Using electronic health records to evaluate the adherence to cervical cancer prevention guidelines: A cross-sectional study.

OBJECTIVE: The fight against cervical cancer requires effective screening together with optimal and on-time treatment along the care continuum. We examined the impact of cervical cancer testing and treatment guidelines on testing practices, and follow-up adherence to guidelines. METHODS: Data from Estonian electronic health records and healthcare provision claims for 50,702 women was used. The annual rates of PAP tests, HPV tests and colposcopies during two guideline periods (2nd version 2012-2014 vs 3rd version 2016-2019) were compared. To assess the adherence to guidelines, the subjects were classified as adherent, over- or undertested based on the timing of the appropriate follow-up test. RESULTS: The number of PAP tests decreased and HPV tests increased during the 3rd guideline period (p < 0.01). During the 3rd guideline period, among 21-29-year-old women, the adherence to guidelines ranged from 38.7% (44.4…50.1) for ASC-US to 73.4% (62.6…84.3) for HSIL and among 30-59-year-old from 49.0% (45.9…52.2) for ASC-US to 65.7% (58.8…72.7) for ASCH. The highest rate of undertested women was for ASC-US (21-29y: 25.7%; 30-59y: 21.9%). The rates of over-tested women remained below 12% for all cervical pathologies observed. There were 55.2% (95% CI 49.7…60.8) of 21-24-year-olds and 57.1% (95% CI 53.6…60.6) of 25-29-year-old women who received HPV test not adherent to guidelines. CONCLUSIONS: Our findings highlighted some shortcomings in guideline adherence, especially among women under 30. The insights gained from this study help to improve the quality of care and, thus, reduce cervical cancer incidence and mortality.

Markov modeling for cost-effectiveness using federated health data network.

OBJECTIVE: To introduce 2 R-packages that facilitate conducting health economics research on OMOP-based data networks, aiming to standardize and improve the reproducibility, transparency, and transferability of health economic models. MATERIALS AND METHODS: We developed the software tools and demonstrated their utility by replicating a UK-based heart failure data analysis across 5 different international databases from Estonia, Spain, Serbia, and the United States. RESULTS: We examined treatment trajectories of 47 163 patients. The overall incremental cost-effectiveness ratio (ICER) for telemonitoring relative to standard of care was 57 472 €/QALY. Country-specific ICERs were 60 312 €/QALY in Estonia, 58 096 €/QALY in Spain, 40 372 €/QALY in Serbia, and 90 893 €/QALY in the US, which surpassed the established willingness-to-pay thresholds. DISCUSSION: Currently, the cost-effectiveness analysis lacks standard tools, is performed in ad-hoc manner, and relies heavily on published information that might not be specific for local circumstances. Published results often exhibit a narrow focus, central to a single site, and provide only partial decision criteria, limiting their generalizability and comprehensive utility. CONCLUSION: We created 2 R-packages to pioneer cost-effectiveness analysis in OMOP CDM data networks. The first manages state definitions and database interaction, while the second focuses on Markov model learning and profile synthesis. We demonstrated their utility in a multisite heart failure study, comparing telemonitoring and standard care, finding telemonitoring not cost-effective.

Transforming Estonian health data to the Observational Medical Outcomes Partnership (OMOP) Common Data Model: lessons learned.

Objective: To describe the reusable transformation process of electronic health records (EHR), claims, and prescriptions data into Observational Medical Outcome Partnership (OMOP) Common Data Model (CDM), together with challenges faced and solutions implemented. Materials and Methods: We used Estonian national health databases that store almost all residents' claims, prescriptions, and EHR records. To develop and demonstrate the transformation process of Estonian health data to OMOP CDM, we used a 10% random sample of the Estonian population (n = 150 824 patients) from 2012 to 2019 (MAITT dataset). For the sample, complete information from all 3 databases was converted to OMOP CDM version 5.3. The validation was performed using open-source tools. Results: In total, we transformed over 100 million entries to standard concepts using standard OMOP vocabularies with the average mapping rate 95%. For conditions, observations, drugs, and measurements, the mapping rate was over 90%. In most cases, SNOMED Clinical Terms were used as the target vocabulary. Discussion: During the transformation process, we encountered several challenges, which are described in detail with concrete examples and solutions. Conclusion: For a representative 10% random sample, we successfully transferred complete records from 3 national health databases to OMOP CDM and created a reusable transformation process. Our work helps future researchers to transform linked databases into OMOP CDM more efficiently, ultimately leading to better real-world evidence.

Technology adoption review for ageing well: analysis of technical solutions.

While several technological solutions are available for older adults to improve their wellbeing and quality of life, little is known about the gaps between the needs, provided solutions, and their adoption from a more pragmatic perspective. This paper reports on reviewing existing technological solutions for older adults, which span the work life, life in the community, and wellbeing at home. We analyzed 50 different solutions to uncover both negative and positive features of these solutions from the perspective of the impact of technology adoption on the quality of life of older adults. Our approach harnesses holistic reasoning to determine the most suitable technologies available today and provides suggestions for improvement toward designing and implementing better solutions.

The use of prescription drugs and health care services during the 6-month post-COVID-19 period.

COVID-19 and other acute respiratory viruses can have a long-term impact on health. We aimed to assess the common features and differences in the post-acute phase of COVID-19 compared with other non-chronic respiratory infections (RESP) using population-based electronic health data. We applied the self-controlled case series method where prescription drugs and health care utilisation were used as indicators of health outcomes during the six-month-long post-acute period. The incidence rate ratios of COVID-19 and RESP groups were compared. The analysis included 146 314 individuals. Out of 5452 drugs analysed, 14 had increased administration after COVID-19 with drugs for cardiovascular diseases (trimetazidine, metoprolol, rosuvastatin) and psychotropic drugs (alprazolam, zolpidem, melatonin) being most prevalent. The health impact of COVID-19 was more apparent among females and individuals with non-severe COVID-19. The increased risk of exacerbating pre-existing conditions was observed for the COVID-19 group. COVID-19 vaccination did not have effect on drug prescriptions but lowered the health care utilisation during post-acute period. Compared with RESP, COVID-19 increased the use of outpatient services during the post-infection period. The long-term negative impact of COVID-19 on life quality must be acknowledged, and supportive health care and public health services provided.

Involving Older Adults During COVID-19 Restrictions in Developing an Ecosystem Supporting Active Aging: Overview of Alternative Elicitation Methods and Common Requirements From Five European Countries.

Background: Information and communication technology solutions have the potential to support active and healthy aging and improve monitoring and treatment outcomes. To make such solutions acceptable, all stakeholders must be involved in the requirements elicitation process. Due to the COVID-19 situation, alternative approaches to commonly used face-to-face methods must often be used. One aim of the current article is to share a unique experience from the Pharaon project where due to the COVID-19 outbreak alternative elicitation methods were used. In addition, an overview of common functional, quality, and emotional goals identified by six pilot sites is presented to complement the knowledge about the needs of older adults. Methods: Originally planned face-to-face co-creation seminars were impossible to carry out, and all pilot sites chose alternative requirements elicitation methods that were most suitable in their situation. The elicited requirements were presented in the form of goal models. In one summary goal model, we provide an overview of common functional, quality, and emotional goals. Results: Different elicitation methods were combined based on the digital literacy of the target group and their access to digital tools. Methods applied without digital technologies were phone interviews, reviews of literature and previous projects, while by means of digital technologies online interviews, online questionnaires, and (semi-)virtual co-creation seminars were conducted. The combination of the methods allowed to involve all planned stakeholders. Virtual and semi-virtual co-creation seminars created collaborative environment comparable to face-to-face situations, while online participation helped to save the time of the participants. The most prevalent functional goals elicited were "Monitor health," "Receive advice," "Receive information." "Easy to use/comfortable," "personalized/tailored," "automatic/smart" were identified as most prevalent quality goals. Most frequently occurring emotional goals were "involved," "empowered," and "informed." Conclusion: There are alternative methods to face-to-face co-creation seminars, which effectively involve older adults and other stakeholders in the requirements elicitation process. Despite the used elicitation method, the requirements can be easily transformed into goal models to present the results in a uniform way. The common requirements across different pilots provided a strong foundation for representing detailed requirements and input for further software development processes.

Agent-Oriented Goal Models in Developing Information Systems Supporting Physical Activity Among Adolescents: Literature Review and Expert Interviews.

BACKGROUND: Information and communication technologies (ICTs) are becoming increasingly popular in supporting the fight against low physical activity (PA) levels among adolescents. However, several ICT solutions lack evidence-based content. Therefore, there is a need to identify important features that have the potential to efficiently and consistently support the PA of adolescents using ICT solutions. OBJECTIVE: This study aims to create evidence-based models of requirements for ICT solutions supporting PA by combining scientific evidence from literature and health experts. In addition, we test the suitability of agent-oriented goal models in this type of modeling process. METHODS: A literature search of PubMed, Web of Science, and Scopus databases was conducted to identify evidence-based functional, quality, and emotional goals that have previously been proven to be relevant in supporting PAs among youth using ICT solutions. The identified goals were presented in the form of goal models. These models were used to collaborate with health experts to receive their input on the topic and suggestions for improvement. The initial goal models were improved based on the feedback from the experts. RESULTS: The results indicated that agent-oriented goal modeling is a suitable method for merging information from the literature and experts. One strength of agent-oriented goal models is that they present emotional requirements together with quality and functional requirements. Another strength is the possibility of presenting results from a literature review in a systematic manner and using them thereafter in the communication process with stakeholders. Agent-oriented goal models that were created were easy to understand for health experts without previous experience in requirements engineering, which facilitates and supports collaboration with nontechnical stakeholders. CONCLUSIONS: The proposed agent-oriented goal models effectively merged information from scientific literature and experts in the field and presented early functional, quality, and emotional requirements in a holistic and coherent manner. We believe that the created models have high potential to help requirements engineers and developers to provide more efficient ICT solutions that support PA among adolescents in the future.

Developing a comprehensive school-based physical activity program with flexible design - from pilot to national program.

This article focuses on the process of designing the vital, participatory school-based intervention program aiming to increase the physical activity in schools. The program analyzed is Estonian nationwide comprehensive physical activity program Schools in Motion (SiM) that recently received European Commission's #BeActive Education Award. The program has a good performance in terms of willingness of schools to participate in co-creation of program development, the high interest to join the program and zero dropouts, and strong partnership with ministries which enables to actively participate in policy making. Authors analyze the key elements of the planning, piloting, implementation, and scaling phases of the SiM program and share their lessons learnt in co-working with schools. The difficulties faced during the development process, the strengths and challenges associated with an interdisciplinary approach, and involvement of schools as experts have been addressed.

Shorter Ground Contact Time and Better Running Economy: Evidence From Female Kenyan Runners.

ABSTRACT: Mooses, M, Haile, DW, Ojiambo, R, Sang, M, Mooses, K, Lane, AR, and Hackney, AC. Shorter ground contact time and better running economy: evidence from female Kenyan runners. J Strength Cond Res 35(2): 481-486, 2021-Previously, it has been concluded that the improvement in running economy (RE) might be considered as a key to the continued improvement in performance when no further increase in V̇o2max is observed. To date, RE has been extensively studied among male East African distance runners. By contrast, there is a paucity of data on the RE of female East African runners. A total of 10 female Kenyan runners performed 3 × 1,600-m steady-state run trials on a flat outdoor clay track (400-m lap) at the intensities that corresponded to their everyday training intensities for easy, moderate, and fast running. Running economy together with gait characteristics was determined. Subjects showed moderate to very good RE at the first (202 ± 26 ml·kg-1·km-1) and second (188 ± 12 ml·kg-1·km-1) run trials, respectively. Correlation analysis revealed significant relationship between ground contact time (GCT) and RE at the second run (r = 0.782; p = 0.022), which represented the intensity of anaerobic threshold. This study is the first to report the RE and gait characteristics of East African female athletes measured under everyday training settings. We provided the evidence that GCT is associated with the superior RE of the female Kenyan runners.

The participation in organised sport doubles the odds of meeting physical activity recommendations in 7-12-year-old children.

The purpose of this study was to determine the contributing role of organised sport participation to daily physical activity (PA) and to describe the PA during training. Children aged 7-12 wore the accelerometer for 1 week. Children with activity data for a minimum of 5 days were included in the analysis (n = 492). Evenson cut-points were used to extract PA data for whole day and training sessions. Compliance with PA recommendations was assessed with two methods - weekly average and daily data. More than half (52.5%) of the children participated in an organised sport at least once a week. Participation in organised sport three or more times a week increased the odds of meeting PA recommendations (average method: OR = 4.02, 95% CI: 1.98-8.19, p < 0.001, days method: OR = 2.82, 95% CI: 1.35-5.88, p = 0.006). On average, children acquired 23.3 ± 15.3 min of moderate to vigorous PA (MVPA) during trainings, while boys accrued more MVPA minutes compared to girls (ß = 5.2, 95% CI: 2.4-8.0) and the training time MVPA decreased with age (ß = -1.0, 95% CI: -1.9 to -0.1), respectively. Each additional MVPA minute during training increased daily MVPA by 1.3 min (95% CI: 1.1-1.5). On days with training children accumulated 24.9 (95% CI: 21.8-28.0) more MVPA minutes compared to days without training. In conclusion, these findings highlight the importance of organised sport in supporting the PA levels of children. However, participation in the organised sport only is not sufficient to meet PA recommendations, and therefore, PA should be supported throughout the day.

Better Economy on Indoor Track Compared to Treadmill Running With 1% Inclination.

Purpose: The purpose of this study was to investigate the differences in metabolic responses between the track and the treadmill (1% inclination) running. The latter is recommended for use in laboratory settings to mimic outdoor running. Method: Seventeen male endurance athletes (mean 25.8, s = 3.8 years) performed 4-min running bouts on an indoor track and the treadmill. Results: At all speeds (11, 13, and 15 km·h-1) athletes showed better economy on the track running compared to the treadmill expressed as oxygen (7.9%, 5.2%, and 2.8%) and caloric (7.0%, 5.3%, and 2.6%) unit cost. Rating of perceived exertion was evaluated substantially higher at all speeds on the treadmill (F(1,16) = 31.45, p < .001, η2p = .663) compared to running on the track. Participants presented lower heart rate (F(1,16) = 13.74, p = .002, η2p = .462) on the track at the speed of 11 and 13 km·h-1 compared to the treadmill, but not at 15 km·h-1 (p = .021). Conclusions: We conclude that constant inclination (i.e.. 1%) during the treadmill test might not be suitable to reproduce comparable effort to running on the track; rather, there is an optimal treadmill inclination for different intensities to reproduce similar effort compared to the track running.

Effects of EPO on Blood Parameters and Running Performance in Kenyan Athletes.

INTRODUCTION: Recombinant human erythropoietin (rHuEpo) administration enhances oxygen carrying capacity and performance at sea level. It remains unknown whether similar effects would be observed in chronic altitude-adapted endurance runners. The aim of this study was to assess the effects of rHuEpo on hematological and performance parameters in chronic altitude-adapted endurance runners as compared to sea level athletes. METHODS: Twenty well-trained Kenyan endurance runners (KEN) living and training at approximately 2150 m received rHuEpo injections of 50 IU·kg body mass every 2 d for 4 wk and responses compared with another cohort (SCO) that underwent an identical protocol at sea level. Blood samples were obtained at baseline, during rHuEpo administration and 4 wk after the final injection. A maximal oxygen uptake (V˙O2max) test and 3000-m time trial was performed before, immediately after and 4 wk after the final rHuEpo injection. RESULTS: Hematocrit (HCT) and hemoglobin concentration (HGB) were higher in KEN compared to SCO before rHuEpo but similar at the end of administration. Before rHuEpo administration, KEN had higher V˙O2max and faster time trial performance compared to SCO. After rHuEpo administration, there was a similar increase in V˙O2max and time trial performance in both cohorts; most effects of rHuEpo were maintained 4 wk after the final rHuEpo injection in both cohorts. CONCLUSIONS: Four weeks of rHuEpo increased the HGB and HCT of Kenyan endurance runners to a lesser extent than in SCO (~17% vs ~10%, respectively) and these alterations were associated with similar improvements in running performance immediately after the rHuEpo administration (~5%) and 4 wk after rHuEpo (~3%).

Validating Fitbit Zip for monitoring physical activity of children in school: a cross-sectional study.

BACKGROUND: Modern activity trackers, including the Fitbit Zip, enable the measurement of both the step count as well as physical activity (PA) intensities. However, there is a need for field-based validation studies in a variety of populations before using trackers for research. Therefore, the purpose of the current study was to investigate the validity of Fitbit Zip step count, moderate to vigorous physical activity (MVPA) and sedentary minutes, in different school segments in 3rd grade students. METHODS: Third grade students (N = 147, aged 9-10 years) wore a Fitbit Zip and an ActiGraph GT3x-BT accelerometer simultaneously on a belt for five days during school hours. The number of steps, minutes of MVPA and sedentary time during class time, physical education lessons and recess were extracted from both devices using time filters, based on the information from school time tables obtained from class teachers. The validity of the Fitbit Zip in different school segments was assessed using Bland-Altman analysis and Spearman's correlation. RESULTS: There was a strong correlation in the number of steps in all in-school segments between the two devices (r = 0.85-0.96, P < 0.001). The Fitbit Zip overestimated the number of steps in all segments, with the greatest overestimation being present in physical education lessons (345 steps). As for PA intensities, the agreement between the two devices in physical education and recess was moderate for MVPA minutes (r = 0.56 and r = 0.72, P < 0.001, respectively) and strong for sedentary time (r = 0.85 and r = 0.87, P < 0.001, respectively). During class time, the correlation was weak for MVPA minutes (r = 0.24, P < 0.001) and moderate for sedentary time (r = 0.57, P < 0.001). For total in-school time, the correlation between the two devices was strong for steps (r = 0.98, P < 0.001), MVPA (r = 0.80, P < 0.001) and sedentary time (r = 0.94, P < 0.001). CONCLUSION: In general, the Fitbit Zip can be considered a relatively accurate device for measuring the number of steps, MVPA and sedentary time in students in a school-setting. However, in segments where sedentary time dominates (e.g. academic classes), a research-grade accelerometer should be preferred.

Physical activity, sedentary time and sleep duration: associations with body composition in 10-12-year-old Estonian schoolchildren.

BACKGROUND: Physical activity, sedentary time, and sleep duration have been associated with body composition among children. The purpose of the present study was to assess the associations of objectively determined daily physical activity, sedentary time, sleep duration and body composition indices in 10-12-year-old children. METHODS: Two hundred and eleven schoolchildren (96 boys and 115 girls) aged 10.9 ± 0.7 years participated in this study. Objective physical activity intensity and sedentary levels were measured for seven days by accelerometry. Sleep duration was self-reported. Percentage of body fat, waist-to-height ratio and fat free mass were calculated from measured anthropometric parameters. Multiple linear regression models were used to examine the associations between sleep duration, moderate-to-vigorous physical activity (MVPA), vigorous physical activity (VPA) level and body composition indices. RESULTS: Boys exceeded girls (p < 0.05) in time spent in MVPA and VPA levels. Only 4.3% of the children met the current daily recommendation of at least 60 min MVPA per day. Sleep duration, MVPA and VPA had a negative association with percentage of body fat and waist-to-height ratio. Vigorous physical activity had a positive association with fat-free mass. Sedentary time had a positive association with percentage of body fat and negative association with fat-free mass. CONCLUSIONS: The present study suggests that both sleep duration and MVPA are associated with body composition parameters. Higher levels of MVPA are associated with lower percentage of body fat and waist-to-height ratio regardless of sleep duration. Sedentary time is associated with higher values of percentage of body fat and lower fat-free mass independently of sleep duration.

Physical Education Increases Daily Moderate to Vigorous Physical Activity and Reduces Sedentary Time.

BACKGROUND: Physical activity (PA) is important to mental and physical health. Physical education (PE) lessons have the potential to increase daily moderate to vigorous PA (MVPA) and reduce sedentary time (SED). We measured MVPA and SED in primary school PE, determined the contribution of PE to daily MVPA and SED, and compared PA on days with and without PE. METHODS: PA was measured in 504 first (ages 7-9) and second (ages 10-12) school level children for 1 school week, with inclusion criteria of at least 10 hours of valid data. Linear mixed methods were used for data analysis. RESULTS: In PE, students spent 28.6 ± 16.5% in MVPA and 29.3 ± 19.8% in SED. Each additional MVPA minute in PE was associated with 1.4 more daily MVPA minutes. On days with PE, students had 12.8 (95% CI 10.5; 15.0) minutes more MVPA and 9.7 (95% CI 16.3; 3.1) minutes less SED compared with days without PE. CONCLUSIONS: Although MVPA in PE was relatively low and SED high, PE significantly increased daily MVPA and reduced SED, confirming the important role of PE in supporting the healthy development of children.

Lower Leg Length is Associated with Running Economy in High Level Caucasian Distance Runners.

The aim of the present study was to investigate lower limb anthropometric and composition variables related to running economy (RE) and running performance in a homogeneous group of high level European distance runners. RE at the speeds of 14, 16 and 18 km·h-1 (189 ± 12; 188 ± 11; 187 ± 11 O2 ml·kg-1·km-1) and maximal oxygen uptake (VO2max) (67.3 ± 2.9 ml·kg-1·min-1) of 13 high level distance runners were determined on a motorised treadmill. Anthropometric variables and body composition were measured. The BMI was related to RE at the speed of 14 (r2 = 0.434; p = 0.014), 16 (r2 = 0.436; p = 0.014) and 18 km·h-1 (r2 = 0.389; p = 0.023). Lower leg length was negatively related to RE at the speed of 16 and showed such a tendency at the speed of 14 and 18 km·h-1. VO2max indicated a moderate relationship with RE at the speeds of 14, 16 and 18 km·h-1 (r2 = 0.372, p = 0.030; r2 = 0.350, p = 0.033; r2 = 0.376, p = 0.026, respectively) which was confirmed by subsequent partial correlation analysis. While lower leg length and the BMI presented a relationship with RE, none of the calculated body composition and anthropometric proportions were related to RE or performance. The relationship between RE and VO2max would confirm the notion that RE could be at least partly compensated by VO2max to achieve high performance results.

Objectively measured sedentary behaviour and moderate and vigorous physical activity in different school subjects: a cross-sectional study.

BACKGROUND: Evidence shows the positive influence of moderate and vigorous physical activity (MVPA) and negative influence of sedentary time on health and academic achievement. Although schools can significantly contribute to overall physical activity, little is known about MVPA and sedentary behaviour in different school subjects in different grades. METHODS: Physical activity of 646 students from 18 schools (94 classes) and from three school stages (grades 1-9, aged 7-16) was measured with accelerometry for 5 school days. Time and proportion of MVPA and sedentary time, also average sedentary bout length was calculated for native language (Estonian), mathematics, science, foreign language, music and crafts lessons. RESULTS: A total of 6363 lessons were measured, with lesson duration of 45 min. The average lesson time MVPA remained below 2.2 min in all school stages and in all subjects. Students in grades 4-6 had greatest decline in the proportion of lesson time MVPA in science (ß = -1.9, 95%CI -3.1- -0.6) and music (-1.2, -2.1- -0.4) and in grades 7-9 in music (-1.7, -3.1- -0.3) lessons compared to grades 1-3. In grades 1-3 students spent on average 76% of lesson time (34.0 ± 7.0 min) as sedentary, whereas in grades 7-9 the average proportion of sedentary time was 87% (38.9 ± 5.7 min). An average sedentary bout length increased from 13 min in grades 1-3 to 20 min in grades 7-9. An increase in sedentary bout length from grades 1-3 compared to grades 7-9 was present in most subjects, except crafts, with smallest increase in foreign language (6 min, 3.5-8.9) and greatest in music lessons (16.6 min, 11.9-21.3). Lessons with prolonged sedentary bouts formed a maximum 36% of all lessons in grades 1-3 and 73% in grades 7-9. CONCLUSION: The long sedentary time, bout length and low MVPA in most subjects were unfavourable in respect of both health and academic achievement. Significantly increasing sedentary time and sedentary bout length in older school stages highlights the need for interventions in all subjects and especially in older grades in order to combat the inactivity of children.

Results From Estonia's 2016 Report Card on Physical Activity for Children and Youth.

BACKGROUND: The 2016 Report Card on Physical Activity for Children and Youth, the first of its kind, aims to set baseline physical activity (PA) indicators using the Active Healthy Kids Global Alliance grading system. METHODS: A research work group analyzed and selected data for the grade assignment meeting (GAM). During the GAM, 17 leading researchers and policy experts from Estonia assessed the data and assigned grades for each of the 9 PA indicators. In addition, recommendations were provided for further actions to improve the grades. RESULTS: Grades from A (highest) to F (lowest) were assigned as follows: 1) Overall PA (F); 2) Organized Sport (C); 3) Active Play [incomplete data (INC)]; 4) Active Transportation (INC); 5) Sedentary Behaviors (F); 6) Family and Peers (C); 7) School (C); 8) Community and the Built Environment (B); and 9) Government (C). An indicator was marked as incomplete (INC) when there was a lack of representative quality data. CONCLUSIONS: Evidence suggests that PA levels of Estonian children remain very low, despite moderately supportive social, environmental, and regulatory factors. There are many challenges to overcome in supporting and promoting PA of children and youth (eg, cross-sectional cooperation, implementing interventions, changing social norms, empowerment of parents and educational institutions).

Objectively measured physical activity levels and sedentary time in 7-9-year-old Estonian schoolchildren: independent associations with body composition parameters.

BACKGROUND: Sufficient daily physical activity (PA) is necessary for physical, social and mental health benefits during growth. Most of the available data on children is based on subjective reports, while only limited data on objective PA and sedentary levels is available for primary school children. Increased PA is also an important health indicator of body composition parameters, especially body adiposity indices. The aim of the present study was to determine objectively the amount of daily PA levels at different intensities and sedentary time in normal-weight (NW) and overweight (OW) 7-9-year-old boys and girls, and to find associations between objectively measured PA levels and sedentary time with different body composition values. METHODS: Two hundred and seventy eight (142 boys and 136 girls) primary school children aged 7.9 ± 0.7 years participated in this study. Objective PA intensity and sedentary levels were measured over 7 days by accelerometry. Indices of total fat mass (body fat %, sum of skinfolds), fat distribution (waist-to-height ratio) and muscular component (fat free mass [FFM]) were calculated from measured anthropometric parameters. RESULTS: There were no differences (p > 0.05) in PA intensity levels and sedentary time between boys and girls as well as between NW and OW children. About 11 % of children met the current guidelines of at least 60 min per day of moderate-to-vigorous PA (MVPA). Sedentary time was positively and negatively associated (p < 0.05) with all body fat and FFM values, respectively. Moderate and vigorous PA along with MVPA were negatively and positively associated (p < 0.05) with all body fat and FFM indices, respectively. CONCLUSIONS: The results of present study showed that about 11 % of primary school children were engaged in PA of at least 60 min of MVPA daily. While MVPA is negatively associated with fat mass indices and positively associated with FFM regardless of different confounders, sedentary time is negatively related to FFM and positively with fat mass values after adjusting for several confounders. These results suggest that higher MVPA level and lower sedentary time level are important in maintaining and developing healthy body composition in primary school children during growth.