACT FROM AUTHOR]

Purpose: Understand the cost of delivering existing community-based, no cost to participant, aerobic dance and yoga classes in an underserved, racial and ethnic minority community in the Midwest. Design: Pilot 4-month observational, descriptive, cost analysis of community fitness classes. Setting: Community-wide, group-based, fitness classes online, and in parks and community centers in traditionally Black neighborhoods in Kansas City. Participants: Participants (N = 1428) were recruited from underserved, racial and ethnic minority areas of Kansas City, Missouri. Intervention: Aerobic dance and yoga classes were provided free of charge to all residents of Kansas City, Missouri online and in-person. Each class was approximately 1 hour, with a warmup and cooldown. All classes were delivered by African American women. Methods: Descriptive statistics of the costs for the program are presented. Cost per metabolic equivalents (MET) were calculated. Independent samples t-tests were conducted to examine differences between aerobic dance and yoga cost per MET. Results: The total program costs were $10,759.88 USD, with 1428 participants attending 82 classes over the 4-month intervention. The cost per MET was $1.67, $1.11, and $0.74/MET-hour/session/attendee for low, moderate, and high-intensity aerobic dance, respectively, and $3.02/MET-hour/session/attendee for yoga. Aerobic dance had a significantly lower cost per MET than yoga (t = 13.6, P <.001, t = 47.6, P <.001, t = 92.8, P <.001, for low, moderate, and high-intensity, respectively). Conclusions: Delivering community-based, physical activity interventions in racial and ethnic minority communities is a potential way to increase physical activity. The costs of group-based fitness classes are similar to other physical activity interventions. Further research needs to be conducted on the costs to increase physical activity of traditionally underserved populations who suffer from higher rates of inactivity and comorbidities. [ABSTRACT FROM AUTHOR]

Patients with coronavirus disease 2019 (COVID-19) from novel coronavirus (SARS-CoV-2) infection may present with immune thrombocytopenia (ITP). Multisystem inflammatory syndrome in children (MIS-C) is a serious complication of SARS-CoV-2 causing systemic organ dysfunction. This case series presents the first reported cases of patients who developed ITP following MIS-C, while completing corticosteroid tapers. These patients responded to standard of care therapies for ITP and had appropriate platelet count recovery. We emphasize the importance of careful monitoring of those recovering from COVID-19 or MIS-C, to proactively identify clinical and laboratory abnormalities, in addition to long-term cardiovascular sequelae. [ABSTRACT FROM AUTHOR]

Purpose: The purposes of this study are to describe the costs of implementing an after-school physical activity intervention in three diverse, low-resourced, schools and to understand the potential aerobic impact of this program by cost. Design: We conducted a cost utilization study from an 8.5-month physical activity intervention. Setting: Three diverse, low-resourced, middle schools in the Midwest; The sample (N = 178) were mostly males (52.2%), African American or Black (54.8%), and divided between 6th, 7th, and 8th grades. Method: Costs were collected from contracts, invoices, payroll, and receipts. Metabolic equivalents were collected from past literature. Costs/MET-hour were calculated for the schools and entire program by dividing costs by total MET-hours engaged in physical activity. Results: Costs were $2.51/MET-hour, $8.96/MET-hour, and $10.73/MET-hour for the three schools. On average, the intervention had a cost of $4.73/MET-hour. Conclusions: Cost/MET-hour for the present study is comparable or lower than other school-based physical activity interventions that require additional staff time and programming outside of standard classroom activities. Scale-up of after-school programs may be one way to improve the costs of programs in both schools and districts. [ABSTRACT FROM AUTHOR]

Background: Effective and scalable interventions are needed to combat chronic low levels of youth physical activity. After-school sport sampling programs may be vital interventions for teaching sports and increasing physical literacy and physical activity, which result in healthy lifelong habits that are maintained into adulthood. Objective: The purpose of this study was to test the effectiveness of an after-school sport sampling intervention among underserved youth in the Midwest. Methods: Youth (n=81) in 3 middle schools within a large Midwest city participated in an 8-month, after-school physical activity intervention that aimed to increase moderate- and vigorous-intensity physical activity, improve physical literacy, and decrease BMI. Difference scores for this 2-group, posttest-only design were calculated. A series of 2-tailed t tests were conducted to assess between-group differences. Results: The intervention group had significantly better physical literacy (t115=7.57; P=.004) and engaged in more moderateand vigorous-intensity physical activity minutes per week (t115=4.28; P=.04) and steps per day (t115=4.29; P=.03). Conclusions: An after-school sport sampling program may be an effective solution for combating youth physical inactivity. Future research should assess the scalability of this intervention with larger populations and in different areas. [ABSTRACT FROM AUTHOR]

Falls are a critical public health issue among older adults. One notable factor contributing to falls in older adults is a deterioration of the structures supporting balance and overall balance control. Preliminary evidence suggests older adults who ride a bicycle have better balance than those who do not. Cycling may be an effective intervention to prevent falls among older adults. This study aims to objectively measure the relationship between bicycling, physical activity, and balance for older adults. Older adult cyclists (n = 19) and non-cyclists (n = 27) were recruited to (1) complete a survey that assessed demographics; (2) wear an accelerometer for 3 weeks to objectively assess physical activity; and (3) complete balance-related tasks on force platforms. Mann-Whitney U-tests were performed to detect differences in balance and physical activity metrics between cyclists and non-cyclists. Cyclists were significantly more physically active than non-cyclists. Cyclists, compared to non-cyclists, exhibited differences in balance-related temporospatial metrics and long-range temporal correlations that suggest a more tightly regulated postural control strategy that may relate to higher stability. Cycling was observed to correlate more strongly with balance outcomes than other physical activity. Taken together, these results demonstrate the possible implications for cycling as an effective intervention to improve balance and reduce fall risk. [ABSTRACT FROM AUTHOR]

Immune thrombocytopenia (ITP), an acquired autoimmune disorder of low platelets and risk of bleeding, has a substantial impact on health‐related quality of life (HRQoL). Patients with ITP often report significant fatigue, although the pathophysiology of this is poorly understood. In this observational cohort of 120 children receiving second‐line therapies for ITP, we assessed reports of fatigue using the Hockenberry Fatigue Scale. Children and adolescents with ITP reported a similarly high level of fatigue with 54% (29/54) of children and 62% (26/42) of adolescents reporting moderate‐to‐severe fatigue. There was no correlation between fatigue and age or gender. Adolescents with newly diagnosed and persistent ITP had higher mean fatigue scores than those with chronic ITP (P = 0·03). Fatigue significantly improved in children and adolescents by 1 month after starting second‐line treatments, and this improvement continued to be present at 12 months after starting treatment. Fatigue scores at all time‐points correlated with general HRQoL using the Kids ITP Tool, but did not correlate with bleeding symptoms, platelet count, or platelet response to treatment. Fatigue is common in children and adolescents with ITP and may benefit from ITP‐directed treatment even in the absence of bleeding symptoms. [ABSTRACT FROM AUTHOR]

In the era of neoadjuvant and adjuvant chemotherapy, extrapulmonary involvement by high-grade osteosarcoma (HGOS) is rare. Importantly however, HGOS metastasis in the form of cardiovascular tumor thrombus portends a dismal prognosis. Thus, prompt and accurate identification of tumor thrombus is crucial. We report here two unique cases of recurrent HGOS, presenting as thrombotic events, in order to increase awareness and index of suspicion among practitioners regarding this presentation. Additionally, we review 14 previously reported pediatric cases of cardiovascular metastatic HGOS. [ABSTRACT FROM AUTHOR]