Self-report recall questionnaires used to measure physical activity and dietary intake in children can be labour intensive and monotonous and tend to focus on either dietary intake or physical activity. The web-based software, Synchronised Nutrition and Activity Program TM (SNAP TM ), was developed to produce a novel, simple, quick and engaging method of assessing energy balance-related behaviours at a population level, combining principles from new and existing 24 h recall methodologies, set within a user-friendly interface. Dietary intake was measured using counts for twenty-one food groups and physical activity levels were measured in min of moderate to vigorous physical activity (MVPA). A combination of the mean difference between methods, type II regression and non-parametric limits of agreement techniques were used to examine the accuracy and precision of SNAP TM . Method comparison analyses demonstrated a good agreement for both dietary intake and physical activity behaviours. For dietary variables, accuracy of SNAP TM (mean difference) was within^1 count for the majority of food groups. The proportion of the sample with between-method agreement within^1 count ranged from 0·40 to 0·99. For min of MVPA, there was no substantial fixed or proportional bias, and a mean difference between methods (SNAP TM -accelerometry) of 29 min. SNAP TM provides a quick, accurate, low-burden, cost-effective and engaging method of assessing energy balance behaviours at a population level. Tools such as SNAP TM , which exploit the popularity, privacy and engagement of the computer interface, and linkages with other datasets, could make a substantial contribution to future public health monitoring and research.Schoolchildren: Diet: Physical activity: Computer programs: Recall As the prevalence of childhood obesity continues to rise in the developed world and countries in transition (1)

BackgroundHigh blood pressure (BP) during acute stroke is associated with poorer stroke outcome. Trials of treatments to lower BP have not resulted in improved outcome, but this may be because treatment commenced too late. Emergency medical service staff (paramedics) are uniquely placed to administer early treatment; however, experience of prehospital randomised controlled trials (RCTs) is very limited.MethodsWe conducted a pilot RCT to determine the feasibility of a definitive prehospital BP-lowering RCT in acute stroke. Paramedics were trained to identify, consent and deliver a first dose of lisinopril or placebo to adults with suspected stroke and hypertension while responding to the emergency call. Further treatment continued in hospital. Study eligibility, recruitment rate, completeness of receipt of study medication and clinical data (eg, BP) were collected to inform the design of a definitive RCT.ResultsIn 14 months, 14 participants (median age=73 years, median National Institute of Health Stroke Scale=4) were recruited and received the prehospital dose of medication. Median time from stroke onset (as assessed by paramedic) to treatment was 70 min. Four participants completed 7 days of study treatment. Of ambulance transported suspected stroke patients, 1% were both study eligible and attended by a PIL-FAST paramedic.ConclusionsIt is possible to conduct a paramedic initiated double-blind RCT of a treatment for acute stroke. However, to perform a definitive RCT in a reasonable timescale, a large number of trained paramedics across several ambulance services would be needed to recruit the number of patients likely to be required.Clinical trial registrationhttp://www.clinicaltrials.gov. Unique identifier: NCT01066572.

The North-East of England is a recognized 'hot spot' for paediatric obesity and the present study shows that low levels of habitual physical activity are typical. Choice of accelerometry threshold affects both the apparent amount of physical activity and the ability to detect groups with particularly low levels of physical activity.

A novel computer tool (peas@tees), designed to assess habitual physical activity levels in children aged 9 and 10 years, was evaluated. Study 1 investigated agreement between peas@tees and accelerometry in 157 children. Bland-Altman limits of agreement (LOA) revealed peas@tees underestimated physical activity levels compared with accelerometry (bias -21 min; 95% LOA -146-105). Study 2 investigated stability of peas@tees in a separate sample of 42 children. Intraclass correlation coefficient was 0.75 (95% CI 0.62-0.84). Computer tools are promising as a cheap, feasible, and useful method to monitor children's habitual levels of physical activity at the group level.Across the globe, attempts to modify children's lifestyles, particularly their physical activity levels and their diets are a global public health priority. The accurate and reliable assessment of these behaviors remains a challenge (5,30). While objective methods such as accelerometry remain the most accurate option in research, simpler alternative measurement methods that are both inexpensive and easy to employ in larger community-based interventions and observational studies Assessing Physical Activity Levels in Schoolchildren 507 in children are required (6,9,35). Although self-report techniques, such as recall questionnaires and diary records, provide the most practical means to measure physical activity and dietary intake for population or surveillance purposes, they are time consuming, monotonous to complete and labor intensive for the researcher. Furthermore, the recall of physical activity and dietary intake in children are generally assessed independently despite the potential interactions between these behaviors (20). Recently, it has been identified that studying energy-balance related behaviors simultaneously with new technology may provide benefits and may assist future health interventions (19).There are two main types of physical activity self-report measures; previousday physical activity recalls and 7-day physical activity recalls. Although previous-day recalls are thought to assist memory recall in younger children, accuracy of this approach is still limited (28). Previous-day recall questionnaires do not represent usual or habitual physical activity which is particularly problematic given that younger children have shown to engage in short, intermittent busts of activity, with varying degrees of intensity and duration (2) which also has high intraday and interday variability (37). Physical activity questionnaires which aim to collect longer term data can be used to measure 'habitual' physical activity. The newly designed questionnaire has been designed by integrating previous-day and more habitual physical activity questionnaires, to combat the limitations of both methods used separately, in accordance with previous literature (21). It was hoped that this combination of techniques might improve the low-to-moderate accuracy of recall when using both techniques independently.Patterns of Eating and Activity at Teesside (peas@tees) is a ...

BackgroundHigh blood pressure during acute stroke is associated with poorer stroke outcome. Previous trials have failed to show benefit from lowering blood pressure but treatment may have been commenced too late to be effective. The earliest that acute stroke treatments could be initiated is during contact with the emergency medical services (paramedics). However, experience of pre-hospital clinical trials is limited and logistical challenges are likely to be greater than for trials performed in other settings. We report the protocol for a pilot randomised controlled trial of paramedic initiated blood pressure lowering treatment for hypertension in acute stroke.MethodsTrial Design: Double blind parallel group external pilot randomised controlled trial.Setting: Participant recruitment and initial treatment by North East Ambulance Service research trained paramedics responding to the emergency call. Continued treatment in three study hospitals.Participants: Target is recruitment of 60 adults with acute arm weakness due to suspected stroke (within 3 hours of symptom onset) and hypertension (systolic BP>160 mmHg).Intervention: Lisinopril 5-10 mg (intervention group), matched placebo (control group), daily for 7 days.Randomisation: Study medication contained within identical pre-randomised "trial packs" carried by research trained paramedics.Outcomes: Study feasibility (recruitment rate, compliance with data collection) and clinical data to inform the design of a definitive randomised controlled trial (blood pressure monitoring, National Institute of Health Stroke Scale, Barthel ADL Index, Modified Rankin Scale, renal function).DiscussionThis pilot study is assessing the feasibility of a randomised controlled trial of paramedic initiated lisinopril for hypertension early after the onset of acute stroke. The results will inform the design of a definitive RCT to evaluate the effects of very early blood pressure lowering in acute stroke.Trial RegistrationEudraCT: 2010-019180-10ClinicalTrials.gov: NCT01066572ISRCTN: 54540667