The Structured Days Hypothesis (SDH) posits that children's behaviors associated with obesity - such as physical activity - are more favorable on days that contain more 'structure' (i.e., a ...pre-planned, segmented, and adult-supervised environment) such as school weekdays, compared to days with less structure, such as weekend days. The purpose of this study was to compare children's moderate-to-vigorous physical activity (MVPA) levels on weekdays versus weekend days using a large, multi-country, accelerometer-measured physical activity dataset.
Data were received from the International Children's Accelerometer Database (ICAD) July 2019. The ICAD inclusion criteria for a valid day of wear, only non-intervention data (e.g., baseline intervention data), children with at least 1 weekday and 1 weekend day, and ICAD studies with data collected exclusively during school months, were included for analyses. Mixed effects models accounting for the nested nature of the data (i.e., days within children) assessed MVPA minutes per day (min/day MVPA) differences between weekdays and weekend days by region/country, adjusted for age, sex, and total wear time. Separate meta-analytical models explored differences by age and country/region for sex and child weight-status.
Valid data from 15 studies representing 5794 children (61% female, 10.7 ± 2.1 yrs., 24% with overweight/obesity) and 35,263 days of valid accelerometer data from 5 distinct countries/regions were used. Boys and girls accumulated 12.6 min/day (95% CI: 9.0, 16.2) and 9.4 min/day (95% CI: 7.2, 11.6) more MVPA on weekdays versus weekend days, respectively. Children from mainland Europe had the largest differences (17.1 min/day more MVPA on weekdays versus weekend days, 95% CI: 15.3, 19.0) compared to the other countries/regions. Children who were classified as overweight/obese or normal weight/underweight accumulated 9.5 min/day (95% CI: 6.9, 12.2) and 10.9 min/day (95% CI: 8.3, 13.5) of additional MVPA on weekdays versus weekend days, respectively.
Children from multiple countries/regions accumulated significantly more MVPA on weekdays versus weekend days during school months. This finding aligns with the SDH and warrants future intervention studies to prioritize less-structured days, such as weekend days, and to consider providing opportunities for all children to access additional opportunities to be active.
Structured settings, such as school, childcare, afterschool programs, summer camps, and physical activity/sport programs are crucial to promoting physical activity (PA) opportunities and reducing ...sedentary (ST) for children and adolescents. However, little is known about how much PA and ST children and adolescents accumulate in structured settings. The aim of this study is to conduct a systematic review and meta-analysis of the absolute amount of time youth spend physically active and sedentary in different structured settings (Prospero number: 42018111804).
Observational and experimental/quasi-experimental studies (baseline data only) with full-text available, written in English and published in a peer-reviewed journal, reporting the total amount of objectively measured PA (light, moderate, vigorous, and/or total physical activity) and/or time spent ST during structured settings among youth (3 to 18 years) were eligible. Adjusted meta-analysis was conducted to estimate the pooled mean of time spent in PA and ST, by settings and sex.
A total of 187 studies (childcare n=60; school n=91; afterschool programs n=14; summer camp n=4; and Physical activity/ sport programs n=18) from 30 countries (47.9% United States), representing 74,870 youth (mean age 8.6 years old) were included. Overall, there was a high variation between studies in outcomes and settings. The meta-analyses revealed, on average, youth spend 221.8 minutes (36.7 min/hour) in ST and 32.1 minutes (5.1 min/hour) in MVPA during childcare hours, and 223.9 minutes (36.7min/hour) in ST and 27.8 min (4.4 min/hour) in MVPA at school. Relatively, youth are engaged in more MVPA in afterschool programs (11.7 min/hour), PA/ sport programs (20.9 min/hour), and summer camps (6.4 min/hour), when compared to childcare and school.
Total PA accumulated during childcare and MVPA accumulated during schools hours were close to recommendations, despite high proportion of ST. Afterschool programs, summer camp and PA/ sport programs are important settings that can contribute to daily PA and reduced ST. Ensuring all youth have access to these structured settings may be an important step forward for public health.
Objectives
To identify patterns of non-dietary obesogenic behaviors, and social and environmental factors associated with overweight and obesity (OWOB).
Methods
A representative sample (
n
= 5520) ...of high school students (55.4% girls, 16.3 ± 1.0 years) from Pernambuco State, Brazil. Latent profile analyses were performed using self-reported daily sleep duration, television use, computer use, videogame use, seated time during the week and weekend days, physical activity, and active commuting to school during the week. Social and environmental factors and body mass index were included to identify classes. Multinomial analysis explored differences in social, environmental factors, and BMI by classes.
Results
Five patterns were identified Computer users (C1), Short sleepers (C2), Typical behaviors (C3), Techno-active-gamers (C4), and Lower screen engagement (C5). Three groups (C1, C3 and C4) included students from better social conditions and a more urbanized environments. The prevalence of OWOB was higher in C1 (34.5%; 95% CI 31.1–38.0) and in C2 (29.7%; 95% CI 26.1–33.5) compared to C5 (23.3% 95% CI 21.3–25.3).
Conclusions
In one of the poorest regions of Brazil, different groups of social/environmental factors and behavior patterns emerged associated with OWOB.
Evidence from a limited sample of countries indicates that time for physical education and recess during school have declined. Schools are called to provide children with 30 minutes of moderate to ...vigorous physical activity (MVPA). This systematic review and meta-analysis estimated temporal trends in children's school day MVPA.
Three online databases were searched to identify studies with objectively measured MVPA, during school hours, in school aged children (5-18 y). Multilevel random-effects meta-analyses estimated MVPA by year, and meta-regression analyses estimated temporal trends in school day MVPA.
Studies (N = 65) providing 171 MVPA estimates, representing 60,779 unique children, from 32 countries, and spanning 2003-2019 were identified. Most studies were conducted in North America (n = 33) or Europe (n = 21). School day MVPA ranged from 18.1 (95% confidence interval, 15.1-21.1) to 47.1 (95% confidence interval, 39.4-54.8) minutes per day in any given year. Meta-regression analyses indicated that MVPA declined from 2003 to 2010 (approximately 15 min decline), plateaued from 2010 to 2015 (approximately 1 min decrease), and increased from 2015 to 2019 (approximately 5 min increase).
School day MVPA decreased from 2003 to 2010 and has recently begun to increase. However, the majority of the evidence is from North America and Europe with some evidence from Oceania and very little evidence from Asia to South America.
Premise of research. Salvia is one of the most species-rich genera in the world. Its outstanding diversity and subcosmopolitan distribution have prevented the preparation of a modern comprehensive ...monograph and reevaluation of its classification. As phylogenetic efforts advance to untangle the evolutionary relationships of Salvia, the need for a solid taxonomic footing is increasingly imperative. Accordingly, we present an updated checklist of the species richness and distribution of Salvia subg. Calosphace, which constitutes more than half of the diversity of the genus.
Methodology. A preliminary checklist of the species of Salvia subg. Calosphace was compiled through examination of the literature and online databases; this was revised and discussed by the authors in order to retrieve a consensus list. The distribution of each species by country or territory as well as by biome was also recorded from the sources consulted; affinities in composition were visualized with the unweighted pair group method with arithmetic mean based on a dissimilarity matrix (Sørensen’s index).
Pivotal results. Salvia subg. Calosphace comprises 580 species; 30 were qualified as unresolved and require further analysis. The countries with the highest species richness are Mexico (295 spp.), Peru (77 spp.), Colombia (60 spp.), Brazil (58 spp.), Guatemala (49 spp.), and Ecuador (41 spp.). The affinity in species composition between countries and between biomes is explained mainly by geographical proximity.
Conclusions. The updated list of the species of Salvia subg. Calosphace will help to guide sampling for phylogenetic analyses, enabling the achievement of a more stable and solid phylogenetic hypothesis. At the same time, it is a potentially important tool for underpinning discussions toward a new sectional classification of the lineage.
From September 2005 to March 2007, 238 individuals being vaccinated for the first time with the yellow fever (YF) -17DD vaccine were enrolled in a cohort established in Recife, Brazil. A prospective ...study indicated that, after immunization, anti-YF immunoglobulin M (IgM) and anti-YF IgG were present in 70.6% (IgM) and 98.3% (IgG) of the vaccinated subjects. All vaccinees developed protective immunity, which was detected by the plaque reduction neutralization test (PRNT) with a geometric mean titer of 892. Of the 238 individuals, 86.6% had IgG antibodies to dengue virus; however, the presence of anti-dengue IgG did not interfere significantly with the development of anti-YF neutralizing antibodies. In a separate retrospective study of individuals immunized with the 17DD vaccine, the PRNT values at 5 and 10 years post-vaccination remained positive but showed a significant decrease in neutralization titer (25% with PRNT titers < 100 after 5 years and 35% after 10 years).
From 2004 to 2006, 658 patients with suspected dengue virus infections were enrolled in a clinical dengue cohort established in Recife, Pernambuco, located at the northeastern region of Brazil. A ...total of 2,364 blood samples were collected, and serum, plasma, and cells were cryopreserved. Among the suspected cases, 354 (54%) were confirmed as acute DENV-3 infection based on reverse transcription-polymerase chain reaction, virus isolation, and ELISA-IgM. According to WHO criteria, 29.4% of the positive acute cases were classified as dengue fever (DF) and 8.2% of the cases as dengue hemorrhagic fever (DHF), grade 1 or 2. The DHF cases represent 100% of those confirmed in Recife during the period of the study. The dengue cases that did not fulfill the definition of either DHF or DF were classified as DF complicated and accounted for 44.0% of the cases. All the acute cases were classified as either primary or secondary acute dengue virus infections. Secondary infection was predominant in patients with DF; however, there was no predominance of either primary or secondary infections in patients with DHF.
Acute Respiratory Distress Syndrome (ADRS) due to coronavirus disease 2019 (COVID-19) has been associated with muscle fatigue, corticospinal pathways dysfunction, and mortality. High-Definition ...transcranial Direct Current Stimulation (HD-tDCS) may be used to attenuate clinical impairment in these patients. The HD-RECOVERY randomized clinical trial was conducted to evaluate the efficacy and safety of HD-tDCS with respiratory rehabilitation in patients with moderate to severe ARDS due to COVID-19.
Fifty-six critically ill patients were randomized 1:1 to active (n = 28) or sham (n = 28) HD-tDCS (twice a day, 30-min, 3-mA) plus respiratory rehabilitation for up to 10 days or until intensive care unit discharge. The primary outcome was ventilator-free days during the first 28 days, defined as the number of days free from mechanical ventilation. Furthermore, secondary outcomes such as delirium, organ failure, hospital length of stay and adverse effects were investigated.
Active HD-tDCS induced more ventilator-free days compared to sham HD-tDCS. Patients in the active group vs in the sham group experienced lower organ dysfunction, delirium, and length of stay rates over time. In addition, positive clinical response was higher in the active vs sham group. There was no significant difference in the prespecified secondary outcomes at 5 days. Adverse events were similar between groups.
Among patients with COVID-19 and moderate to severe ARDS, use of active HD-tDCS compared with sham HD-tDCS plus respiratory rehabilitation resulted in a statistically significant increase in the number of ventilator-free days over 28 days. HD-tDCS combined with concurrent rehabilitation therapy is a safe, feasible, potentially add-on intervention, and further trials should examine HD-tDCS efficacy in a larger sample of patients with COVID-19 and severe hypoxemia.
•High-definition transcranial direct current stimulation as add-on therapy in severe patients with COVID-19 is proposed.•HD-tDCS increases the number of days alive and free of mechanical ventilation over 28 days.•Modulations include clinical response and delirium improvement and no serious adverse effects.
A single-dose dengue vaccine that protects individuals across a wide age range and regardless of dengue serostatus is an unmet need. We assessed the safety and efficacy of the live, attenuated, ...tetravalent Butantan-dengue vaccine (Butantan-DV) in adults, adolescents, and children. We previously reported the primary and secondary efficacy and safety endpoints in the initial 2 years of follow-up. Here we report the results through an extended follow-up period, with an average of 3·7 years of follow-up.
In this double-blind, randomised, placebo-controlled, phase 3, multicentre trial in Brazil, healthy participants (aged 2–59 years) who had not previously received a dengue vaccine were enrolled and randomly assigned 2:1 (stratified by age 18–59 years, 7–17 years, and 2–6 years) using a central electronic randomisation system to receive 0·5 mL of Butantan-DV (containing approximately 103 plaque-forming units of each of the four vaccine virus strains) or placebo, administered subcutaneously. Syringes containing vaccine or placebo were prepared by an unmasked trial pharmacist who was not involved in any subsequent participant assessments; other site staff and the participants remained unaware of the group allocations. Vaccine efficacy was calculated with the accrual of virologically confirmed dengue (VCD) cases (by RT-PCR) at least 28 days after vaccination up until the cutoff (at least 2 years of follow-up from the last participant enrolled). The primary endpoint was vaccine efficacy against VCD after day 28 by any dengue virus (DENV) serotype regardless of dengue serostatus at baseline in the per-protocol population. The primary and secondary safety endpoints up until day 21 were previously reported; secondary safety endpoints include the frequency of unsolicited vaccine-related adverse events after day 22. Safety analyses were done on all participants as treated. This trial is registered with ClinicalTrials.gov (NCT02406729) and is ongoing.
Of 16 363 participants assessed for eligibility, 16 235 were randomly assigned between Feb 22, 2016, and July 5, 2019, and received single-dose Butantan-DV (10 259 participants) or placebo (5976 participants). 16 162 participants (Butantan-DV n=10 215; placebo n=5947) were included in the per-protocol population and 16 235 (Butantan-DV n=10 259; placebo n=5976) in the safety population. At the data cutoff (July 13, 2021), participants had 2–5 years of follow-up (mean 3·7 years SD 1·0, median 4·0 years IQR 3·2–4·5). 356 VCD cases were captured through the follow-up (128 in the vaccine group and 228 in the placebo group). Vaccine efficacy against VCD caused by any DENV serotype was 67·3% (95% CI 59·4–73·9); cases caused by DENV-3 or DENV-4 were not observed. The proportions of participants who had serious adverse events were similar between treatment groups (637 6·2% in the vaccine group and 395 6·6% in the placebo group) up until the cutoff.
A single dose of Butantan-DV was generally well tolerated and efficacious against symptomatic VCD (caused by DENV-1 and DENV-2) for a mean of 3·7 years. These findings support the continued development of Butantan-DV to prevent dengue disease in children, adolescents, and adults regardless of dengue serostatus.
Instituto Butantan and Merck Sharp & Dohme LLC, a subsidiary of Merck & Co.
For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.
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