Search

ObjectiveKey components in the assessment of a child in the emergency department (ED) are their heart and respiratory rates. In order to interpret these signs, practitioners must know what is normal for a particular age. The aim of this paper is to develop age-specific centiles for these parameters and to compare centiles with the previously published work of Fleming and Bonafide, and the Advanced Paediatric Life Support (APLS) reference ranges.DesignA retrospective cross-sectional study.SettingThe ED of the Children's Hospital at Westmead, Australia.PatientsAfebrile, Triage Category 5 (low priority) patients aged 0–15 years attending the ED.InterventionsCentiles were developed using quantile regression analysis, with cubic B-splines to model the centiles.Main outcome measuresCentile charts were compared with previous studies by concurrently plotting the estimates.Results668 616 records were retrieved for ED attendances from 1995 to 2011, and 111 696 heart and respiratory rates were extracted for inclusion in the analysis. Graphical comparison demonstrates that with heart rate, our 50th centile agrees with the results of Bonafide, is considerably higher than the Fleming centiles and fits well between the APLS reference ranges. With respiratory rate, our 50th centile was considerably lower than the comparison centiles in infants, becomes higher with increasing age and crosses the lower APLS range in infants and upper range in teenagers.ConclusionsClinicians should consider adopting these centiles when assessing acutely unwell children. APLS should review their normal values for respiratory rate in infants and teenagers.

BackgroundYoung women are under-represented in cardiovascular disease research, with obesity and cardiometabolic risk factor interventions generally targeting older adults. Furthermore, appropriate study designs for young women remain uncertain. This study aimed to assess the impact of a 12 week multi-disciplinary lifestyle intervention on cardiometabolic risk factors in premenopausal women with abdominal obesity.MethodsWomen aged 18-30 y with abdominal obesity [waist circumference (WC) ≥ 80 cm] were randomised to a 12 week lifestyle intervention (n = 26) of physical activity, nutrition education and cognitive behavioural therapy, or a wait-list control group (n = 17). Both groups completed anthropometric, biochemical, nutrition and fitness testing, at pre (0 weeks) and post (12 weeks), with intervention participants completed follow-up testing at 24 weeks.ResultsResults from a linear mixed model showed no between-group differences, other than increased physical activity in the intervention group, at post. In the intervention group alone, positive within-group changes were observed in WC, waist-hip-ratio (WHR), waist-height-ratio (WHtR), resting heart rate, blood pressure, predicted VO2max, and total energy intake. Most changes were maintained at 24 weeks post-intervention. Similar within-group improvements were observed in control participants in WC, WHR, WHtR, and systolic blood pressure but no changes were detected in physical activity and nutrition.ConclusionsCardiometabolic risk factors were decreased as a result of a lifestyle intervention in young women with abdominal obesity. It is difficult to describe observations in the control group without greater understanding of the behaviour of wait-list participants.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12612001017819.

International audience; Objectives: This study aimed to (1) investigate cardiometabolic risk markers in young women (18–30 years) with overweight/obesity, and (2) establish whether the measures of waist circumference and body mass index possess similar associations of cardiometabolic risk. Design: Cross-sectional. Methods: Cardiometabolic risk factors including, anthropometric, metabolic syndrome markers, biochemical , and other health/fitness indicators were assessed in women when classified as overweight/obese by waist circumference [waist circumference 91.9 ± 10.1 cm, age 22.3 ± 3.5 years, n = 38] versus control [n = 30, waist circumference 71.4 ± 3.5 cm, age 20.1 ± 0.9 years], and when classified by body mass index [n = 35, body mass index 32.2 ± 5.2 kg m 2 , age 22.5 ± 3.6 years] versus control [body mass index 21.7 ± 1.9 kg m 2 , age 20.1 ± 0.9 years, n = 33]. Results: Compared with controls, women with overweight/obesity (classified by waist circumference or body mass index) displayed elevated body mass, systolic blood pressure and homeostasis model assessment of insulin resistance, and reduced estimated VO 2max and weekly physical activity, with no differences in self-reported energy intake. The unadjusted odds ratio of being classified with overweight/obesity and an elevated homeostasis model assessment of insulin resistance and/or less than recommended physical activity ranged between 5.1 and 10.0. Receiver operator characteristic curves indicated waist circumference , body mass index and waist-to-height ratio cutoff points of ≥84.2 cm, ≥30.6 kg m −2 and ≥0.5, respectively, for homeostasis model assessment of insulin resistance, and ≥80.6 cm, ≥25.2 kg m −2 and ≥0.46, respectively, for less than recommended physical activity. Conclusions: Waist circumference and body mass index have similar associations with cardiometabolic risk, with greater homeostasis model assessment of insulin resistance and lower physical activity, rather than differences in traditional metabolic syndrome markers, observed in young women with over-weight/obesity.

Background There is a need for valid population level measures of physical activity in young children. The aim of this paper is to report the development, and the reliability and validity, of the Preschool-age Children's Physical Activity Questionnaire (Pre-PAQ) which was designed to measure activity of preschool-age children in the home environment in population studies. Methods Pre-PAQ was completed by 103 families, and validated against accelerometry for 67 children (mean age 3.8 years, SD 0.74; males 53%). Pre-PAQ categorizes activity into five progressive levels (stationary no movement, stationary with limb or trunk movement, slow, medium, or fast-paced activity). Pre-PAQ Levels 1-2 (stationary activities) were combined for analyses. Accelerometer data were categorized for stationary, sedentary (SED), non-sedentary (non-SED), light (LPA), moderate (MPA) and vigorous (VPA) physical activity using manufacturer's advice (stationary) or the cut-points described by Sirard et al and Reilly et al. Bland-Altman methods were used to assess agreement between the questionnaire and the accelerometer measures for corresponding activity levels. Reliability of the Pre-PAQ over one week was determined using intraclass correlations (ICC) or kappa (κ) values and percentage of agreement of responses between the two questionnaire administrations. Results Pre-PAQ had good agreement with LPA (mean difference 1.9 mins.day-1) and VPA (mean difference -4.8 mins.day-1), was adequate for stationary activity (mean difference 7.6 mins.day-1) and poor for sedentary activity, whether defined using the cut-points of Sirard et al (mean difference -235.4 mins.day-1) or Reilly et al (mean difference -208.6 mins.day-1) cut-points. Mean difference between the measures for total activity (i.e. Reilly's non-sedentary or Sirard's LMVPA) was 20.9 mins.day-1 and 45.2 mins.day-1. The limits of agreement were wide for all categories. The reliability of Pre-PAQ question responses ranged from 0.31-1.00 (ICC (2, 1)) for continuous measures and 0.60-0.97 (κ) for categorical measures. Conclusions Pre-PAQ has acceptable validity and reliability and appears promising as a population measure of activity behavior but it requires further testing on a more broadly representative population to affirm this. Pre-PAQ fills an important niche for researchers to measure activity in preschool-age children and concurrently to measure parental, family and neighborhood factors that influence these behaviors.

The purpose of this study was to determine the feasibility, acceptability, and potential efficacy of a school-based physical activity program delivered during school sport time among adolescent girls from low income predominately linguistically diverse backgrounds in New South Wales, Australia. Using a 3-month, 2-arm, parallel-group pilot RCT design, 38 adolescent girls (Year 11) were recruited to participate in the program and randomised into intervention (n=17) or control groups (n=21). The intervention program aimed to increase physical activity by improving enjoyment, physical self-perception and perceived competence. Baseline and follow-up (12 weeks) assessments included enjoyment of physical activity, physical self-perception, and objectively measured physical activity during school sport sessions. Process data were collected through observations of lessons, attendance records, and interviews with participants and staff. Recruitment (63%) and retention (68%) goals were less than anticipated but similar to other studies. Participation was higher for the intervention (72%) than the control (60%) group and the intervention group reported high levels of satisfaction with the program. At follow-up, girls in the intervention group, compared with the control group, showed greater improvement in their enjoyment of physical activity during school sport (adjusted mean difference=3.8, 95% Confidence Interval [CI] -2.4, 10.1; Cohen's d=0.42 standard deviation units) and body image (adjusted difference mean=1.0, 95% CI -0.4, 2.3; d=0.50). There was a smaller decline in participation in physical activity during school sport (adjusted mean=13.6, 95% CI -21.8, 48.9; d=0.24). This study highlights major barriers confronting adolescent girls' participation in school sport. Some of these include teacher attitudes and support, activities and programming, purpose and distinction, and student input. Negotiating these barriers and overcoming them in a school setting appears feasible with support from the entire school community.

Background In developing countries, infectious diseases such as diarrhoea and acute respiratory infections are the main cause of mortality and morbidity in infants aged less than one year. The importance of exclusive breastfeeding in the prevention of infectious diseases during infancy is well known. Although breastfeeding is almost universal in Bangladesh, the rates of exclusive breastfeeding remain low. This cohort study was designed to compare the prevalence of diarrhoea and acute respiratory infection (ARI) in infants according to their breastfeeding status in a prospective cohort of infants from birth to six months of age. Methods A total of 351 pregnant women were recruited in the Anowara subdistrict of Chittagong. Breastfeeding practices and the 7-day prevalence of diarrhoea and ARI were recorded at monthly home visits. Prevalences were compared using chi-squared tests and logistic regression. Results A total of 272 mother-infant pairs completed the study to six months. Infants who were exclusively breastfed for six months had a significantly lower 7-day prevalence of diarrhoea [AOR for lack of EBF = 2.50 (95%CI 1.10, 5.69), p = 0.03] and a significantly lower 7-day prevalence of ARI [AOR for lack of EBF = 2.31 (95%CI 1.33, 4.00), p < 0.01] than infants who were not exclusively breastfed. However, when the association between patterns of infant feeding (exclusive, predominant and partial breastfeeding) and illness was investigated in more detail, there was no significant difference in the prevalence of diarrhoea between exclusively [6.6% (95% CI 2.8, 10.4)] and predominantly breastfed infants [3.7% (95% CI 0.09, 18.3), (p = 0.56)]. Partially breastfed infants had a higher prevalence of diarrhoea than the others [19.2% (95% CI 10.4, 27.9), (p = 0.01)]. Similarly, although there was a large difference in prevalence in acute respiratory illness between exclusively [54.2% (95%CI 46.6, 61.8)] and predominantly breastfed infants [70.4% (95%CI 53.2, 87.6)] there was no significant difference in the prevalence (p = 0.17). Conclusion The findings suggest that exclusive or predominant breastfeeding can reduce rates of morbidity significantly in this region of rural Bangladesh.