Development and validation of a scale to measure social isolation in adolescents.

There is a lack of questionnaires specifically designed to assess social isolation in adolescents. We developed and validated a self-report measure of social isolation in adolescents, the Social Isolation Questionnaire (QIS). A literature review on social isolation and mental health in adolescents indicated 20 questions to form QIS. Two cross-sectional surveys with 48 and 1135 adolescents, respectively, evaluated the reproducibility and validity of QIS. The Bland-Altman plot did not indicate a systematic difference between measurements 15 days apart. Bartlett's sphericity test verified a correlation between the questions and the Kaiser-Meyer-Olkin test showed good adequacy (.896) to the factor analysis. Exploratory factor analysis suggested the exclusion of three questions (loading factors <0.3), and eigenvalues (4.9-0.8) indicated that the questionnaire should be composed of three factors (dimensions). The Cronbach's alpha indicated high internal consistency of the 17 questions (0.850 overall; Dimensions: 0.815 'feeling of loneliness'; 0.760 'friendship'; and, 0.680 'Family support'). The QIS score ranged from 0 to 131 (maximum social isolation score). The correlation between QIS and depressive symptoms (r = .543) indicated the construct validity of QIS. We evaluated QIS in the Portuguese version, thus translation and cultural adaptation are necessary to evaluate the questionnaire in other settings. We constructed and validated the QIS questionnaire, a self-administered questionnaire to assess social isolation in adolescents, composed of three dimensions; feelings of loneliness, friendship and family support. The QIS questionnaire seems a very promising tool to support practitioners and researchers in assessing social isolation among adolescents.

The Longitudinal Association of Cardiorespiratory Fitness and Adiposity With Clustered Cardiometabolic Risk: A Mediation Analysis.

PURPOSE: Previous literature has demonstrated the mediating role of adiposity in the association between cardiorespiratory fitness (CRF) and cardiometabolic risk as well as the potential role of CRF in attenuating the adverse consequences associated with excess weight. This study aimed to evaluate the mediating role of CRF and adiposity in the possible association with cardiometabolic risk. METHOD: Observational 3-year longitudinal study that included 420 children and adolescents (10.50 [2.05] y of age at baseline; 56.2% girls). Body mass index (BMI) was calculated, and CRF was evaluated using field assessments. A clustered cardiometabolic risk score (cMetS) was calculated from glucose, systolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, and triglycerides z scores. Analyses evaluated the mediating role of BMI in the association between CRF and cMetS as well as whether CRF mediated the association between BMI and cMetS. RESULTS: BMI at baseline was directly associated with the cMetS at follow-up (0.102; 95% confidence interval, 0.020 to 0.181), independently of CRF, whereas CRF was only indirectly associated with cMetS at follow-up through BMI (-0.036; 95% confidence interval, -0.070 to -0.009), meaning that the association between CRF and cMetS was explained via the mediation role of BMI. CONCLUSIONS: BMI presented direct association with cMetS, whereas CRF exhibited indirect association with cMetS mediated via BMI.

Mediators of lifestyle intervention effects on neonatal adiposity: are we missing a piece of the puzzle?

We evaluated possible mediators underlying lifestyle intervention effects on neonatal adiposity, assessed with sum of skinfolds and cord blood leptin. This is a secondary analysis of the DALI study, a randomised controlled trial in nine European countries. Pregnant women with a pre-pregnancy body mass index of ≥29 kg/m2 were randomly assigned to counselling for healthy eating (HE), physical activity (PA), HE&PA combined, or to usual care. We considered five maternal metabolic factors at 24-28 and 35-37 weeks of gestation, and four cord blood factors as possible mediators of the effect of combined HE&PA counselling on neonatal adiposity. From all potential mediators, the intervention only affected cord blood non-esterified fatty acids (NEFA), which was higher in the HE&PA group compared to UC (0.068 (mmol/L), 95% CI: 0.004 to 0.133). Cord blood NEFA did not mediate the HE&PA intervention effects on neonatal sum of skinfolds or cord blood leptin, based on an indirect effect on skinfolds of 0.018 (mm), 95% CI: -0.217 to 0.253 and an indirect effect on leptin of -0.143 (µg/l), 95% CI: -0.560 to 0.273. The Dali study observed reductions in neonatal adiposity in pregnant women with obesity, but we were not able to identify the underlying metabolic pathway.

Universal school-based intervention targeting depressive symptoms in adolescents: A cluster randomized trial.

We investigated the effects of three different interventions on depressive symptoms in adolescents. As a secondary aim, we explored the mediating role of social isolation, anxiety, sleep quality, and cognitive function of the intervention effect on depressive symptoms. We conducted a cluster randomized controlled trial, in which schools were randomly assigned to 1. Doubling physical education (PE) classes (3:20 h of PE/week); 2. Workshop with the PE teachers; 3. Workshop with the PE teachers + Doubling PE classes; and 4. Control group (1:40 h of PE/week). In total, 1279 adolescents were included, 56.4% females. Doubling PE classes and the workshop with the PE teachers + Doubling PE classes groups did not affect depressive symptoms (-0.947, 95% CI -3.176 to 1.281; and, 0.726, 95% CI -1.558 to 3.009, respectively). The workshop with the PE teachers decreased adolescents' depressive symptoms (-2.495, 95% CI -4.668 to -0.323), social isolation (-4.759, 95% CI -9.025 to -0.493), and poor sleep quality (-0.560, 95% CI -1.108 to -0.012) compared with the control group. Social isolation mediated 32% of the workshop effect on depressive symptoms. The workshop with the PE teachers and the workshop with the PE teachers + Doubling PE classes groups lowered in 93% and in 54% the risk of the adolescents in developing high depressive symptomatology compared with the control group, respectively. A workshop updating PE teachers on pedagogical and health-related topics decreased depressive symptoms in adolescents. Moreover, improvements in the adolescents' social isolation mediated the effect of PE teachers' workshop intervention on the depressive symptoms in adolescents.

The causal pathway effects of a physical activity intervention on adiposity in children: The KISS Study cluster randomized clinical trial.

BACKGROUND: Very little information on the potential mechanisms of the physical activity interventions effects on adiposity is available. We evaluated the possible mediating factors of a physical activity school-based intervention on the sum of skinfolds in children. METHODS: This is a cluster randomized trial, secondary analysis of the KISS study. Children (n = 499) from the first and fifth grades were randomly assigned to intervention or control group. Adiposity was estimated by four skinfolds, aerobic fitness assessed by the shuttle run test, and insulin, triglycerides, total cholesterol, high-density lipoprotein (HDL), and glucose collected via fasting blood samples. RESULTS: The intervention affected aerobic fitness (0.140 SD, 95% CI 0.011 to 0.270), triglycerides (0.217 SD, 95% CI -0.409 to -0.025), cholesterol/HDL ratio (-0.191 SD, 95% CI -0.334 to -0.047), glucose (-0.330 SD, 95% CI -0.538 to -0.121), and skinfolds (-0.122 SD, 95% CI -0.189 to -0.056). No intervention effect on insulin was found. We observed that changes in aerobic fitness impacted children's triglycerides and cholesterol/HDL ratio and consecutively the glucose levels mediating 30% of the intervention effect on skinfolds. CONCLUSIONS: Our findings provided evidence of the positive metabolic distress caused by a physical activity intervention on adiposity levels in children.

Three times as much physical education reduced the risk of children being overweight or obese after 5 years.

AIM: We evaluated the effect that increasing physical education lessons from 1.5 to 4.5 hours per week for 5 years had on the body mass index (BMI) and waist circumferences of children aged 5-11 years at inclusion. METHODS: From 2008 to 2013, six intervention schools in Svendborg, Denmark, delivered 4.5 hours of physical education lessons per week to 750 children. Meanwhile, four matched control schools gave 549 children the standard 1.5 hours of physical education lessons per week. Measurements were taken at baseline and yearly for 5 years. Of the 1299 children, 81 joined the schools after 2008. RESULTS: At baseline, the percentage of overweight children was 12% in the intervention schools and 13% in the control schools, whereas 15% and 19% were abdominal obese, respectively. After 5 years, the respective risks of remaining abdominal obese or overweight were 43% and 51% in the intervention schools and 78% and 84% in the control schools. Mean BMI increased 0.450 kg/m2 more in the control group over the five-year period. The intervention was not effective in decreasing the average waist circumference. CONCLUSION: Three times as much physical education lessons per week, for 5 years, effectively decreased BMI and the likelihood of remaining overweight or obese.

Association between body mass index, physical activity and motor competence in children: moderation analysis by different environmental contexts.

BACKGROUND: Although the association between body mass index (BMI), physical activity (PA) and motor competence (MC) has been widely investigated, the influence of different environmental contexts is not well defined. AIM: To analyse the relationship between BMI, PA and MC and the moderating role of the environmental context. SUBJECTS AND METHODS: A cross-sectional study was performed with 668 children (318 boys) aged 5-7 years (north-eastern district - Brazil). MC (Körper koordination test fur Kinder; KTK), BMI and PA (parent reporting) were assessed. To classify three contexts of the environment a variable was created based on the presence of a sports court in school and/or environment for play or sports practice out of school. Multilevel mixed-effects linear regressions, interaction test and estimation of coefficients in moderation analysis were used. RESULTS: BMI (ß = -2.93; p < .01) and age (ß = 19.02; p < .01) were associated, and PA was not associated (ß = 0.07; p = .05) with MC. The strength of the association between BMI and MC changed based on the environmental contexts. The better the environment context the weaker the association between BMI and MC (ß = -2.93, p < .01 to ß = -2.38, p = .33 to ß = 0.26, p = .94). CONCLUSIONS: The association between BMI and MC is moderated by environmental contexts.

Reciprocal longitudinal relationship between dental fear and oral health in schoolchildren.

BACKGROUND: No longitudinal study has evaluated the mutual relationship between dental fear and oral health in the same investigation. AIM: To evaluate the reciprocal longitudinal relationship between dental fear and oral health in schoolchildren. DESIGN: This longitudinal study monitored 416 Brazilian children aged 5-7 years of age at baseline for 2 years. The decayed, filled and missing teeth were clinically assessed for each child. Dental fear was evaluated by Dental Anxiety Question. Multilevel mixed-effects linear and logistic regressions analysed the reciprocal relationship between dental fear and oral health. RESULTS: Children with caries experience had 1.8 times higher odds of dental fear compared to children who were caries free. The presence of a carious tooth increased the odds of dental fear by 1.2 times. Children with dental fear had 0.46 additional carious tooth; an additional 0.22 tooth indicated for extraction; and a 0.67 higher caries experience score compared to children without dental fear. CONCLUSIONS: We observed a reciprocal relationship between dental fear and poor oral health. Both parents and dentists should provide realistic information for the children, discouraging biased negative expectations regarding dental treatment. Ultimately, the child would acquire positive perceptions of the dental environment, reducing their phobia and consequently improving oral health.

Influence of a 2- to 6-year physical education intervention on scholastic performance: The CHAMPS study-DK.

The aim of this study was to investigate the influence of a school-based intervention with a tripling of physical education (PE) lessons from two (90 minutes) to six lessons per week (270 minutes) on scholastic performance. This study is part of the CHAMPS study-DK, a quasi-experimental study that began in 2008. The intervention group consisted of six schools, and the control group consisted of four matched schools (mean age at baseline=8.4 years, kindergarten class fourth grade). Academic performance was extracted from the national test system from 2010 to 2014 (Math and Danish were measured at third and sixth, and second, fourth and sixth grades, respectively). Participants included 1888 students participating in at least one scholastic performance test. Linear mixed models were applied to test for differences between groups and adjusted for known confounders. No significant differences were observed between groups in the academic performance tests (control group reference); Danish second grade ß=-1.34 (95% CI -9.90, 7.22), fourth grade ß=0.22 (95% CI -6.12, 6.56), sixth grade ß=1.03 (95% CI -5.02, 7.08), and all grades combined ß=0.28 (95% CI -5.74, 6.31) and Math third grade ß=-2.87 (95% CI -9.65, 3.90), sixth grade ß=0.99 (95% CI -7.36, 9.34) and combined ß=-1.20 (95% CI -8.10, 5.71). In conclusion, no significant differences were observed between intervention and control schools for scholastic performance. Importantly, there were no negative effects of additional PE on scholastic outcomes, despite more PE and longer school days for intervention children.

Physical Fitness Is Longitudinally Associated With Academic Performance During Childhood and Adolescence, and Waist Circumference Mediated the Relationship.

PURPOSE: The current investigation aimed to investigate the longitudinal association between physical fitness and academic performance over 3 years in adolescents. A secondary aim was to determine to what extent waist circumference mediated the association between physical fitness and academic performance. METHODS: For the current study, 1020 students from first grade [mean age: 7.87 (0.34) y] to fifth grade [mean age: 11.87 (0.37) y] were monitored annually for 3 years (2010-2013). Physical fitness was assessed using the Andersen test, 5 × 5-m shuttle run, jump height, and grip strength tests and by constructing a composite score combining all 4 fitness tests. Academic performance was assessed by national standardized tests in Danish language and math. Generalized structural equation modeling was used to evaluate the relationships between these variables. RESULTS: The Andersen test (standardized ß = 0.15 SD), shuttle run (ß = -0.18 SD), jump height (ß = 0.10 SD), and the fitness composite score (ß = 0.23 SD) were positively associated with academic performance over 3 years. In addition, waist circumference partially mediated the association between physical fitness and academic performance. CONCLUSION: Thus, physical fitness abilities should be stimulated during childhood and early adolescence because of their positive association with academic performance.

Predictors of dental anxiety in Brazilian 5-7years old children.

OBJECTIVES: The aim of this study was to analyze the predictors of dental anxiety in 5 to 7-year-old children in a two years follow-up. MATERIALS AND METHODS: This is a longitudinal study conducted with 784 children with 5 to 7years old. A face-to-face interview was conducted with the parents. The Dental Anxiety Question (DAQ) answers were categorized as presence or absence of dental anxiety. The possible predictor factors analyzed were: related to the children (age, sex, parentage, childbirth, physical activity, body satisfaction, psychological well-being, physical well-being, dentist visit); and related to the parents or guardians (excessive alcohol consumption, smoke, family income, number of children). Forward stepwise logistic binary regression was performed for the multivariate analysis. The analysis was controlled by gender. RESULTS: The prevalence of dental anxiety was 17.4%. Children in lower family income had 2.3 (95% CI: 1.3-4.0) greater chance to report high dental anxiety in comparison to children in higher family income. Similarly, children's parents who reported lower psychological well-being had 1.5 (95% CI: 1.0-3.0) greater chance to report high dental anxiety in comparison to children's parents with higher psychological well-being. CONCLUSIONS: The prevalence of dental anxiety was high, and the family income and psychological well-being were inversely associated to dental anxiety in children. CLINICAL RELEVANCE: Knowing the dental anxiety predictors could help the pediatric dentist to analyze and understand who is more susceptible to develop dental anxiety. An adequate approach, a trust relationship could be built, improving the oral health conditions and reducing the need of treatment in children.

Cross-Lagged Associations between Physical Activity, Motor Performance, and Academic Skills in Primary School Children.

PURPOSE: Few longitudinal studies have investigated the interwoven longitudinal dynamics between physical activity (PA), motor performance, and academic skills in middle childhood. Therefore, we investigated the cross-lagged associations between PA, motor performance, and academic skills from grade 1 to grade 3 in Finnish primary school children. METHODS: A total of 189 children 6-9 yr old at baseline comprised the study sample. Total PA was assessed using a questionnaire filled out by parents, moderate-to-vigorous PA by combined heart rate and body movement monitor, motor performance by 10 × 5-m shuttle run test, and academic skills by arithmetic fluency and reading comprehension tests in grade 1 and grade 3. Data were analyzed using structural equation modeling adjusted for gender, parental education, and household income. RESULTS: The final model fitted the data very well ( χ237 = 68.516, P = 0.0012, root-mean-square error of approximation = 0.067, comparative fit index = 0.95, Tucker-Lewis Index = 0.89) and explained 91% of variance in the latent academic skills variable, 41% of the variance in the latent PA variable, and 32% of variance in motor performance in grade 3. Better motor performance in grade 1 was associated with higher academic skills in grade 3, but it did not predict PA. PA was not directly or indirectly associated with academic skills. However, higher levels of PA in grade 1 predicted better motor performance in grade 3. Academic skills did not predict PA or motor performance. CONCLUSIONS: These results suggest that better motor performance, but not PA, predicts later academic skills. Academic skills in grade 1 do not contribute to PA or motor performance in the early school years.

The stability of cardiometabolic risk factors clustering in children and adolescents: a 2-year longitudinal study.

Objective: The present study aims to verify the odds of remaining with the clustering of 3 or more, 4 or more, and 5 or more risk factors across a 2-year time span. Methods: Observational longitudinal study that included 358 children and adolescents (10.96 ± 2.28 years of age at baseline). Cardiorespiratory fitness, glucose, systolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, triglycerides, and waist circumference were assessed. The number of children in whom the risk factors were not independently distributed was analyzed. Odds ratios of presenting n risk factors clustered at follow-up according to the number of risk factors observed at baseline were calculated. Results: More participants than expected were found presenting clustering of 4 or more and 5 or more risk factors at both baseline (11.7% and 5.6%, respectively) and follow-up (9.5% and 5.6%, respectively). The odds ratios calculated demonstrated that the odds of presenting the same number of risk factors clustered or more at follow-up increased according to the number of risk factors clustered at baseline. Conclusion: The higher the number of risk factors a child had at baseline, the higher the odds of presenting the same number of risk factors or more after two years of follow-up. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-022-01174-1.

The Role of Adiposity in the Association Between Physical Activity and Blood Pressure in Children.

Purpose: To analyze whether body adiposity mediates and/or moderates the association between time in moderate-to-vigorous physical activities (MVPA) and blood pressure in children. Methods: This was a cross-sectional study of 577 children aged 5 to 7 years old. MVPA was measured by accelerometry. Body mass index (BMI), waist circumference (WC), and the sum of tricipital and subscapular skinfolds (skinfolds) assessed children's body adiposity. Systolic (SBP) and diastolic blood pressure (DBP) were used as the dependent variables. Results: In the primary analysis adjusting for BMI or skinfolds measures, additional time in MVPA was associated with higher SBP. On the other hand, further analyses showed that children in the largest BMI tertile (ßSBP:0.18; 95%CI: 0.12-0.24; ßDBP:0.11; 95%CI: 0.05-0.17), waist circumference (ßSBP:0.16; CI: 0.09-0.22; ßDBP:0.08; CI:0.02-0.14), or sum of skinfolds (ßSBP:0.18; CI: 0.11-0.24; ßDBP:0.09; CI: 0.03-0.16) presented a positive relationship between MVPA and blood pressure whereas no positive association was observed for children in the first and second adiposity tertiles. Adiposity also mediated the association between MVPA and blood pressure. A decrease of 0.03 mmHg in the systolic blood pressure was observed by decreasing the sum of skinfolds for each additional minute per day in MVPA. A decrease in diastolic blood pressure of 0.02 mmHg was observed for each additional minute per day in MVPA, which was related to a negative association between time in MVPA and waist circumference and sum of skinfolds. Conclusion: Not accounting for the potential moderation and mediation role of adiposity may lead to misinterpretations in the MVPA and blood pressure relationship.

Determinants of Cognitive Performance in Children and Adolescents: A Populational Longitudinal Study.

We evaluated the determinants of cognitive performance in children and adolescents. This is a longitudinal study, secondary analysis of the Physical Activity and Nutrition in Children (PANIC) study. We assessed 502 children (51.6% girls) at middle childhood (range: 6.6 to 9.0 years), at late childhood, 437 children (51.0% girls, range: 8.8 to 11.2 years), and in 277 adolescents (54.5% girls, range: 15.0 to 17.4 years). Raven's progressive matrices tests estimated the participants' cognitive performance (outcome variable) at all time points. In total, we evaluated 29 factors from various dimensions (prenatal, neonatal, child fitness, lifestyle and anthropometrics). None of the neonatal and anthropometric parameters were associated with cognitive performance. Preeclampsia (prenatal) and listening to music, writing, arts and craft and watching TV (lifestyle) were negatively associated with cognitive performance. Shuttle run and box and block tests (fitness), and playing music, reading and time at the computer (lifestyle) were positive determinants of cognitive performance in children and adolescents. Fitness and lifestyle factors during childhood and adolescence diminished the importance of prenatal factors on cognitive performance and lifestyle factors were especially relevant in regard to cognitive performance. Reading was positively associated with cognitive performance, regardless of age and time dedicated, and should be promoted.

Study protocol of EMPOWER: A cluster randomized trial of a multimodal eHealth intervention for promoting mental health in the workplace following a stepped wedge trial design.

Objective: This article describes the EMPOWER study, a controlled trial aiming to determine the effectiveness and cost-effectiveness of an eHealth intervention to prevent common health problems and reduce presenteeism and absenteeism in the workplace. Intervention: The EMPOWER intervention spans universal, secondary and tertiary prevention and consists of an eHealth platform delivered via a website and a smartphone app designed to guide employees throughout different modules according to their specific profiles. Design: A stepped-wedge cluster randomized trial will be implemented in four countries (Finland, Poland, Spain and UK) with employees from small and medium enterprises (SMEs) and public agencies. Companies will be randomly allocated in one of three groups with different times at which the intervention is implemented. The intervention will last 7 weeks. Employees will answer several questionnaires at baseline, pre- and post-intervention and follow-up. Outcome measures: The main outcome is presenteeism. Secondary outcomes include depression, anxiety, insomnia, stress levels, wellbeing and absenteeism. Analyses will be conducted at the individual level using the intention-to-treat approach and mixed models. Additional analyses will evaluate the intervention effects according to gender, country or type of company. Cost-effectiveness and cost-utility analyses [based on the use of quality-adjusted life-years (QALYS)] will consider a societal, employers' and employees' perspective.

A Novel Monitoring System (AUT FIT) for Anthropometrics and Physical Fitness in Primary School Children in Austria: A Cross-Sectional Pilot Study.

Monitoring of anthropometric and physical fitness parameters in primary school children is important for the prevention of future health problems. Many of the existing test batteries that are useful for monitoring require expensive test materials, specialized test administrators, and a lot of space. This limits the usefulness of such tests for widespread use. The aim of this pilot study was to design and evaluate monitoring tools for anthropometrics and physical fitness tests in primary schools, called AUT FIT. The test battery consists of height, weight, and waist circumference measurement and eight fitness tests (6 min run, V sit-and-reach, jumping sideways, standing long jump, medicine ball throw, 4 × 10 m shuttle run, ruler drop, single leg stand). Data of 821 children aged 7 to 10 years were gathered. Most AUT FIT tests showed excellent test-retest and interrater reliability and were easy to implement. Criterion-related validity was evident by a strong correlation between physical education teacher rankings and rank scores for motor fitness. Nationwide implementation in the Austrian school system could be an important component for monitoring and improving the health and fitness of primary school children.

Cardiometabolic risk factors in children and adolescents from southern Brazil: comparison to international reference values.

OBJECTIVES: To compare cardiometabolic risk factors of Brazilian children and adolescents with international reference values. Cardiometabolic risk factors constitute the Metabolic Syndrome, whose evaluation is important to assess pediatric populations' health and potential to experience metabolic disorders. METHODS: Cross-sectional study that included 2,250 randomly selected children and adolescents (55.6% girls), aged 6 to 17. Cardiometabolic parameters (body mass index [BMI], waist circumference [WC], systolic and diastolic blood pressures [SBP and DBP], total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], TC:HDL-C ratio, triglycerides [TG], glucose and peak oxygen uptake [VO2peak]), and clustered risk scores were compared to international age- and sex-specific reference values. A clustered risk score was calculated by summing the WC, glucose, SBP, TG, and the TC:HDL-C ratio Z-scores divided by five. A second clustered was calculated including VO2peak (inverted) Z-score, but divided by six. RESULTS: The clustered risk score, considering the all ages sample, was better in the Brazilian boys (-0.20 [-0.41;0.01] and -0.18 [-0.37;0.01], including or not VO2peak, respectively) but not significantly, and worse in girls (0.24 [0.05;0.43] and 0.28 [0.11;0.44], including or not VO2peak, respectively) than the international reference. Additionally, Brazilian youth had a statistically better profile in TC, LDL-C, HDL-C, TC:HDL-C ratio, and VO2peak (only girls) as well as a worse profile in BMI, WC, SBP, DBP, TG (only girls), and VO2peak (only boys). CONCLUSIONS: The clustered cardiometabolic risk score (including or not VO2peak), considering the all ages sample, was better in the Brazilian boys, but not significantly, and worse in girls compared to the international reference.

Constructs of poor sleep quality in adolescents: associated factors.

This study aims to evaluate factors associated with sleep quality (overall and by domains) in adolescents. A cross-sectional study. This study was conducted with 1,296 first-year high school students from public schools in the Northern Region of the State of Pernambuco, Brazil. Demographic, socioeconomic, and behavioral data were obtained with a questionnaire. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) Body mass index (BMI) was calculated based on the ratio of weight and height squared. Multilevel linear and logistic regressions evaluated factors associated with sleep quality. We observed 53% of adolescents reported poor sleep quality. Adolescents at higher risk of clinical depression were 3.45 times more likely to have poor sleep quality (95%CI: 2.04; 5.81), and each additional unit in the social anxiety score presented 1.03 (95%CI: 1.01; 1.05) higher odds of adolescents having poor sleep quality. Adolescents with depressive symptoms had higher sleep latency, greater sleep disturbance, and greater daytime sleep dysfunction. Social anxiety was associated with sleep latency, sleep disturbance, and daytime sleep dysfunction. Higher risk of clinical depression was associated with all domains related to sleep quality. Negative health perception was associated with sleep disturbance, and physical inactivity was associated with daytime sleep dysfunction. Social anxiety and especially higher risk of clinical depression were determinants of poor sleep quality. Changes in sleep latency, sleep disturbance and daytime sleep dysfunction seems to be relevant to poor sleep quality.

Depressive symptoms in older adults: the role of physical activity and social support.

OBJECTIVE: To evaluate the role of social support in the association between physical activity (PA) in its various domains and depressive symptoms in older adults. METHODS: This was a cross-sectional study involving 399 older adults seen at basic health units in the municipality of Recife, state of Pernambuco, northeastern Brazil. Linear regression was implemented using the forward method to assess the association between PA and its domains and depressive symptoms, as well as to test the possible moderating component of social support in this association. RESULTS: Of the total sample, 17.6% reported not practicing PA; 6.7% presented depressive symptoms, with a mean score of 1.59 points. A total of 18.6% of the older adults assessed reported not having social support. Older adults who did not practice total, transportation or domestic PA showed increased scores of depressive symptoms when compared to older adults who practiced PA in these domains. Older adults with social support also had fewer depressive symptoms. Practicing domestic, leisure and total PA, and/or having social support, decreased depressive symptoms in older adults. Having social support or practicing PA decreased depressive symptoms in older adults in a similar way. CONCLUSIONS: Older adults with social support and who practiced PA, especially domestic and total PA, presented the lowest scores of depressive symptoms. The data showed the importance of providing elements to strengthen social support and PA practice in older adults living in poor communities as a strategy to prevent and reduce depressive symptoms.