A Health promoting schools (HPS) approach aims to make schools a healthy place through a holistic approach that promotes a supportive ‘school ethos’ and emphasizes improvements in physical, social, and emotional well-being and educational outcomes. A HPS initiative in rural Nova Scotia (Canada) provided an opportunity for a population-level natural experiment. This study investigated student well-being and health behaviours between schools with and without HPS implementation and schools with high and low school ethos scores.Student well-being, nutrition, and physical activity were examined in a cross-sectional survey of elementary students in Nova Scotia, Canada in 2014. Multiple regression was used to assess the relationship with student well-being using the Quality of Life in School (QoLS) instrument and health behaviours. The main exposure was attending one of the 10 HPS schools; secondary exposure was the school ethos score.The overall QoLS score and its subdomain scores in the adjusted models were higher in students attending HPS schools compared to those in non-HPS schools, but the differences were not statistically significant and the effect sizes were small. Students in schools that scored high on school ethos score had higher scores for the QoLS and its subdomains, but the difference was only significant for the teacher-student relationship domain.Although this study did not find significant differences between HPS and non-HPS schools, our results highlight the complexity of evaluating HPS effects in the real world. The findings suggest a potential role of a supportive school ethos for student well-being in school.
Body mass index (BMI) is commonly used to assess a child's weight status but it does not provide information about the distribution of body fat. Since the disease risks associated with obesity are related to the amount and distribution of body fat, measures that assess visceral or subcutaneous fat, such as waist circumference (WC), waist-to-height ratio (WHtR), or skinfolds thickness may be more suitable. The objective of this study was to develop percentile curves for BMI, WC, WHtR, and sum of 5 skinfolds (SF5) in a representative sample of Canadian children and youth. The analysis used data from 4115 children and adolescents between 6 and 19 years of age that participated in the Canadian Health Measures Survey Cycles 1 (2007/2009) and 2 (2009/2011). BMI, WC, WHtR, and SF5 were measured using standardized procedures. Age- and sex-specific centiles were calculated using the LMS method and the percentiles that intersect the adult cutpoints for BMI, WC, and WHtR at age 18 years were determined. Percentile curves for all measures showed an upward shift compared to curves from the pre-obesity epidemic era. The adult cutoffs for overweight and obesity corresponded to the 72nd and 91st percentile, respectively, for both sexes. The current study has presented for the first time percentile curves for BMI, WC, WHtR, and SF5 in a representative sample of Canadian children and youth. The percentile curves presented are meant to be descriptive rather than prescriptive as associations with cardiovascular disease markers or outcomes were not assessed.
Background: The oncological effects of obesity on liver transplant (LT) patients with hepatocellular carcinoma (HCC) remains unclear. We investigated patient overall survival and tested two-way interactions between donor and recipient obesity status. Methods: Using the UNOS database, a total of 8352 LT recipients with HCC were included. Donors and recipients were stratified in normal weight (NW), overweight (OW) and obese (OB). Hazard ratios (HR) for any cause of death and interactions between recipient and donor BMI were estimated by multivariate flexible parametric models. Results: Five-year overall survival was 66% for NW, 67% for OW and 68% for OB recipients. The HRs of death from all causes were 0.96 (95% CI: 0.86-1.08) for OW and 0.93 (95% CI: 0.82-1.05) for OB recipients when compared to NW patients. At multivariate analysis, predictors of inferior survival were recipient age (65 years), donor age (45 years), need for pre-operative dialysis, HCV infection, transplants performed before 2007, and UNOS regions 2,3,9,10, and 11. The lowest adjusted HR was measured for recipients with BMI between 25 and 35 and there were no interactions between recipient and donor BMI. Conclusions: the overall survival of LT recipients with HCC was not affected by donor or recipient obesity.
At a time of significant upheaval in American health policy, maintaining a focus on a "North Star" is critical. For implementation science, this star is the knowledge base on how to optimally disseminate evidence related to health and health care, how to implement interventions to improve care within the many settings where people receive health care and make health-related decisions, and how to improve the health of the global population. To that end, the end of 2016 brought over 1100 engaged and activated "disciples of D & I" to Washington, DC for the 9 th Annual Conference on the Science of Dissemination and Implementation in Health. Once again, the accompanying abstracts in this issue demonstrate the breadth, depth and vigor of this continually expanding and evolving subset of health research. During three dynamic plenaries with rows and rows of filled seats and packed concurrent sessions presenters and attendees shared findings, raised methodologic and other challenges, and discussed future priorities, trends, and next steps for this community of research. For the third year in a row, we were buoyed by a strong partnership, co-led by AcademyHealth and the National Institutes of Health (NIH), with co-sponsorship from others committed to implementation science: the Agency for Healthcare Research and Quality (AHRQ), the Patient Centered Outcomes Research Institute (PCORI), the Robert Wood Johnson Foundation (RWJF), and the US Department of Veterans Affairs (VA). The multidisciplinary program planning committee informed the development of the key themes for the conference, identified the plenary sessions topics and speakers, established track leads to manage the review process for concurrent panels, papers, and posters, and convened a scientific advisory panel to advise on the overall conference, thus ensuring a robust, inclusive, and rigorous process. Together, the opening keynote address and the three plenary panel sessions set a tone of innovation and dialogue, raised critical issues, surfaced different perspectives, and ensured that follow on lunchtime and hallway discussions delved deeper into thorny challenges facing the field. Roy Rosin, Chief Innovation Officer for the University of Pennsylvania's Perelman School of Medicine, introduced the audience to a range of methods for rapid testing, innovation in healthcare delivery, and lessons learned from other industries to maximize potential of new practices to be scaled-up. Each of the three plenary panels presented a general discussion on a high priority challenge for dissemination and implementation (D & I) research. A panel on the balance between intervention and implementation fidelity and local adaptation touched on the very real dynamic that is playing out in communities across this country as policy and payment changes are driving providers and others to seek new ways to solve the challenges in their particular contexts. A panel on the longerterm decisions around sustainment or de-implementation of interventions could not be more timely given the "im...
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