In adults, there is evidence that physical activity effectively improves insulin sensitivity regardless of adiposity. Whether this is also the case in children and adolescents has been less clear. Whether this is also the case in children and adolescents is less clear. Clarifying this matter may help to identify the best outcomes to target in exercise programs for these age groups, where changes in adiposity may not always be desirable or realistic. A review of the literature was conducted on studies that examined the relationships of physical activity, cardiorespiratory fitness and strength with insulin sensitivity independent of adiposity in children and adolescents. Experimental (intervention) and correlational (longitudinal and cross-sectional) studies on participants ages 18 and younger were identified. A total of 42 studies were included in this review. Sample sizes in the studies ranged from 14 to 4,955 participants, with individual ages ranging from 5 to 19 years. A significant relationship with SI existed in 78% of studies on physical activity, 69% of studies on cardiorespiratory fitness and 66% of studies on strength. In studies that examined both physical activity and cardiorespiratory fitness concurrently, evidence suggests that they are both correlated with insulin sensitivity independent of adiposity, especially when physical activity is at higher intensities. However the strength of this relationship might be influenced by study design, measurement techniques and participant characteristics. This is the first review of its type to take research design into account, and to examine study outcomes according to participant ethnicity, gender, age, pubertal status and weight status.

Purpose To evaluate the reliability and validity of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Patient-Centered Medical Home Survey. Methods We conducted a field test of the CAHPS patient-centered medical home (PCMH) survey with 2,740 adults collected by mail (n = 1,746), phone (n = 672), and web (n = 322) from 6 sites of care affiliated with a west-coast staff model health maintenance organization. Findings An overall response rate of 37% was obtained. Internal consistency reliability estimates for 7 multi-item scales were as follows: access to care (5 items, alpha = 0.79), communication with providers (6 items, alpha = 0.93), office staff courtesy and respect (2 items, alpha = 0.80), shared decision-making about medicines (3 items, alpha = 0.67), self-management support (2 items, alpha = 0.61), attention to mental health issues (3 items, alpha = 0.80), and care coordination (4 items, alpha = 0.58). The number of responses needed to get reliable information at the site of care level for the composites was generally acceptable (< 300 for 0.70 reliability-level) except for self-management support and shared decision-making about medicines. Item-scale correlations provided support for distinct composites except for access to care and shared decision-making about medicines, which overlapped with the communication with providers scale. Shared decision-making and self-management support were significantly uniquely associated with the global rating of the provider (dependent variable) along with access and communication in a multiple regression model. Implications This study provides further support for the reliability and validity of the CAHPS PCMH survey, but refinement of the self-management support and shared decision-making scales is needed. The survey can be used to provide information about the performance of different health plans on multiple domains of health care, but future efforts to improve some of the survey items is needed.

Overweight is related to higher levels of C-reactive protein (CRP) and leptin, which have been independently associated with increased risk for diabetes, cardiovascular disease, and the metabolic syndrome. Elevated CRP may trigger leptin resistance by inhibiting the binding of leptin to its receptors. We cross-sectionally examined the relationship between CRP, leptin, BMI z-score, percent body fat (%BF) assessed by air plethysmography (BodPod), and insulin sensitivity (SI) and acute insulin response (AIRg) measured by intravenous glucose tolerance test in 51 Latina and African-American females (77% Latina), mean age 9.2 (±0.9) years, at either Tanner Pubertal Stage (TPS) 1 (n = 25) or TPS 2 (n = 26). Females at TPS 2 had higher BMI z-scores, %BF (23% ± 10.1 vs. 30% ± 10.0, P = 0.02), AIRg (976.7 ± 735.2 vs. 1555.3 ± 1,223 µIU/ml, P = 0.05), fasting insulin (11.0 ± 10.8 vs. 17.2 ± 13.6 µlU/ml, P = 0.00) and leptin levels (11.0 ± 7.1 vs. 19.6 ± 10.9 ng/ml, P < 0.001) than those at TPS 1. There were no ethnic differences in any of the measured variables. CRP was positively correlated with BMI z-score (P = 0.001), %BF (P = 0.006), fasting insulin and AIRg (P = 0.02), and fasting leptin (P = 0.00), and negatively correlated with SI (P = 0.05). A linear regression model showed that CRP independently explained 10% (P = 0.00) of the variance in leptin after adjusting %BF, TPS, ethnicity, habitual physical activity and SI. Hence, low-grade inflammation may contribute to prolonged leptin exposure and leptin resistance, even in healthy children.