Implementation of medication for opioid use disorder treatment during a natural disaster: The PROUD-LA study.

BACKGROUND: The impacts of climate change-related extreme weather events (EWEs) on Medication for Opioid Use Disorders (MOUD) implementation for Medicaid beneficiaries are relatively unknown. Such information is critical to disaster planning and other implementation strategies. In this study we examined implementation determinants and strategies for MOUD during EWEs. METHODS: The Louisiana-based Community Resilience Learning Collaborative and Research Network (C-LEARN) utilized Rapid Assessment Procedures-Informed Community Ethnography (RAPICE), involving community leaders in study design, execution, and data analysis. We conducted qualitative semi-structured interviews with 42 individuals, including MOUD Medicaid member patients and their caregivers, healthcare providers and administrators, and public health officials with experience with climate-related disasters. We mapped key themes onto updated Consolidated Framework for Implementation Research domains. RESULTS: MOUD use is limited during EWEs by pharmacy closures, challenges to medication prescription and access across state lines, hospital and clinic service limits, overcrowded emergency departments, and disrupted communications with providers. MOUD demand simultaneously increases due to the stress associated with displacement, resource loss, the COVID-19 pandemic, and social determinants of health. Effective implementation strategies include healthcare system disaster plans with protocols for clear and regular patient-provider communication, community outreach, additional staffing, and virtual delivery of services. Providers can also increase MOUD access by having remote access to EHRs, laptops and contact information, resource lists, collaborative networks, and contact with patients via call centers and social media. Patients can retain access to MOUD via online patient portals, health apps, call centers, and provider calls and texts. The impact of EWEs on MOUD access and use is also influenced by individual characteristics of both patients and providers. CONCLUSIONS: The increasing frequency and severity of climate-related EWEs poses a serious threat to MOUD for Medicaid beneficiaries. MOUD-specific disaster planning and use of telehealth for maintaining contact and providing care are effective strategies for MOUD implementation during EWEs. Potential considerations for policies and practices of Medicaid, providers, and others to benefit members during hurricanes or major community stressors, include changes in Medicaid policies to enable access to MOUD by interstate evacuees, improvement of medication refill flexibilities, and incentivization of telehealth services for more systematic use.

Sports participation plays a relevant role in the relationship between birth weight and bone mineral content in adolescents.

The Developmental Origins of Health and Disease hypothesis (DOHaD) proposes that growth during the prenatal period might play a critical role in health, affecting the development of diseases, such as osteoporosis. Bone health is particularly affected by human behaviors when sports participation constitutes the main manifestation of physical exercise. The aim of this study is to analyze the relationship between birth weight (BW) and bone mineral content (BMC) among adolescents, as well as to identify if sports participation and maturity can affect this relationship. The sample was composed of adolescents with ages ranging from 11 to 18 years, stratified according to normal birth weight (n = 331), low birth weight (n = 36), and macrosomia (n = 47), extracted from a wider cross-sectional study (ABCD Growth Study). BW was self-reported by the adolescent's parent. Sports participation was assessed by face-to-face interview. BMC was assessed using dual-energy X-ray absorptiometry. In the multivariate models, the relationships between BW and BMC remained non-significant, while sports participation was significantly related to BMC on lower limbs among boys (r = 0.154; p value = .001) and BMC of upper limbs among girls (r = 0.124; p value = .044). APHV was related to BMC of upper limbs among boys (r = 0.137; p value = .001). In conclusion, BMC was not affected by BW, while this phenomenon seems to be significantly affected by the positive impact of sports participation and maturation on it.

Overweight and Blood Pressure in Pre-Pubertal Children: A Longitudinal Study.

OBJECTIVE: To analyze the longitudinal relationship between overweight and hypertension in school children. METHODS: This cohort study enrolled children 6-8 years of age who were then prospectively followed up over a 24 months period with repeat assessments performed at an interval of 11-13 months. Information on participation in physical education classes in school, sports practice outside of school, and economic status were obtained through questionnaires answered by parents/guardians. The measurement of blood pressure, weight, height, and waist circumference was performed during the serial follow-up visits in school. RESULTS: The proportion of hypertension did not change significantly over the 24 months (7.1% to 8.2%; P = 0.690). However, children with overweight and obesity throughout the period, had a 198% [HR (95% CI) 2.98 (1.40, 6.35)] higher risk of having hypertension diagnosed during follow-up when compared to eutrophic children in the same period. CONCLUSION: The development trajectory of overweight and obesity in children aged 6-8 years was associated with hypertension.

The Association between Perceived Stress, Quality of Life, and Level of Physical Activity in Public School Teachers.

Chronic high stress levels related to work impact the quality of life (QoL). Although physical activity improves QoL, it is not clear whether this life study habit could attenuate possible relationships between QoL and stress in public school teachers. The sample for this study was made up of 231 teachers from public schools. QoL was assessed using the Short-Form Health Survey and physical activity via Baecke's questionnaire. A Likert scale assessed stress level perception. Poisson Regression analyzed the association between stress level and QoL domains adjusted for sex, age, and socioeconomic conditions (model 1). In model 2, physical activity level was inserted in addition to model 1. Seven out of eight domains of QoL, except the domain of pain, were associated with high levels of stress (all p < 0.05-model 1). However, in model 2, the associations of the high levels of stress with general health status (p = 0.052) and functional capacity (p = 0.081) domains of QoL were mitigated. Our results indicated that physical activity mitigated the relationship between higher levels of stress and lower perception of general health status and functional capacity domains in secondary public school teachers.

Physical activity and sedentary behaviour of adolescents and their parents: a specific analysis by sex and socioeconomic status.

BACKGROUND: The association of lifestyle habits of parents and of their children has been widely investigated as an important determinant for healthy habits in youth. Although parental sociodemographic characteristics are potential confounding factors in parent-child physical activity (PA) and sedentary behaviour (SB), it is still unclear whether these factors have a moderating role in this association. This study aimed to analyze the association of parent-child PA and SB according to parental sex and economic level in adolescents. METHODS: The study sample was made up of 1231 adolescents (15.6 ± 1.1 years, 58.2% of girls), 1202 mothers and 871 fathers. The leisure-time and commuting PA was assessed by the Baecke questionnaire, while sedentary behaviour (SB) was assessed according to hours per week of television viewing and computer use, by both adolescents and their parents. Economic status was analyzed using a questionnaire and classified as low, medium, and high. Linear models were used to assess the association of parent-child PA and SB in the different domains according to parental sex and economic level. RESULTS: Leisure time was associated between boys and their fathers in high (ß = 0.23, p = 0.044) and low economic classes (ß = 0.31, p < 0.001), and girls and their mothers in low economic class (ß = 0.38, p < 0.001). Commuting PA was associated between adolescents and both parents in low economic class (fathers ß = 0.21, p = 0.005; mothers (ß = 0.15, p = 0.020). TV time of boys was associated with TV time of fathers in low economic class (ß = 0.13, p = 0.022) and with TV time of mothers in medium economic class (ß = 0.13, p = 0.046). Among girls, TV time was associated with TV time of both parents only in low economic class (fathers ß = 0.28, p < 0.001; mothers ß = 0.25, p < 0.001). Computer use of girls was associated with computer use of fathers in high economic class (ß = 1.72, p = 0.043) and mothers in low economic class (ß = 0.57, p = 0.014), while no association was observed among boys. CONCLUSION: Economic status was shown to be an important moderator of the association between parent-child PA and SB in adolescents.

Effect of Resistance Training on Body Composition of Adolescents: ABCD Growth Study.

OBJECTIVE: To analyze the relationship between resistance training and body composition in adolescents. METHODS: A longitudinal 12-month follow up of 190 adolescents of both sexes categorized into three groups according to resistance training practice, as non-engagement (n=121), irregular engagement (n=44), and frequent engagement (n=25). The outcomes adopted were bone mineral density (BMD), lean soft tissue (LST), and body fatness (BF). RESULTS: Adolescents frequently engaged in resistance training presented higher gains in mean (95 CI) LST [6.1 (3.7 to 8.5) kg vs 2.4 (1.4 to 3.4) kg; P= 0.027] and BMD-upper limbs [0.096 (0.072 to 0.121) g/cm2 vs 0.046 (0.036 to 0.056) g/cm2; P=0.002] than adolescents who were not engaged in resistance training, respectively. Findings were more consistent for boys than girls (models were not significant among girls: LST P= 0.721; BMD-upper limbs P= 0.053). CONCLUSION: Regular engagement in resistance training was related to higher gains in muscle mass and bone density, especially among boys.

Impact of sports participation on cardiovascular health markers of children and adolescents: Systematic review and meta-analysis.

BACKGROUND: Cardiovascular diseases have a high prevalence in adults and their development begins in the first decades of life. On the other hand, sports participation in childhood and adolescence provides benefits which can delay the onset of these diseases. AIM: To synthesize the available literature on the impact of sports participation on cardiovascular outcomes in children and adolescents. METHODS: This systematic review was conducted on studies of children and adolescents (aged 8-18 years) who regularly practiced a sport and had reported cardiovascular outcomes (blood pressure and intima-media thickness) recorded. The Medline/PubMed, SciELO, Reference Citation Analysis (https://www.referencecitationanalysis.com/) and Bireme databases were searched. RESULTS: In total, 3314 publications for blood pressure and 122 publications for intima-media thickness were identified in the databases. After exclusions (e.g., duplicate articles, animal studies and those that did not meet the inclusion criteria), four publications for blood pressure (449 adolescents) and two publications for intima-media thickness were included (402 adolescents). For blood pressure, all publications were longitudinal in design (follow-up ranging from 12 wk to 12 mo) and involved adolescents aged from 8 years to 18 years of age. For intima-media thickness, both publications were longitudinal in design and involved adolescents aged from 11 years to 18 years of age. CONCLUSION: Sports participation seems to promote benefits to cardiovascular structure and function in adolescents. However, studies with adolescents are scarce and further research is needed to understand this phenomenon.

Relationship of Objectively Measured Physical Activity, Sedentary Behavior and Sleep Time with Cardiovascular and Mtabolic Outcomes in Adolescents (A Pilot Study): ABCD Growth Study.

STUDY OBJECTIVE: Different behaviors are considered important factors that may influence a healthy lifestyle. Given this fact, we aim to analyze the relationship between moderate-vigorous physical activity (MVPA), sleep time, and sedentary time, with cardiometabolic outcomes in adolescents. METHODS: Cross-sectional study, with 152 eutrophic and healthy adolescents. The behavioral variables were collected objectively and the arterial thickness was measured through ultrasound. Blood variables (LDL, TG, HDL, glucose, and insulin) were collected in a private laboratory. To analyze the data, the Student t test and Kruskal-Wallis test were used to compare the groups. All analyses adopted p < 0.05. RESULTS: Girls who demonstrated better combined behaviors, presented significant results for TG (p = 0.045), BP (p = 0.016), and cardiovascular score (p = 0.049) when compared to their peers. Furthermore, the practice of physical activity combined with sufficient sleep time was associated with lower values of arterial thickening (p = 0.017). CONCLUSIONS: In view of the results presented, it is possible to state that the aggregation of behaviors was more consistent in females and that the practice of physical activity and adequate sleep time can reflect on cardiovascular health.

Relationship between vigorous physical activity and health care costs among adolescents: ABCD Growth Study.

BACKGROUND: The relationship between physical activity and health care costs among adolescents is not yet clear in the literature. OBJECTIVE: To analyze the relationship between physical activity and annual health care costs among adolescents. METHODS: The present sample was composed of 85 adolescents of both sexes with ages ranging from 11 to 18 years (mean age 15.6 ± 2.1). Health care costs were self-reported every month for 12 months, and information on health care values was verified with local pharmacies, private health care plans, and the National Health Service. The time spent in different physical activity intensities was objectively measured by accelerometers. Confounding variables were: sex, age, somatic maturation, body fatness, blood pressure, and components of dyslipidemia and insulin resistance. Multivariate models were generated using generalized linear models with gamma distribution and a log-link function. RESULTS: The overall annual health care cost was US$ 733.60/ R$ 2,342.38 (medication: US$ 400.46 / R$ 1,278.66; primary and secondary care: US$ 333.14 / R$ 1,063.70). The time spent in vigorous physical activity (minutes/day) was negatively related to health care costs (r = -0.342 [95% CI: -0.537,-0.139]; ß = -0.06 cents (95% CI: -0.089, -0.031). CONCLUSION: Vigorous physical activity seems to be associated with lower health care costs among adolescents.

Impact of sports participation on components of metabolic syndrome in adolescents: ABCD growth study.

OBJECTIVES: This study aimed to analyze the impact of sports participation (12 months of practice) on the components of metabolic syndrome (MetS) in both sexes. METHODS: This is an observational longitudinal study, a part of which is entitled "Analysis of Behaviors of Children During Growth" (ABCD Growth Study), Presidente Prudente, São Paulo, Brazil. The sample was composed of 171 adolescents (112 boys and 59 girls), divided into non-sports and sports groups. High-density lipoprotein-cholesterol (HDL-c), triglycerides, and glucose were analyzed by the colorimetric method of dry chemistry and processed biochemically. Systolic blood pressure and diastolic blood pressure were measured using an automatic device. Body fat was estimated using a densitometry scanner. RESULTS: Adolescents who practiced sports were younger (p-value=0.001) and had a lower peak height velocity (p-value=0.001) than the non-sports group. The differences (Δ) after 12 months were of greater magnitude for the sports group when compared to the non-sports group (p-value=0.013), glucose (moderate magnitude in favor of the sports group; p-value=0.001), HDL-c (small magnitude in favor of the sports group; p-value=0.0015), and MetS (moderate magnitude in favor of the sports group; p-value=0.001). CONCLUSIONS: The practice of sports in adolescents had a protective effect on the metabolic components of MetS.

Impact of Moderate-To-Vigorous Sports Participation Combined with Resistance Training on Metabolic and Cardiovascular Outcomes among Lean Adolescents: ABCD Growth Study.

BACKGROUND: To investigate the combined impact of being engaged in resistance training (RT) and meeting the physical activity guidelines through sports participation (SP) on cardiovascular and metabolic parameters in lean adolescents. METHODS: A longitudinal study, part of the ongoing study entitled "ABCD Growth Study" (Analysis of Behaviors of Children During Growth), assessed data from 64 adolescents (23 from the sport group, 11 from the sport + RT group, and 30 from the control group). Metabolic and cardiovascular outcomes were analyzed as dependent variables. For the independent variables, sports participation and resistance training were considered, and for the covariates, sex, chronological age, body weight, height, and somatic maturation. RESULTS: After 12 months of follow-up, the RT + SP presented improvements in triglycerides (TG) and the SP presented a reduction in LDL-c, TG, and glucose when compared to the control group. CONCLUSIONS: Being engaged in RT and SP is a good strategy to improve health in eutrophic adolescents, with a great impact on TG from the lipid profile.

Testosterone and lean mass show a positive correlation with the technical performance of footballers.

BACKGROUND: Monitoring technical performance during a soccer match has become an indispensable practice, since the players perform different functions within the tactical system adopted by the team, resulting in specific technical actions that are fully responsive to the individual technical level of each player. Thus, current study aimed to investigate the possible direct and mediating relationship between salivary testosterone and the technical performance of semi-professional footballers during a training game. METHODS: To characterize the sample, the anthropometric profile, body composition, biological maturation, lower limb power, speed, estimation of maximum oxygen consumption, and physical performance were used. To determine testosterone concentrations, saliva was collected before and after the training game, for subsequent measurement using enzyme immunoassay (ELISA) and Salimetrics Kits. For quantification of technical performance and participation with the ball during the training game, scout software was used from the footage of the training game. The reliability of the technical performance analyses was determined through the repetition test of two attempts (Cohen's Kappa agreement index). RESULTS: The direct relationship between postgame testosterone and total participation with the ball in the second half; the direct relationship between the percentage of lean mass with postgame testosterone and an apparent relationship between percentage of lean mass and total participation with the ball from the set of relations mediated by postgame testosterone concentrations. CONCLUSIONS: The results suggest that testosterone concentrations combined with high levels of lean mass may have an important role in the technical performance and participation with the ball of semi-professional footballers.

Participation in Non-professional Sports and Cardiovascular Outcomes Among Adolescents: ABCD Growth Study.

OBJECTIVES: Sports are an important way to improve health during adolescence. However, it is still unclear whether the association between sports, blood pressure, and metabolic profile could be affected by sex, biological maturation, and trunk fatness. The aim of this study was to analyze the association between sports participation and the cluster of cardiovascular markers among adolescents of both sexes. METHODS: A cross-sectional study involving 285 adolescents aged from 11 to 17 years of age (202 boys and 83 girls). Cardiovascular variables were composed of systolic blood pressure (SBP), diastolic blood pressure (DBP), resting heart rate (RHR), and carotid (CIMT) and femoral (FIMT) intima-media thickness, which were used to calculate the CardiovascularZ score. Sports participation was assessed through a face-to-face interview. Age of peak height velocity (APHV) was used as a covariate. RESULTS: Among girls, the group engaged in sports presented lower values of RHR (sport: - 0.344 [95% CI - 0.650 to - 0.037] versus non-sport: 0.540 [95% CI 0.125 to 0.954]) and CardiovascularZ score (sport: - 0.585 [95% CI - 1.329 to 0.159] versus non-sport: 0.879 [95% CI - 0.127 to 1.884]), explaining 12.2% and 6.1% of all variance, respectively. Among boys, the group engaged in sports presented lower values of DBP (sport: - 0.158 [95% CI - 0.335 to 0.018] versus non-sport: 0.160 [95% CI - 0.091 to 0.412]) and FIMT (sport: - 0.128 [95% CI - 0.300 to - 0.044] versus non-sport: 0.211 [95% CI - 0.032 to 0.454]), explaining 2.2% and 2.6% of all variance, respectively. CONCLUSIONS FOR PRACTICE: Adolescents engaged in sports presented healthier cardiovascular parameters, and sports participation seems to affect cardiovascular health differently in boys and girls.

Association between Cluster of Lifestyle Behaviors and HOMA-IR among Adolescents: ABCD Growth Study.

Objective: To analyze the association of potential risk factors to health with body fatness and insulin resistance. Baseline measures of the ongoing longitudinal Analysis of Behaviors of Children During (ABCD) Growth Study. Materials and Methods: The sample was composed of 280 adolescents of both sexes (198 boys and 82 girls) aged from 10 to 18 years. Four risk factors were considered, as follows: no sports practice, skipping breakfast, poor sleep quality, and TV viewing. The outcomes considered were insulin resistance (HOMA-IR) and body fatness (densitometer scanner). Age, sex, maturity offset, and ethnicity were treated as covariates. Results: No sports practice and skipping breakfast were associated with higher body fatness (Sports practice: Wald: 8.786; p = 0.003. Breakfast: Wald: 9.364; p = 0.002). Poor sleep quality was related to a greater HOMA-IR index (Wald: 6.013; p = 0.014). Adolescents with ≥3 risk factors presented a higher risk of high HOMA-IR (OR = 4.89 (95%CI: 1.61 to 14.84)) than their counterparts with no risk factors. Conclusion: Lifestyle risk factors seem relevant to affect obesity and insulin resistance, while the aggregation of these risk factors affects insulin resistance, independent of adiposity.

Occurrence of physical therapy consultations in the last 12 months among adults from a medium sized brazilian city / Ocorrência de consultas fisioterápicas nos últimos 12 meses entre adultos de uma cidade de porte médio brasileira

Cross-sectional design. Introduction: Physical Therapy is a profession with a diversity of methods and s, and although it extends to all age groups with a huge number of clinics, the occurrence of searches for physiotherapists is still low. Aim: To analyze the occurrence of physical therapy consultations in the past 12 months among adults in Presidente Prudente, as well as to identify some variables associated with the outcome. Methods: The population (n=743) had a mean age of 49.9±17.3 years. The procedures set out the dependent variable: physical therapy consultation and independent variables: low back pain and physical activity during leisure time and at work, respecting the confounding factors. Results: The occurrence of physiotherapy consultations in the last 12 months was 21%, which was more frequent among adults of 30-44.9 years (OR=2.02 [1.02-3.99]) and for those with low back pain (OR=2.18 [1.18-4.06]). Conclusion: Physical therapy utilization is an outcome with a low rate, which is associated with low back pain among adults at a productive age.