hildhood obesity has become a critical public health issue in Canada, as rates have tripled over the past three decades. 1 Over one in four Canadian children are either overweight or obese (17% and 9% respectively). 2 The increased prevalence of childhood obesity has been linked to the concurrent rise of physical health problems normally associated with adults, including Type 2 diabetes, hypertension, heart disease and pulmonary diseases, as well as socio-psychological afflictions such as discrimination, behavioural problems, negative self-esteem, anxiety and depression. [3][4][5][6] A rapidly expanding avenue of research suggests that rising rates of obesity are due not only to individual-level factors (i.e., genetics), but also to characteristics of our local built environments that may be encouraging or discouraging the healthy diets or active lifestyles associated with healthy body weights. [7][8][9][10] Previous research has confirmed that obesity is linked to the consumption of energy-rich, fast foods. 11 Large-scale US studies have found that adult obesity rates are positively associated with the density of neighbourhood fast-food outlets 12 and convenience stores. 13 Much of the emphasis on the link between food and children's health focuses on advertising 14 or food policies within schools; 15-17 however, some policy-makers and public health professionals are shifting their focus to the food environments surrounding schools, as new research indicates that many children visit food retailers on their way to and from school, mostly filling up on high-sugar or high-fat, energy-dense foods. 18 Several studies have shown that fast-food outlets are more prevalent near schools 19,20 and in low-income neighbourhoods, 21,22 suggesting that these vulnerable populations may be at heightened risk of developing poor eating habits as a result of increased exposure to unhealthy foods. Furthermore, it has been shown in London, ON,

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Background: Bacterial translocation (BT) from the gut can develop and persist after short periods of hemorrhagic shock secondary to traumatic injuries. Erythroopoietin (EPO) exerts hemodynamic and anti-inflammatory effects in addition to its erythropoietic effect. We tested the hypothesis that EPO given at the time of acute resuscitation with normal saline (NS), Ringer's lactate (RL) or 7.5% hypertonic saline (7.5%HTS) will limit shock-induced mucosal injury and BT. Methods: Rats were hemorrhaged 30 mL/kg over 10 minutes via arterial catheter for 50 minutes, then randomized to 1 of 6 resuscitation groups (n = 5/group): NS, NS+EPO, RL, RL+EPO, 7.5%HTS and 7.5%HTS+EPO. Intravenous EPO (1000 U/kg) was given at the start of NS or RL (3 times the volume of shed blood) and 4 mL/kg of 7.5%HTS+1 volume of RL resuscitation. Postresuscitation gut function was evaluated using agar cultures of mesenteric lymph nodes and portal vein plasma lipopolysaccharide, IL-6 and TNF-α levels. Three of 5 rats per group underwent light microscopic examination using semi-thin plastic sections of the distal ileum and fluorescein isothiocyanate dextran 4000 used to assess the distal ileum mucosal permeability to macromolecules. Results: Two hours postshock and resuscitation, BT to mesenteric lymph nodes decreased in the NS+EPO versus the NS group (299 ± 104 v. 1050 ± 105 CFU/gm, p < 0.05); the addition of EPO to the RL or 7.5%HTS had no effect. Comparing different solutions, there was a significant increase in BT in the NS group versus the RL+EPO, 7.5%HTS+EPO and 7.5%HTS groups (1050 ± 105 v. 357 ± 134, 462 ± 129, 428 ± 106 CFU/gm, respectively; p < 0.05). There were no significant differences in terminal ileum permeability between groups, but there was a noticeable trend in decreasing terminal ileum permeability in the EPO-treated groups: NS versus NS+EPO (18.0 ± 9.5 v. 12.9 ± 6.3 µg/mL, p = 0.84), RL versus RL+EPO (17.7 ± 5.9 v. 8.4 ± 2.7 µg/mL, p = 0.22) and 7.5%HTS versus 7.5%HTS+EPO (11.4 ± 6.4 v. 6.5 ± 2.9 µg/mL, p = 0.69). There was no significant morphological evidence of mucosal injuries and no cytokine differences between groups and within groups. Conclusion: Preliminary data from an uncontrolled mean arterial pressure hemorrhagic shock rat model revealed that BT is an early event occurring within 2 hours of injury and resuscitation before any evidence of histological injury. Erythroopoietin with NS significantly decreased BT to the portal vein as compared with NS alone, but not with RL and 7.5%HTS.Analgesia in the management of pediatric trauma in the resuscitative phase: the role of the trauma centre.