The impact of COVID-19 on mental health and well-being in critical care nurses - a longitudinal, qualitative study.

BACKGROUND: The COVID-19 pandemic has had both a psychological and physiological effect on the human race. For those working in health care, particularly in critical care, the pandemic has put unprecedented strain on staff. Witnessing suffering during crisis in an organizational setting can be a traumatic experience and critical care nurses often risked, not only their own lives, but their psychological well-being, so that those infected with the virus might have a better chance at survival. AIM: The aim of this study was to explore the challenges to mental health and psychological well-being experienced by Critical Care Nurses during the COVID-19 pandemic. STUDY DESIGN: A longitudinal, qualitative study involving semi-structured interviews with 54 critical care nurses across 38 hospitals in the United Kingdom and Ireland. Interviews were transcribed verbatim and analysed using thematic analysis. RESULTS: Four key themes were identified which represent the challenges faces by critical care nurses during the COVID-19 pandemic: Lack of control, Psychological trauma, Unexpected leadership, Public-political betrayal. CONCLUSIONS: While public-political praise may lead to a short-term lift in morale for front line workers; where it is not accompanied by practical support in terms of appropriate equipment, leadership, emotional support and renumeration it is likely to be damaging in the longer term. RELEVANCE TO CLINICAL PRACTICE: This study has provided a greater understanding of the factors which affected the well-being and mental health of critical care nurses during a global pandemic.

Feeling like the enemy: the emotion management and alienation of hospital doctors.

Introduction: Globally, an epidemic of psychological distress, burnout, and workforce attrition signify an acute deterioration in hospital doctors' relationship with their work-intensified by COVID-19. This deterioration is more complicated than individual responses to workplace stress, as it is heavily regulated by social, professional, and organizational structures. Moving past burnout as a discrete "outcome," we draw on theories of emotion management and alienation to analyze the strategies through which hospital doctors continue to provide care in the face of resource-constraints and psychological strain. Methods: We used Mobile Instant Messaging Ethnography (MIME), a novel form of remote ethnography comprising a long-term exchange of digital messages to elicit "live" reflections on work-life experiences and feelings. Results: The results delineate two primary emotion-management strategies-acquiescence and depersonalization-used by the hospital doctors to suppress negative feelings and emotions (e.g., anger, frustration, and guilt) stemming from the disconnect between professional norms of expertise and self-sacrifice, and organizational realities of impotence and self-preservation. Discussion: Illustrating the continued relevant of alienation, extending its application to doctors who disconnect to survive, we show how the socio-cultural ideals of the medical profession (expertise and self-sacrifice) are experienced through the emotion-management and self-estrangement of hospital doctors. Practically, the deterioration of hospital doctors' relationship with work is a threat to health systems and organizations. The paper highlights the importance of understanding the social structures and disconnects that shape this deteriorating relationship and the broad futility of self-care interventions embedded in work contexts of unrealized professional ideals, organizational resource deficits and unhappy doctors, patients, and families.

COVID-19 and healthcare worker mental well-being: Comparative case studies on interventions in six countries.

Healthcare worker (HCW) mental well-being has become a global public health priority as health systems seek to strengthen their resilience in the face of the COVID-19 pandemic. Analysing data from the Health System Response Monitor, we present six case studies (Denmark, Italy, Kyrgyzstan, Lithuania, Romania, and the United Kingdom) as a comparative review of policy interventions supporting HCW mental health during the pandemic. The results illustrate a wide range of interventions. While Denmark and the United Kingdom built on pre-existing structures to support HCW mental wellbeing during the pandemic, the other countries required new interventions. Across all cases, there was a reliance on self-care resources, online training tools, and remote professional support. Based on our analysis, we develop four policy recommendations for the future of HCW mental health supports. First, HCW mental health should be seen as a core facet of health workforce capacity. Second, effective mental health supports requires an integrated psychosocial approach that acknowledges the importance of harm prevention strategies and organisational resources (psychological first aid) alongside targeted professional interventions. Third, personal, professional and practical obstacles to take-up of mental health supports should be addressed. Fourth, any specific support or intervention targeting HCW's mental health is connected to, and dependent on, wider structural and employment factors (e.g. system resourcing and organisation) that determine the working conditions of HCWs.

An exploratory study of the effects of strenuous exercise on markers of coagulation activation, circulating microparticles, and inflammation in sickle cell trait.

This exploratory study evaluated the effect of intense exercise on biomarkers of inflammation and coagulation activation in subjects with and without sickle cell trait (SCT). Fifteen healthy African American men (18-35 years, 5 SCT, 10 control) completed a strenuous exercise protocol. Microparticle-associated prothrombinase and tissue factor activities, as well as soluble VCAM, total white cell and monocyte count increased transiently in all subjects following exercise. In the SCT group, exercise resulted in increased d-dimer, erythrocyte phosphatidylserine exposure, as well as increased circulating erythrocyte- and endothelial-derived microparticle numbers. These alterations could contribute to exercise-related complications in people with SCT.

Calibration of activity-related energy expenditure in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

OBJECTIVES: Usual physical activity (PA) is a complex exposure and typical instruments to measure aspects of PA are subject to measurement error, from systematic biases and biological variability. This error can lead to biased estimates of associations between PA and health outcomes. We developed a calibrated physical activity measure that adjusts for measurement error in both self-reported and accelerometry measures of PA in adults from the US Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a community-based cohort study. DESIGN: Total energy expenditure (TEE) from doubly labeled water and resting energy expenditure (REE) from indirect calorimetry were measured in 445 men and women aged 18-74years in 2010-2012, as part of the HCHS/SOL Study of Latinos: Nutrition & Physical Activity Assessment Study (SOLNAS). Measurements were repeated in a subset (N=98) 6months later. METHOD: Calibration equations for usual activity-related energy expenditure (AEE=0.90×TEE-REE) were developed by regressing this objective biomarker on self-reported PA and sedentary behavior, Actical accelerometer PA, and other subject characteristics. RESULTS: Age, weight and height explained a significant amount of variation in AEE. Actical PA and wear-time were important predictors of AEE; whereas, self-reported PA was not independently associated with AEE. The final calibration equation explained fifty percent of variation in AEE. CONCLUSIONS: The developed calibration equations can be used to obtain error-corrected associations between PA and health outcomes in HCHS/SOL. Our study represents a unique opportunity to understand the measurement characteristics of PA instruments in an under-studied Hispanic/Latino cohort.

Accuracy of Right Upper Quadrant Ultrasound in Estimating Gallbladder Wall Thickness.

OBJECTIVE: Ultrasound (US) evaluation of biliary pathology can be influenced by a variety of factors. This study examines the effect of patient specific factors on the accuracy of sonographic evaluation of gallbladder wall thickness (GBW). METHODS: We performed a retrospective review of all patients who underwent cholecystectomy at a single institution from November 2012 to October 2015. GBW measured on US was compared with pathology results. Results were analyzed in relation to patient specific factors to include BMI, age, presence of diabetes, sex, and urgent versus elective cases. RESULTS: In total 601 patients underwent cholecystectomy, 484 of which had paired preoperative US GBW measurement and postoperative pathologic specimen measurement. No significant difference in accuracy or precision of US measurement of the GBW based on BMI was found. Accuracy was not related to age, sex, urgency, or diabetes. Precision decreased with pathologic thickening, age, male sex, and urgent case performance. CONCLUSIONS: US is accurate in measuring GB wall thickness regardless of patient specific factors. A nonsignificant trend exists with decreased precision with pathologic thickening, age, male sex, and urgently performed cases.

Benefits for African American and white low-income 7-10-year-old children and their parents taught together in a community-based weight management program in the rural southeastern United States.

BACKGROUND: Low-income children and parents are at increased risk for developing overweight and obesity. Therefore, the purpose of this exploratory study was to compare whether African American and white children and parents benefitted equally from a community-based weight management intervention delivered in two rural counties in southeastern North Carolina (N.C.). METHODS: We compared the efficacy of the Family Partners for Health intervention for African American and white children and their parents by testing the three-way interaction of the intervention group according to visit and race. RESULTS: African American children in the intervention group weighed significantly (P = 0.027) less than those in the control group, while white children in the intervention group weighed less than those in the control group, but the difference did not reach statistical significance. African American and white parents in the intervention group weighed less than their respective control groups across all three data collections, but the difference was only significant in the group of white parents (P = 0.010) at the completion of the study. At the completion of the study, African American children in the intervention group received significantly (P = 0.003) more support for physical activity than African American children in the control group. At both time points, white children in the intervention group were not significantly different from those in the control group. African American parents in the intervention group scored slightly worse in the stress management assessment compared to those in the control group, while white parents in the intervention group showed a significantly (P = 0.041) better level of stress management than those in the control group. At the completion of the study, African American parents in the intervention group scored somewhat worse in emotional eating self-efficacy compared to the scores of the African American parents in the control group, while white parents in the intervention group scored significantly (P < 0.001) better than those in the control group. CONCLUSIONS: We were successful in affecting some outcomes in both African American and white children and parents using the same intervention. TRIAL REGISTRATION: NCT01378806 Registered June 22, 2011.

Utility of the Youth Compendium of Physical Activities.

PURPOSE: The purposes of this article are to: (a) describe the rationale and development of the Youth Compendium of Physical Activities (Youth Compendium); and (b) discuss the utility of the Youth Compendium for audiences in research, education, community, health care, public health, and the private sector. METHODS: The Youth Compendium provides a list of 196 physical activities (PA) categorized by activity types, specific activities, and metabolic costs (youth metabolic equivalents of task [METy]) as measured by indirect calorimetry. The utility of the Youth Compendium was assessed by describing ways in which it can be used by a variety of audiences. RESULTS: Researchers can use METy values to estimate PA levels and determine changes in PA in intervention studies. Educators can ask students to complete PA records to determine time spent in physical activities and to identify health-enhancing activities for classroom PA breaks. Community leaders, parents, and health care professionals can identify activity types that promote healthful behaviors. Public health agencies can use the METy values for surveillance and as a resource to inform progress toward meeting national physical activity guidelines. Applications for the private sector include the use of METy in PA trackers and other applications. CONCLUSION: The National Collaborative on Childhood Obesity Research Web site presents the Youth Compendium and related materials to facilitate measurement of the energy cost of nearly 200 physical activities in children and youth. The Youth Compendium provides a way to standardize energy costs in children and youth and has application for a wide variety of audiences.

Correction to: A cluster randomized controlled trial for child and parent weight management: children and parents randomized to the intervention group have correlated changes in adiposity.

[This corrects the article DOI: 10.1186/s40608-017-0175-z.].

Ventilatory Responses During Submaximal Exercise in Children With Prader-Willi Syndrome.

PURPOSE: Prader-Willi syndrome (PWS) is a genetic neurobehavioral disorder presenting hypothalamic dysfunction and adiposity. At rest, PWS exhibits hypoventilation with hypercapnia. We characterized ventilatory responses in children with PWS during exercise. METHODS: Participants were children aged 7-12 years with PWS (n = 8) and without PWS with normal weight (NW; n = 9, body mass index ≤ 85th percentile) or obesity (n = 9, body mass index ≥ 95th percentile). Participants completed three 5-minute ambulatory bouts at 3.2, 4.0, and 4.8 km/h. Oxygen uptake, carbon dioxide output, ventilation, breathing frequency, and tidal volume were recorded. RESULTS: PWS had slightly higher oxygen uptake (L/min) at 3.2 km/h [0.65 (0.46-1.01) vs 0.49 (0.34-0.83)] and at 4.8 km/h [0.89 (0.62-1.20) vs 0.63 (0.45-0.97)] than NW. PWS had higher ventilation (L/min) at 3.2 km/h [16.2 (13.0-26.5) vs 11.5 (8.4-17.5)], at 4.0 km/h [16.4 (13.9-27.9) vs 12.7 (10.3-19.5)], and at 4.8 km/h [19.7 (17.4-31.8) vs 15.2 (9.5-21.6)] than NW. PWS had greater breathing frequency (breaths/min) at 3.2 km/h [38 (29-53) vs 29 (22-35)], at 4.0 km/h [39 (29-58) vs 29 (23-39)], and at 4.8 km/h [39 (33-58) vs 32 (23-42)], but similar tidal volume and ventilation/carbon dioxide output to NW. CONCLUSION: PWS did not show impaired ventilatory responses to exercise. Hyperventilation in PWS may relate to excessive neural stimulation and metabolic cost.

Energy Cost Expression for a Youth Compendium of Physical Activities: Rationale for Using Age Groups.

PURPOSE: This study compared the accuracy of physical activity energy expenditure (PAEE) prediction using 2 methods of accounting for age dependency versus 1 standard (single) value across all ages. METHODS: PAEE estimates were derived by pooling data from 5 studies. Participants, 6-18 years (n = 929), engaged in 14 activities while in a room calorimeter or wearing a portable metabolic analyzer. Linear regression was used to estimate the measurement error in PAEE (expressed as youth metabolic equivalent) associated with using age groups (6-9, 10-12, 13-15, and 16-18 y) and age-in-years [each year of chronological age (eg, 12 = 12.0-12.99 y)] versus the standard (a single value across all ages). RESULTS: Age groups and age-in-years showed similar error, and both showed less error than the standard method for cycling, skilled, and moderate- to vigorous-intensity activities. For sedentary and light activities, the standard had similar error to the other 2 methods. Mean values for root mean square error ranged from 0.2 to 1.7 youth metabolic equivalent across all activities. Error reduction ranged from -0.2% to 21.7% for age groups and -0.23% to 18.2% for age-in-years compared with the standard. CONCLUSIONS: Accounting for age showed lower errors than a standard (single) value; using an age-dependent model in the Youth Compendium is recommended.

A Youth Compendium of Physical Activities: Activity Codes and Metabolic Intensities.

PURPOSE: A Youth Compendium of Physical Activities (Youth Compendium) was developed to estimate the energy costs of physical activities using data on youth only. METHODS: On the basis of a literature search and pooled data of energy expenditure measurements in youth, the energy costs of 196 activities were compiled in 16 activity categories to form a Youth Compendium of Physical Activities. To estimate the intensity of each activity, measured oxygen consumption (V˙O2) was divided by basal metabolic rate (Schofield age-, sex-, and mass-specific equations) to produce a youth MET (METy). A mixed linear model was developed for each activity category to impute missing values for age ranges with no observations for a specific activity. RESULTS: This Youth Compendium consists of METy values for 196 specific activities classified into 16 major categories for four age-groups, 6-9, 10-12, 13-15, and 16-18 yr. METy values in this Youth Compendium were measured (51%) or imputed (49%) from youth data. CONCLUSION: This Youth Compendium of Physical Activities uses pediatric data exclusively, addresses the age dependency of METy, and imputes missing METy values and thus represents advancement in physical activity research and practice. This Youth Compendium will be a valuable resource for stakeholders interested in evaluating interventions, programs, and policies designed to assess and encourage physical activity in youth.

A cluster randomized controlled trial for child and parent weight management: children and parents randomized to the intervention group have correlated changes in adiposity.

Background: Studies have suggested that obesity is linked within families and that successful interventions involve both the parent and child with obesity. However little information exists regarding similarities in adiposity and weight loss between the parent and child, especially in low socio-economic ethnically diverse households. Methods: The purpose of this study was to examine the relationships between the changes from baseline over time in adiposity, weight, health behaviors, and self-efficacy in children (n = 184) and parents (n = 184) participating in an 18-month weight loss program. Within the intervention group only and for each post-baseline time point, Pearson correlation coefficients were computed for children's changes (from baseline) in adiposity, weight, health behaviors, and self-efficacy, with their parents' corresponding changes from baseline, to determine how strongly the dyads were correlated. Results: At the completion of 18 months, the intervention group parents demonstrated strong positive correlations between parent and child change in waist circumference (r = 0.409, p < 0.001), triceps (r = 0.332, p < 0.001), and subscapular (r = 0.292, p = 0.002) skinfolds. There were no significant correlations between weight, health behaviors, eating, and exercise self-efficacy. Conclusions: The results suggest that in the Southern United States low-income parents and their children with obesity are strongly correlated. Trial registration: NCT01378806 Retrospectively Registered on June 22, 2011.

Pediatric Exercise Testing: Value and Implications of Peak Oxygen Uptake.

Peak oxygen uptake (peak V ˙ O 2 ) measured by clinical exercise testing is the benchmark for aerobic fitness. Aerobic fitness, estimated from maximal treadmill exercise, is a predictor of mortality in adults. Peak V ˙ O 2 was shown to predict longevity in patients aged 7-35 years with cystic fibrosis over 25 years ago. A surge of exercise studies in young adults with congenital heart disease over the past decade has revealed significant prognostic information. Three years ago, the first clinical trial in children with pulmonary arterial hypertension used peak V ˙ O 2 as an endpoint that likewise delivered clinically relevant data. Cardiopulmonary exercise testing provides clinicians with biomarkers and clinical outcomes, and researchers with novel insights into fundamental biological mechanisms reflecting an integrated physiological response hidden at rest. Momentum from these pioneering observations in multiple disease states should impel clinicians to employ similar methods in other patient populations; e.g., sickle cell disease. Advances in pediatric exercise science will elucidate new pathways that may identify novel biomarkers. Our initial aim of this essay is to highlight the clinical relevance of exercise testing to determine peak V ˙ O 2 , and thereby convince clinicians of its merit, stimulating future clinical investigators to broaden the application of exercise testing in pediatrics.

The influence of physical characteristics on the resting energy expenditure of youth: A meta-analysis.

OBJECTIVE: To examine the literature on resting energy expenditure (REE) of youth and determine the influence of age, sex, BMI, and body composition on REE. METHODS: A literature search was conducted using PubMed, BIOSIS Previews, NTIS, EMBASE, MEDLINE, and Pascal databases for studies with data on resting metabolic rate, REE, resting oxygen uptake (or VO2 ) in healthy children, youth, or adolescents (age = 1-18 years). Over 200 publications were identified; sixty-one publications met criteria and were included in the meta-analyses, resulting in 142 study population estimates (totaling 5,397 youth) of REE. RESULTS: Pooled mean was 1414 kcal·day-1 with a significant and moderate-to-high between-study heterogeneity [Q(140) = 7912.42, P < 0.001; I2 = 98.97%]. A significantly greater (P < 0.001) pooled mean kcal·day-1 was estimated for studies with male participants (1519 kcal·day-1 ) comparing to studies with female participants (1338 kcal·day-1 ). Age, height, and body mass resulted in the highest R2 of 86.4 for males and 83.9% for females. Fat free mass and body mass index (BMI) did not improve total R2 . CONCLUSIONS: These data suggest that using a linear equation including age, height, and body mass to estimate REE based on kcal·day-1 is more accurate than estimates based on body mass kcal·kg-1 ·h-1 . Further, if kcal·kg-1 ·h-1 is used, including a quadratic component for the physical characteristics improves the predictive ability of the equation. Regardless of the metric, separate equations should be used for each sex.

An unusual presentation of a rare disease: posterior reversible encephalopathy syndrome following abdominal sepsis.

Posterior reversible encephalopathy syndrome (PRES) is an unusual disease of unknown incidence and cause. There are a wide range of associated, predisposing medical causes to include pregnancy, renal failure, immunosuppressive medication administration and hypertension. The diagnosis is made following the radiographic identification of characteristic vasogenic edema in the setting of neurologic impairment. A significant portion of patients will have long-term, if not permanent, sequelae of the disease. We present a patient who developed PRES following a hemicolectomy that was complicated by an anastomotic leak. She went on to a complete recovery following surgical treatment of the leak and supportive care.

Primary aortoduodenal fistula: a rare entity with lethal effects.

Primary aortoduodenal fistula (ADF) is a rare but morbid diagnosis. Here, we present the case of a patient with a primary ADF that resulted in mortality. Despite multiple attempts at radiographic and endoscopic diagnosis, the fistula did not declare itself until the patient exsanguinated. Given the morbidity associated with ADF and the imperfection of associated diagnostic studies, a high index of suspicion is required to make a timely diagnosis.

Comparison of Energy Expenditure of Youth Playing Tennis During Practice and Match Settings.

BACKGROUND: Researchers have investigated the energy expenditure of tennis practice and match play in adults but not youth. METHODS: VO2 was recorded for 36 youth, ages 9 to 18, during 10-minute bouts of tennis practice and match play. A GLM was used to compare VO2 between practice and match play and among age groups (9-12 years, 13-15 years, and 16-18 years); also to compare the difference in adult and child-derived MET values (ΔMET). RESULTS: VO2 was higher for tennis match play vs. practice (P < .05) and there was a trend for 16 to 18 year olds having lower VO2 than 9 to 12 year olds (P = .055). ΔMET did not differ between settings but varied by age group (P = .004); it was highest in 9- to 12-year-olds and lowest in 16- to 18-year-olds. CONCLUSIONS: Youth expend more energy while playing a tennis match than practice, regardless of age. Child-derived MET values equaled those of adults once youth reached ages 16 to 18.

Relationships of physical activity and sedentary time in obese parent-child dyads: a cross-sectional study.

BACKGROUND: Research suggests physical activity is linked to obesity. Further, the physical activity of healthy parents and their children is associated with each other. However, this relationship has not been examined in obese parents and their obese children. METHODS: The purpose of this study was to compare the physical activity and sedentary time of obese, low-income, ethnic minority parents and their children on weekdays and weekend days using accelerometry. Data were obtained from eight rural sites in the middle and eastern part of North Carolina (N.C.), United States (U.S.) from 2007-2010 using a rolling enrollment. One hundred and ninety-nine obese parents (94 % female) and their obese children (54 % female) wore accelerometers simultaneously for three weekdays and one weekend day. Total physical activity, moderate-to-vigorous physical activity (MVPA) and sedentary time and proportions were determined. RESULTS: Parents' and children's total physical activity and MVPA levels were lower on weekend days than weekdays. Total counts per minute for children on weekdays and weekend days were greater than for parents (p < 0.001). Total counts per minute were more highly correlated on weekend days than weekdays (r = 0.352, p < 0.0002 versus r = 0.165, p < 0.025). Parents' performed MVPA for 14 (SD = ±25) and 9 (SD = ±16) minutes/day on weekdays and weekend days, respectively; children performed MVPA for 37 (SD = ±25) and 31(SD = ±38) minutes/day for weekdays and weekend days, respectively. Correlations between parents and children for MVPA were higher on weekend days versus weekdays (r = 0.253 and 0.177, respectively; p < 0.015). Associations for sedentary time followed a similar trend, with r = 0.33 (p < 0.0002) for weekend days and r = 0.016 (p < 0.026) for weekdays. Associations between obese parent-child dyads on sedentary time were stronger for girls, while associations between dyads on MVPA were stronger for boys. However, formal interaction analyses were not significant (p > 0.13). DISCUSSION: Since physical activity levels of obese parents and their obese child are somewhat related, especially on weekend days, combined parent-child obesity programs focused on reducing sedentary time could be beneficial, particularly for the child. CONCLUSION: In conclusion, this study of the physical activity levels of obese parents and their obese children found some relationships between the parents' and children's physical activity and sedentary behavior patterns, especially on weekend days. TRIAL REGISTRATION: NCT01378806 .

Exploring Metrics to Express Energy Expenditure of Physical Activity in Youth.

BACKGROUND: Several approaches have been used to express energy expenditure in youth, but no consensus exists as to which best normalizes data for the wide range of ages and body sizes across a range of physical activities. This study examined several common metrics for expressing energy expenditure to determine whether one metric can be used for all healthy children. Such a metric could improve our ability to further advance the Compendium of Physical Activities for Youth. METHODS: A secondary analysis of oxygen uptake (VO2) data obtained from five sites was completed, that included 947 children ages 5 to 18 years, who engaged in 14 different activities. Resting metabolic rate (RMR) was computed based on Schofield Equations [Hum Nutr Clin Nut. 39(Suppl 1), 1985]. Absolute oxygen uptake (ml.min-1), oxygen uptake per kilogram body mass (VO2 in ml.kg-1.min-1), net oxygen uptake (VO2 - resting metabolic rate), allometric scaled oxygen uptake (VO2 in ml.kg-0.75.min-1) and YOUTH-MET (VO2.[resting VO2] -1) were calculated. These metrics were regressed with age, sex, height, and body mass. RESULTS: Net and allometric-scaled VO2, and YOUTH-MET were least associated with age, sex and physical characteristics. For moderate-to-vigorous intensity activities, allometric scaling was least related to age and sex. For sedentary and low-intensity activities, YOUTH-MET was least related to age and sex. CONCLUSIONS: No energy expenditure metric completely eliminated the influence of age, physical characteristics, and sex. The Adult MET consistently overestimated EE. YOUTH-MET was better for expressing energy expenditure for sedentary and light activities, whereas allometric scaling was better for moderate and vigorous intensity activities. From a practical perspective, The YOUTH-MET may be the more feasible metric for improving of the Compendium of Physical Activities for Youth.