The current evidence suggests that many diet and exercise interventions to prevent obesity in children are not effective in preventing weight gain, but can be effective in promoting a healthy diet and increased physical activity levels.Being very overweight (obese) can cause health, psychological and social problems for children. Children who are obese are more likely to have weight and health problems as adults. Programmes designed to prevent obesity focus on modifying one or more of the factors considered to promote obesity.This review included 22 studies that tested a variety of intervention programmes, which involved increased physical activity and dietary changes, singly or in combination. Participants were under 18 and living in Asia, South America, Europe or North America. There is not enough evidence from trials to prove that any one particular programme can prevent obesity in children, although comprehensive strategies to address dietary and physical activity change, together with psycho-social support and environmental change may help. There was a trend for newer interventions to involve their respective communities and to include evaluations.Future research might usefully assess changes made on behalf of entire populations, such as improvements in the types of foods available at schools and in the availability of safe places to run and play, and should assess health effects and costs over several years.The programmes in this review used different strategies to prevent obesity so direct comparisons were difficult. Also, the duration of the studies ranged from 12 weeks to three years, but most lasted less than a year.

/pdf/interventions-for-preventing-obesity-in-children-4arhbcud58.pdf

Interventions for preventing obesity in children

Cryotherapy has theoretical and practical applications in the reduction of pain, swelling, and blood loss after trauma. We performed a systematic review and meta-analysis of randomized controlled trials on the efficacy of cryotherapy after total knee arthroplasty (TKA). Eleven studies involving 793 TKAs were included. There was considerable clinical and methodological heterogeneity. Cryotherapy resulted in small benefits in blood loss and discharge knee range of motion. There were no benefits in transfusion and analgesia requirements, pain, swelling, length of stay, and gains in knee range of motion after discharge. Despite some early gains, cryotherapy after TKA yields no apparent lasting benefits. Patient-centered outcomes remain underinvestigated. The current evidence does not support the routine use of cryotherapy after TKA. Keywords: total knee arthroplasty, cryotherapy, cold therapy, Cryo/Cuff.

A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Exercise Physiology: Energy, Nutrition and Human Performance

OBJECTIVE
To identify factors in childhood which might influence the development of obesity in adulthood.


BACKGROUND
The prevalence of obesity is increasing in the UK and other developed countries, in adults and children. The adverse health consequences of adult obesity are well documented, but are less certain for childhood obesity. An association between fatness in adolescence and undesirable socio-economic consequences, such as lower educational attainment and income, has been observed, particularly for women. Childhood factors implicated in the development of adult obesity therefore have far-reaching implications for costs to the health-services and economy.


SEARCH STRATEGY
In order to identify relevant studies, electronic databases--Medline, Embase, CAB abstracts, Psyclit and Sport Discus-were searched from the start date of the database to Spring 1998. The general search structure for electronic databases was (childhood or synonyms) AND (fatness or synonyms) AND (longitudinal or synonyms). Further studies were identified by citations in retrieved papers and by consultation with experts.


INCLUSION CRITERIA
Longitudinal observational studies of healthy children which included measurement of a risk factor in childhood (<18 y), and outcome measure at least 1 y later. Any measure of fatness, leanness or change in fatness or leanness was accepted. Measures of fat distribution were not included. Only studies with participants from an industrialized country were considered, and those concerning minority or special groups, e.g. Pima Indians or children born preterm, were excluded.


FINDINGS
Risk factors for obesity included parental fatness, social factors, birth weight, timing or rate of maturation, physical activity, dietary factors and other behavioural or psychological factors. Offspring of obese parent(s) were consistently seen to be at increased risk of fatness, although few studies have looked at this relationship over longer periods of childhood and into adulthood. The relative contributions of genes and inherited lifestyle factors to the parent-child fatness association remain largely unknown. No clear relationship is reported between socio-economic status (SES) in early life and childhood fatness. However, a strong consistent relationship is observed between low SES in early life and increased fatness in adulthood. Studies investigating SES were generally large but very few considered confounding by parental fatness. Women who change social class (social mobility) show the prevalence of obesity of the class they join, an association which is not present in men. The influence of other social factors such as family size, number of parents at home and childcare have been little researched. There is good evidence from large and reasonably long-term studies for an apparently clear relationship for increased fatness with higher birth weight, but in studies which attempted to address potential confounding by gestational age, parental fatness, or social group, the relationship was less consistent. The relationship between earlier maturation and greater subsequent fatness was investigated in predominantly smaller, but also a few large studies. Again, this relationship appeared to be consistent, but in general, the studies had not investigated whether there was confounding by other factors, including parental fatness, SES, earlier fatness in childhood, or dietary or activity behaviours. Studies investigating the role of diet or activity were generally small, and included diverse methods of risk factor measurement. There was almost no evidence for an influence of activity in infancy on later fatness, and inconsistent but suggestive evidence for a protective effect of activity in childhood on later fatness. No clear evidence for an effect of infant feeding on later fatness emerged, but follow-up to adulthood was rare, with only one study measuring fatness after 7y. Studies investigating diet in childhood were limited and inconc

Childhood predictors of adult obesity: a systematic review.

Wild and managed pollinators provide a wide range of benefits to society in terms of contributions to food security, farmer and beekeeper livelihoods, social and cultural values, as well as the maintenance of wider biodiversity and ecosystem stability. Pollinators face numerous threats, including changes in land-use and management intensity, climate change, pesticides and genetically modified crops, pollinator management and pathogens, and invasive alien species. There are well-documented declines in some wild and managed pollinators in several regions of the world. However, many effective policy and management responses can be implemented to safeguard pollinators and sustain pollination services.

/pdf/safeguarding-pollinators-and-their-values-to-human-well-2dege9v9a6.pdf

Safeguarding pollinators and their values to human well-being

Honey is a viscous, supersaturated sugar solution derived from nectar gathered and modified by the honeybee, Apis mellifera. Honey has been used since ancient times as a remedy in wound care. Evidence from animal studies and some trials has suggested honey may accelerate wound healing. The objective was to determine whether honey increases the rate of healing in acute wounds (burns, lacerations and other traumatic wounds) and chronic wounds (venous ulcers, arterial ulcers, diabetic ulcers, pressure ulcers, infected surgical wounds).

/pdf/honey-as-a-topical-treatment-for-wounds-3lu1p47o9n.pdf

Honey as a topical treatment for wounds

This study sought to quantify the energy expenditure and physical activity associated with playing the "new generation" active and nonactive console-based video games in 21 children ages 10-14 years. Energy expenditure (kcal) derived from oxygen consumption (VO2) was continuously assessed while children played nonactive and active console video games. Physical activity was assessed continuously using the Actigraph accelerometer. Significant (p < .001) increases from baseline were found for energy expenditure (129-400%), heart rate (43-84%), and activity counts (122-1288 versus 0-23) when playing the active console video games. Playing active console video games over short periods of time is similar in intensity to light to moderate traditional physical activities such as walking, skipping, and jogging.

/pdf/energy-expended-playing-video-console-games-an-opportunity-50bfc5xo11.pdf

Energy Expended Playing Video Console Games: An Opportunity to Increase Children’s Physical Activity?

The primary objective of this pilot study was to evaluate the effect of active video games on children's physical activity levels. Twenty children (mean ± SD age = 12 ± 1.5 years; 40% female) were randomised to receive either an active video game upgrade package or to a control group (no intervention). Effects on physical activity over the 12-week intervention period were measured using objective (Actigraph accelerometer) and subjective (Physical Activity Questionnaire for Children [PAQ-C]) measures. An activity log was used to estimate time spent playing active and non-active video games. Children in the intervention group spent less mean time over the total 12-week intervention period playing all video games compared to those in the control group (54 versus 98 minutes/day [difference = -44 minutes/day, 95% CI [-92, 2]], p = 0.06). Average time spent in all physical activities measured with an accelerometer was higher in the active video game intervention group compared to the control group (difference at 6 weeks = 194 counts/min, p = 0.04, and at 12 weeks = 48 counts/min, p = 0.06). This preliminary study suggests that playing active video games on a regular basis may have positive effects on children's overall physical activity levels. Further research is needed to confirm if playing these games over a longer period of time could also have positive effects on children's body weight and body mass index. ACTRN012606000018516

https://link.springer.com/content/pdf/10.1186%2F1479-5868-5-8.pdf

Couch potatoes to jumping beans: A pilot study of the effect of active video games on physical activity in children

Background
Healing of venous leg ulcers is improved by the use of compression bandaging but some venous ulcers remain unhealed, and some people are unsuitable for compression therapy. Pentoxifylline, a drug which helps blood flow, has been used to treat venous leg ulcers but to date there has been no systematic review.

Objectives
To assess the effects of pentoxifylline (oxpentifylline or Trental 400) for treating venous leg ulcers, compared with placebo, or other therapies, in the presence or absence of compression therapy.

Search strategy
We searched the Cochrane Peripheral Vascular Diseases and Wounds Groups specialised registers (date of last search was May 2001), and reference lists of relevant articles. We hand searched relevant journals and conference proceedings, and contacted Hoechst (the manufacturer of the drug) and experts in the field.

Selection criteria
Randomised trials comparing pentoxifylline with placebo or other therapy in the presence or absence of compression, in patients with venous leg ulcers.

Data collection and analysis
Details from eligible trials were extracted and summarised by one reviewer using a coding sheet. Data extraction was independently verified by one other reviewer.

Main results
Nine trials involving 572 adults were included. The quality of trials was variable. Eight trials compared pentoxifylline with placebo; in five of these trials patients received compression therapy. In one trial pentoxifylline was compared with defibrotide in patients who also received compression. Combining eight trials that compared pentoxifylline with placebo (with or without compression) demonstrated that pentoxifylline is more effective than placebo in terms of complete ulcer healing or significant improvement (relative risk of healing with pentoxifylline compared with placebo 1.41, 95% confidence interval 1.19 -1.66). Pentoxifylline plus compression is more effective than placebo plus compression (relative risk of healing with pentoxifylline 1.30, 95% confidence interval 1.10-1.54). A comparison between pentoxifylline and defibrotide found no statistically significant difference in healing rates.

More adverse effects were reported in patients receiving pentoxifylline, although this was not statistically significant (relative risk of adverse effects with pentoxifylline 1.25, 95% confidence interval 0.87-1.80). Nearly half of the reported adverse effects were gastrointestinal.

Authors' conclusions
Pentoxifylline appears to be an effective adjunct to compression bandaging for treating venous ulcers. There was no cost effectiveness data available and healthcare commissioners may therefore conclude that it not be considered a routine adjunct. Pentoxifylline in the absence of compression may be effective for treating venous leg ulcers, although the evidence should be cautiously interpreted. The majority of adverse effects are gastrointestinal disturbances (indigestion, diarrhoea and nausea).

Pentoxifylline for treating venous leg ulcers

Background: The efficacy of honey as a treatment for venous ulcers has not been evaluated, despite widespread interest. This trial aimed to evaluate the safety and effectiveness of honey as a dressing for venous ulcers. Methods: This community-based open-label randomized trial allocated people with a venous ulcer to calcium alginate dressings impregnated with manuka honey or usual care. All participants received compression bandaging. The primary outcome was the proportion of ulcers healed after 12 weeks. Secondary outcomes were: time to healing, change in ulcer area, incidence of infection, costs per healed ulcer, adverse events and quality of life. Analysis was by intention to treat. Results: Of 368 participants, 187 were randomized to honey and 181 to usual care. At 12 weeks, 104 ulcers (55·6 per cent) in the honey-treated group and 90 (49·7 per cent) in the usual care group had healed (absolute increase 5·9 (95 per cent confidence interval (c.i.) −4· 3t o 15·7) per cent; P = 0·258). Treatment with honey was probably more expensive and associated with more adverse events (relative risk 1·3 (95 per cent c.i. 1· 1t o 1·6); P = 0·013). There were no significant differences between the groups for other outcomes. Conclusion: Honey-impregnated dressingsdid notsignificantlyimprovevenousulcerhealingat12 weeks compared with usual care. Registration number: ISRCTN 06161544 (http://www.controlled-trials.com).

http://www.manukahonning.no/uploads/3/9/6/3/39639435/2008_randomized_clinical_trial_of_honey-impregnated_dressings_for_venous_leg_ulcers.pdf

Andrew Jull

Papers

Honey as a topical treatment for wounds

Energy Expended Playing Video Console Games: An Opportunity to Increase Children’s Physical Activity?

Couch potatoes to jumping beans: A pilot study of the effect of active video games on physical activity in children

Pentoxifylline for treating venous leg ulcers

Randomized clinical trial of honey-impregnated dressings for venous leg ulcers