Annette Kjær Ersbøll

Using accelerometers and global positioning system devices to assess gender and age differences in children’s school, transport, leisure and home based physical activity

BackgroundKnowledge on domain-specific physical activity (PA) has the potential to advance public health interventions and inform new policies promoting children’s PA. The purpose of this study is to identify and assess domains (leisure, school, transport, home) and subdomains (e.g., recess, playgrounds, and urban green space) for week day moderate to vigorous PA (MVPA) using objective measures and investigate gender and age differences.MethodsParticipants included 367 Danish children and adolescents (11–16xa0years, 52% girls) with combined accelerometer and Global Positioning System (GPS) data (mean 2.5xa0days, 12.7xa0hrs/day). The Personal Activity and Location Measurement System and a purpose-built database assessed data in 15-second epochs to determine PA and assign epochs to 4 domains and 11 subdomains. Frequencies and proportions of time spent in MVPA were determined and differences assessed using multi-level modeling.ResultsMore than 90% of MVPA was objectively assigned to domains/subdomains. Boys accumulated more MVPA overall, in leisure, school and transport (all pu2009<u20090.05). Children compared with adolescents accumulated more MVPA, primarily through more school MVPA (pu2009<u20090.05). Boys spent a large proportion of time accumulating MVPA in playgrounds, active transport, Physical Education, sports facilities, urban green space and school grounds. Girls spent a significant proportion of time accumulating MVPA in active transport and playgrounds. No gender or age differences were found in the home domain.ConclusionsLarge variations were found in PA frequency and intensity across domains/subdomains. Significant gender differences were found, with girls being less active in almost all domains and subdomains. Objectively measured patterns of PA across domains/subdomains can be used to better tailor PA interventions and inform future policies for promoting child PA.

Cytokines and Organ Failure in Acute Pancreatitis: Inflammatory Response in Acute Pancreatitis

Objectives We aimed at synchronously examining the early time course of 4 proinflammatory cytokines as predictive factors for development of organ failure in patients with acute pancreatitis (AP). Methods Interleukin (IL) 6, IL-8, IL-18, and tumor necrosis factor &agr; were measured on admission and at days 1, 2, and 14 in 60 patients admitted with first attack of AP. The prediction of single-organ and multiorgan failure from the cytokine profiles was evaluated by receiver operating characteristic analyses. Results Interleukin 6 and IL-8 levels were significantly higher in patients who developed renal, respiratory, and circulatory failure, as was the case for patients with multiorgan failure. Interleukin 18 levels were significantly elevated in renal and respiratory failure only. Tumor necrosis factor &agr; was significantly elevated in all types of organ failures, except for intestinal failure. Conclusions Synchronous measurements of 4 cytokines demonstrated IL-6 and IL-8 to be predictive as early surrogate markers with regard to organ failures in AP. The fact that all of the cytokines were particularly elevated in patients with organ failures calls for evaluation of agents modifying the severe inflammatory response in patients with AP.

T-lymphocyte subsets, thymic size and breastfeeding in infancy

We followed the changes in concentration of T‐lymphocyte subsets (CD4+ and CD8+ cells) in peripheral blood and thymus size during infancy. Previous studies have found increased thymus size in breastfed infants. The present study analyzed the association between breastfeeding and the number of CD4+ and CD8+ cells. Two different populations of infants between birth and 1u2003year of age were examined. Study Group I: infants with a variable duration of breastfeeding. Study Group II: long‐term breastfed infants. In both groups a correlation was found between CD8+ cells and the thymic index at 10u2003months of age. In Group I, infants still breastfed at the 8‐month examination had a higher CD8% than formula‐fed infants (pu2003=u20030.05), and infants breastfed at the 4‐month examination had a higher CD4% at 10u2003months of age (p=u200a0.03). Group II showed an increase in the absolute number of CD4+ and CD8+ cells from 8 to 10u2003months of age; and a positive correlation between the number of breastfeedings per day at 8u2003months of age, and an increase in CD4+ cells from 8 to 10u2003months of age (p <0.01). In conclusion, a correlation was found between thymus size and CD8+ cells. Breastfeeding might have both a current and long‐term immune‐modulating effect on the developing cellular immune system.

Ecological Determinants of Highly Pathogenic Avian Influenza (H5N1) Outbreaks in Bangladesh

Background The agro-ecology and poultry husbandry of the south Asian and south-east Asian countries share common features, however, with noticeable differences. Hence, the ecological determinants associated with risk of highly pathogenic avian influenza (HPAI-H5N1) outbreaks are expected to differ between Bangladesh and e.g., Thailand and Vietnam. The primary aim of the current study was to establish ecological determinants associated with the risk of HPAI-H5N1 outbreaks at subdistrict level in Bangladesh. The secondary aim was to explore the performance of two different statistical modeling approaches for unmeasured spatially correlated variation. Methodology/Principal Findings An ecological study at subdistrict level in Bangladesh was performed with 138 subdistricts with HPAI-H5N1 outbreaks during 2007–2008, and 326 subdistricts with no outbreaks. The association between ecological determinants and HPAI-H5N1 outbreaks was examined using a generalized linear mixed model. Spatial clustering of the ecological data was modeled using 1) an intrinsic conditional autoregressive (ICAR) model at subdistrict level considering their first order neighbors, and 2) a multilevel (ML) model with subdistricts nested within districts. Ecological determinants significantly associated with risk of HPAI-H5N1 outbreaks at subdistrict level were migratory birds staging areas, river network, household density, literacy rate, poultry density, live bird markets, and highway network. Predictive risk maps were derived based on the resulting models. The resulting models indicate that the ML model absorbed some of the covariate effect of the ICAR model because of the neighbor structure implied in the two different models. Conclusions/Significance The study identified a new set of ecological determinants related to river networks, migratory birds staging areas and literacy rate in addition to already known risk factors, and clarified that the generalized concept of free grazing duck and duck-rice cultivation interacted ecology are not significant determinants for Bangladesh. These findings will refine current understanding of the HPAI-H5N1 epidemiology in Bangladesh.

Intervention Effects on Adolescent Physical Activity in the Multicomponent SPACE Study: A Cluster Randomized Controlled Trial

Background Multicomponent school-based interventions have the potential to reduce the age-related decline in adolescents physical activity (PA), yet there is not consistent evidence to guide non-curricular and school environment interventions. The aim of this study was to assess the effectiveness of a multicomponent environmental school-based intervention, designed to reduce the age-related decline in PA among adolescents. Methods A cluster randomized controlled trial was conducted with 7 intervention and 7 control schools. Baseline measurements were carried out in spring 2010 with 2 years of follow-up. A total of 1,348 students (11–13 years, in grade 5 and 6) enrolled in the study at baseline. The 14 schools included in the study were located in the Region of Southern Denmark. The intervention consisted of organizational and physical changes in the school environment with a total of 11 intervention components. The primary outcome measure was overall PA (cpm, counts per minute) and was supported by analyses of time spent in MVPA, and time spent sedentary. Furthermore, a secondary outcome measure was PA in school time and during recess. PA was measured using accelerometer (Actigraph GT3X). Results A total of 797 students completed the trial and had valid accelerometer data. No significant difference was found for overall PA with an adjusted difference of −19.1 cpm (95% CI: −93, 53) or for school time activity with an adjusted difference of 6 cpm (95% CI: −73, 85). A sensitivity analysis revealed a positive significant intervention effect of PA in recess with an adjusted difference of 95 cpm. Conclusions No evidence was found of the overall effect of a non-curricular multicomponent school-based intervention on PA among Danish adolescents. The intervention was positively associated with PA during school time and recess, however, with small estimates. Lack of effect on overall PA could be due to both program theory and different degrees of implementation. Trial Registration www.Controlled-Trials.com ISRCTN79122411

Echocardiographic evaluation of changes in left ventricular size and valvular regurgitation associated with physical training during and after maturity in Standardbred trotters

OBJECTIVEnTo assess whether physical training induces cardiac hypertrophy and valvular regurgitation in maturing Standardbred trotters and to establish a prediction model for the size of the left ventricle.nnnDESIGNnLongitudinal observational study.nnnANIMALSn53 Standardbred trotters.nnnPROCEDURESnEach horse underwent 2-D, M-mode, and color flow Doppler echocardiography at 5.5 years of age; previously, each horse had been examined at 2, 2.5, 3, and 3.5 (time of maturity) years of age. Horses were or were not in training or racing for variable periods during the entire assessment period; data for a given horse were assigned to 1 of 2 groups on the basis of the horses status at the fifth examination (racing [n = 40] or not racing [13]). At each examination, left ventricular (LV) internal diameter in diastole (LVIDd), LV mass, and mean and relative LV wall thicknesses were measured. Prevalence and severity of tricuspid, pulmonary, mitral, and aortic valve regurgitation were determined.nnnRESULTSnDuring the assessment period, LVIDd, LV mass, and mean LV wall thickness increased; body weight was significantly associated with those variables. Prediction of LV mass was possible when sex and weight were included in the model. Prevalence of valvular regurgitation increased for all valves. An increased risk of development of tricuspid and pulmonary valve regurgitation for horses in racing was observed.nnnCONCLUSIONS AND CLINICAL RELEVANCEnThe LV mass and prevalence of valvular regurgitation increased (indicative of development of exercise-induced cardiac hypertrophy and valvular regurgitation) in young horses, even during the latter part of the assessment period, when maturity was attained.

Molecular epidemiology of circulating highly pathogenic avian influenza (H5N1) virus in chickens, in Bangladesh, 2007–2010

Bangladesh has been severely hit by highly pathogenic avian influenza H5N1 (HPAI-H5N1). However, little is known about the genetic diversity and the evolution of the circulating viruses in Bangladesh. In the present study, we analyzed the hemagglutinin gene of 30 Bangladeshi chicken isolates from 2007 through 2010. We analyzed the polybasic amino acid sequence motif of the cleavage site and amino acid substitution pattern. Phylogenetic history was reconstructed using neighbor-joining and Bayesian time-scaled methods. In addition, we used Mantel correlation tests to analyze the relation between genetic relatedness and spatial and temporal distances. Neighbor-joining phylogeography revealed that virus circulating in Bangladesh from 2007 through 2010 belonged to clade 2.2. The results suggest that clade 2.2 viruses are firmly entrenched and have probably become endemic in Bangladesh. We detected several amino acid substitutions, but they are not indicative of adaptation toward human infection. The Mantel correlation test confirmed significant correlation between genetic distances and temporal distances between the viruses. The Bayesian tree shows that isolates from waves 3 and 4 derived from a subgroup of isolates from the previous waves grouping with a high posterior probability (pp=1.0). This indicates the possibility of formation of local subclades. One surprising finding of spatio-temporal analysis was that genetically identical virus caused independent outbreaks over a distance of more than 200 km and within 14 days of each other. This might indicate long distance dispersal through vectors such as migratory birds and vehicles, and challenges the effectiveness of movement restriction around 10 km radius of an outbreak. The study indicates possible endemicity of the clade 2.2 HPAI-H5N1 virus in Bangladesh. Furthermore, the formation of a subclade capable of transmission to humans cannot be ruled out. The findings of this study might provide valuable information for future surveillance, prevention and control programme.

Adolescent Alcohol Use Reflects Community-Level Alcohol Consumption Irrespective of Parental Drinking

PURPOSEnRisk factors for adolescent alcohol use are typically conceptualized at the individual level, and school- and community-level risk factors have received little attention. Based on the theoretical understanding of youth alcohol consumption as a reflection of community social practice, we analyzed whether adolescent drunkenness was related to community-level adult alcohol use (AAC), when taking individual and school-level risk factors for drunkenness into account. Furthermore, we investigated whether the association between community-level AAC and adolescent drunkenness was attenuated after inclusion of parental drinking.nnnMETHODSnWe used data from three sources: data about adolescent drunkenness from the Health Behavior in School-Aged Children 2010 survey (N = 2,911; 13- to 15-year-olds nested in 175 school classes and 51 schools); data about community-level AAC derived from the Danish National Health Survey 2010 (177,639 participants); and data on school-level variables from Health Behavior in School-Aged Children School Leader Survey 2010. We performed multilevel logistic regression analysis with data from students nested within school classes and schools.nnnRESULTSnOverall, 33.5% of students had been drunk twice or more. High community-level AAC was significantly associated with adolescent drunkenness (odds ratio [95% confidence interval], 1.94 [1.21-3.11]). Parental drinking was strongly related to adolescent drunkenness but did not attenuate the relationship between community-level AAC and adolescent drunkenness. We found no association between adolescent drunkenness and school-level variables (youth friendly environment, alcohol education, and exposure to alcohol outlets).nnnCONCLUSIONSnAdolescent drunkenness was associated with community-level AAC and was not explained by parental drinking.

Identification of biosecurity measures and spatial variables as potential risk factors for Aleutian disease in Danish mink farms.

Eradication of Aleutian disease was initiated in Denmark in 1976. The prevalence of positive farms has since then been reduced from 100% to only being continuously present in the region of Vendsyssel, Northern Denmark since 2004. In this study, we attempted to identify risk factors for the infection in this region based on logistic regression of spatial (environmental, neighbourhood) variables and biosecurity measures. Information on potential biosecurity (management) risk factors in the region was obtained from interviews in 342 registered farms in the region using a structured questionnaire. A total of 279 questionnaires were completed (response rate 82%). Additional spatial variables were included in the analysis. The study shows that farm size (the number of animals in the farm) and proportion of infected neighbouring farms were significant risk factors for infection with Aleutian Mink Disease Virus. These factors account for 35% of the variation of the infection status of mink farms located in Vendsyssel during 2009. These results indicate that only a coordinated effort from the farmers in the area will succeed in eradicating the disease from Denmark, because individual farms that have eradicated the disease will be at risk of re-infection from test-positive neighbours.

Injuries in children with extra physical education in primary schools.

PURPOSEn(1) Examine the influence of extra physical education (EPE) on the number of musculoskeletal injuries in public schools accounting for organized sports participation (OSP) outside school. (2) Examine the major injury subgroup: growth-related overuse (GRO) through the overuse-related injury group.nnnMETHODSnA longitudinal controlled school-based study among Danish public schools. At baseline, 1216 children participated age 6.2-12.4 yr. Six schools (701 children) with EPE and four control schools (515 children) were followed up with weekly automated mobile phone text messages for information on musculoskeletal problems and OSP. Health care personnel diagnosed the children according to the World Health Organizations International Classification of Diseases, Tenth Revision. Data were analyzed using a two-part zero-inflated negative binomial (ZINB) regression model.nnnRESULTSnSchool type had no influence on the odds of sustaining an injury but increased the probability of sustaining a higher injury count for children with injuries, with total injuries by a factor of 1.29 (95% confidence interval [CI] = 1.07-1.56), overuse by a factor of 1.29 (95% CI = 1.06-1.55), and GRO by a factor of 1.38 (95% CI = 1.02-1.80). Weekly mean OSP decreased the odds of belonging to the group of children with no injuries, by a factor of 0.29 (95% CI = 0.14-0.58), 0.26 (95% CI = 0.14-0.48), and 0.17 (95% CI = 0.06-0.52) for total, overuse, and GRO, respectively. OSP also increased the probability of sustaining a higher injury count for children with injuries by a factor of 1.11 (95% CI = 1.02-1.22), 1.10 (95% CI = 1.00-1.22), and 1.14 (95% CI = 1.00-1.30), respectively.nnnCONCLUSIONSnChildren enrolled in EPE schools with high OSP have the highest odds of injury and a high probability of sustaining a higher injury count compared to their peers at schools with normal PE. Special attention should be assigned to these children during compulsory PE.