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Purpose: Previous literature has demonstrated the mediating role of adiposity in the association between cardiorespiratory fitness (CRF) and cardiometabolic risk as well as the potential role of CRF in attenuating the adverse consequences associated with excess weight. This study aimed to evaluate the mediating role of CRF and adiposity in the possible association with cardiometabolic risk. Method: Observational 3-year longitudinal study that included 420 children and adolescents (10.50 [2.05] y of age at baseline; 56.2% girls). Body mass index (BMI) was calculated, and CRF was evaluated using field assessments. A clustered cardiometabolic risk score (cMetS) was calculated from glucose, systolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, and triglycerides z scores. Analyses evaluated the mediating role of BMI in the association between CRF and cMetS as well as whether CRF mediated the association between BMI and cMetS. Results: BMI at baseline was directly associated with the cMetS at follow-up (0.102; 95% confidence interval, 0.020 to 0.181), independently of CRF, whereas CRF was only indirectly associated with cMetS at follow-up through BMI (−0.036; 95% confidence interval, −0.070 to −0.009), meaning that the association between CRF and cMetS was explained via the mediation role of BMI. Conclusions: BMI presented direct association with cMetS, whereas CRF exhibited indirect association with cMetS mediated via BMI. [ABSTRACT FROM AUTHOR]

Background: Understanding the relationship of social network use and addictive behaviors with adolescent psychosocial health is crucial in today's digital age. Aim: To verify the associations between social network use, messaging applications, and the addictive behaviors to social network with psychosocial health in Spanish adolescents. Methods: A cross-sectional study was developed with 632 adolescents, aged 12 to 17 years from the Region of Murcia, Spain. The assessment of social network use (Facebook, Twitter, Instagram, Snapchat, and TikTok) involved evaluating the frequency of use of each social network individually using a single-item scale with five response options. WhatsApp use (i.e., a messaging application) was evaluated in the same manner. The Short Social Networks Addiction Scale-6 Symptoms was employed to assess potential addictive behaviors to social network use. The psychosocial health was assessed using the Strengths and Difficulties Questionnaire. Generalized linear regression models were conducted, and predictive probabilities of having psychosocial health problems were calculated. Results: The predicted probability of presenting psychosocial health problems in the medium users and high users of social networks was 19.3% (95% confidence interval [CI] 13.0 to 27.7), and 16.2% (95% CI 10.2 to 24.6) higher compared to low users, respectively. High usage of Instagram, TikTok, Snapchat, and Facebook was associated with increased probabilities of psychosocial health problems, with Facebook showing the highest probabilities, at 31.3% (95% CI 14.8 to 54.2) for medium users and 51.9% (95% CI 26.5 to 76.3) for high users. Additionally, adolescents with addictive behaviors to social network use had from 19.0 to 25.2% probabilities of experiencing psychosocial health problems. Finally, the highest probabilities of having psychosocial health problems were identified in adolescents with high addictive behaviors when using social networks (28.9%; 95% CI 19.3 to 40.8%) and the lowest in those with low addictive behaviors (6.8%; 95% CI 3.3 to 13.6%). Conclusion: Adolescents who use social networks more frequently and exhibit more addictive behaviors related to their use are more likely to experience psychosocial health problems compared to those who do not. Facebook showed the strongest association, followed by Snapchat, Instagram, and TikTok. Our data also revealed that adolescents exhibit various signs of addictive behaviors to social network use. [ABSTRACT FROM AUTHOR]

To evaluate the simultaneous moderating role of sleep duration and screen time in the relationship between waist circumference (WC) and clustered cardiometabolic risk score (cMetS) according to children and adolescents' physical activity. A cross‐sectional study was conducted on 3072 children and adolescents (aged 6–17 years, 57.5% girls). Physical activity, sleep duration, and screen time were assessed through a self‐report questionnaire. The cMetS was determined by averaging the z‐scores of risk factors and dividing it by four. Moderation analyses were tested through multiple linear regression models. Among physically active individuals, sleep duration (p = 0.85) and screen time (p = 0.96) had no influence on the relationship between WC and cMetS. However, a positive interaction between WC x screen time and cMetS (p = 0.04) was observed for physically inactive participants. Concerning sleep duration, there was no interaction with WC. Participants who spent 60 min of screen time presented lower cMetS, even presenting high WC, compared to the higher tertiles of screen time (180 and 360 min). However, although the interaction between sleep duration and WC was not significant, it was observed that the lowest tertile of sleep duration (482 min) combined with 60 min of screen time presented lower cMetS even with the presence of high WC. Our findings encourage compliance with physical activity guidelines associated with the adoption of adequate screen time to minimize the influence of waist circumference on cMetS. Highlights: Sleep duration and screen time influence adiposity and cardiometabolic risk in physically inactive children and adolescents;Meeting the PA guidelines seems crucial in preventing cardiometabolic risk factors;In inactive individuals, the screen has a deleterious effect on cardiometabolic health. [ABSTRACT FROM AUTHOR]

Purpose: To verify the reciprocal longitudinal relationships between cardiorespiratory fitness (CRF), percentage body fat (%body fat), and metabolic syndrome in Brazilian primary school students. Method: This longitudinal study involved 420 children and adolescents followed for 3 years (2011–2014). The continuous Metabolic Syndrome (cMetSyn) score was calculated by summing adjusted z scores of glucose, systolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, triglycerides, and waist circumference. The CRF was assessed using running/walking tests, and %body fat was assessed through sex-specific 2-site skinfold thickness. Cross-lagged panel models were used to analyze longitudinal reciprocal relationships between CRF and %body fat with cMetSyn. Results: Results indicated that 2011 %body fat significantly predicted both 2014 CRF scores and 2014 cMetSyn scores (P <.001); however, 2011 CRF only predicted 2014 %body fat (P <.001) but not 2014 cMetSyn (P =.103). Furthermore, 2011 cMetSyn predicted 2014 %body fat (P =.002). The model explained 36%, 48%, and 37% of the variance in 2014 CRF, %body fat, and cMetSyn, respectively. Conclusion: The results suggest a reciprocal inverse relationship between %body fat and metabolic syndrome risk and that %body fat may play a more important role in the risk of developing metabolic syndrome compared with CRF. [ABSTRACT FROM AUTHOR]

Background: The Questionnaire on Palliative Care for Advanced Dementia (qPAD) is increasingly being used to assess residential aged care workers' knowledge and attitudes about palliative care for people with dementia. The qPAD developers performed an exploratory factor analysis and assessed the internal consistency using a small sample. Aim: The aim of this study was to further assess the structural validity of the qPAD using a large sample of qPAD responses from staff who work in residential aged care homes in Australia. Methods: Data from 727 care staff who participated in an Australian dementia palliative care training project were used for exploratory factor analyses, assessment of internal consistency, and confirmatory factor analysis of the knowledge test and attitude scale components of the qPAD. Results: The exploratory factor analysis of the knowledge test produced a four‐factor solution. One item loaded weakly, and four items had cross‐loadings. Factor labels for the knowledge test were difficult to define. Factor analysis of the attitude scale produced a three‐factor structure with good internal consistency—Feeling valued and part of the care team (α = 0.88), Family and team engagement (α = 0.75) and Perceptions and beliefs (α = 0.83). Confirmatory factor analysis indicated improvements in model fit were needed for both the knowledge test and attitude scale. Conclusion: The findings of this factor analysis differed from the original study. The attitude scale produced a three‐factor structure, but the knowledge test requires further development due to weak and cross‐loadings of several items, inadequate internal consistency of factors and poor model fit. [ABSTRACT FROM AUTHOR]

The aim of the present study was to verify whether the amount of sleep duration, screen time, and physical activity moderate the relationship between FTO rs9939609 polymorphism and waist circumference (WC) in children and adolescents. This is a cross-sectional study conducted with 1338 children and adolescents, aged between 6 and 17 years. Lifestyle habits were assessed through self-reported questionnaire. WC was measured on the narrowest part of the trunk between the last rib and the iliac crest. FTO rs9939609 polymorphism was genotyped by real time polymerase chain reaction. The PROCESS macro for the SPSS was used for moderation analyses, through multiple linear regression models. Results indicated significant interactions were found between sleep duration and screen time X FTO rs9939609, showing that these lifestyle behaviours are moderators in the relationship between a genetic predisposition for obesity and higher WC. For physical activity, there was no significant interaction. Therefore, sleeping more than 564 min a day (i.e. 9.4 h) and spending no more than 233 min in front of screen may counteract the genetic predisposition to obesity in children and adolescents. Highlights A healthy lifestyle may counteract the genetic predisposition to central obesity; Children and adolescents should sleep more than approximately 9 h (564 min) per day and spend less than approximately 4 h (233 min) per day in front of screens in order to counteract the genetic predisposition to central obesity conferred by the FTO gene variant. It is fundamental to promote actions for the adoption of a healthy lifestyle, including the importance of presenting adequate sleep habits and low screen time for a better cardiometabolic health and reduction of obesity. [ABSTRACT FROM AUTHOR]

The purpose of the current study was to identify the most appropriate "body shape" associated with six athletic performance (AP) tests, using three-dimensional allometry (height (HT), body mass (M), and waist circumference (WC)), in a sample of Brazilian children and adolescents. The sample consisted of 11018 Brazilian children/adolescents (5147 boys) aged 7–17 years. The 6 AP tests were, a 20 m sprint test, an agility test, a 6/9 minute walk/run endurance test, an upper body strength test, an abdominal muscular endurance test, and a lower limb strength test. The "three-dimensional" allometric model was, A P = a ⋅ M k 1 ⋅ H T k 2 ⋅ W C k 3 . Results indicated that two of the three body-size dimensions (HT and WC) were consistently associated with all six athletic performance tests. These were a positive HT exponent/term together with a negative WC exponent/term, confirming that being taller benefited all six performance tests but excess WC was always detrimental. The contribution of M depended on whether the athletic performance required the children/adolescent to perform the exercise/test in a "weight-baring" protocol, i.e. having to perform the test carrying their own body weight or not. In conclusion, three-dimensional allometry provides new insights into what constitutes the "ideal" athletic shape associated with children/adolescents. [ABSTRACT FROM AUTHOR]

This study analyzed the associations between the 24‐hour movement behaviors composition and fitness in preschoolers and investigated predicted changes in fitness when time in active behaviors is reallocated. This cross‐sectional study was carried out with 270 preschoolers (132 boys; 3.97 ± 0.80 years‐old). Light and moderate‐to‐vigorous physical activity (LPA and MVPA), and sedentary behavior (SB) were verified using an accelerometer. Sleep time was obtained through interviews with parents. Components of physical fitness (cardiorespiratory fitness—CRF, speed‐agility, and lower‐body muscular strength) were assessed using the PREFIT Battery. To verify the association between 24‐hour movement behaviors and physical fitness, the compositional analysis was used, and for the time reallocation, the compositional isotemporal substitution analysis was used for active behaviors (LPA and MVPA). The daily composition, adjusted for body mass index, sex, and age, was significantly associated with CRF (P =.007; r2 = 0.29), speed‐agility (P <.001; r2 = 0.14), and lower‐body muscular strength (P =.01; r2 = 0.07). For CRF, the addition of MVPA, at the expense of any other behavior, was associated with significant improvements. For speed‐agility and lower‐body muscular strength, only reallocations between sleep and LPA yielded significant associations. The variation in CRF, speed‐agility, and lower‐body muscular strength was associated with the 24 hours movement composition, and reallocating 5, 10 or 15 minutes of SB or sleep for MVPA was significantly positive for CRF (P <.05). The present findings highlight the relevance of decreasing SB and increasing physical activity practice, particularly at high intensities, to promote a better CRF profile for preschoolers. [ABSTRACT FROM AUTHOR]

Background: The Responding to Urgency of Need in Palliative Care (RUN-PC) Triage Tool is a novel, evidence-based tool by which specialist palliative care services can manage waiting lists and workflow by prioritising access to care for those patients with the most pressing needs in an equitable, efficient and transparent manner. Aim: This study aimed to establish the intra- and inter-rater reliability, and convergent validity of the RUN-PC Triage Tool and generate recommended response times. Design: An online survey of palliative care intake officers applying the RUN-PC Triage Tool to a series of 49 real clinical vignettes was assessed against a reference standard: a postal survey of expert palliative care clinicians ranking the same vignettes in order of urgency. Setting/Participants: Intake officers (n = 28) with a minimum of 2 years palliative care experience and expert clinicians (n = 32) with a minimum of 10 years palliative care experience were recruited from inpatient, hospital consultation and community palliative care services across metropolitan and regional Victoria, Australia. Results: The RUN-PC Triage Tool has good intra- and inter-rater reliability in inpatient, hospital consultation and community palliative care settings (Intraclass Correlation Coefficients ranged from 0.61 to 0.74), and moderate to good correlation to expert opinion used as a reference standard (Kendall's Tau rank correlation coefficients ranged from 0.68 to 0.83). Conclusion: The RUN-PC Triage Tool appears to be a reliable and valid tool for the prioritisation of patients referred to specialist inpatient, hospital consultation and community palliative care services. [ABSTRACT FROM AUTHOR]

Introduction: Hyperuricemia is related to health issues among children and adolescents, once the uric acid concentration is associated with metabolic syndrome, hypertension, insulin resistance, obesity, and dyslipidemia. However, few studies are addressing uric acid levels and food uptake in this age group. Aim: To verify the association between food consumption and uric acid in children and adolescents. Methods: This is a cross-sectional study developed with 2335 children and adolescents of both genders aged 6–17 years old. Blood collection was performed after 12 h of fasting. Uric acid values were classified according to tertiles, in which the highest tertile was considered as hyperuricemia. Food consumption was evaluated by weekly consumption frequency questionnaire. Pearson correlation and logistic binary regressions were used for statistical analysis. Models were adjusted for age, systolic blood pressure, body mass index (BMI), and skin color/ethnicity. Results: It was found an association between red meat consumption and hyperuricemia only in boys in the crude model (OR = 1.56; 95% CI 1.12; 2.18). Also, there was an association between pasta (OR = 1.52; 95% CI 1.11; 2.10) with hyperuricemia in boys, when adjusted age, systolic blood pressure, BMI, and skin color/ethnicity. Conclusion: The knowledge of food patterns which are predisposing factors for the increase in serum uric acid levels is important for the implementation of strategies and public health policies for health promotion among children and adolescents. [ABSTRACT FROM AUTHOR]

Objective: to profile the trajectory of, and risk factors for, functional decline in older patients in the 30 days following Emergency Department (ED) discharge. Methods: prospective cohort study of community-dwelling patients aged ≥65 years, discharged home from a metropolitan Melbourne ED, 31 July 2012 to 30 November 2013. The primary outcome was functional decline, comprising either increased dependency in personal activities of daily living (ADL) or in skills required for living independently instrumental ADL (IADL), deterioration in cognitive function, nursing home admission or death. Univariate analyses were used to select risk factors and logistic regression models constructed to predict functional decline. Results: at 30 days, 34.4% experienced functional decline; with 16.7% becoming more dependent in personal ADL, 17.5% more dependant in IADL and 18.4% suffering deterioration in cognitive function. Factors independently associated with decline were functional impairment prior to the visit in personal ADL (Odds Ratio [OR] 3.21, 95% confidence interval [CI] 2.26-4.53) or in IADL (OR 6.69, 95%CI 4.31-10.38). The relative odds were less for patients with moderately impaired cognition relative to those with normal cognition (OR 0.38, 95%CI 0.19-0.75). There was a 68% decline in the relative odds of functional decline for those with any impairment in IADL who used an aid for mobility (OR 0.32, 95%CI 0.14-0.7). Conclusion: older people with pre-existing ADL impairment were at high risk of functional decline in the 30 days following ED presentation. This effect was largely mitigated for those who used a mobility aid. Early intervention with functional assessments and appropriate implementation of support services and mobility aids could reduce functional decline after discharge. [ABSTRACT FROM AUTHOR]

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Objective: To evaluate the feasibility of Pilates exercise in older people to decrease falls risk and inform a larger trial. Design: Pilot Randomized controlled trial. Setting: Community physiotherapy clinic. Participants: A total of 53 community-dwelling people aged ⩾60 years (mean age, 69.3 years; age range, 61–84). Interventions: A 60-minute Pilates class incorporating best practice guidelines for exercise to prevent falls, performed twice weekly for 12 weeks. All participants received a letter to their general practitioner with falls risk information, fall and fracture prevention education and home exercises. Main outcome measure(s): Indicators of feasibility included: acceptability (recruitment, retention, intervention adherence and participant experience survey); safety (adverse events); and potential effectiveness (fall, fall injury and injurious fall rates; standing balance; lower limb strength; and flexibility) measured at 12 and 24 weeks. Results: Recruitment was achievable but control group drop-outs were high (23%). Of the 20 participants who completed the intervention, 19 (95%) attended ⩾75% of the classes and reported classes were enjoyable and would recommend them to others. The rate of fall injuries at 24 weeks was 42% lower and injurious fall rates 64% lower in the Pilates group, however, was not statistically significant (P = 0.347 and P = 0.136). Standing balance, lower-limb strength and flexibility improved in the Pilates group relative to the control group (P < 0.05). Estimates suggest a future definitive study would require 804 participants to detect a difference in fall injury rates. Conclusion: A definitive randomized controlled trial analysing the effect of Pilates in older people would be feasible and is warranted given the acceptability and potential positive effects of Pilates on fall injuries and fall risk factors. Trial Registration: The protocol for this study is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN1262000224820). [ABSTRACT FROM AUTHOR]

Background: an emergency department (ED) visit is a sentinel event for an older person, with increased likelihood of adverse outcomes post-discharge including early re-presentation. Objectives: to determine factors associated with early re-presentation. Methods: prospective cohort study conducted in the ED of a large acute Melbourne tertiary hospital. Community-dwelling patients >65 years were interviewed including comprehensive assessment of cognitive and functional status, and mood. Logistic regression was used to identify risk factors for return within 30 days. Results: nine hundred and fifty-nine patients, median age 77 years, were recruited. One hundred and forty patients (14.6%) represented within 30 days, including 22 patients (2.3%) on ≥2 occasions and 75 patients (7.8%) within 7 days. Risk factors for representation included depressive symptoms, cognitive impairment, co-morbidity triaged as less urgent (ATS 4) and attendance in the previous 12 months, with a decline in risk after 85 years of age. Logistic regression identified chronic obstructive pulmonary disease (OR 1.78, 95% CI 1.02-3.11), moderate cognitive impairment (OR 2.07, 95% CI 1.09-3.90), previous ED visit (OR 2.11, 95% CI 1.43-3.12) and ATS 4 (OR 2.34, 95% CI 1.10-4.99) as independent risk factors for re-presentation. Age ≥85 years was associated with reduced risk (OR 0.81, 95% CI 0.70-0.93). Conclusion: older discharged patients had a high rate of early re-presentation. Previously identified risk factors--increased age, living alone, functional dependence and polypharmacy--were not associated with early return in this study. It is not clear whether these inconsistencies represent a change in patient case-mix or strategies implemented to reduce re-attendance. This remains an important area for future research. [ABSTRACT FROM AUTHOR]

Background: a decline in health state and re-attendance are common in people aged ≥65 years following emergency department (ED) discharge. Diverse care models have been implemented to support safe community transition. This review examined ED community transition strategies (ED-CTS) and evaluated their effectiveness. Methods: a systematic review and meta-analysis using multiple databases up to December 2013 was conducted. We assessed eligibility, methodological quality, risk of bias and extracted published data and then conducted random effects meta-analyses. Outcomes were unplanned ED representation or hospitalisation, functional decline, nursing-care home admission and mortality. Results: five experimental and four observational studies were identified for qualitative synthesis. ED-CTS included geriatric assessment with referral for post-discharge community-based assistance, with differences apparent in components and delivery methods. Four studies were included in meta-analysis. Compared with usual care, the evidence indicates no appreciable benefit for ED-CTS for unplanned ED re-attendance up to 30 days (odds ratio (OR) 1.32, 95% confidence interval (CI) 0.99-1.76; n = 1,389), unplanned hospital admission up to 30 days (OR 0.90, 95% CI 0.70-1.16; n = 1,389) or mortality up to 18 months (OR 1.04, 95% CI 0.83-1.29; n = 1,794). Variability between studies precluded analysis of the impact of ED-CTS on functional decline and nursing-care home admission. Conclusions: there is limited high-quality data to guide confident recommendations about optimal ED community transition strategies, highlighting a need to encourage better integration of researchers and clinicians in the design and evaluation process, and increased reporting, including appropriate robust evaluation of efficacy and effectiveness of these innovative models of care. [ABSTRACT FROM AUTHOR]

Background: Patients with severe chronic obstructive pulmonary disease (COPD) experience substantial symptom burden, psychological and social morbidity. The experience of this illness has an impact beyond the patient. Objective: This study seeks to understand the experiences and needs of family carers of people with severe COPD. Design: Semistructured interviews were held with current and bereaved carers of people with severe COPD. Several areas of content were targeted in the interviews, including the experience of caring for someone with COPD, views of treatment and prognosis, information and communication needs, and the understanding of palliative care. Data were analyzed thematically. Results: The carers' and bereaved carers' experiences and needs around COPD are best understood as a dynamic of change, recognition, and adaptation. Carers faced many changes as the patients' general condition deteriorated. These were changes in the nature of caring tasks, in their relationships, and their own expectations. Carers usually recognized change had happened and sought to adapt through new approaches, new equipment, a new stance of thinking, and in most cases, continued caring. Within this theme of change, recognition, and adaptation were a series of subthemes: (1) the impact of caring, (2) recognizing the role of the carer, and (3) the needs of the carer including their needs from palliative care services. Conclusion: The impact of caring borne by family carers is substantial and life changing. Health professionals may assist carers in their role through acknowledgement, facilitating recognition of the changes that have occurred (and their implications), and enabling creative adaptive responses for carers. Such assistance is likely to enhance the ability of carers to continue in this demanding role. [ABSTRACT FROM AUTHOR]