The impact of pharmacological and non-pharmacological interventions on physical health outcomes in people with mood disorders across the lifespan: An umbrella review of the evidence from randomised controlled trials.

OBJECTIVE: People with mood disorders have increased risk of comorbid medical diseases versus the general population. It is paramount to identify interventions to improve physical health in this population. METHODS: Umbrella review of meta-analyses of randomised controlled trials (RCTs) on pharmacological/non-pharmacological interventions for physical health outcomes/intolerability-related discontinuation in mood disorders (any age). RESULTS: Ninety-seven meta-analyses were included. Among youths, against placebo, in depression, antidepressants/antipsychotics had higher discontinuation rates; in bipolar depression, olanzapine+fluoxetine worsened total cholesterol (TC)/triglycerides/weight gain (WG) (large ES). In adults with bipolar disorder, olanzapine worsened HbA1c/TC/WG (moderate/large ES); asenapine increased fasting glucose (small ES); quetiapine/cariprazine/risperidone induced WG (small/moderate ES). In bipolar depression, lurasidone was metabolically neutral. In depression, psychological interventions improved physical health-related quality of life (PHQoL) (small ES), fasting glucose/HbA1c (medium/large ES); SSRIs improved fasting glucose/HbA1c, readmission for coronary disease, pain (small ES); quetiapine/aripiprazole/olanzapine induced WG (small to large ES). Exercise improved cardiorespiratory fitness (moderate ES). In the elderly, fluoxetine yielded more detrimental cardiovascular effects than sertraline/escitalopram (large ES); antidepressants were neutral on exercise tolerance and PHQoL. In mixed age groups, in bipolar disorder aripiprazole was metabolically neutral; in depression, SSRIs lowered blood pressure versus placebo and serotonin-noradrenaline reuptake inhibitors (small ES); brexpiprazole augmentation caused WG and was less tolerated (small ES); exercise improved PHQoL (moderate ES). CONCLUSIONS: Some interventions (psychological therapies, exercise and SSRIs) improve certain physical health outcomes in mood disorders, few are neutral, but various pharmacological interventions are associated with negative effects. Evidence from this umbrella review has limitations, should consider evidence from other disorders and should be integrated with recent evidence from individual RCTs, and observational evidence. Effective treatments with either beneficial or physically neutral profiles should be prioritized.

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.

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.

[Trends in suicide rates in Brazil from 2011 to 2020: special focus on the COVID-19 pandemicTendencia de las tasas de suicidio en Brasil, 2011-2020, con especial atención a la pandemia de COVID-19]. / Tendência de suicídio no Brasil de 2011 a 2020: foco especial na pandemia de covid-19.

Objective: To describe the trends in suicide rates in Brazil from 2011 to 2020 and determine whether these rates are associated with COVID-19 pandemic-related variables. Method: This ecological time series study analyzed mortality from suicide with a focus on 2020, the first year of the COVID-19 pandemic. The suicide mortality rate per 100,000 population was the primary outcome. The trends in suicide rates were estimated using generalized Prais-Winsten regression. An autoregressive integrated moving average (ARIMA) model was used to predict suicide rates in 2020. The association between suicide rates and death rates from COVID-19, unemployment, receiving emergency financial aid, and rates of social distancing was investigated. Results: From 2011 to 2020, 115 469 deaths by suicide were recorded in Brazil (60.5 deaths/100 000 population). The suicide rate in 2020 was 6.68/100 000 population. An increasing trend in suicide rates was observed from 2011 to 2020 in both sexes, with annual percent change of 0.23 (95%CI: 0.141; 0.322) in women; and 1.19 (95%CI: 0.714; 1.810) in men. Mortality by suicide increased in all regions, with the highest increase recorded in the South. There was no evidence of increase in deaths by suicide in relation to the expected number during the first year of the COVID-19 pandemic. Conclusions: Suicide rates increased for both sexes and in all Brazilian states. In the first pandemic year, the number of deaths by suicide did not increase in relation to the expected number, with a stability trend during the months of 2020.

Objetivo: Describir la tendencia de las tasas de suicidio en Brasil durante el período 2011-2020 y determinar su asociación con las variables relacionadas con la pandemia de COVID-19. Métodos: En este estudio ecológico y de serie temporal se analizó la mortalidad por suicidio, en particular en el 2020, el primer año de la pandemia de COVID-19. El resultado principal fue la tasa de mortalidad por suicidio por 100.000 habitantes. La tendencia de las tasas de suicidio se calculó mediante una regresión generalizada de Prais-Winsten y para el pronóstico correspondiente al 2020 se utilizó el modelo autorregresivo integrado de promedio móvil (ARIMA). Se investigó la asociación entre las tasas de suicidio y las tasas de muerte por COVID-19, el desempleo, el recibir ayuda económica de emergencia y las tasas de distanciamiento social. Resultados: En el período 2011-2020, se registraron 115.469 suicidios en Brasil (60,5 muertes por 100.000 habitantes). La tasa de suicidio en el 2020 fue de 6,68 por 100.000 habitantes. Se observó un aumento en la tendencia de las tasas de suicidio en las personas de ambos sexos en el período 2011-2020, con una variación anual porcentual de 0,23 (IC 95%: 0,141; 0,322) en las mujeres y de 1,19 (IC 95%: 0,714; 1,810) en los hombres. La mortalidad por suicidio aumentó en todas las regiones y la mayor tasa se registró en la región sur. No hubo evidencia de una intensificación del número de casos de suicidio con respecto a lo previsto en el primer año de la pandemia de COVID-19. Conclusiones: Las tasas de suicidio de personas de ambos sexos aumentaron en todos los estados de Brasil. En el primer año de la pandemia no se observó ningún aumento en comparación con la tasa prevista y la tendencia se mantuvo estable durante el transcurso del 2020.

Acculturation and 4-year caries increment among children of foreign-born mothers in Sweden: a register-based cohort study.

BACKGROUND: To study the association of maternal age upon arrival and length of residence in Sweden with the 4-year caries increment in their children between ages 3 and 7 years in relation to the human development index (HDI) of the maternal country of origin. METHOD: This registry-based cohort study included all children born in 2000-2003 who resided in Stockholm County, Sweden, at age 3 years and who were followed up at age 7 (n = 63,931). Negative binomial regressions were used to analyze different models adjusted for sociodemographic factors. RESULTS: Children of foreign-born mothers, regardless of the HDI of the maternal country of origin, had a higher risk of caries increment between ages 3 and 7 years than children of Swedish-born mothers. Furthermore, children of mothers who had arrived from a low or medium HDI country had a lower caries increment if their mothers arrived before age 7 compared with after age 7. Nearly half (44%) of the children whose mothers arrived in Sweden at age ≥ 20 years from a low HDI country had a caries increment compared to 22% of the children whose mothers had arrived in Sweden before 7 years of age. Furthermore, children whose mothers were born in a low HDI country and had resided in Sweden ≤ 19 years had approximately 1.5 times higher risk of caries increment compared to children of mothers who had resided in Sweden for more than 20 years. CONCLUSIONS: Caries increment in the children of foreign-born mothers was associated with the age of their mother when she arrived in Sweden and was lower when the mother had arrived before age 7 years. This indicates an intergenerational effect that carries over to the children and is greater the longer the mother has participated in Swedish dental healthcare.

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.

U-shaped association between maternal age at delivery and dental caries in offspring.

OBJECTIVE: To determine the association between maternal age at delivery and caries in offspring. MATERIALS AND METHODS: This registry-based cohort study included all children born between 2000 and 2003 and who were residing in Stockholm County, Sweden, at 7 years of age. Between 2007 and 2010, the cohort (n = 65,259) was examined to determine caries experience (deft scores) at 7 years of age. Age of mother at childbirth was retrieved from the patient histories. Data were analysed using linear regressions. RESULTS: The lowest mean deft occurred in children born to mothers aged 25-34 years. The final model - adjusted for sex, income, educational level, migration background, family situation, smoking, obesity, small for gestational age, and number of siblings - found that young mothers and older mothers were significant risk indicators for caries experience at 7 years of age. CONCLUSIONS: The present study found a U-shaped relationship between maternal age at childbirth and caries experience in the offspring at age 7 years. The offspring of mothers under 25 or over 34 years of age are at greater risk of having more teeth with caries experience.

Adverse birth outcomes and the risk of dental caries at age 3 years.

BACKGROUND: Since birth outcome is associated with maternal and newborn health, it can be a predictor of the future health of the child. AIM: To investigate the association between adverse birth outcomes and dental caries. DESIGN: The present registry-based cohort study included all children born in 2000-2003, residing in Stockholm County, Sweden and who received a dental examination at the age of 3 years (n = 74 748). National registries supplied data on socioeconomic conditions, maternal health, maternal health behavior, and birth outcomes. Forward stepwise binary logistic regression was performed to determine predictors of caries experience in the 3-year-olds. RESULTS: Of the subjects, 6.0% had caries experience (decayed, extracted, and filled teeth [deft] ≥ 1), 5.6% were born preterm (<37 weeks); 2.2% were born small (SGA) and 3.7% large (LGA) for gestational age. Of the studied adverse birth outcomes, only SGA was significantly associated with caries experience at 3 years of age, and only for mothers who had refrained from smoking during pregnancy. CONCLUSIONS: SGA is associated with caries experience in 3-year-old children; however, this relationship occurs only in mothers who did not smoke during pregnancy.

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.

Intraoperative and immediate postoperative transfusion: Clinical-hematological profile of transfunded patients in a university hospital.

INTRODUCTION: The transfusion practice by surgery blood reserve, varied among services, must be performed through the rational and restrictive use of blood components because it is a scarce and expensive resource for health care services. OBJECTIVE: Analyze the use of blood products for surgery blood reserve by means of the study of the clinical-hematological profile of patients submitted to intraoperative and immediate postoperative transfusions. METHODS: This was an observational, cross-sectional, and retrospective study, conducted by collecting biological, operational, and laboratory variables, involving 680 patients at a university hospital who had elective surgery with surgery blood reserve request sent during the period from October 2021 to October 2022. RESULTS: The overall transfusion rate was 25.44%, and the mean preoperative hemoglobin level of transfused patients was 9.74 ± 2.50 g/dL, with the mean number of transfusions packed red blood cell units was 1.58 ± 0.77. Patients with higher preoperative hemoglobin levels were less likely to have transfusion (p < 0.001) and patients who had surgical oncologic were more likely to require transfusion (p = 0.048). The transfusion rate of packed red blood cells and platelets concentrates, compared to what was requested, was 15.86% and 5.82%. CONCLUSION: There is a tendency of transfusions to follow restrictive models, with higher transfusion probability in surgical oncologic. Furthermore, there should be more a conscise use of the surgery blood reserves request.

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.

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.

Violence and psychosocial stress: A 10-year time trend analysis.

AIM: The aim of this study was to analyze the temporal trend of psychosocial stress and its association between exposure to violence in adolescents. METHODS: This is a cross-sectional study of temporal trends based on three school-based and statewide surveys with regular intervals of five years. The target population consisted of high school students from public schools. A total of 4,207 adolescents were evaluated in 2006, 6,264 in 2011, and 6,002 in 2016. The psychosocial stress indicator was the dependent study variable and was analyzed according to questions: a) Feeling of loneliness; b) Feeling of sadness; c) Difficulty sleeping due to worry; d) Number of close friends; e) Suicide ideation. Exposure variables were exposure to physical violence, involvement in fights and bullying. Logistic and linear regressions were used to verify the temporal trend of psychosocial stress, and to analyze the association between exposure of violence and psychosocial stress. RESULTS: Regardless of gender, the psychosocial stress score increasing trend between 2006 and 2016. The girls showed a variation in the feeling of loneliness from 18.7% to 22.8%, and suicide ideation increased from 10.4% to 14.2% between 2006 and 2016. All types of violence were associated with greater psychosocial stress for both boys and girls. CONCLUSION: Adolescents had a higher prevalence of feelings of loneliness, difficulty sleeping due to worry and suicide ideation during the period from 2006 to 2016, regardless of gender. Exposure to violence is associated with psychosocial stress in both genders, however, the strongest associations occurred in girls.

Risk and protective factors for mental disorders with onset in childhood/adolescence: An umbrella review of published meta-analyses of observational longitudinal studies.

The patho-etiology of mental disorders with onset in childhood or adolescence remains largely unknown. We conducted an umbrella review of meta-analyses (MAs) on environmental factors associated with mental disorders with onset in childhood/adolescence. We searched Pubmed-MEDLINE/EMBASE/PsycInfo databases, last search April 29th, 2020. Quality of MAs was measured with AMSTAR-2. Out of 6851 initial references, ten articles met inclusion criteria, providing 23 associations between 12 potential environmental factors and nine disorders (cases: 8884; N = 3,660,670). While almost half of the associations were nominally significant, none of them met criteria from either convincing or highly suggestive evidence. A single association was supported by suggestive evidence (maternal exposure to lithium or antipsychotics with neuromotor deficits), but it was affected by confounding by indication. Ten more associations had weak evidence, and 12 associations were not statistically significant. Quality of meta-analyses was rated as high in two, moderate in one, low in four, critically low in two, and not pertinent in one (individual participant data). Methodologically-sound research is needed in this field.

Effects of a Physical Education Intervention on Academic Performance: A Cluster Randomised Controlled Trial.

BACKGROUND: We investigated the effects of three different interventions on academic performance in students enrolled in the first year of high school. METHODS: This was a cluster randomised controlled trial conducted with 1200 students enrolled in the first year of high school. 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 and doubling the PE classes; and 4. control group (1:40 h of PE/week). We assured that the schools within the groups were equal regarding: The structural condition of the sports court; number of PE teachers; number of school classes; and the average number of students per classroom. RESULTS: Overall, the intervention was not effective in improving the students' academic performance. However, the subgroup analysis showed that the workshop intervention group increased the academic performance of students who had failed an academic year (from 16 years of age), compared to their peers in the doubling the PE classes (1.3 points on average) and the control groups (1.4 points on average). CONCLUSIONS: Enhancing the pedagogical skills of the teachers is a promising approach in improving the academic performance of students who failed an academic year.

[Perception of barriers and facilitators for users to participate in physical activity programs]. / Percepção de barreiras e facilitadores dos usuários para participação em programas de promoção da atividade física.

In Brazil, physical activity is a priority area in health promotion in the Brazilian Unified National Health System (SUS). The study aims to describe users' profiles and the barriers and facilitators in basic healthcare for participation in programs to promote physical activity. This was a statewide cross-sectional study in municipalities (counties) in Pernambuco State. Between 2 and 21 individuals were interviewed per municipality, using a previous tested instrument, validated in the following dimensions: sociodemographic; health status; participation; information on the program; reasons for participation; facilitators; barriers; and preference of activities. Descriptive and inferential analyses (chi-square) were performed. The sample consisted of 1,153 users, 35.9% of whom between 41-59 years of age; 90.1% lived in urban areas; 58.2% had participated in physical activities for at least a year. Weekly frequency of 3-4 days was 44.9%, and 71.1% practiced activities of an hour or more. The results showed that 40% of the barriers to participation in physical activity programs and 77.5% of the facilitators belonged to the intrapersonal domain. The most prevalent barrier was "current health condition" and the facilitator was the desire "to be healthier". Women perceived more barriers than men. The conclusion is that barriers and facilitators from the intrapersonal domain, related to health, are the main factors involved in users' engagement and retention in programs and interventions to promote physical activity, developed in basic healthcare services in the state of Pernambuco.

No Brasil, a atividade física é eixo prioritário das ações de promoção da saúde no Sistema Único de Saúde (SUS). O presente estudo tem como objetivo descrever o perfil dos usuários, as barreiras e os facilitadores para participação em programas para promoção de atividades físicas na atenção básica à saúde. Trata-se de um estudo transversal com abrangência estadual realizado nos municípios de Pernambuco. Foram entrevistados de 2 a 21 indivíduos, por município, por meio de instrumento previamente testado e validado nas dimensões: sociodemográfica; estado de saúde; participação; informações sobre o programa; motivos de participação; facilitadores para a prática; barreiras para a prática e preferência de atividades. Foram realizadas análises descritivas e inferenciais (qui-quadrado). A amostra foi de 1.153 usuários, sendo 35,9% com idade entre 41-59 anos; 90,1% residentes em áreas urbanas; 58,2% dos usuários participavam das atividades há, pelo menos, um ano. A frequência semanal de 3-4 dias foi de 44,9%, e 71,1% praticavam atividades de uma hora ou mais. Observou-se que 40% das barreiras para a participação nos programas de atividade física e 77,5% dos facilitadores relatados foram de domínio intrapessoal. A barreira mais prevalente foi "condição atual de saúde", e o facilitador foi "ter uma condição melhor de saúde". As mulheres percebem mais barreiras do que os homens. Conclui-se que as barreiras e os facilitadores de domínio intrapessoal, relacionados com a saúde, são os fatores envolvidos na manutenção e no engajamento dos usuários dos programas e intervenções para promoção da atividade física desenvolvidos pela atenção básica à saúde do Estado de Pernambuco.

En Brasil, la actividad física es el eje prioritario de las acciones de promoción de la salud en el Sistema Único de Salud (SUS). El presente estudio tiene como objetivo describir el perfil de los usuarios, barreras y facilitadores para la participación en programas de promoción de actividades físicas en la atención básica de la salud. Se trata de un estudio transversal con alcance estatal, realizado en los municipios de Pernambuco. Se entrevistaron de 2 a 21 individuos, por municipio, mediante un instrumento previamente testado y validado en las siguientes dimensiones: sociodemográfica; estado de salud; participación; información sobre el programa; motivos de participación; facilitadores para la práctica; barreras para la práctica y preferencia de actividades. Se realizaron análisis descriptivos e inferenciales (chi-cuadrado). La muestra fue de 1.153 usuarios, un 35,9% con una edad comprendida entre los 41-59 años; un 90,1% residentes en áreas urbanas; un 58,2% de los usuarios participaban en actividades desde hacía por lo menos un año. La frecuencia semanal de 3-4 días fue de 44,9%, y un 71,1% practicaban actividades de una hora o más. Se observó que el 40% de las barreras para la participación en los programas de actividad física, y un 77,5% de los facilitadores relatados, fueron de dominio intrapersonal. La barrera más prevalente fue "estado actual de salud" y el facilitador fue "tener un estado mejor de salud". Las mujeres perciben más barreras que los hombres. Se concluye que las barreras y los facilitares de dominio intrapersonal, relacionados con la salud, son los factores implicados en el mantenimiento e implicación de los usuarios en los programas e intervenciones para la promoción de la actividad física, desarrollados por la atención básica a la salud del estado de Pernambuco.

The synergic relationship between social anxiety, depressive symptoms, poor sleep quality and body fatness in adolescents.

BACKGROUND: The aim of the current study was to evaluate the cross-sectional synergic relationship among social anxiety, poor sleep quality, depressive symptoms and body fatness. METHODS: A cross-sectional study was performed with 1,242 adolescents from a north-eastern district in Brazil. It was used the Social Anxiety Scale for Adolescents for symptoms of social anxiety, the Pittsburgh Sleep Quality Index for sleep quality and the Depression Scale of the Center for Epidemiologic Studies for depressive symptoms. Body fatness was the sum of triceps and subscapular skinfolds. Structural equation modelling was used to evaluate associations among these comorbidities. RESULTS: Social anxiety was directly and positively associated with depressive symptoms, poor sleep quality and body fatness (ß = 0.316 standard deviations [SD]; ß = 0.299 SD; ß = 0.072 SD, respectively). Moreover, social anxiety was indirectly associated with depressive symptoms via poor sleep quality (ß = 0.113 SD). Poor sleep quality was directly associated with depressive symptoms (ß = 0.377 SD). We did not observe a significant relationship of poor sleep quality and depressive symptoms with body fatness. LIMITATIONS: This is a cross-sectional study; therefore, we cannot infer causality in the interpretation of the findings. CONCLUSIONS: Social anxiety seemed to play pivotal role in adolescents' health, since it was associated with poor sleep quality, depressive symptoms and body fatness. Interventions targeting sleep quality, depressive symptoms and body fatness in adolescents should designate relevant effort addressing social anxiety.

Moving More and Sitting Less as Healthy Lifestyle Behaviors are Protective Factors for Insomnia, Depression, and Anxiety Among Adolescents During the COVID-19 Pandemic.

PURPOSE: This study aimed to investigate associations of physical activity time (PAT) and sitting time (ST) independently and jointly with insomnia, depressive and anxiety symptoms among Chinese adolescents in the context of COVID-19. METHODS: A cross-sectional study including 965 adolescents (mean age = 15.26, SD = 0.46) was conducted in May 2020. PAT, ST and the symptoms of insomnia, depression and anxiety were assessed with the International Physical Activity Questionnaire Short Form, the Youth Self-Rating Insomnia Scales, the 9-item Patient Health Questionnaire and the Generalized Anxiety Disorder scale via an online survey platform. Logistic regression was used to analyze the association between COVID-19-related fear, PAT, ST and combinations of PAT and ST with insomnia, depressive and anxiety symptoms. RESULTS: COVID-19-related fear was associated with higher odds of insomnia, depressive and anxiety symptoms. PAT was associated with lower odds of insomnia and depressive symptoms, while ST was associated with higher odds of these three symptoms. After combining PAT and ST, the group with both low PAT and high ST was set as the referent. For insomnia, groups with low ST reported significantly lower odds of symptoms. For depression, groups with high PAT and/or low ST reported lower odds of symptoms. Regarding anxiety, only the group with both high PAT and low ST reported lower odds of symptoms. Generally, group with both high PAT and low ST reported lower odds of the three symptoms than the referent. CONCLUSION: COVID-19-related fear was a risk factor for developing insomnia, depressive and anxiety symptoms among Chinese adolescents. Fortunately, moving more and sitting less were good for sleep and mental health in Chinese adolescents during the pandemic. Educators should help adolescents to be more physically active in their daily life in the primary prevention of adolescent insomnia, depression and anxiety.