Compression asphyxia and other clinicopathological findings from the Hillsborough Stadium disaster.

Ninety-six people died following a crowd crush at the Hillsborough Football Stadium, Sheffield, UK in 1989. The cause of death in nearly all cases was compression asphyxia. The clinical and pathological features of deaths encountered in crowds are discussed with a particular focus on the Hillsborough disaster.

Healthcare system impacts of the 2017 Manchester Arena bombing: evidence from a national trauma registry patient case series and hospital performance data.

INTRODUCTION: In response to detonation of an improvised explosive device at the Manchester Arena on 22 May 2017, we aimed to use detailed information about injured patients flowing through hospital healthcare to objectively evaluate the preplanned responses of a regional trauma care system and to show how routinely collected hospital performance data can be used to assess impact on regional healthcare. METHODS: Data about injury severity, management and outcome for patients presenting to hospitals were collated using England's major trauma registry for 30 days following hospital attendance. System-wide data about hospital performance were collated by National Health Service England's North West Utilisation Management Unit and presented as Shewhart charts from 15 April 2017 to 25 June 2017. RESULTS: Detailed information was obtained on 153 patients (109 adults and 44 children) who attended hospital emergency departments after the incident. Within 6 hours, a network of 11 regional trauma care hospitals received a total of 138 patients (90%). For the whole patient cohort, median Injury Severity Score (ISS) was 1 (IQR 1-10) and median New ISS (NISS) was 2 (IQR 1-14). For the 75 patients (49%) attending a major trauma centre, median ISS was 7.5 (IQR 1-14) and NISS was 10 (IQR 3-22). Limb and torso body regions predominated when injuries were classified as major life threatening (Abbreviated Injury Scale>3). Ninety-three patients (61%) required hospital admission following emergency department management, with 21 (14%) requiring emergency damage control surgery and 24 (16%) requiring critical care. Three fatalities occurred during early resuscitative treatment and 150 (98%) survived to day 30. The increased system-wide hospital admissions and care activity was linked to increases in regional hospital care capacity through cancellations of elective surgery and increased community care. Consequently, there were sustained system-wide hospital service improvements over the following weeks. CONCLUSIONS: The systematic collation of injured patient and healthcare system data has provided an objective evaluation of a regional major incident plan and provided insight into healthcare system resilience. Hospital patient care data indicated that a prerehearsed patient dispersal plan at incident scene was implemented effectively.

The impact of a new exercise facility on physical activity at the community level: a non-randomized panel study in Japan.

BACKGROUND: Considering that building a sports facility is a major investment to promote population health, it is important to understand whether it is effective in increasing the level of physical activity (PA) in the community. This study examined the impact of building a new multipurpose exercise facility on community-level PA in Japan. METHODS: This non-randomised panel study compared two sites: an intervention site where a new exercise facility was built (opened after baseline data collection) and a control site where there was no such additional exercise facility. From each site, 3200 adult residents (aged 30-74 years) were randomly selected at baseline (2013) and at follow-up (2015). The number of participants retained for analysis was 845 at baseline and 924 at follow-up for the intervention site, and 821 at baseline and 1018 at follow-up for the control site. The outcomes were participants' self-reported PA, perceived availability of PA facilities, awareness of others being active, and willingness to engage in PA. We examined the interaction terms between the sites and time of measurement in regression analyses to examine whether the magnitude of change from baseline to follow-up differed between the two sites. RESULTS: The changes in the proportion of participants meeting the PA guideline and those engaging in moderate-to-vigorous intensity PA were not significantly different between the intervention and control sites. The intervention site had a greater increase in the proportion of participants who were aware of PA facilities from baseline to follow-up than in the control site. The odds ratio for awareness of others being active approached significance, suggesting that there was a tendency at the intervention site towards a greater increase in the proportion of participants who noticed physically active people. CONCLUSIONS: This study did not find community-level increases in PA after the construction of the exercise facility. However, a significant improvement in the awareness of PA facilities was observed in the intervention site. A sustained community-level effort to promote PA, possibly including social components, and a further tracking of residents' PA are needed to take a full advantage of the new exercise facility and to assess its long-term impact. TRIAL REGISTRATION: UMIN-CTR UMIN000034116 (retrospectively registered: 13 September 2018).

Neighborhood Physical Environment and Changes in Body Mass Index: Results From the Multi-Ethnic Study of Atherosclerosis.

Longitudinal associations between neighborhood characteristics and body mass index (BMI; weight (kg)/height (m)2) were assessed from 2000 to 2011 among 5,919 participants in the Multi-Ethnic Study of Atherosclerosis. The perceived availability of healthy food and walking environment were assessed via surveys, and 1-mile (1.6-km) densities of supermarkets, fruit-and-vegetable stores, and recreational facilities were obtained through a commercial database. Econometric fixed-effects models were used to estimate the association between within-person changes in neighborhood characteristics and within-person change in BMI. In fully adjusted models, a 1-standard-deviation increase in the healthy food environment index was associated with a 0.16-kg/m2 decrease in BMI (95% confidence interval (CI): -0.27, -0.06) among participants with obesity at baseline. A 1-standard-deviation increase in the physical activity environment index was associated with 0.13-kg/m2 (95% CI: -0.24, -0.02) and 0.14-kg/m2 (95% CI: -0.27, -0.01) decreases in BMI for participants who were overweight and obese at baseline, respectively. Paradoxically, increases in the physical activity index were associated with BMI increases in persons who were normal-weight at baseline. This study provides preliminary longitudinal evidence that favorable changes in neighborhood physical environments are related to BMI reductions in obese persons, who comprise a substantial proportion of the US population.

Shared use agreements and leisure time physical activity in North Carolina public schools.

Although increasing community access to public schools through shared use agreements (SUAs) has been a recommended strategy for promoting physical activity (PA) among national, state and local organizations, empirical evidence examining the efficacy of SUAs is limited. This study examined the degree of usage and production of PA among schools with shared use, and how variation in PA output is related to characteristics of the school, type of activity, facility type, and when activity occurs. Data were collected in 20 schools across North Carolina using System for Observing Play and Recreation in Communities (SOPARC) and Structured Physical Activity Surveys (SPAS) to assess PA in school athletic facilities during out of school time. Findings indicated that although schools had a policy of shared or open use, most facilities were empty during non-school hours. Hierarchal linear regression models also showed that formal programming was positively associated with both use and PA levels. Given the abundance of empty facilities, community groups in need of space to facilitate structured PA programs should pursue avenues of sharing facilities with public schools. Furthermore, to increase the efficacy of shared use, structured physical activity programs may be needed. Future studies are encouraged to further explore the effects of the specific types of shared use programs on PA production as well other aspects of the built environment surrounding schools.

Neighborhood Environments and Incident Hypertension in the Multi-Ethnic Study of Atherosclerosis.

We examined relationships between neighborhood physical and social environments and incidence of hypertension in a cohort of 3,382 adults at 6 sites in the United States over 10 years of follow-up (2000-2011), using data from the Multi-Ethnic Study of Atherosclerosis. The sample was aged 45-84 years (mean = 59 years) and free of clinical cardiovascular disease and hypertension at baseline. Of the participants, 51% were female, 44% white, 23% Hispanic, 21% black, and 13% Chinese-American; 39% of participants developed hypertension during an average of 7.2 years of follow-up. Cox models were used to estimate associations of time-varying cumulative average neighborhood features (survey-based healthy food availability, walking environment, social cohesion, safety, and geographic information system-based density of favorable food stores and recreational resources) with incident hypertension. After adjustment for individual and neighborhood-level covariates, a 1-standard-deviation increase in healthy food availability was associated with a 12% lower rate of hypertension (hazard ratio = 0.88, 95% confidence interval: 0.82, 0.95). Other neighborhood features were not related to incidence of hypertension. The neighborhood food environment is related to the risk of hypertension.

Associations between access to recreational physical activity facilities and body mass index in Scottish adults.

BACKGROUND: The aim of this country-wide study was to link individual health and behavioural data with area-level spatial data to examine whether the body mass index (BMI) of adults was associated with access to recreational physical activity (PA) facilities by different modes of transport (bus, car, walking, cycling) and the extent to which any associations were mediated by PA participation. METHODS: Data on individual objectively-measured BMI, PA (number of days of (a) ≥20 min of moderate-to-vigorous PA, and (b) ≥15 min of sport or exercise, in previous 4 weeks), and socio-demographic characteristics were obtained from a nationally representative sample of 6365 adults. The number of accessible PA facilities per 1,000 individuals in each small area (data zones) was obtained by mapping a representative list of all fixed PA facilities throughout mainland Scotland. A novel transport network was developed for the whole country, and routes on foot, by bike, by car and by bus from the weighted population centroid of each data zone to each facility were calculated. Separate multilevel models were fitted to examine associations between BMI and each of the 24 measures of accessibility of PA facilities and BMI, adjusting for age, gender, longstanding illness, car availability, social class, dietary quality and urban/rural classification. RESULTS: We found associations (p < 0.05) between BMI and 7 of the 24 accessibility measures, with mean BMI decreasing with increasing accessibility of facilities-for example, an estimated decrease of 0.015 BMI units per additional facility within a 20-min walk (p = 0.02). None of these accessibility measures were found to be associated with PA participation. CONCLUSIONS: Our national study has shown that some measures of the accessibility of PA facilities by different modes of transport (particularly by walking and cycling) were associated with BMI; but PA participation, as measured here, did not appear to play a part in this relationship. Understanding the multi-factorial environmental influences upon obesity is key to developing effective interventions to reduce it.

Weather sensitivity for zoo visitation in Toronto, Canada: a quantitative analysis of historical data.

Based on a case study of the Toronto Zoo (Canada), multivariate regression analysis, involving both climatic and social variables, was employed to assess the relationship between daily weather and visitation. Zoo visitation was most sensitive to weather variability during the shoulder season, followed by the off-season and, then, the peak season. Temperature was the most influential weather variable in relation to zoo visitation, followed by precipitation and, then, wind speed. The intensity and direction of the social and climatic variables varied between seasons. Temperatures exceeding 26 °C during the shoulder season and 28 °C during the peak season suggested a behavioural threshold associated with zoo visitation, with conditions becoming too warm for certain segments of the zoo visitor market, causing visitor numbers to decline. Even light amounts of precipitation caused average visitor numbers to decline by nearly 50 %. Increasing wind speeds also demonstrated a negative influence on zoo visitation.

The Effect of Men's Body Attitudes and Motivation for Gym Attendance.

Caudwell, KM and Keatley, DA. The effect of men's body attitudes and motivation for gym attendance. J Strength Cond Res 30(9): 2550-2556, 2016-The current study integrates men's body attitudes with implicitly and explicitly measured motivation to investigate the role of these factors in predicting gym attendance. Male participants (N = 99) who regularly attended a gym were recruited to participate in an online questionnaire. Participants completed implicit and explicit measures of motivation, explicitly measured men's body attitudes, and reported the average number of gym visits per week. Attitudes related to body fat and explicitly measured autonomous motivation significantly predicted typical gym attendance. Implicitly measured motivation significantly and negatively predicted gym attendance. Results indicate some support for a dual-systems account of gym attendance. Men's body attitudes and autonomous motivation influences gym attendance; however, implicitly measured motivation showed antagonistic effects. Although individuals may explicitly state their autonomous motivation for gym attendance, attendance may also be influenced at the explicit level. Health and fitness professionals may improve gym attendance by focusing on people's reasons for attending a gym, facilitating autonomous motivation in clients, and minimizing the influence of controlled reasons for exercise.

The Associations Between Access to Recreational Facilities and Adherence to the American Heart Association's Physical Activity Guidelines in US Adults.

Physical activity decreases the risk of long-term health consequences including cardiac diseases. According to the American Health Association (AHA), adults should perform at least 75 min of vigorous physical activity (PA) or 150 min of moderate PA per week to impact long-term health. Results of previous studies are varied and have yet to integrate perceived access to facilities with AHA PA guidelines. We investigated whether access to free or low-cost recreational facilities was associated with meeting the AHA PA guidelines. Methodology: This cross-sectional study utilized data extracted from the Family Life, Activity, Sun, Health, and Eating (FLASHE) database collected in 2017 (n = 1,750). The main exposure variable was access to free or low-cost recreational facilities. The main outcome variable was meeting the AHA guidelines of 150 min moderate PA or 75 min vigorous PA per week. Covariates included age, sex, level of education, overall health, BMI, ethnicity, hours of work per week, income, and time living at current address. Unadjusted and adjusted logistic regression analysis were used to calculate measures of odds ratio (OR) and corresponding 95% confidence interval (CI). Results: Of the 1,750 included participants, 61.7% (n = 1,079) reported to have access to recreational facilities. Of those with access to facilities, 69.9% met AHA PA guidelines while 30.4% did not. After adjusting for covariates, participants who reported access to recreational facilities were 42% more likely to meet AHA PA guidelines compared with participants who did not (adjusted OR 1.42; 95% CI 1.14-1.76). Secondary results suggest that healthier individuals were more likely to have met AHA PA guidelines. Conclusions: Having access to free or low-cost recreational facilities such as parks, walking trails, bike paths and courts was associated with meeting the AHA PA guidelines. Increasing prevalence and awareness of neighborhood recreational facilities could assist in access to these facilities and increase the ability of individuals to meet AHA PA guidelines. Future research should determine which types of recreational facilities impact physical activity strongest and discover methods of increasing their awareness.

Association of Limited In-Person Attendance in US National Football League and National Collegiate Athletic Association Games With County-Level COVID-19 Cases.

Importance: In 2020 and early 2021, the National Football League (NFL) and National Collegiate Athletic Association (NCAA) opted to host football games in stadiums across the country. The in-person attendance of games varied with time and from county to county. There is currently no evidence on whether limited in-person attendance of games is associated with COVID-19 case numbers on a county-level. Objective: To assess whether NFL and NCAA football games with limited in-person attendance were associated with increased COVID-19 cases in the counties they were held compared with a matched set of counties. Design, Setting, and Participants: In this time-series cross-sectional study, every county hosting NFL or NCAA games with in-person attendance (treated group) in 2020 and 2021 was matched with a county that that did not host a game on the corresponding day but had an identical game history for up to 14 days prior (control group). A standard matching method was used to further refine this matched set so that the treated and matched control counties had similar population size, nonpharmaceutical interventions in place, and COVID-19 trends. The association of hosting games with in-person attendance with COVID-19 cases was assessed using a difference-in-difference estimator. Data were analyzed from August 29 to December 28, 2020. Exposures: Hosting NFL or NCAA games. Main Outcomes and Measures: The main outcome was estimation of new COVID-19 cases per 100 000 residents at the county level reported up to 14 days after a game among counties with NFL and NCAA games with in-person attendance. Results: A total of 528 games with in-person attendance (101 NFL games [19.1%]; 427 NCAA games [80.9%]) were included. The matching algorithm returned 361 matching sets of counties. The median (interquartile range [IQR]) number of attendance for NFL games was 9949 (6000 to 13 797) people. The median number of attendance for NCAA games was not available, and attendance was recorded as a binary variable. The median (IQR) daily new COVID-19 cases in treatment group counties hosting games was 26.14 (10.77-50.25) cases per 100 000 residents on game day. The median (IQR) daily new COVID-19 cases in control group counties where no games were played was 24.11 (9.64-48.55) cases per 100 000 residents on game day. The treatment effect size ranged from -5.17 to 4.72, with a mean (SD) of 1.21 (2.67) cases per 100 000 residents, within the 14-day period in all counties hosting the games, and the daily treatment effect trend remained relatively steady during this period. Conclusions and Relevance: This cross-sectional study did not find a consistent increase in the daily COVID-19 cases per 100 000 residents in counties where NFL and NCAA games were held with limited in-person attendance. These findings suggest that NFL and NCAA football games hosted with limited in-person attendance were not associated with substantial risk for increased local COVID-19 cases.

Neighborhood environmental factors associated with leisure walking in adolescents.

OBJECTIVE To verify the associations of leisure walking with perceived and objective measures of neighborhood environmental factors stratified by gender and socioeconomic status (SES) in Brazilian adolescents. METHODS Cross-sectional study with a random sample of 1,130 high school students (47.3% girls; aged 14 to 20 years old) from Porto Alegre, Brazil. Leisure walking and SES were self-reported by the adolescents. Perceived environmental factors were assessed through Neighborhood Environment Walkability Scale for Youth (NEWS-Y). Objective measures were evaluated using Geographic Information Systems, with road network calculated around the adolescent's residential address, using 0.5km and 1.0km buffers. Data collection was carried out in 2017 and generalized linear regression models were used. RESULTS Leisure walking was positively associated with access to services (0.5 km buffers [Odds ratio (OR) = 2.22] 1.0 km buffers [OR = 2.17]) and lower distance to parks and squares (0.5 km [OR=2.80] 1.0 km [OR = 2.73]) in girls from low SES. Residential density (0.5 km [OR = 1.57] 1.0 km [OR = 1.54]) and walkability index (0.5 km [OR = 1.17] 1.0 km [OR = 1.20]) were associated with leisure walking in girls from middle SES. Boys from low SES showed an inverse association between crime safety and leisure walking (0.5 km [OR = 0.59] 1.0 km [OR = 0.63]). Neighborhood recreation facilities was positively associated with leisure walking in middle SES (0.5 km [OR = 1.55] 1.0 km [OR = 1.60]). Land use mix (0.5 km [OR = 1.81] 1.0 km [OR = 1.81]), neighborhood recreation facilities (0.5 km [OR = 2.32] 1.0 km [OR = 2.28]) and places for walking (0.5 km [OR=2.07] 1.0 km [OR=2.22]) were positively associated with leisure walking in high SES. CONCLUSION Environmental factors (objectively and subjectively measured) and leisure walking show association in boys and girls of different SES.

Objectively measured access to recreational destinations and leisure-time physical activity: Associations and demographic moderators in a six-country study.

Within the growing body of research linking neighbourhood environmental attributes with physical activity, associations between recreational destinations and non-walking leisure-time physical activity (LTPA) are rarely studied, and to date, not across multiple cities. We examined six potential associations of objectively-measured access to private recreational facilities (e.g., fitness centres, swimming pools) and parks with adults' non-walking LTPA (e.g., swimming, cycling, tennis), using data gathered with consistent methods from adults living in international cities with a range of environment attributes. The potential effects of socio-demographic moderators and between-city variations were also examined. Data from 6725 adults from 10 cities (6 countries) were gathered. Adults were more likely to engage in non-walking LTPA if they had a greater number of private recreational facilities within 0.5 or 1 km of the home, particularly in women, and if they lived closer to a park. The amount of non-zero LTPA was only associated (positively) with the number of recreational facilities within 1 km. Relationships between amount of LTPA and park proximity appear complex, with likely contextual and cultural differences. Improving access to private recreational facilities could promote non-walking LTPA, especially in women.

Public open spaces and physical activity: disparities of resources in Florianópolis.

OBJECTIVE: To analyze the association between sociodemographic characteristics of census tracts and the presence/quality of public open spaces and physical activity facilities. METHODS: A cross-sectional study was conducted in 643 census tracts in Florianópolis, Brazil, the presence and quality of public open spaces and physical activity facilities were objectively analyzed and the data by census tracts using Geographic Information Systems was treated. Outcomes were analyzed considering the census tracts as having: ≥ 1 public open spaces; ≥ 1 public open spaces with high quality; ≥ 2 physical activity facilities and high-quality physical activity facilities. Sociodemographic characteristics were the independent variables. Logistic regression analysis was performed. RESULTS: Census tracts with a medium-income (OR = 1.8; 95%CI 1.1-3.0) and high-income (OR = 2.4; 95%CI 1.4-4.0), in those with medium (OR = 1.7; 95%CI 1.0-2.7) and high residential density (OR = 2.0; 95%CI 1,2-3.3), and with higher proportions of older adults (OR = 3.3; 95%CI 1.9-5.7) had a higher proportion of public open spaces. Census tracts with higher proportions of children/adolescents (OR = 0.3; 95%CI 0.2-0.6) and non-white residents (OR= 0.6; 95%CI 0.3-0.9) were less likely to contain public open spaces. The tracts with medium (OR = 4.0; 95%CI 1.4-11.3) and high-income (OR = 3.6; 95%CI 1.2-10.2) were more likely to contain public open spaces with ≥ 2 structures for physical activity, compared with those with low-income. We observed the inverse in sectors with a high proportion of non-white residents (OR = 0.3; 95%CI 0.1-0.9). CONCLUSIONS: Census tracts with higher proportions of children or adolescents, non-white individuals and those in the low-income strata had lower odds of containing public open spaces and physical activity facilities.

Associations among Neighborhood Socioeconomic Deprivation, Physical Activity Facilities, and Physical Activity in Youth during the Transition from Childhood to Adolescence.

BACKGROUND: This study aims to examine the longitudinal association of neighborhood socioeconomic deprivation (SED) with physical activity in youth during the transition from elementary to middle school, and to determine if access to physical activity facilities moderates this relationship. METHODS: Data were obtained from the Transitions and Activity Changes in Kids (TRACK) study, which was a multilevel, longitudinal study designed to identify the factors that influence changes in physical activity as youth transition from elementary to middle school. The analytic sample for the current study included 660 youth with complete data in grades 5 (baseline) and 7 (follow-up). A repeated measures multilevel framework was employed to examine the relationship between SED and physical activity over time and the potential moderating role of elements of the built environment. RESULTS: Decreases in physical activity varied by the degree of neighborhood SED with youth residing in the most deprived neighborhoods experiencing the greatest declines in physical activity. Access to supportive physical activity facilities did not moderate this relationship. CONCLUSION: Future research studies are needed to better understand how neighborhood SED influences youth physical activity over time.

The Gillette Stadium Experience: A Retrospective Review of Mass Gathering Events From 2010 to 2015.

OBJECTIVE: Mass gathering events can substantially impact public safety. Analyzing patient presentation and transport rates at various mass gathering events can help inform staffing models and improve preparedness. METHODS: A retrospective review of all patients seeking medical attention across a variety of event types at a single venue with a capacity of 68,756 from January 2010 through September 2015. RESULTS: We examined 232 events with a total of 8,260,349 attendees generating 8157 medical contacts. Rates were 10 presentations and 1.6 transports per 10,000 attendees with a non-significant trend towards increased rates in postseason National Football League games. Concerts had significantly higher rates of presentation and transport than all other event types. Presenting concern varied significantly by event type and gender, and transport rate increased predictably with age. For cold weather events, transport rates increased at colder temperatures. Overall, on-site physicians did not impact rates. CONCLUSIONS: At a single venue hosting a variety of events across a 6-year period, we demonstrated significant variations in presentation and transport rates. Weather, gender, event type, and age all play important roles. Our analysis, while representative only of our specific venue, may be useful in developing response plans and staffing models for similar mass gathering venues. (Disaster Med Public Health Preparedness. 2018;12:752-758).

Polychlorinated biphenyls (PCBs) in recreational marina sediments of San Diego Bay, southern California.

Polychlorinated biphenyl (PCB) concentrations were determined in surface sediments from three recreational marinas in San Diego Bay, California. Total PCB concentrations ranged from 23 to 153, 31-294, and 151-1387ngg-1 for Shelter Island Yacht Basin (SIYB), Harbor Island West (HW) and Harbor Island East (HE), respectively. PCB concentrations were significantly higher in HE and PCB group composition differed relative to HW and SIYB, which were not significantly different from each other in concentration or group composition. In marina sediments there was a predominance (82-85%) of heavier molecular weight PCBs with homologous groups (6CL-7CL) comprising 59% of the total. In HE 75% of the sites exceeded the effect range median (ERM), and toxicity equivalence (TEQ dioxin-like PCBs) values were higher relative to those of HW and SIYB, suggesting a potential ecotoxicological risk.

Dietary Supplement Intake and Associated Factors Among Gym Users in a University Community.

Dietary supplement intake and associated factors among gym users in a university community in Sharjah, United Arab Emirates (UAE), were assessed using a structured, self-administered questionnaire in this cross-sectional study. Adults (N = 320) from five gyms in the University City of Sharjah participated in this cross-sectional study. The prevalence of dietary supplement intake was 43.8%. Statistically significant associations were found between the use of dietary supplements and sex (47.7% males, 28.1% females; p = .006), as well as weight lifting (88.6% taking supplements vs. 11.4% not taking supplements; p < .001), favoring male gym users. The reasons attributed to the use of dietary supplements varied between the sexes. Male exercisers used supplements to increase or maintain muscles mass, strength, and power and to boost exercise recovery. Females mainly used dietary supplements to increase energy, maintain their health, and prevent nutrition deficiency. Overall, protein supplements (whey proteins [48.6%] and protein powder [45.7%]) were among the most-consumed dietary supplements, followed by multivitamins (38.6%), branched-chain amino acids (36.4%), caffeine (35.0%), and creatine (29.3%). A widespread use of Internet-driven, self-prescribed dietary supplement intake was reported among gym users (60.7%). Only 12.8% of dietary supplement users sought information from dietitians. Practical implications suggest that gym instructors and coaches should be sufficiently trained to be able to provide accurate and scientifically sound information on dietary supplements to the exercisers in gyms in the university environment.

Quantification of pathogens and markers of fecal contamination during storm events along popular surfing beaches in San Diego, California.

Along southern California beaches, the concentrations of fecal indicator bacteria (FIB) used to quantify the potential presence of fecal contamination in coastal recreational waters have been previously documented to be higher during wet weather conditions (typically winter or spring) than those observed during summer dry weather conditions. FIB are used for management of recreational waters because measurement of the bacterial and viral pathogens that are the potential causes of illness in beachgoers exposed to stormwater can be expensive, time-consuming, and technically difficult. Here, we use droplet digital Polymerase Chain Reaction (digital PCR) and digital reverse transcriptase PCR (digital RT-PCR) assays for direct quantification of pathogenic viruses, pathogenic bacteria, and source-specific markers of fecal contamination in the stormwater discharges. We applied these assays across multiple storm events from two different watersheds that discharge to popular surfing beaches in San Diego, CA. Stormwater discharges had higher FIB concentrations as compared to proximal beaches, often by ten-fold or more during wet weather. Multiple lines of evidence indicated that the stormwater discharges contained human fecal contamination, despite the presence of separate storm sewer and sanitary sewer systems in both watersheds. Human fecal source markers (up to 100% of samples, 20-12440 HF183 copies per 100 ml) and human norovirus (up to 96% of samples, 25-495 NoV copies per 100 ml) were routinely detected in stormwater discharge samples. Potential bacterial pathogens were also detected and quantified: Campylobacter spp. (up to 100% of samples, 16-504 gene copies per 100 ml) and Salmonella (up to 25% of samples, 6-86 gene copies per 100 ml). Other viral human pathogens were also measured, but occurred at generally lower concentrations: adenovirus (detected in up to 22% of samples, 14-41 AdV copies per 100 ml); no enterovirus was detected in any stormwater discharge sample. Higher concentrations of avian source markers were noted in the stormwater discharge located immediately downstream of a large bird sanctuary along with increased Campylobacter concentrations and notably different Campylobacter species composition than the watershed that had no bird sanctuary. This study is one of the few to directly measure an array of important bacterial and viral pathogens in stormwater discharges to recreational beaches, and provides context for stormwater-based management of beaches during high risk wet-weather periods. Furthermore, the combination of culture-based and digital PCR-derived data is demonstrated to be valuable for assessing hydrographic relationships, considering delivery mechanisms, and providing foundational exposure information for risk assessment.

Relation of Adolescents' Physical Activity to After-School Recreation Environment.

BACKGROUND: The after-school period provides an opportune context for adolescent physical activity. This study examined how characteristics of after-school recreation environments related to adolescent physical activity. METHODS: Participants were 889 adolescents aged 12 to 17 (mean = 14.1, SD = 1.4) from 2 US regions. Adolescents reported on whether their school offered after-school supervised physical activity, access to play areas/fields, and presence of sports facilities. Outcomes were accelerometer-measured after-school physical activity, reported physical activity on school grounds during nonschool hours, attainment of 60 minutes of daily physical activity excluding school physical education, and BMI-for-age z-score. Mixed regression models adjusted for study design, region, sex, age, ethnicity, vehicles/licensed drivers in household, and distance to school. RESULTS: School environment variables were all significantly associated with self-reported physical activity on school grounds during non-school hours (P < .001) and attainment of 60 minutes of daily physical activity (P < .05). Adolescents' accelerometer-measured after-school physical activity was most strongly associated with access to supervised physical activity (P = .008). CONCLUSIONS: Policies and programs that provide supervised after-school physical activity and access to play areas, fields, and sports facilities may help adolescents achieve daily physical activity recommendations.