Global, regional, and national trends and patterns in physical activity research since 1950: a systematic review.

BACKGROUND: National, regional and global scientific production and research capacity for physical activity - PA may contribute to improving public health PA policies and programs. There is an uneven distribution of research productivity by region and country income group, where countries with the highest burden of non-communicable diseases attributable to physical inactivity having low research productivity. A first step towards improving global research capacity is to objectively quantify patterns, trends, and gaps in PA research. This study describes national, regional and global trends and patterns of PA research from 1950 to 2019. METHODS: A systematic review using searches in PubMed, SCOPUS and ISI Web of Knowledge databases was conducted in August 2017 and updated between January and May 2020. The review was registered at the PROSPERO database number CRD42017070153. PA publications per 100,000 inhabitants per country was the main variable of interest. Descriptive and time-trend analyses were conducted in STATA version 16.0. RESULTS: The search retrieved 555,468 articles of which 75,756 were duplicates, leaving 479,712 eligible articles. After reviewing inclusion and exclusion criteria, 23,860 were eligible for data extraction. Eighty-one percent of countries (n = 176) had at least one PA publication. The overall worldwide publication rate in the PA field was 0.46 articles per 100,000 inhabitants. Europe had the highest rate (1.44 articles per 100,000 inhabitants) and South East Asia had the lowest (0.04 articles per 100,000 inhabitants). A more than a 50-fold difference in publications per 100,000 inhabitants was identified between high and low-income countries. The least productive and poorest regions have rates resembling previous decades of the most productive and the richest. CONCLUSION: This study showed an increasing number of publications over the last 60 years with a growing number of disciplines and research methods over time. However, striking inequities were revealed and the knowledge gap across geographic regions and by country income groups was substantial over time. The need for regular global surveillance of PA research, particularly in countries with the largest data gaps is clear. A focus on the public health impact and global equity of research will be an important contribution to making the world more active.

Reduction of chronic malnutrition for infants in Bogotá, Colombia.

BACKGROUND: According to the 2015 National Survey of the Nutritional Situation in Colombia the prevalence of stunting in children under 5 years of age was 10.8%. In terms of region, Bogotá, presented the highest prevalence rate (13%), a figure that exceeded national records. With the collaboration of local and national government, and nongovernmental it was decided to develop a pilot study involving a public health intervention with residents of Bogotá under 1 year of age with nutritional classification by anthropometry compatible with stunting risk or stunting. METHODS: Pre-experimental, before and after study that sought to determine the magnitude of the change in nutritional status through a 10 months public health nutrition intervention in children under one-year-old residing in 3 prioritized territories of Bogotá. RESULTS: The intervention comprised 1126 children living in the following territories in Bogotá: Kennedy, San Cristóbal, and Engativá. A total of 43.3% children presented delay in height for age, and 56.7% presented risk of short stature. In the final measurement, data were obtained from 686 children, identifying that 17% of the children progressed from stunting to a stunting risk and that 4.5% recovered their growth trajectory, achieving an adequate length for their age. CONCLUSION: That children classified as at risk or stunting at the beginning of the intervention showed an increased probability of approaching or being in the appropriate growth trajectory according to the length-for-age indicator after the intervention.

National physical activity and sedentary behaviour policies in 76 countries: availability, comprehensiveness, implementation, and effectiveness.

BACKGROUND: Evidence on current, national physical activity (PA) and sedentary behaviour (SB) policies is limited. We, therefore, analysed availability, comprehensiveness, implementation, and effectiveness of PA and SB policies internationally. METHODS: In this cross-sectional study, Global Observatory for Physical Activity (GoPA!) Country Contacts from 173 countries were asked to provide data on their national PA and SB policies by completing GoPA! Policy Inventory. Data were collected for 76 countries (response rate = 44%). RESULTS: Formal written policies for PA and SB were found in 92% (95% confidence interval [CI]: 86, 98) and 62% (95% CI: 50, 75) of countries, respectively. Sixty-two percent (95% CI: 51, 73) of countries have national PA guidelines, while 40% (95% CI: 29, 52) have SB guidelines. Fifty-two (95% CI: 40, 64) and 11% (95% CI: 3, 19) of countries have quantifiable national targets for PA and SB, respectively. The most represented ministries/departments involved in the promotion of more PA and/or less SB were in the sport (reported by 99% countries; 95% CI: 96, 100), health (97%; 95% CI: 94, 100), education (94%; 95% CI: 88, 100), and recreation and leisure (85%; 95% CI: 71, 99) sectors. The median score (0-10) for the comprehensiveness of PA and SB policies was 4 (95% CI: 4, 5) and 2 (95% CI: 2, 3), respectively. For PA and SB policy implementation it was 6 (95% CI: 5, 6). For the effectiveness of PA and SB policies it was 4 (95% CI: 3, 5) and 3 (95% CI: 2, 4), respectively. PA and SB policies were generally best developed in high-income countries and countries of European and Western-Pacific regions. CONCLUSIONS: Most of the included countries have PA policies, but their comprehensiveness, implementation, and effectiveness are generally low-to-moderate. SB policies are less available, comprehensive, implemented, and effective than PA policies. PA and SB policies are better developed in high-income countries, compared with low- and lower-middle-income countries, and in countries of European and Western-Pacific regions, compared with other world regions. More investment is needed in development and implementation of comprehensive and effective PA and SB policies, particularly in low- and lower-middle-income countries.

Factors influencing delivery of intersectoral actions to address infant stunting in Bogotá, Colombia - a mixed methods case study.

BACKGROUND: Intersectoral actions (ISA) are a recognized relationship between the health sector and other sectors to improve health outcomes. Although a frequent topic in public health studies, evidence for systematic evaluation of implementation of ISA is scarce. An intersectoral health intervention for infants under one-year-old with, and at risk of, stunting (low height-for-age) was developed by a public-private partnership in Bogotá, Colombia, during 2018 and 2019. Here we report a case study conducted in parallel to the intervention designed to assess factors that influenced implementation of the ISA. METHODS: The case study was developed using a concurrent mixed-methods design, with the qualitative component giving context to the quantitative results. The qualitative component was obtained from four workshops, three focus groups, and 17 semi-structured interviews with actors involved in the intersectoral intervention. The quantitative component was obtained with two questionnaires that evaluated perceptions on improvement and partnership functioning of the ISA. RESULTS: This study collected information from 122 participants. The intervention demanded intersectoral collaboration. Political will, motivated human resources, and recognition that health improvement results from collaboration, were factors that facilitated intersectoral actions. Intersectoral actions were limited by difficulties in engaging the health sector, communication challenges related to local health service decentralization, and administrative barriers. CONCLUSIONS: Intersectoral actions have recently been discussed in the literature due to challenges in implementation and doubts regarding economic outcomes. The implementation of intersectoral public health interventions can be jeopardized by a lack of coordination and management skills.

Towards better evidence-informed global action: lessons learnt from the Lancet series and recent developments in physical activity and public health.

In the past few decades, the field of physical activity has grown and evolved in scope, depth, visibility and impact around the world. Global progress has been observed in research and practice in physical activity regarding surveillance, health outcomes, correlates/determinants, interventions, translation and policy. The 2012 and 2016 Lancet series on physical activity provide some of the most comprehensive global analysis on various topics within physical activity. Based on the Lancet series and other key developments in the field, literature searches, and expert group meetings and consultation, we provide a global summary on the progress of, gaps in and future directions for physical activity research in the following areas: (1) surveillance and trends, (2) correlates and determinants, (3) health outcomes and (4) interventions, programmes and policies. Besides lessons learnt within each specific area, several recommendations are shared across areas of research, including improvement in measurement, applying a global perspective with a growing emphasis on low-income and middle-income countries, improving inclusiveness and equity in research, making translation an integral part of research for real-world impact, taking an 'upstream' public health approach, and working across disciplines and sectors to co-design research and co-create solutions. We have summarised lessons learnt and recommendations for future research as 'roadmaps' in progress to encourage moving the field of physical activity towards achieving population-level impact globally.

The development of the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework.

BACKGROUND: Policy analysis is considered essential for achieving successful reforms in health promotion and public health. The only framework for physical activity (PA) policy analysis was developed at a time when the field of PA policy research was in its early stages. PA policy research has since grown, and our understanding of what elements need to be included in a comprehensive analysis of PA policy is now more refined. This study developed a new conceptual framework for PA policy analysis - the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework. METHODS: The development of the CAPPA framework was based on: (i) an extensive review of literature; (ii) an open discussion between the authors; (iii) three rounds of a Delphi process; and (iv) two-rounds of consultations with PA policy stakeholders. RESULTS: The CAPPA framework specifies 38 elements of a comprehensive analysis of PA policies in the following six categories, which comprise the building blocks of the framework: (i) purpose of analysis (including auditing and assessment of policies); (ii) policy level (including: international; national; subnational; local; and institutional policies); (iii) policy sector (including: health; sport; recreation and leisure; education; transport; environment; urban/rural planning and design; tourism; work and employment; public finance; and research sectors); (iv) type of policy (including: formal written policies; unwritten formal statements; written standards and guidelines; formal procedures; and informal policies); (v) stage of policy cycle (including: agenda setting; formulation; endorsement/legitimisation; implementation; evaluation; maintenance; termination; and succession); and (vi) scope of analysis (including availability; context; processes; actors; political will; content; and effects). Based on the CAPPA framework, we also proposed broad and inclusive definitions of PA policy and PA policy analysis. CONCLUSION: The CAPPA framework may be used to guide future studies related to PA policy and to provide a context for the analysis of its specific components. The framework could be used in the same way for sedentary behaviour policy research. Future research should examine the extent to which PA policy analysis has covered each of the elements specified in the CAPPA framework and analyse the elements for which evidence is lacking. Future studies should also determine whether the existing tools allow for auditing and assessment of all the CAPPA elements and develop new tools if needed to allow for a more comprehensive PA policy analysis.

Agreement of antenatal care indicators from self-reported questionnaire and the antenatal care card of women in the 2015 Pelotas birth cohort, Rio Grande do Sul, Brazil.

BACKGROUND: Studies of healthcare service use during the pregnancy-postpartum cycle often rely on self-reported data. The reliability of self-reported information is often questioned as administrative data or medical records, such as antenatal care cards, are usually preferred. In this study, we measured the agreement of antenatal care indicators from self-reported information and antenatal care cards of pregnant women in the 2015 Pelotas Birth Cohort, Brazil. METHODS: In a sample of 3923 mothers, indicator agreement strengths were estimated from Kappa and prevalence-and-bias-adjusted Kappa (PABAK) coefficients. Maternal characteristics associated with indicator agreements were assessed with heterogeneity chi-squared tests. RESULTS: The self-reported questionnaire and the antenatal care card showed a moderate to high agreement in 10 of 21 (48%) antenatal care indicators that assessed care service use, clinical examination and diseases during pregnancy. Counseling indicators performed poorly. Self-reported information presented a higher frequency data and a higher sensitivity but slightly lower specificity when compared to the antenatal card. Factors associated with higher agreement between both data sources included lower maternal age, higher level of education, primiparous status, and being a recipient of health care in the public sector. CONCLUSIONS: Self-reported questionnaire and antenatal care cards provided substantially different information on indicator performance. Reliance on only one source of data to assess antenatal care quality may be questionable for some indicators. From a public health perspective, it is recommended that antenatal care programs use multiple data sources to estimate quality and effectiveness of health promotion and disease prevention in pregnant women and their offspring.

Quality assessment indicators in antenatal care worldwide: a systematic review.

PURPOSE: To describe indicators used for the assessment of antenatal care (ANC) quality worldwide under the World Health Organization (WHO) framework and based on a systematic review of the literature. DATA SOURCES: Searches were performed in MEDLINE, SciELO, BIREME and Web of Science for eligible studies published between January 2002 and September 2016. STUDY SELECTION: Original articles describing women who had received ANC, any ANC model and, any ANC quality indicators were included. DATA EXTRACTION: Publication date, study design and ANC process indicators were extracted. RESULTS OF DATA SYNTHESIS: Of the total studies included, 69 evaluated at least one type of ANC process indicator. According to WHO ANC guidelines, 8.7% of the articles reported healthy eating counseling and 52.2% iron and folic acid supplementation. The evaluation indicators on maternal and fetal interventions were: syphilis testing (55.1%), HIV testing (47.8%), gestational diabetes mellitus screening (40.6%) and ultrasound (27.5%). Essential ANC activities assessment ranged from 26.1% report of fetal heart sound, 50.7% of maternal weight and 63.8% of blood pressure. Regarding preventive measures recommended by WHO, tetanus vaccine was reported in 60.9% of the articles. Interventions performed by health services to improve use and quality of ANC care, promotion of maternal and fetal health, and the number of visits to the ANC were evaluated in 65.2% of the studies. CONCLUSION: Numerous ANC content indicators are being used to assess ANC quality. However, there is a need to use standardized indicators across countries and efforts to improve quality evaluation.

Worldwide use of the first set of physical activity Country Cards: The Global Observatory for Physical Activity - GoPA!

BACKGROUND: The work of The Global Observatory for Physical Activity-GoPA! is the first global effort to compile standardized country-level surveillance, policy and research data for physical activity in order to better understand how countries and regions address promoting physical activity. GoPA! developed standardized country-specific physical activity profiles ("Country Cards") to summarize country-level data through 2013. The aim of this study was to assess use of the Country Cards, identify the factors associated with their use, and develop recommendations for supporting country-level physical activity promotion. METHODS: Cross sectional internet-based survey conducted between August-October 2016. Target study participants were national physical activity leaders and advocates in academia, government and practice from the GoPA! countries, and members of the International Society of Physical Activity and Health. A Country Card use composite score was created based on the diversity and frequency of use. Statistical analyses on the associations between the composite score and respondent characteristics, country characteristics, barriers and opinions were conducted (including descriptive analyses and a logistic regression with robust standard errors). RESULTS: One hundred forty three participants from 68 countries completed the survey. Use of the Country Cards was associated with being part of the GoPA! network, knowing about the Country Cards, and on the stage of country capacity for physical activity promotion. Country Card knowledge varied by country income group, region and the country specific context. More diverse and frequent use of the cards (highest tertile of the composite score for use) was associated with: 1. Being a country contact vs general participant (OR 18.32-95% CI 5.63-59.55, p = 0.002), and 2. Collaborating with a government representative working in NCDs on a monthly or more frequent contact vs less frequent contact (OR 3.39-95% CI 1.00-11.54, P < 0.05). CONCLUSIONS: For the Country Cards to have a broader impact, GoPA! will need to widen its reach beyond the academic sector. With further refinement of the cards, and training in their implementation, they could be an important tool for advancing country capacity for contextually-relevant strategies, actions and timelines for PA promotion.

Physical activity during pregnancy and offspring neurodevelopment: A systematic review.

BACKGROUND: Maternal physical activity (PA) during pregnancy could affect offspring's neurodevelopment. However, studies in humans in early childhood are scarce and show inconsistent results. We aimed to review the literature on the association between physical activity during pregnancy and offspring neurodevelopment. METHODS: LILACS, MEDLINE and Web of Science were searched for studies published since 1977. Original studies conducted in humans, without language, country, or study type restriction, were eligible. Information on the study methodology like study design, sample size, PA exposure and neurodevelopment assessment, covariates, and the effect measure were extracted from the selected articles. RESULTS: From 802 non-duplicated titles initially located, 6 articles were selected and included (one randomised clinical trial and 5 cohort studies). The instruments used to measure PA during pregnancy and neurodevelopment varied between the studies. PA was self-reported at different gestational ages and neurodevelopment was assessed prospectively in offspring aged 1-8 years old. Only the randomised clinical trial found no effect of PA over offspring neurodevelopment. Cohort studies found a positive association between PA practice during pregnancy and offspring neurodevelopment. CONCLUSIONS: These findings suggest that leisure-time physical activity practice may have positive association with language offspring's neurodevelopment in the age range of 18 from 60 months.

Lifelong robbery victimisation and mental disorders at age 18 years: Brazilian population-based study.

PURPOSE: Urban violence is a major problem in Brazil and may contribute to mental disorders among victims. The aim of this study was to assess the association between robbery victimisation and mental health disorders in late adolescence. METHODS: At age 18 years, 4106 participants in the 1993 Pelotas Birth Cohort Study were assessed. A questionnaire about history of robbery victimisation was administered, the Self-Report Questionnaire was used to screen for common mental disorders, and the Mini International Neuropsychiatric Interview was used to assess major depressive disorder and generalised anxiety disorder. Cross-sectional prevalence ratios between lifetime robbery victimisation and mental disorders were estimated using Poisson regression with robust standard errors, adjusting for socioeconomic variables measured at birth and violence in the home and maltreatment measured at age 15. RESULTS: There was a dose-response relationship between frequency of lifetime robberies and risk of mental disorders. Adolescents who had been robbed three or more times had twice the risk (PR 2.04; 95% CI 1.64-2.56) for common mental disorders, over four times the risk for depression (PR 4.59; 95% CI 2.60-8.12), and twice the risk for anxiety (PR 1.93; 95% CI 1.06-3.50), compared with non-victims, adjusting for covariates. Experiencing frequent robberies had greater impact on common mental disorders than experiencing an armed robbery. Population attributable fractions with regard to robbery were 9% for common mental disorders, 13% for depression, and 8% for anxiety. CONCLUSIONS: Robberies are associated with common mental disorders in late adolescence, independently of violence between family members. Reducing urban violence could significantly help in preventing common mental illnesses.

An Overview of Physical Activity Research Evolution in Africa: The Global Observatory for Physical Activity-GoPA!

OBJECTIVE: To describe the evolution of physical activity (PA) research in Africa, examine income and gender inequalities, and discuss future possibilities. METHODS: A secondary analyses of the Global Observatory for Physical Activity data on PA research in Africa (1950-2019). RESULTS: We identified 514 PA articles from 47 African countries in the past 70 years. Majority (83.1%) of the articles were published between 2012 and 2019. Fifteen countries had no publications. Six countries (South Africa [n = 156], Nigeria [n = 85], Ethiopia [n = 44], Ghana [n = 41], Kenya [n = 39], and Cameroon [n = 20]) accounted for about 75% of the publications. Most articles were observational (92.4%), single-country studies (78.4%), with male first (58.4%) and last authors (68%), and were classified as surveillance studies (45.1%). Few studies addressed interventions (5.8%) and policy (3.5%) or used device-based PA measurement (14.0%). The number of articles per country was positively related to human population level (r = .552, P = .000) and gross domestic product % spent on research and development (r = .301, P = .040). The publication rate per 100,000 people was positively related with the human development index (r = .349, P = .016) and negatively with the gender inequality index (r = -.360, P = .019). CONCLUSIONS: Our results provide an overview and status of PA research in Africa, highlighting country differences and gender inequalities in authorship. The findings may be used to benchmark the evolution of research in the region and to inform areas for improvement. There is an urgent need for more PA interventions and policy studies in Africa.

Breaking Barriers: An Innovative Tool to Assess the National and City-Level Physical Activity Policy Development to Practice Disconnect.

BACKGROUND: Population-level physical activity increases are improbable without intersectoral collaboration across government levels and sectors to develop and implement physical activity promotion policies. This study aims to provide information about the development of the Interaction between National and Local Government Levels in Development and Implementation of Physical Activity Policies Tool (INTEGRATE PA-Pol). A framework was created to examine the development and implementation of national and subnational physical activity policies and the (mis)alignment between government levels. METHODS: The work was conducted in 3 phases: (1) a scoping review was carried out to identify local government physical activity promotion policies and instruments for assessing them, (2) an expert group designed 6 questionnaires, and (3) cognitive response testing was employed for validity testing and item modification with a panel of research and policy experts. RESULTS: The INTEGRATE PA-Pol Tool consists of 6 questionnaires assessing how national and subnational governments collaborate to develop and implement physical activity promotion policies. CONCLUSION: This tool can assist in better understanding the development and implementation of a public policy monitoring system that will allow for benchmarking and priority setting to comprehend how physical activity promotion policies are designed and executed.

Gender Differences in Physical Activity and Health-Related Authorships Between 1950 and 2019.

BACKGROUND: The objective of this study was to investigate gender differences in authorship in physical activity and health research. METHODS: A bibliometric study including 23,399 articles from 105 countries was conducted to estimate the participation of female researchers in physical activity publications from 1950 to 2019. The frequency of female researchers was analyzed and classified by first and last authors and the overall percentage of female authors by region and country. RESULTS: The proportion of female first authors increased from <10% in the 50s and 80s to 55% in the last decade. On the other hand, the proportion of last authors increased from 8.7% to 41.1% in the same period. Most publications with female researchers were from the United States, Canada, Australia, Brazil, the Netherlands, Spain, England, Germany, Sweden, and China. Nine of these countries had over 50% of the articles published by female first authors. However, in all 10 countries, <50% of the articles were published by female last authors. CONCLUSIONS: The proportion of female researchers increased over time. However, regional differences exist and should be addressed in gender equity policies. There is a gap in the participation of female researchers as last authors. By actively addressing the gender gap in research, the global society can harness the full potential of all talented individuals, regardless of gender, leading to more inclusive and impactful scientific advancements.

The Evolution of Physical Activity and Health Research in China: A Bibliometric Analysis of Study Areas and Sex Balance in Authorship.

BACKGROUND: This article evaluates the evolution of physical activity and health research in China through a bibliometric analysis focused on number of publications, study areas, and sex balance in authorship. METHODS: A systematic review was conducted by the Global Observatory for Physical Activity for "physical activity and health" publications between 1950 and 2019. Here, we focus on the 610 Chinese publications identified, defined as those in which data collection took place in China. We assessed the number of publications, classified them into 5 areas (1) surveillance, (2) correlates and determinants, (3) health consequences, (4) interventions, and (5) policy, and analyzed female participation in authorship. RESULTS: The first Chinese publication identified in the review was in 1990. Since, the average number of physical activity and health publications increased from one per year in the 1990s to 7.6 per year in the 2000s, and to 47 per year in the 2010s. Most publications focused on the correlates and determinants (38.7%) and the health consequences of physical activity (35.9%). Physical activity policy accounted for 2.3% of the publications. In the 1990s, 64% of the publications included at least one female author; this proportion increased to 90% in the 2010s. CONCLUSION: Despite a slow start, China's research on physical activity and health has grown rapidly since 2000. The distribution of publications by study areas and female participation in authorship is similar to that observed globally, with fewer publications focused on interventions and policy as compared with other topics.

Self-perception of mental health, COVID-19 and associated sociodemographic-contextual factors in Latin America.

This study aimed to estimate the prevalence of alterations in self-perceived mental health during the COVID-19 pandemic and their associated factors in four Latin American countries. This is a cross-sectional study based on data collected from adults in 2021 through the Collaborative Response COVID-19 Survey by the MacDonnell Academy at Washington University in St. Louis (United States). The sample was composed of 8,125 individuals from Brazil, Colombia, Mexico, and Chile. A generalized linear model for a binary outcome variable with a logistic link and fixed country effects was used. There were 2,336 (28.75%) individuals who considered having suffered alterations in self-perceived mental health. Unemployed individuals (OR = 1.40; 95%CI: 1.24-1.58), those with bad/regular quality of life (OR = 5.03; 95%CI: 4.01-6.31), and those with high socioeconomic status (OR = 1.66; 95%CI: 1.41-1.96) had a higher risk of self-perceived mental health alterations than those with full-time employment, excellent quality, and low socioeconomic status. According to the fixed-effects model, Brazilians living in the country during the pandemic, who disagreed with their government's decisions (OR = 2.05; 95%CI: 1.74-2.42) and lacked trust in their government (OR = 2.10; 95%CI: 1.74-2.42) had a higher risk of having self-perceived mental health alterations. Nearly 30% of respondents indicated that the COVID-19 pandemic altered their self-perceived mental health. This outcome was associated with political, sociodemographic, and health risk factors. These findings should help policymakers develop post-pandemic community interventions.

Severity and mortality of acute respiratory failure in pediatrics: A prospective multicenter cohort in Bogotá, Colombia.

Background and Aims: Acute respiratory failure (ARF) is the most frequent cause of cardiorespiratory arrest and subsequent death in children worldwide. There have been limited studies regarding ARF in high altitude settings. The aim of this study was to calculate mortality and describe associated factors for severity and mortality in children with ARF. Methods: The study was conducted within a prospective multicentric cohort that evaluated the natural history of pediatric ARF. For this analysis three primary outcomes were studied: mortality, invasive mechanical ventilation, and pediatric intensive care unit (PICU) length of stay. Eligible patients were children older than 1 month and younger than 18 years of age with respiratory difficulty at the time of admission. Patients who developed ARF were followed at the time of ARF, 48 h later, at the time of discharge, and at 30 and 60 days after discharge. It was conducted in the pediatric emergency, in-hospital, and critical-care services in three hospitals in Bogotá, Colombia, from April 2020 to June 2021. Results: Out of a total of 685 eligible patients, 296 developed ARF for a calculated incidence of ARF of 43.2%. Of the ARF group, 90 patients (30.4%) needed orotracheal intubation, for a mean of 9.57 days of ventilation (interquartile range = 3.00-11.5). Incidence of mortality was 6.1% (n = 18). The associated factors for mortality in ARF were a history of a neurologic comorbidity and a higher fraction of inspired oxygen at ARF diagnosis. For PICU length of stay, the associated factors were age between 2 and 5 years of age, exposure to smokers, and respiratory comorbidity. Finally, for mechanical ventilation, the risk factors were obesity and being unstable at admission. Conclusions: ARF is a common cause of morbidity and mortality in children. Understanding the factors associated with greater mortality and severity of ARF might allow earlier recognition and initiation of prompt treatment strategies.

Shaping Policy and Practice: Analyzing the Reach of Highly Cited and High Altmetrics Publications for Broader Impact on Physical Activity.

BACKGROUND: A significant gap remains between the availability of physical activity (PA) evidence-based interventions and their application in real-world settings in policy and practice areas. This study aims to describe highly cited and high altmetrics publications in PA research and explore their impact on PA policy and practice. METHODS: Mixed-methods sequential explanatory study including the identification and description of the top highly cited and high altmetrics PA publications from the last 10 years (including study design, population, type of PA study, number of citations, and altmetrics score), and interviews with key informants regarding research dissemination and implications on PA policy and practice. RESULTS: When considering publication type, the most frequent highly cited publications were health consequences (40%, altmetrics = 42%), measurement/trends (23%, altmetrics = 10%), and correlates/determinants (21%, altmetrics = 26%) studies. They were predominantly cross-sectional (50%, altmetrics = 28%), systematic reviews (38%, altmetrics = 18%), and longitudinal studies (8%, altmetrics = 37%). All authors who participated in the interviews agreed that the most important factors in disseminating findings and influencing PA policy and practice were the published peer-reviewed manuscript itself, the reputation of the journal, the communication strategy, and the use of online platforms. CONCLUSIONS: To have a real-world influence on PA policy and practice, it is not enough to publish the results in scientific journals and participate in media outreach. To successfully involve policymakers and communities in appropriating the evidence and evaluating the extent to which these findings affect policy and practice outcomes, it is critical to lead co-creation, co-dissemination, advocacy, and capacity building efforts.