The Flipped Break-Even: Re-Balancing Demand- and Supply-Side Financing of Health Centers in Cambodia.

Supply-side healthcare financing still dominates healthcare financing in many countries where the government provides line-item budgets for health facilities irrespective of the quantity or quality of services rendered. There is a risk that this approach will reduce the efficiency of services and the value of money for patients. This paper analyzes the situation of public health centers in Cambodia to determine the relevance of supply- and demand-side financing as well as lump sum and performance-based financing. Based on a sample of the provinces of Kampong Thom and Kampot in the year 2019, we determined the income and expenditure of each facility and computed the unit cost with comprehensive step-down costing. Furthermore, the National Quality Enhancement Monitoring Tool (NQEMT) provided us with a quality score for each facility. Finally, we calculated the efficiency as the quotient of quality and cost per service unit as well as correlations between the variables. The results show that the largest share of income was received from supply-side financing, i.e., the government supports the health centers with line-item budgets irrespective of the number of patients and the quality of care. This paper demonstrates that the efficiency of public health centers increases if the relevance of performance-based financing increases. Thus, the authors recommend increasing performance-based financing in Cambodia to improve value-based healthcare. There are several alternatives available to re-balance demand- and supply-side financing, and all of them must be thoroughly analyzed before they are implemented.

Reply to: Letter to the Editor regarding "Covid-19 transmission in fitness centers in Norway-a randomized trial".

In this correspondence we respond to critique of our randomized trial of Covid-19 transmission in fitness centers. The trial was performed in Norway during May and June 2020.

Letter to the editor regarding "Covid-19 transmission in fitness centers in Norway - a randomized trial".

In a recently published paper in BMC Public Health we read about a randomized trial on Covid-19 transmission performed in five fitness centers in Oslo, Norway, during the spring of 2020. In our opinion, this study has major shortcomings in design and methodology, which have not been addressed by the authors.

Uso de redes sociales y consumo de alimentos en adultos jovenes que asisten a gimnasios de la ciudad de Guayaquil / Use of social networks and food consumption of young adults who attendgyms in the city of Guayaquil

Introducción: La capacidad de las redes sociales para in-fluir en las audiencias de adultos jóvenes también ha desper-tado el interés de los profesionales de la salud pública comouna plataforma potencial para la promoción de la salud.Objetivo: Determinar uso de las redes sociales y consumode alimentos de adultos jóvenes que asisten a gimnasios dela ciudad de Guayaquil. Materiales y Métodos: Estudio transversal de tipo des-criptivo. Se trabajó con una muestra 509 adultos jóvenes de18 a 26 años que asisten a diferentes gimnasios de la ciudadde Guayaquil en Ecuador durante los meses de julio a di-ciembre del 2021. Se recolectó la información por medio deluso de un cuestionario online estructurado y creado enGoogle forms previamente validado. Para la identificación delos hábitos alimentarios se utilizó el cuestionario semicuanti-tativo de frecuencia de consumo de alimentos. Resultados: El 91,8% de los investigados usan casi siem-pre las redes sociales (p0,018), el tiempo promedio dedicadoal uso de las redes sociales es de 1 a 2 horas por día (37,7%; p0,048) y la red social que más utilizan es Facebook (42,4%;p<0,0001). Con respecto a la alimentación los jóvenes siguenpáginas que brindan información sobre dietas (62,1%;p<0,0001) teniendo la intención de prepararlas en algún mo-mento (80,7%), la información es brindada por nutricionistas(63,5%; p0,015). De acuerdo con la frecuencia de consumode alimentos (Tabla III) los investigados refieren una ingestainsuficiente de lácteos y derivados (84,1%; p<0,0001), ver-duras y hortalizas (71,5%), frutas (78,2%; p<0,0001), cere-ales y derivados (55,2%). Conclusiones: Las redes sociales pueden influir en formapositiva o negativa en la conducta alimentaria de los adoles-centes y adultos jóvenes, por lo cual es necesaria la educa-ción alimentaria de expertos en nutrición para prevenir quelas publicaciones engañosas puedan repercutir en el estadode salud del individuo.(AU)

Introduction: The ability of social media to influenceyoung adult audiences has also piqued the interest of pub-lic health professionals as a potential platform for healthpromotion. Objective: To determine the use of social networks andfood consumption of young adults who attend gyms in thecity of Guayaquil. Materials and Methods: Cross-sectional descriptivestudy. We worked with a sample of 509 young adults from 18to 26 years old who attend different gyms in the city ofGuayaquil in Ecuador during the months of July to December2021. The information was collected through the use of astructured online questionnaire created in Google forms pre-viously validated. For the identification of eating habits, thesemi-quantitative food frequency questionnaire was used.Results: 91.8% of those surveyed almost always use so-cial networks (p0.018), the average time spent using socialnetworks is 1 to 2 hours per day (37.7%; p0.048) and thesocial network they use the most is Facebook (42.4%;p<0.0001). Regarding food, young people follow pages thatprovide information on diets (62.1%; p<0.0001) with the in-tention of preparing them at some point (80.7%), the infor-mation is provided by nutritionists (63, 5%; p0.015).According to the frequency of food consumption (Table III),those surveyed report an insufficient intake of dairy prod-ucts and derivatives (84.1%; p<0.0001), greens and veg-etables (71.5%), fruits (78.2%; p<0.0001), cereals and de-rivatives (55.2%).Conclusions: Social networks can positively or negativelyinfluence the eating behavior of adolescents and youngadults, which is why food education from nutrition experts isnecessary to prevent misleading publications from havingrepercussions on the individual’s health status.(AU)

Autopercepción y uso de suplementos nutricionales en usuarios de gimnasios / Self-Perception and Use of Nutritional Supplements in Gym Users

La insatisfacción con la imagen corporal puede desencadenar preocupación excesiva por la estética conduciendo a una utilización indiscriminada de suplementos nutricionales. Por ello, el objetivo de este estudio fue investigar la relación entre percepción y conformidad de imagen corporal al uso de suplementos nutricionales en usuarios regulares de gimnasios de la región del Biobío, Chile. La investigación corresponde a un estudio analítico transversal realizado en el segundo semestre del año 2018, en el que participaron 262 personas mayores de 18 años. Se observó una asociación estadísticamente significativa entre el uso de suplementos nutricionales y la percepción de la imagen corporal (OR 0,58, IC95%0,34–0,98; p=0,045), y entre el uso de suplementos nutricionales y la conformidad con la imagen corporal (OR 0,43, IC95%0,25–0,75; p=0,003). En conclusión, a mayor disconformidad con la imagen corporal o la presencia de una percepción alterada de ésta, mayor es la probabilidad de consumir suplementos nutricionales. (AU)

Dissatisfaction with body image can trigger excessive concern for aesthetics aspects leading to indiscriminate use of nutritional supplements. Therefore, the objective of this study was to investigate the relationship between the perception and conformity of body image with the use of nutritional supplements in regular users of gyms in the Biobío region, Chile. The research corresponds to a cross-sectional analytical study conducted in the second half of the year 2018, in 262 participants over 18 years old. A statistically significant association between the use of nutritional supplements and the perception of body image (OR 0.58, 95% CI 0.34–0.98; p = 0.045), and between the use of nutritional supplements and conformity with body image (OR 0.43, 95% CI 0.25-0.75; p = 0.003) were observed. In conclusion, to greater disagreement with body image or the presence of an altered perception of it, more likely to consume nutritional supplements. (AU)

Difficulties and countermeasures in implementing age-friendly policies in primary health centers in Taiwan.

BACKGROUND: Taiwan is predicted to become a super-aged society by 2025, and primary health centers (PHCs) are set to play a crucial role in the care of older adults. The Taiwanese government has developed an age-friendly verification framework for PHC. The aims of this study were to explore the difficulties faced by PHC staff in the implementation of age-friendly policies and their solution strategies. METHODS: This study adopted a qualitative research method. The first stage involved conducting five focus groups with the responsible staff of PHCs (n = 41) that have been certified "age-friendly." The focus groups covered the effectiveness, difficulties, and resources of PHCs in regards to the introduction of age-friendly policies. In the second stage, in-depth interviews were conducted with executives of PHCs (n = 5), both certified and not certified as age-friendly, to further compare the difficulties faced by these two types of PHCs, thereby gaining perspectives for solution strategies. The principles of grounded theory were used for data analysis. RESULTS: Four major PHC strategies are employed in the promotion of age-friendliness. First, organizational management, through which managers apply management methods and analyze the present PHC-related health concerns; second, resource utilization, which refers to the tallying, linking, and integrating of resources; third, business operation process, in which work efficiency is improved through the combination of business operations and staff training; finally, hardware improvement, which is achieved through comprehensive cataloging of facility environments. CONCLUSION: The implementation of age-friendliness in PHCs requires the efforts of both the service units and government. With resources provided by the government, PHCs can integrate management methods, businesses operations, and essential resources. Moreover, PHC executives can lead their teams in promoting age-friendly policies, and closely monitor their effectiveness.

Development of a health-promoting sports club's intervention in France applying participatory action research.

The recognition of sports clubs (SC) as health-promoting settings is increasing, as well as the number of health promotion (HP) interventions implemented in this setting. However, minimal understanding of their development process and the persistent gap between theoretical knowledge and real-life practice is a major limitation to their implementation. This article describes a participatory research approach, implicating 29 stakeholders in sports and HP (6 HP researchers, 9 HP professionals, 6 representatives from regional and national sports organizations and 8 representatives from SC), leading to the co-construction of a health-promoting SC intervention. Stakeholders were mobilized through four stages: (i) analysis of effective programs, (ii) co-construction workshops, (iii) evaluation of relevance and acceptability, and (iv) beta-testing of a massive open online course (MOOC). A qualitative analysis was carried out on data collected through notetaking, recordings, transcripts, email exchanges and produced documents. This work led to the development of an HP intervention, including an MOOC, as well as a seven-step SC-tailored program. The convergence of theoretical knowledge and contextual real-life practice made it possible to respond to the specific needs and implementation problems encountered by SC actors and to develop acceptable strategies and tools.

Sports clubs (SC) can promote health beyond the offer of physical activity and sport by acting on health determinants (economic, social, environmental and organizational). To this end, interventions can be implemented. This study presents the way in which researchers and field actors can collaborate to develop adapted interventions. Involving 29 sport and health promotion (HP) actors (6 HP researchers, 9 HP professionals, 6 representatives from regional and national sports organizations, and 8 representatives from SC), four stages were set up to develop a Massive Open Online Course (MOOC) and an SC-tailored program: (i) analysis of effective programs, (ii) co-construction workshops, (iii) evaluation of relevance and acceptability, and (4) beta-testing of the MOOC. The results of these stages were qualitatively analyzed and allowed for the development of content, tools and planning consistent with the realities faced by SC. This work presents ways in which field actors and researchers can collaborate to develop acceptable strategies and tools to promote health.

BeatPain Utah: study protocol for a pragmatic randomised trial examining telehealth strategies to provide non-pharmacologic pain care for persons with chronic low back pain receiving care in federally qualified health centers.

INTRODUCTION: Although evidence-based guidelines recommend non-pharmacologic treatments as first-line care for chronic low back pain (LBP), uptake has been limited, particularly in rural, low-income and ethnically diverse communities. The BeatPain study will evaluate the implementation and compare the effectiveness of two strategies to provide non-pharmacologic treatment for chronic LBP. The study will use telehealth to overcome access barriers for persons receiving care in federally qualified health centres (FQHCs) in the state of Utah. METHODS AND ANALYSIS: BeatPain Utah is a pragmatic randomised clinical trial with a hybrid type I design investigating different strategies to provide non-pharmacologic care for adults with chronic LBP seen in Utah FQHCs. The intervention strategies include a brief pain consult (BPC) and telehealth physical therapy (PT) component provided using either an adaptive or sequenced delivery strategy across two 12-week treatment phases. Interventions are provided via telehealth by centrally located physical therapists. The sequenced delivery strategy provides the BPC, followed by telehealth PT in the first 12 weeks for all patients. The adaptive strategy uses a stepped care approach and provides the BPC in the first 12 weeks and telehealth PT to patients who are non-responders to the BPC component. We will recruit 500 English-speaking or Spanish-speaking participants who will be individually randomised with 1:1 allocation. The primary outcome is the Pain, Enjoyment and General Activity measure of pain impact with secondary outcomes including the additional pain assessment domains specified by the National Institutes (NIH) of Health Helping to End Addiction Long Initiative and implementation measures. Analyses of primary and secondary measures of effectiveness will be performed under longitudinal mixed effect models across assessments at baseline, and at 12, 26 and 52 weeks follow-ups. ETHICS AND DISSEMINATION: Ethics approval for the study was obtained from the University of Utah Institutional Review Board. On completion, study data will be made available in compliance with NIH data sharing policies. TRIAL REGISTRATION NUMBER: NCT04923334.

Conhecimentos em nutrição para o esporte e consumo de suplementos por praticantes de musculação em uma rede de academias / Sports Nutrition Knowledge and Supplement Consumption by Resistance Training Practitioners at a Gym Chain

Conhecimentos em nutrição para o esporte e consumo de suplementos por praticantes de musculação em uma rede de academiasARTIGO ORIGINALErivan de Olivindo Cavalcante1, Maria Rosimar Teixeira Matos2Objetivo: Este estudo objetivou avaliar os conhecimentos em nutrição para o esporte e o consumo de suplementos alimentares entre praticantes de musculação de uma rede de academias. Métodos: Trata-se de um estudo transversal, realizado com 168 praticantes de musculação em três unidades de uma rede de academias de Fortaleza, Ceará, Brasil. Foram avaliados os conhecimentos em nutrição para o esporte e o consumo de suplementos através de um questionário estruturado, abordando os dados de identificação, informações sobre a prática de musculação e sobre a utilização de suplementos e questões objetivas acerca dos conhecimentos de nutrição para o esporte, sendo esses posteriormente classificados em baixo, moderado e alto, de acordo com pontuação obtida. A análise estatística foi realizada pela construção de frequências simples e relativas, médias e desvio-padrão, assim como por medidas de correlação, com significância fixada em 5%. Resultados: Observou-se que quase metade dos praticantes referiu o consumo de suplementos alimentares. Dentre os suplementos mais consumidos, destacaram-se os proteicos, estando o consumo independente de gênero, tempo de prática de musculação e conhecimentos em nutrição (p<0,05). A maioria dos indivíduos mostrou conhecimento moderado em nutrição, entretanto, observou-se dificuldade em associar os nutrientes com suas funções e suas utilizações para o esporte, principalmente quanto ao manejo proteico. Conclusão: Os achados deste estudo revelaram uma supervalorização do consumo proteico no âmbito da musculação, predispondo à adoção de práticas alimentares e de suplementação inadequadas. Faz-se necessária, assim, a elaboração e efetivação de ações de educação e assistência nutricional voltadas a esse público. (AU)

Objective: This study aims to assess knowledge on sports nutrition and dietary supplements consumption among resistance-training practitioners at a gym chain. Methods: This is a cross-sectional study, carried out among 168 resistance-training practitioners in three units of a gym chain in Fortaleza, Ceará, Brazil. The participants' sports nutrition and supplement consumption knowledge was assessed using a structured questionnaire that addressed: identification data, information on training and supplement use, and objective questions on sports nutrition awareness, classifying the results as low, moderate and high, accordingly to the obtained scores. Statistical analysis was performed by simple and relative frequencies, mean, standard deviation, and correlation, with significance set as 5%. Results: It was observed that half of the respondents mentioned the consumption of dietary supplements. Among the most consumed, protein-based supplements were prominent, with consumption independent of gender, years of resistance training, and nutrition awareness (p<0.05). Most participants showed moderate nutrition knowledge, despite a perceivable difficulty in associating nutrients to their functions and sport-related uses, especially protein handling. Conclusion: These findings show an overvaluation of protein intake in the context of resistance training, which may lead to the adoption of inadequate dietary and supplementation practices. It is thus necessary to develop and implement education and nutrition assistance actions targeting this public (AU)

A qualidade do serviço avaliada pelos clientes que não frequentam o ginásio de acordo com as diferenças sociodemográficas / La calidad del servicio evaluada por los clientes que no asisten al gimnasio según diferencias sociodemográficas / The quality of service evaluated by customers who do not attend the gym according to sociodemographic differences

La calidad del servicio es una cuestión muy importante en la gestión de las organizaciones. Los clientes buscan calidad y su fidelidad depende de la importancia y el desempeño de cada dimensión de la calidad del servicio. Así, este estudio tiene como objetivo identificar el nivel de importancia y desempeño de los atributos de calidad del servicio, desde la perspectiva de los antiguos clientes de un club de salud y estudiar el comportamiento de las variables género, nivel de educación, edad, precio, duración de la estancia y frecuencia en relación con la importancia y el desempeño de los atributos de calidad del servicio, desde la perspectiva de los antiguos clientes de un club de salud. Los métodos se basaron en un cuestionario a una muestra de 101 antiguos clientes de un club de salud, utilizando el análisis desempeño-importancia y el ANCOVA para evaluar qué características de los antiguos clientes influyen en el diferencial entre desempeño e importancia, utilizando el género y la educación como factores y la edad, la cuota mensual, la duración de la estancia y la frecuencia mensual como covariables. Los resultados mostraron una influencia estadísticamente significativa de las variables género, educación, duración de la estancia y frecuencia en las dimensiones de importancia y desempeño. (AU)

Service quality is a very important issue in the management of organizations. Customers seek quality, and their loyalty depends on the importance and performance of each of the dimensions of service quality. Thus, this study aims to understand the level of importance and performance of service quality attributes, from the perspective of former customers of a health club and to study the behavior of the variables gender, level of education, age, price, length of stay and frequency as to the dimensions importance and performance given to service quality attributes, from the perspective of former customers of a health club.The methods were based on a questionnaire to a sample of 101 former clients of a health club, using the performance-importance analysis and ANCOVA to evaluate which characteristics of former clients influence the differential between performance and importance, using gender and education as factors and age, monthly fee, length of stay and monthly frequency as covariates.The results showed a statistically significant influence of gender, education qualification, length of stay and frequency on the importance and performance dimensions. (AU)

A qualidade de serviço é um tema muito importante na gestão das organizações, os clientes procuram qualidade, e a sua fidelização depende da importância e do desempenho de cada uma das dimensões da qualidade de serviços. Assim, este estudo tem como objetivo conhecer o nível de importância e desempenho dos atributos da qualidade de serviço, na ótica dos ex-clientes de um health club e estudar o comportamento das variáveis o género, o nível de escolaridade, a idade, o preço, a permanência e a frequência quanto às dimensões importância e desempenho dado aos atributos da qualidade de serviço, na ótica dos ex-clientes de um health club. Os métodos tiveram por base um questionário a uma amostra de 101 ex-clientes de um health club, tendo sido utilizada a análise desempenho- importância e a ANCOVA, para avaliar quais as caraterísticas dos ex-clientes que influenciam o diferencial entre o desempenho e a importância, tendo como fatores o género e a escolaridade e como covariáveis a idade, a mensalidade, o período de permanência e a frequência mensal. Os resultados obtidos demonstraram uma influência estatisticamente significativa das variável género, habilitações literárias, permanência e frequência nas dimensões importância e desempenho. (AU)

Validação da Passion Scale para a população portuguesa praticante de exercício físico / Validación de la Escala de Pasión para la población portuguesa que practica ejercicio físico / Validation of the Passion Scale for the Portuguese population practicing exercise

El concepto de pasión se refiere a una fuerte inclinación a realizar una actividad que las personas disfrutan, que encuentran importante y en la que invierten tiempo y energía. El Modelo Dualístico de la Pasión explora este concepto en las dimensiones armoniosa y obsesiva y sus implicaciones en la motivación y parámetros asociados a la realización de conductas. Para apoyar la modificación conductual orientada a la práctica del ejercicio, son cruciales instrumentos adecuados y de calidad para evaluar la pasión. El objetivo principal del presente estudio fue analizar la validez y confiabilidad de la Escala de la Pasión en practicantes de ejercicio físico en el contexto del gimnasio y clubes de salud. La muestra estuvo compuesta por 203 participantes (sexo femenino = 109; sexo masculino = 94), con edades comprendidas entre 18 y 68 (M = 29.24; DT = 9.76) años. Los resultados de este estudio indican que el modelo de medición original de la Escala de Pasión de 16 ítems presentó un ajuste aceptable a los datos. Con la excepción de la pasión obsesiva por el hábito, todos los factores de la escala mostraron asociaciones positivas con la intención y el hábito. Los datos de este estudio sugieren que el modelo de medición Passion Scale (16 ítems/tres factores) adaptado al contexto del ejercicio se ajusta a los datos de la muestra del estudio y es una herramienta viable para el estudio de los factores involucrados en la adherencia continua en la práctica. (AU)

The concept of passion refers to a strong inclination to carry out an activity that people enjoy, that they find important and in which they invest time and energy. The Dualistic Model of Passion explores this concept in the harmonious and obsessive dimensions and its implications for motivation and parameters associated with the performance of behaviors. To support behavioral modification oriented towards the practice of exercise, adequateand quality instruments to assess passion are crucial.The main objective of the present study was to analyze the validity and reliability of the Passion Scale in practitioners of physical exercise in the context of the gym and health clubs. The sample consisted of 203 participants (female sex = 109; male sex = 94), aged between 18 and 68 (M = 29.24; SD = 9.76) years.The results of this study indicate that the original 16-item Passion Scale measurement model presented an acceptable fit to the data. Exceptfor the association between obsessive passion on habit, all factors on the scale showed positive associations with intention and habit. The data from this study suggest that the Passion Scale measurement model (16 items/three factors) adapted to the exercise context fits the data in the study sample and is a viable tool for the study of factors involved in continued adherence in practice. (AU)

O conceito de paixão refere-se a uma forte inclinação para a realização de uma atividade que as pessoas gostam, que acham importante e na qual investem tempo e energia. O Modelo Dualístico da Paixão explora esse conceito nas dimensões harmoniosa e obsessiva e suas implicações na motivação e parâmetros associados à realização de comportamentos. Visando o apoio à modificação comportamental orientada para a prática de exercício, instrumentos adequados e com qualidade para avaliar a paixão são determinantes. O objetivo do presente estudo foi analisar a validade e a fiabilidade da Passion Scale em praticantes de exercício físico no contexto do ginásio e health clubs. A amostra foi constituída por 203 participantes (sexo feminino = 109; sexo masculino = 94), com idades compreendidas entre 18 e 68 (M = 29.24; DP = 9.76) anos. Os resultados deste estudo indicam que o modelo de medida original de 16 itens da Passion Scale apresentou um ajustamento aceitável aos dados. Há exceção da paixão obsessiva com o hábito, todos os fatores da escala apresentaram associações positivas com a intenção e hábito. Os dados deste estudo sugerem que o modelo de medida da Passion Scale (16 itens/três fatores) adaptado ao contexto do exercício se ajusta aos dados na amostra em estudo e é uma ferramenta viável para o estudo de fatores envolvidos à adesão continuada na prática. (AU)

Development of the health promoting sports club-national audit tool.

BACKGROUND: Sports clubs have requested support from national governing authorities to invest in health promotion (HP), by developing policies, guidelines and dedicated funding. This article outlines the development of a national audit tool to review policies development and implementation to support HP in sports clubs. METHODS: A five-step process was undertaken by an international project team: (i) a rapid literature review to identify items assessing policies in physical activity, HP and sports, (ii) a thematic analysis to categorize items, (iii) a Delphi method to analyze item relevance, country specificity, reformulation, validation and organization, (iv) face validity through an online survey and in-depth interviews with expert representatives on physical activity and sports and (v) audit tool finalization though project team consensus. RESULTS: Eight sources were reviewed with 269 items identified. Items were coded into 25 categories with 3 broad themes: policies, actors and settings-based approach. The Delphi study extracted and refined 50 items and categorized them into 10 sections. After revisions from 22 surveys and 8 interviews, consensus was reached by the international project team on 41 items categorized into 11 sections: Role of ministry or department; Policies; Communication; Implementation and Dissemination; Evaluation and Measurement methods; Sub-national-level policies; Funding and Coordination; Participative approach; Actors and Stakeholders; National sporting events; Case studies and Implicated stakeholders. CONCLUSION: To progress HP in the sports club context it is necessary to understand existing national-level policies. This national audit tool will aid in monitoring and assessing national policies for health promoting sports clubs.

Study on the Construction and Development Path of Gymnasiums considering Ecological Environment Restrictions.

Under the restriction of ecological and environmental factors, our requirements have improved for the development path of gymnasium construction. According to the previous way to carry out the development path of gymnasium construction will make our construction work encounter a lot of unnecessary troubles, so we can improve the success rate of the development path of gymnasium construction under the constraints of the ecological environment by carrying out relevant evasive operations according to the constraints of ecological environment. The topological path and path algorithm used to improve the efficiency of stadium construction and development path under the constraints of ecological environment, TEG algorithm, Q-TEG model, Q-TEG algorithm, Dtra algorithm, TraD algorithm, ResR algorithm, and Q-TED algorithm used in resource reservation plus time slot plus hosting bring the following advantages: (1) we use topological path and path algorithm to explore topological representation methods suitable for development path. The overview provides a theoretical basis for guidance, for forwarding technology scheduling mechanisms and multi-path forwarding mechanisms to provide higher flexibility. (2) We use the TEG algorithm of resource reservation plus time slot plus trusteeship, Q-TEG model, and Q-TEG algorithm under multi-model model can deal with the capacity and link of queue in each stadium construction development path well. It is more convenient to set the packet loss threshold for the propagation experiment tested in the simulation. Better help gymnasium construction and development path transmission is successful. (3) The use of the Dtra algorithm, TraD algorithm, ResR algorithm, and Q-TED algorithm in our stadium construction development path of a good deal of the transmission link structure between each node, so that the transmission efficiency between nodes becomes higher, making our stadium construction development path operation more efficient and convenient.

Perceived barriers and facilitators of physical activity in adults living in activity-friendly urban environments: A qualitative study in Sri Lanka.

BACKGROUND: Despite reforming health policies to create more enabling environments, insufficient physical activity in Sri Lanka remains a major public health issue. Socio-culture specific determinants underlying the physical activity of adults living in such environments need to be identified. The aim of this study was to explore the barriers and facilitators for physical activity, as perceived by adult urban dwellers in activity-friendly environments in Colombo District, Sri Lanka. METHODS: A qualitative study using in-depth interviews was conducted among adults aged 20-60 years living in an urban area which has been recently re-designed for recreational and rejuvenating purposes in Sri Lanka. Recruitment targeted varying socio-economic status and risk of non-communicable diseases; and was continued until the data saturation point was reached. Interviews were conducted in homes, primary healthcare units and fitness centres, and were transcribed verbatim and analysed using framework analysis. RESULTS: A total of 31 eligible and consenting adults were interviewed. Of the reported barriers to physical activity, lack of time was very common. Other frequently reported barriers included unpleasant experiences following exercise and misconceptions about exercise, whereas physical environmental factors, weather and road safety were reported less frequently. All participants reported at least one facilitator for engaging in exercise. Expectations of preventing diseases, improving health, physical fitness, psycho-social wellbeing, optimising body functions and increasing lifespan were frequently cited as reasons to be active, while social factors such as positive attitudes of family members and the influence of peers were found to be motivating. CONCLUSIONS: The study showed that while participants valued the health benefits of physical activity and refurbished activity-friendly urban environments, these were not sufficient to support them to overcome key perceived barriers to being physically active.

Contenido de proteínas en suplementos proteicos y disconformidad con el etiquetado / Protein content in protein supplements and labelling non-compliance

JUSTIFICACIÓN: el ejercicio físico y el deporte se acompaña, especialmente si la actividad física se orienta a la ganancia de masa muscular, del consumo de suplementos proteicos. A nivel global se observa un incremento y diversificación en la comercialización y el consumo de suplementos proteicos que invita a evaluar su calidad y la conformidad de su etiquetado e información al consumidor.OBJETIVOS: determinar el contenido de proteínas en suplementos proteicos y verificar su conformidad con los valores declarados por el fabricante en el etiquetado.MATERIAL Y MÉTODOS: el contenido proteico de 19 muestras de suplementos proteicos (47,4 % adquiridas en tiendas de deporte. 31,6 % en gimnasios, 10,5 % en herbolarios y 10,5 % en tiendas online) de 11 marcas diferentes y de 4 tipo de proteína (suero 73,7 %, suero y huevo 10,5 %, guisante 5,3 %, guisante y arroz 10,5 %) y con origen europeo (89 %) y extracomunitario (UK 11 %) fue analizado mediante el método Kjeldahl.RESULTADOS/DISCUSIÓN: el contenido medio de proteínas en los complementos proteicos analizados oscila entre 19,47 - 91,57 g/100 g producto. 3 muestras (16%), todas ellas de origen animal extraídas del suero, cumplían o incluso superaban la cantidad de proteínas indicada en la etiqueta del producto. 4 muestras (21 %) presentaron una conformidad superior al 90 % entre el contenido real y declarado de proteínas. 12 muestras (63 %) registraron una diferencia por defecto de más de 10 g de proteína respecto al etiquetado lo que supone un porcentaje de conformidad entre la concentración proteica real y la declarada en el etiquetado por el fabricante del 40 – 88 % lo que revela la variabilidad y cuestiona la calidad de estos productos. Además, la falta de conformidad en el contenido proteico puede derivar en una ingesta de proteínas inferior a la prevista por el consumidor. (AU)

Impacto de la Covid19 en las barreras percibidas para practicar actividad física en las personas usuarias de centros fitness en España / Impacto da Covid19 nas barreiras percebidas para a prática de atividade física em pessoas em centros de fitness na Espanha / Impact of Covid19 on perceived barriers to practice physical activity in users of fitness centers in Spain

Esta investigación pretende conocer las barreras percibidas, así como posibles variables predictoras, en personas que practican actividad física en centros fitness que se encontraban confinadas en el hogar porla pandemia de COVID-19. La muestra estuvo conformada por 8.087 practicantes de actividad física. Se administró un cuestionario en línea por correo electrónico. Se realizó un análisis descriptivo de las barreras percibidas y un análisis de regresión logística para determinar posibles variables predictoras. Las barreras percibidas más importantes fueron el precio y la suerte de la seguridad. La edad, el sexo, la frecuencia de práctica física vigorosa y la observación de las recomendaciones de la OMS serían las variables predictoras en mayor medida de las barreras percibidas. Los resultados son relevantes para que las organizaciones deportivas planifiquen su oferta de servicios después del confinamiento. (AU)

This research intends to know the perceived barriers, as well as their predictor variables, in people who practice Physical Activity in fitness centers and were home confined due to the COVID-19 pandemic. The sample was conformed of 8,087 physical activity practitioners. An online questionnaire was administered by email. A descriptive analysis of the perceived barriers was done, and logistic regression analysis to determine possible predictor variables. The most important perceived barriers were price and a lack of safety. Age, gender, the vigorous physical practice frequency and the observation of the WHO recommendations would be the predictor variables to a larger extend for the perceived barriers. The results arerelevant for sport organizations to plan their services offer post lockdown. (AU)

Esta pesquisa tem como objetivo conhecer as barreiras percebidas, bem como possíveis variáveis preditivas, em pessoas que praticam atividade física em academias de ginástica que ficaram confinadas em casa pela pandemia do COVID-19. A amostra foi composta por 8.087 praticantes de atividade física. Um questionário online foi administrado pore-mail. Uma análise descritiva das barreiras percebidas e uma análise de regressão logística foram realizadas para determinar possíveis variáveis preditoras. As barreiras percebidas mais importantes foram o preço e a sorte na segurança. Idade, sexo, frequência de prática física vigorosa e observância das recomendações da OMS seriam as variáveis preditoras em maior extensão das barreiras percebidas. Os resultados são relevantes para que as organizações esportivas planejem sua oferta de serviços após o confinamento. (AU)

Fit for LIFE: the development and optimization of an intervention delivered through prison gymnasia to support incarcerated men in making positive lifestyle changes.

BACKGROUND: Despite prison settings presenting opportunities for healthy eating and regular exercise, many incarcerated men supplement prison food with unhealthy snacks and drinks, and are less likely to achieve recommended physical activity guidelines than non-incarcerated men. This paper describes the co-development with prison staff of a healthy lifestyle intervention for delivery to incarcerated men, and feasibility testing of its delivery through prison physical education departments. METHODS: The starting point for intervention development was Football Fans in Training (FFIT), an evidence-based intervention successful in engaging men and supporting them to lose weight, make positive lifestyle changes and maintain these long term. We iteratively tested and adapted FFIT for delivery in prison gym facilities through a four Phase pilot and optimisation study. Methods used to evaluate each phase included: observations of session deliveries; semi-structured interviews with participants; and a focus group/semi-structured interviews with prison Physical Education Instructors (PEIs) who delivered the programme. Data were analysed thematically using the Framework approach. Findings from each phase informed development of the optimised programme. RESULTS: We iteratively co-developed a healthy lifestyle intervention (known as Fit for LIFE) tailored to the needs of incarcerated men and prison operational constraints. Fit for LIFE comprises elements specifically designed to address common barriers to a healthy lifestyle within prison, including: discussion of healthiest available food choices; trying out different physical activity options in the prison gym; and strategies (such as in-cell workouts) for dealing with prolonged time in cells at evenings/weekends. Weight loss was not always the most valued outcome. Instead, participants cited a wide range of behavioural, physical and mental health improvements as important to them, and were more motivated if they could focus on identifying and achieving personally relevant objectives. CONCLUSIONS: Fit for LIFE is a 10-week, group-based healthy lifestyle programme tailored for delivery to incarcerated men in prison gymnasia. Weekly 90-min sessions include informative and interactive 'classroom' activities followed by a practical physical activity training session, often with group activities. Fit for LIFE aims to help incarcerated men to: increase physical activity; reduce sedentary time; eat more healthily; and start and maintain using prison gym facilities with confidence.

Sportsmen's Attitude towards Dietary Supplements and Nutrition Knowledge: An Investigation in Selected Roman Area Gyms.

The non-professional sport environment is a grey zone not as widely assessed as that of elite athletes. The purpose of this research was to investigate the dietary supplementation habits and the nutrition knowledge on sport (NKS) in a sample of gym users. The level of adequacy of NKS was set at ≥60% of correct answers. Almost half (46.4%) of respondents stated they used food supplements, in particular multivitamins (31.0%), amino acid pills (29.5%), minerals (29.1%), and protein powders (28.7%). Supplements were used to increase muscle mass (36.9%) and to repair muscle (35.1%). Gym trainers were the preferred source of information on the use of supplements, especially in males (84%). The NKS correct response rate was 57.1% and the proportion of respondents with a sufficient level of NKS was 47.3%. The prevalence of correct answers was highest in males (61.5%) and for respondents with the highest educational attainment levels (44.5% and 53%). This study demonstrated that non-professional sportsmen do not have sufficient knowledge of nutrition and that the gym environment does not facilitate the circulation of the correct information on the role of supplementation. Considering the importance of nutrition for sportsmen, it is necessary to put in place actions aimed at increasing the knowledge of nutrition of gym users and their trainers.

Geographic access to federally qualified health centers before and after the affordable care act.

BACKGROUND: The Affordable Care Act (ACA) increased funding for Federally Qualified Health Centers (FQHCs). We defined FQHC service areas based on patient use and examined the characteristics of areas that gained FQHC access post-ACA. METHODS: We defined FQHC service areas using total patient counts by ZIP code from the Uniform Data System (UDS) and compared this approach with existing methods. We then compared the characteristics of ZIP codes included in Medically Underserved Areas/Populations (MUA/Ps) that gained access vs. MUA/P ZIP codes that did not gain access to FQHCs between 2011-15. RESULTS: FQHC service areas based on UDS data vs. Primary Care Service Areas or counties included a higher percentage of each FQHC's patients (86% vs. 49% and 71%) and ZIP codes with greater use of FQHCs among low-income residents (29% vs. 22% and 22%), on average. MUA/Ps that gained FQHC access 2011-2015 included more poor, uninsured, publicly insured, and foreign-born residents than underserved areas that did not gain access, but were less likely to be rural (p < .05). CONCLUSIONS: Measures of actual patient use provide a promising method of assessing FQHC service areas and access. Post-ACA funding, the FQHC program expanded access into areas that were more likely to have higher rates of poverty and uninsurance, which could help address disparities in access to care. Rural areas were less likely to gain access to FQHCs, underscoring the persistent challenges of providing care in these areas.

Trabajadores de centros deportivos fitness percepción de liderazgo, engagement y estrés / Sports centre workers fitness effects of leadership, engagement and stress

El objetivo del estudio fue determinar la influencia del liderazgo, engagement y estrés percibido en trabajadores de centros deportivos fitness. Realizando un estudio cuantitativo, descriptivo de corte transversal. La muestra compuesta por 106 trabajadores, con una edad media de 35 años (35.2 ± 8.5). Los instrumentos utilizados fueron, Multifactor Leadership Questionnaire (MLQ-6S) para medir el tipo de liderazgo; la Utrecht Work Engagement Scale (UWES) para saber el nivel de engagement y Perceived Stress Scale (PSS), para conocer la percepción del estrés. Se comparan y correlacionan variables, t-Student, ANOVA y correlación lineal de Pearson (r) y regresión lineal múltiple. Los principales resultados resaltan que el nivel de estrés percibido es mayor en trabajadores fijos (20.97) y mujeres (21.54). A modo de conclusión indicar que un mayor nivel de engagement se traduce en un menor nivel de estrés percibido. (AU)

The aim of the study was to determine the influence of leadership, engagement and perceived stress on workers in fitness centres. Conducting a quantitative, descriptive cross-sectional study. The sample consisted of 106 workers, with an average age of 35 years (35.2 ± 8.5). The instruments used were, Multifactor Leadership Questionnaire (MLQ-6S) to measure the type of leadership; the Utrecht Work Engagement Scale (UWES) to know the level of engagement and Perceibed Stress Scale (PSS) to know the perception of stress. Variables, t-Student, ANOVA and Pearson (r) linear correlation and multiple linear regression are compared and correlated. The main results highlight that the level of perceived stress is higher in permanent workers (20.97) and women (21.54). In conclusion, a higher level of engagement translates into a lower level of perceived stress. (AU)