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ABSTRACT Objectives Methods Results Conclusions Preschooler physical activity (PA) is vital for growth and development. The World Health Organization PA guidelines state preschoolers should achieve ≥ 180 min/day of Total PA (TPA) of which ≥ 60 min is moderate‐to‐vigorous PA (MVPA). A step/day recommendation to match these guidelines may be a more practical metric for caregivers to promote PA. The purpose of our investigation is to improve upon existing step recommendations by creating one for indoor‐based activities, acknowledging where preschoolers spend most of their time, and various cut‐points for PA.In a laboratory study (Aim 1), a validated direct observation protocol was used to quantify preschooler PA intensity while performing indoor activities (n = 35). Actigraph GT3x accelerometers were placed on the waist, wrist, and ankle to measure step count. In a field study (Aim 2), habitual PA of 881 preschoolers (7113 valid days) via waist‐worn accelerometers was used to assess the agreement between created guidelines (Aim 1) and other step recommendations with PA guidelines using Receiver Operating Characteristic and Area Under the Curve (ROC‐AUC).In the laboratory study, calculated indoor step ranges were 6960–7440 (waist), 7200–8640 (wrist), and 7680–9120 (ankle) to align with existing PA guidance. In the field, the higher step guidelines (> 12 000) achieved very limited agreement, due to few preschoolers achieving this metric. The 6000 step/day guidelines had the highest agreement (AUCs: TPA: 0.637; MVPA: 0.751; TPA + MVPA: 0.761) with PA guideline.When preschoolers are indoors, 6000 steps may be the minimum for adequate PA. [ABSTRACT FROM AUTHOR]

This paper examines the within-day, bidirectional associations between physical activity and self-reported pain among older adults. Older adults (N = 104; range: 60–98 years) participated in a 10-day Ecological Momentary Assessment (EMA) study. Participants received six EMA prompts/day with a single item assessing pain. Participants wore an activPAL monitor measuring step counts. At the within-person level, on occasions when participants took more steps than usual in the 30 min before the EMA prompt, they were more likely to experience pain at the prompt ( β ^ 02 = 0.0003 , p <.03). At the between-person level, greater step counts in the 30 min before the EMA prompt, on average, were associated with less pain on occasions when pain was experienced ( β ^ 01 = − 0.0005 , p <.04). Pain was not related to subsequent stepping. Bidirectional associations between physical activity and pain were not documented, but physical activity did appear to be related to subsequent pain. [ABSTRACT FROM AUTHOR]

Cadence thresholds have been widely used to categorize physical activity intensity in health-related research. We examined the convergent validity of two cadence-based intensity classification approaches against a machine-learning-based intensity schema in 84,315 participants (≥ 40 years) with wrist-worn accelerometers. Validity study. Both cadence-based methods (one-level cadence, two-level cadence) calculated intensity-specific time based on cadence-thresholds while the two-level cadence identified stepping behaviors first. We used an overlapping plot, mean absolute error, and Spearman's correlation coefficient to examine agreements between the cadence-based and machine-learning methods. We also evaluated agreements between methods based on practically-important-difference (moderate-to-vigorous-physical activity: ± 20 min/day, moderate-physical activity: ± 15, vigorous-physical activity: ± 2.5, light-physical activity: ± 30). The group-level (median) minutes of moderate-to-vigorous- and moderate-physical activity estimated by one-level cadence were within the range of practically-important-difference compared to the machine-learning method (bias of median: moderate-to-vigorous-physical activity, − 3.5, interquartile range [− 15.8, 12.2]; moderate-physical activity, − 6.0 [− 17.2, 4.1]). The group-level vigorous- and light-physical activity minutes derived by two-level cadence were within practically-important-difference range (vigorous-physical activity: − 0.9 [− 3.1, 0.5]; light-physical activity, − 1.3 [− 28.2, 28.9]). The individual-level differences between the cadence-based and machine learning methods were high across intensities (e.g., moderate-to-vigorous-physical activity: mean absolute error [one-level cadence: 24.2 min/day; two-level cadence: 26.2]), with the proportion of participants within the practically-important-difference ranging from 8.4 % to 61.6 %. One-level cadence showed acceptable group-level estimates of moderate-to-vigorous and moderate-physical activity while two-level cadence showed acceptable group-level estimates of vigorous- and light-physical activity. The cadence-based methods might not be appropriate for individual-level intensity-specific time estimation. [ABSTRACT FROM AUTHOR]

• Stair ambulation is integral for mobility and independence in PwMS. • STEPS is a reliable and valid tool for assessing stair ambulation in PwMS. • STEPS is correlated with established clinical mobility assessments in PwMS. • STEPS was associated with information processing speed and activity levels in PwMS. To establish the inter- and intra-rater reliability of The Step Test Evaluation of Performance on Stairs (STEPS) for people with multiple sclerosis (PwMS) and examine its relation to clinical mobility measures, cognition, and activity levels. STEPS performance was rated by 3 raters at the initial visit. Two raters observed the STEPS performance via videotape at the initial visit and then 1 week later. Participants also completed in lab clinical mobility tests and cognitive assessments at their initial visit. Activity levels were tracked for the subsequent 6 months. In total, 23 people with relapsing-remitting MS (N=23). Not applicable. Intraclass correlation coefficients (ICCs) were used to assess intra-rater and inter-rater reliability, while correlation analyses compared STEPS performance with cognition, clinical mobility assessments, and activity levels. The inter-rater reliability analysis among the 3 raters included scoring from only the initial evaluation. For the intra-rater reliability, 2 raters viewed and rated the videotaped session for each of the participants and then repeated the same process 1 week later. Total STEPS scores demonstrated excellent agreement by ICC for inter- (ICC=0.97) and intra-rater reliability (ICC>0.95) and significant correlations with established clinical mobility assessments in PwMS. Better performance on STEPS was associated with information processing speed and prospective activity levels in PwMS. Stair ambulation is a challenging task, integral for mobility and independence, therefore, having a sensitive and valid reliable assessment of stair performance is critical for PwMS. The STEPS assessment is a quick, easily administered, reliable, and valid tool for assessing stair ambulation in PwMS. [ABSTRACT FROM AUTHOR]

Purpose: Low levels of physical activity during pregnancy go along with increased risks for numerous health complications. We investigated whether an integrated lifestyle intervention leads to higher levels of physical activity and reduces the rate of excessive gestational weight gain (EGWG). Methods: We conducted a randomized-controlled trial on 97 pregnant women, randomly assigned to receive an additional telehealth lifestyle intervention (experimental group, EG; n = 49) or conventional antenatal care (control group, CG; n = 48). The core lifestyle intervention comprised regular video calls, providing integrated personal support and motivation to physical activity. The primary outcome was change in physical activity measured in steps per day. An additional exploratory outcome was the proportion of participants with EGWG. Results: The mean step count during the third trimester was 6483 steps/day (EG) and 5957 steps/day (CG), respectively (p = 0.078). Repeated-measures ANOVA revealed a significant interaction effect (p = 0.045) reflecting an overall increase of 497 steps per day in the EG vs. a decrease of 300 steps per day in the CG. The proportion of participants who met the IOM recommendation for total weight gain during pregnancy was significantly higher in the EG (p = 0.048) and the ratio of women that gained excessively was higher in the CG (p = 0.026). Conclusions: We assume that the personalized online intervention supports women in increasing or at least maintaining their level of physical activity during the course of pregnancy. Additionally, it reduces the rate of excessive weight gain. [ABSTRACT FROM AUTHOR]

Background and Aims: The objective of this study was to assess current condition of three noncommunicable diseases (NCDs)‐diabetes, hypertension, and hypercholesterolemia and vulnerable cohorts among adults in Bangladesh. Methods: The STEPwise Approach to the NCD Risk Factor Surveillance survey of 2018 was analyzed to evaluate the association between NCDs and sociodemographic factors, levels of physical activity, and behavioral measurements. Complex survey weight‐adjusted logistic models were fitted. Results: From 6875 samples, prevalence of diabetes, hypertension and hypercholesterolemia were 27.3%, 9.8%, and 30.2%, respectively. The prevalence of the three NCDs were higher among older respondents. Low occupational activity with obese‐BMI status people was more prone to NCDs. Lower prevalence of hypercholesterolemia was observed in Rangpur, Rajshahi, and Mymensingh, whereas lesser diabetes in Khulna region. Likelihood of NCDs were higher among highly educated, urban residents with low physical activity. Lesser physical activity, and lack of weight maintenance were found to be key factors in higher rates of NCDs in Bangladesh. Conclusion: Greater education and less strenuous profession led to a higher chance of NCDs. Overall, physical activity and maintenance of weight seem to be factors driving higher rates of NCDs in Bangladesh. As a preventive measure against NCDs, an active lifestyle is to be encouraged, particularly to the most vulnerable cohort. [ABSTRACT FROM AUTHOR]

Objective: The American Heart Association’s Life’s Essential 8 (LE8) metric includes self-reported physical activity as one of the metrics for assessing cardiovascular health. Self-reported physical activity is prone to misclassification, whereas accelerometer measures are less biased. We examined associations of LE8 and incident cardiovascular disease (CVD) using self-reported and accelerometer-measured physical activity. Methods: Participants in the Women’s Health Initiative (WHI) Objective Physical Activity and Cardiovascular Health Study (n = 4,243; mean age = 79 ± 7 years) with no CVD history completed the WHI physical activity questionnaire and the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire prior to wearing a hip-worn accelerometer for up to seven days in 2012–2014. LE8 components (physical activity, diet, sleep, body mass index, smoking, blood pressure, non-HDL cholesterol, and glucose) were scored according to guidelines. Scores were created using five physical activity measures: WHI questionnaire (LE8WHI), CHAMPS (LE8CHAMPS), accelerometer-measured physical activity (LE8A), and sample quantiles of accelerometer-measured physical activity (LE8AQ) and daily steps (LE8STEPS). Hazard ratios (HR) for physician-adjudicated CVD were estimated using Cox regression. Results: 707 incident CVD events occurred over an average 7.5 years. Multivariable HRs (95 % CI) comparing women in the highest vs. lowest quartiles of LE8 scores were: LE8WHI = 0.53 (0.43–0.67), LE8CHAMPS = 0.47 (0.38–0.60), LE8A = 0.44 (0.36–0.56), LE8AQ = 0.44 (0.35–0.55), and LE8STEPS = 0.45 (0.35–0.57). Conclusions: The LE8-incident CVD association varies by physical activity measurement, however all methods showed reduced risk. Device-measures of physical activity may be more accurate in the LE8, but when impractical to implement, also support use of self-reported measures.

This work aims at enhancing the thermal efficiency of pyramid distiller solar still (PDSS). A modified version (MPDSS) was developed, featuring suspended v-steps on the vertical walls of the distiller. Additionally, the MPDSS was equipped with external reflectors (MPDSS-R) designed to concentrate solar energy, thereby potentially increasing evaporation rates. To further boost the condensation rate, three different methods were implemented and evaluated independently: an external condensation unit integrated with the MPDSS (MPDSS-C), a fixed nano-enhanced thermal storing material (NTSM) within the MPDSS (MPDSS-NTSM), and an installed Peltier device (MPDSS-P). The results indicated that the MPDSS with suspended steps achieved a significant improvement, with a 40 % increase in distillate yield over PDSS. MPDSS with reflectors resulted in a 96 % increase in yield. Moreover, integrating a Peltier device with the MPDSS led to a 148 % boost in distillate yield, while the yields increased by 139 % and 143 % when utilizing the NTSM and the condenser, respectively. Consequently, the optimal performance for the MPDSS was achieved with the combination of reflectors and the Peltier device, attaining a thermal efficiency of 53.96 % and a 148 % improvement in distillate yield. Also, the thermal efficiency of PDSS, MPDSS, MPDSS-R, MPDSS-C, MPDSS-NTSM, and MPDSS-P was 35.46 %, 42.23 %, 46.77 %, 50.89 %, 48.33 %, and 54.67 %, respectively. While the exergy efficiencies ranged from 3.44 % for the PDSS configuration to 4.87 % for the MPDSS-P configuration. Interestingly, the MPDSS-C configuration achieved an exergy efficiency of 4.64 %. The emissions for MPDSS, MPDSS-R, MPDSS-C, MPDSS-NTSM, and MPDSS-P are estimated at 15.03, 14.62, 14.09, 14.30, and 13.79 tons a year, severally. The enviroeconomic parameters were 218, 212, 204, 207, and 200 a year for MPDSS, MPDSS-R, MPDSS-C, MPDSS-NTSM, and MPDSS-P, respectively. Finally, the water expenses are as follows: $0.343/L for the PDSS, $0.292/L for the MPDSS, $0.220/L for the MPDSS-R, $0.082/L for MPDSS-P, $0.105/L for the MPDSS-C, and $0.114/L for the MPDSS-NTSM.

Abstract Background More than half of the people with Tuberculosis (TB) symptoms in India seek care from the private sector. People with TB getting treatment from private sector in India are considered to be at a higher risk for receiving suboptimal quality of care in terms of incorrect diagnosis and treatment, lack of treatment adherence support with a high loss to follow-up rate that could eventually increase their risk of drug resistance. The current study aims at documenting the approach and efforts taken by the Kerala state to partner with the private health care delivery providers for ensuring quality TB care to the people with presumed TB reaching them. Methods A case study approach was adopted with review of all available literature followed by five Key Informant Interviews to understand the case through a primary descriptive exploration. Grounded theory approach was used to generating the single theory of the case itself that explains it. Results Kerala state has taken a variety of interventions to ensure universal access to TB care for citizens reaching the private sector with documented improvement in the quality of TB care. Key learnings from these initiatives were (i) patients need to be at the centre of partnerships, (ii) good governance is essential for ensuring Universal Health Coverage in a mixed health system, (iii) data intelligence is required to guide partnerships, (iv) identification of the correct ‘problems’ is crucial for effective design of partnerships and (v) a platform for meaningful dialogue of key stakeholders is needed. Conclusion Kerala experience demonstrated that if governments take a proactive role in engaging the private sector, in an informed and evidence-based way, they can leverage the advantages of the private sector while protecting the public health interest.

Abstract Background This study aimed to explore predictors associated with intermediate (six months) and post-intervention (24 months) increases in daily steps among people with prediabetes or type 2 diabetes participating in a two-year pedometer intervention. Methods A secondary analysis was conducted based on data from people with prediabetes or type 2 diabetes from two intervention arms of the randomised controlled trial Sophia Step Study. Daily steps were measured with an ActiGraph GT1M accelerometer. Participants were divided into two groups based on their response to the intervention: Group 1) ≥ 500 increase in daily steps or Group 2) a decrease or

Background: More than half of the people with Tuberculosis (TB) symptoms in India seek care from the private sector. People with TB getting treatment from private sector in India are considered to be at a higher risk for receiving suboptimal quality of care in terms of incorrect diagnosis and treatment, lack of treatment adherence support with a high loss to follow-up rate that could eventually increase their risk of drug resistance. The current study aims at documenting the approach and efforts taken by the Kerala state to partner with the private health care delivery providers for ensuring quality TB care to the people with presumed TB reaching them. Methods: A case study approach was adopted with review of all available literature followed by five Key Informant Interviews to understand the case through a primary descriptive exploration. Grounded theory approach was used to generating the single theory of the case itself that explains it. Results: Kerala state has taken a variety of interventions to ensure universal access to TB care for citizens reaching the private sector with documented improvement in the quality of TB care. Key learnings from these initiatives were (i) patients need to be at the centre of partnerships, (ii) good governance is essential for ensuring Universal Health Coverage in a mixed health system, (iii) data intelligence is required to guide partnerships, (iv) identification of the correct 'problems' is crucial for effective design of partnerships and (v) a platform for meaningful dialogue of key stakeholders is needed. Conclusion: Kerala experience demonstrated that if governments take a proactive role in engaging the private sector, in an informed and evidence-based way, they can leverage the advantages of the private sector while protecting the public health interest. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore predictors associated with intermediate (six months) and post-intervention (24 months) increases in daily steps among people with prediabetes or type 2 diabetes participating in a two-year pedometer intervention. Methods: A secondary analysis was conducted based on data from people with prediabetes or type 2 diabetes from two intervention arms of the randomised controlled trial Sophia Step Study. Daily steps were measured with an ActiGraph GT1M accelerometer. Participants were divided into two groups based on their response to the intervention: Group 1) ≥ 500 increase in daily steps or Group 2) a decrease or < 500 increase in daily steps. Data from baseline and from six- and 24-month follow-ups were used for analysis. The response groups were used as outcomes in a multiple logistic regression together with baseline predictors including self-efficacy, social support, health-related variables, intervention group, demographics and steps at baseline. Predictors were included in the regression if they had a p-value < 0.2 from bivariate analyses. Results: In total, 83 participants were included. The mean ± SD age was 65.2 ± 6.8 years and 33% were female. At six months, a lower number of steps at baseline was a significant predictor for increasing ≥ 500 steps per day (OR = 0.82, 95% CI 0.69–0.98). At 24 months, women had 79% lower odds of increasing ≥ 500 steps per day (OR = 0.21, 95% CI 0.05–0.88), compared to men. For every year of increase in age, the odds of increasing ≥ 500 steps per day decreased by 13% (OR = 0.87, 95% CI 0.78–0.97). Also, for every step increase in baseline self-efficacy, measured with the Self-Efficacy for Exercise Scale, the odds of increasing ≥ 500 steps per day increased by 14% (OR = 1.14, 95% CI 1.02–1.27). Conclusions: In the Sophia Step Study pedometer intervention, participants with a lower number of steps at baseline, male gender, lower age or higher baseline self-efficacy were more likely to respond to the intervention with a step increase above 500 steps per day. More knowledge is needed about factors that influence response to pedometer interventions. Trial registration: ClinicalTrials.gov, NCT02374788. [ABSTRACT FROM AUTHOR]

This study examined the impact of group composition of a 6-week group-based employee Fitbit intervention on daily physical activity steps. Group composition comprised heterogenous and homogeneous groupings based on variations in baseline high, medium, and low steppers. The intervention included weekly step leaderboard information, motivational and informative messages, and the ability to participate in group step challenges. Repeated measures analysis of variance (ANOVA) examined differences in change of steps across time, step-level groups (low, medium, and high), and group composition (low/high, similar, and mixed), and replicated with a subgroup of participants who participated in group step challenges. While group and step level did not emerge as significant interactions in the overall sample, when focused within the group step challenge subsample, relationships among time, the group composition, and participant step-level categories emerged. Overall, the greatest increases in steps occurred at the mid-point time period, among lower steppers, and within the low/high comparison group. This study provides evidence of the importance of group composition in physical activity interventions as well as the fidelity of intervention design in facilitating group comparisons. [ABSTRACT FROM AUTHOR]

Evidence for the effectiveness of physical activity (PA) in the treatment of depression prevails for outpatients with mild and moderate symptom levels. For inpatient treatment of severe depression, evidence-based effectiveness exists only for structured and supervised group PA interventions. The Step Away from Depression (SAD) study investigated the effectiveness of an individual pedometer intervention (PI) combined with an activity diary added to inpatient treatment as usual (TAU). In this multicenter randomized controlled trial, 192 patients were randomized to TAU or TAU plus PI. The two primary outcomes at discharge were depression—blindly rated with the Montgomery–Åsberg Depression Rating Scale (MADRS)—and average number of daily steps measured by accelerometers. Secondary outcomes were self-rated depression and PA, anxiety, remission and response rates. Multivariate analysis of variance (MANOVA) revealed no significant difference between both groups for depression and daily steps. Mean MADRS scores at baseline were 29.5 (SD = 8.3) for PI + TAU and 28.8 (SD = 8.1) for TAU and 16.4 (SD = 10.3) and 17.2 (SD = 9.9) at discharge, respectively. Daily steps rose from 6285 (SD = 2321) for PI + TAU and 6182 (SD = 2290) for TAU to 7248 (SD = 2939) and 7325 (SD = 3357). No differences emerged between groups in secondary outcomes. For severely depressed inpatients, a PI without supervision or further psychological interventions is not effective. Monitoring, social reinforcement and motivational strategies should be incorporated in PA interventions for this population to reach effectiveness. [ABSTRACT FROM AUTHOR]

Asthma is one of the most common chronic conditions in developed countries. We examined whether physical activity (PA) is related to asthma control and body mass index (BMI) in asthma patients. Cross-sectional data collected on PA (ActiGraph GT3X-BT), asthma control (the Asthma Control Questionnaire; ACQ), and BMI were examined in 206 adults (mean[sd] age 47.2[13.8] years; 49.5% had an obese BMI) with clinically diagnosed asthma. Relationships between PA and continuous BMI and asthma control were assessed using linear regression. Differences in PA across obesity (non-obese: <30 Kg/m2/obese: ≥30 Kg/m2) and asthma control categories (controlled: ≤0.75/uncontrolled: >0.75 ACQ score) were also examined. Median (p25, p75) steps counts and peak cadence were 6035 (4248, 8461) steps/day and 123 (115, 133) steps in a minute, respectively. There were nearly 2000 fewer steps/day among those with uncontrolled asthma versus controlled and among those with obese BMI versus nonobese, respectively (both p < 0.05). In regression models adjusted for relevant covariates each 1-unit increase in ACQ score was associated with −686 [95%CI −997, −13] (p ≤ 0.05) average steps/day. The statistical significance of these findings was attenuated (p ≥ 0.05) when BMI was added to the model. However, the point estimate was not reduced (-766 [95%CI −1060, 34]. Overall step counts were low in this population despite peak cadence values suggesting that most participants could perform moderate intensity activity. Increasing step counts should be considered an important lifestyle intervention goal in obese and non-obese asthma patients with low PA levels. [ABSTRACT FROM AUTHOR]

Abstract Background and Aims The objective of this study was to assess current condition of three noncommunicable diseases (NCDs)‐diabetes, hypertension, and hypercholesterolemia and vulnerable cohorts among adults in Bangladesh. Methods The STEPwise Approach to the NCD Risk Factor Surveillance survey of 2018 was analyzed to evaluate the association between NCDs and sociodemographic factors, levels of physical activity, and behavioral measurements. Complex survey weight‐adjusted logistic models were fitted. Results From 6875 samples, prevalence of diabetes, hypertension and hypercholesterolemia were 27.3%, 9.8%, and 30.2%, respectively. The prevalence of the three NCDs were higher among older respondents. Low occupational activity with obese‐BMI status people was more prone to NCDs. Lower prevalence of hypercholesterolemia was observed in Rangpur, Rajshahi, and Mymensingh, whereas lesser diabetes in Khulna region. Likelihood of NCDs were higher among highly educated, urban residents with low physical activity. Lesser physical activity, and lack of weight maintenance were found to be key factors in higher rates of NCDs in Bangladesh. Conclusion Greater education and less strenuous profession led to a higher chance of NCDs. Overall, physical activity and maintenance of weight seem to be factors driving higher rates of NCDs in Bangladesh. As a preventive measure against NCDs, an active lifestyle is to be encouraged, particularly to the most vulnerable cohort.

Abstract Background Vietnam conducted the national Noncommunicable Disease Risk-Factor Surveillance (STEPs) surveys in the years 2010, 2015, and 2021. This study aims to use STEPs data to assess the burden of comorbidity between diabetes and hypertension, analyze trends over time, and identify factors associated with this comorbidity. Methods The study extracted data for the population aged 25–64 years old from three STEPs surveys. Survey weight was used for all estimations of prevalence and 95% CI. Correlated factors with comorbidity were examined by a multivariate logistics model. Results The prevalence of comorbidity in 2021 was about 3.92% among Vietnamese people aged 25–64. In the last 10 years, this prevalence has increased more than 8 times (from 0.44% to 3.92%). Sub-populations demonstrating the most significant changes included the male population, people living in urban areas, and older people. Significant factors correlated with comorbidity included demographic factors, body mass index (BMI), and clustering of 4 noncommunicable diseases (NCDs) behavioral risk factors (OR = 3.48, p

Introduction: Physical activity has significant positive effects on health. Accelerometers can be used to track daily physical activity. The Fitbit Inspire 3 is a commercially available health and fitness tracker, but its validity for tracking steps among individuals with transtibial amputation has not been examined. Therefore, the purpose of this study was to evaluate the concurrent validity of the Fitbit Inspire 3 for assessing free-living daily steps in adults with transtibial amputation. Methods: Participants (n = 79) completed a general health survey and were provided with a Fitbit Inspire 3 and activPAL 3 accelerometer to wear concurrently for seven days in their home environment. Relationships between the activPAL and Fitbit Inspire 3 were examined using Pearson's Correlation. Paired samples t-tests, mean difference, mean absolute difference, and equivalence testing were used to compared daily step counts between Fitbit Inspire 3 and activPAL 3. Results: Average step counts were 5,768 ± 3,750 (mean ± SD) and 4,674 ± 3,081 by the Fitbit Inspire 3 and activPAL, respectively. A high correlation (r = 0.93) but significant mean difference was found between the activPAL 3 and Fitbit Inspire 3 (p < 0.001). The mean absolute difference between the devices was 1,347 ± 1,184 steps. On average, the Fitbit Inspire 3 counted 1,094 ± 1,423 more daily steps than the activPAL 3. Equivalency could not be claimed between the devices. Discussion: The Fitbit Inspire 3 counted more steps compared to the activPAL. Because of the significant mean differences and the large mean absolute difference between the devices, the activPAL 3 and Fitbit Inspire 3 are not interchangeable for estimating physical activity in individuals with transtibial amputation. However, due to the high correlation, the devices will produce similar classification rankings based on step counts. [ABSTRACT FROM AUTHOR]

Recently, worldwide, the attention being paid to hydrogen and its derivatives as alternative carbon-free (or low-carbon) options for the electricity sector, the transport sector, and the industry sector has increased. Several projects in the field of low-emission hydrogen production (particularly electrolysis-based green hydrogen) have either been constructed or analyzed for their feasibility. Despite the great ambitions announced by some nations with respect to becoming hubs for hydrogen production and export, some quantification of the levels at which hydrogen and its derived products are expected to penetrate the global energy system and its various demand sectors would be useful in order to judge the practicality and likelihood of these ambitions and future targets. The current study aims to summarize some of the expectations of the level at which hydrogen and its derivatives could spread into the global economy, under two possible future scenarios. The first future scenario corresponds to a business-as-usual (BAU) pathway, where the world proceeds with the same existing policies and targets related to emissions and low-carbon energy transition. This forms a lower bound for the level of the role of hydrogen and its penetration into the global energy system. The second future scenario corresponds to an emission-conscious pathway, where governments cooperate to implement the changes necessary to decarbonize the economy by 2050 in order to achieve net-zero emissions of carbon dioxide (carbon neutrality), and thus limit the rise in the global mean surface temperature to 1.5 °C by 2100 (compared to pre-industrial periods). This forms an upper bound for the level of the role of hydrogen and its penetration into the global energy system. The study utilizes the latest release of the annual comprehensive report WEO (World Energy Outlook—edition year 2023, the 26th edition) of the IEA (International Energy Agency), as well as the latest release of the annual comprehensive report WETO (World Energy Transitions Outlook—edition year 2023, the third edition) of the IRENA (International Renewable Energy Agency). For the IEA-WEO report, the business-as-usual situation is STEPS (Stated "Energy" Policies Scenario), and the emissions-conscious situation is NZE (Net-Zero Emissions by 2050). For the IRENA-WETO report, the business-as-usual situation is the PES (Planned Energy Scenario), and the emissions-conscious situation is the 1.5°C scenario. Through the results presented here, it becomes possible to infer a realistic range for the production and utilization of hydrogen and its derivatives in 2030 and 2050. In addition, the study enables the divergence between the models used in WEO and WETO to be estimated, by identifying the different predictions for similar variables under similar conditions. The study covers miscellaneous variables related to energy and emissions other than hydrogen, which are helpful in establishing a good view of how the world may look in 2030 and 2050. Some barriers (such as the uncompetitive levelized cost of electrolysis-based green hydrogen) and drivers (such as the German H2Global initiative) for the hydrogen economy are also discussed. The study finds that the large-scale utilization of hydrogen or its derivatives as a source of energy is highly uncertain, and it may be reached slowly, given more than two decades to mature. Despite this, electrolysis-based green hydrogen is expected to dominate the global hydrogen economy, with the annual global production of electrolysis-based green hydrogen expected to increase from 0 million tonnes in 2021 to between 22 million tonnes and 327 million tonnes (with electrolyzer capacity exceeding 5 terawatts) in 2050, depending on the commitment of policymakers toward decarbonization and energy transitions. [ABSTRACT FROM AUTHOR]

Objective: To assess changes in physical activity (PA) after a COVID-19 shutdown on a primarily residential university campus. Methods: Eighty students, faculty, and staff (FS) of a university (age: 32.2 ± 13.6 yr) who wore a consumer wearable technology (CWT) device completed an anonymous survey by inputting data for 30 days prior to- and 30 days following an academic break in 2020, in which the university transitioned to remote learning. Results: Steps decreased after spring break in all subjects (p <.001), but steps were impacted to a greater extent in students. 30-day, weekday, and weekend step averages all decreased in students (p <.001). FS were able to maintain their weekend step averages. Conclusions: PA decreased in a university community after the COVID-19 shutdown. Students, no longer active transport for campus life, saw a greater impact on their PA. These changes could have an impact on health status. [ABSTRACT FROM AUTHOR]

The realization of a project requires the application of stages, which are often prone to the appearance of risks. They can affect, negatively or positively, the evolution of a project, from all points of view. A good identification and framing of risks can lead to their effective management, throughout the life of a project, in order to implement an effective project. Through the present research, we consider the global framing of risks, to support their effective management, for the benefit of projects. [ABSTRACT FROM AUTHOR]

Background: Vietnam conducted the national Noncommunicable Disease Risk-Factor Surveillance (STEPs) surveys in the years 2010, 2015, and 2021. This study aims to use STEPs data to assess the burden of comorbidity between diabetes and hypertension, analyze trends over time, and identify factors associated with this comorbidity. Methods: The study extracted data for the population aged 25–64 years old from three STEPs surveys. Survey weight was used for all estimations of prevalence and 95% CI. Correlated factors with comorbidity were examined by a multivariate logistics model. Results: The prevalence of comorbidity in 2021 was about 3.92% among Vietnamese people aged 25–64. In the last 10 years, this prevalence has increased more than 8 times (from 0.44% to 3.92%). Sub-populations demonstrating the most significant changes included the male population, people living in urban areas, and older people. Significant factors correlated with comorbidity included demographic factors, body mass index (BMI), and clustering of 4 noncommunicable diseases (NCDs) behavioral risk factors (OR = 3.48, p < 0.05). Conclusion: The high comorbidity between hypertension and diabetes underscores the imperative for integrated treatment and management approaches in Vietnam. Coordinated care is essential for addressing the complex interplay between these two prevalent conditions. [ABSTRACT FROM AUTHOR]

IntroductionPhysical inactivity is a risk factor for obesity and non-communicable diseases. Despite myriad health and non-health benefits resulting from physical activity (PA), most individuals do not meet PA recommendations. Providing an incentive for meeting activity goals may increase activity levels. Classical economists argue that cash is the best incentive. Behavioral economists have posited that hedonic (pleasurable) incentives (e.g., massages, restaurant meals) may be superior to cash when incentives are offered over multiple time periods. To date, no studies have directly compared the effectiveness of cash versus hedonic incentives in promoting PA across multiple time periods.MethodsWe conducted a two-arm, parallel, 4-month randomized controlled trial with healthy adults in Singapore where participants were randomized to either cash or hedonic incentives. Participants could earn up to SGD50 (≈USD37) in cash or hedonic incentives each month they met the study’s step target of 10,000 steps daily on at least 20/25 days out of the first 28 days of a month. The primary objective was to compare the mean proportion of months that participants met the step target between the two arms.ResultsBy month 4, participants in the cash (N = 154) and hedonic incentive (N = 156) arms increased their mean daily steps by 870 (p

Though lawyers often expect their apprentices to have a sufficient command of legal letter writing, structuring a legal letter seems to be a challenging task for the apprentices. Many genre analyses in English for Specific Purposes (ESP) have proposed move-step models or sequences of communicative functions (moves) and strategies used to predict those moves (steps) to help ESP learners to write professional letters. However, there is a paucity of move analysis of legal letters of demand though it is a frequently used genre by lawyers. Therefore, this study analyzed 30 authentic legal letters of demand, collected from 15 Sri Lankan lawyers to identify patterns in the genre organization. The Constructivist Grounded Theory methods were intersected with the move analysis to analyze emergent moves and steps. The results include a sequence of four obligatory moves (i.e., Opening, Stating Background Details, Stating the Cause of Action, Demanding), and an optional move (Closing), which were realized in 14 steps, and classified into obligatory, conventional and optional. The accuracy of the moves and steps generated were checked for consistency with two lawyers who were interviewed at two stages of coding the letters. The movestep model could be incorporated into teaching materials of legal letters of demand writing, to help novices learn the rhetorical structure and discursive practices associated with writing legal letters of demand. The model contributes to the body of knowledge of ESP genre analysis, move analysis and to the field of teaching English for Legal Purposes.

Few validated tools exist for measuring physical activity following total knee arthroplasty (TKA) despite the importance of returning to sufficient levels of physical activity post-TKA to achieve health benefits. This study examined the validity of two clinical measures—the Fitbit, a commercially available personal activity monitor, and the Community Healthy Activities Model Program for Seniors (CHAMPS), a self-report questionnaire—compared with a reference standard accelerometer, the SenseWearTM Armband (SWA). At 6-month post-TKA, 47 participants wore the Fitbit and SWA for 4 days and then completed the CHAMPS. Moderate-to-good correlation was observed between the Fitbit and SWA for steps (intraclass correlation coefficient [ICC] =.79), energy expenditure (ICC =.78), and energy expenditure <3 METS (ICC =.79). Poor-to-moderate correlation was observed between the CHAMPS and SWA (ICC =.43) with the questionnaire reporting lower daily energy expenditures than the SWA. Results showed that Fitbit may be a reasonable measurement tool to measure steps and energy expenditures in older adults following TKA. [ABSTRACT FROM AUTHOR]

There is no established method for processing data from commercially available physical activity trackers. This study aims to develop a standardized approach to defining valid wear time for use in future interventions and analyses. Sixteen African American women (mean age = 62.1 years and mean body mass index = 35.5 kg/m2) wore the Fitbit Charge 2 for 20 days. Method 1 defined a valid day as ≥10-hr wear time with heart rate data. Method 2 removed minutes without heart rate data, minutes with heart rate ≤ mean − 2 SDs below mean and ≤2 steps, and nighttime. Linear regression modeled steps per day per week change. Using Method 1 (n = 292 person-days), participants had 20.5 (SD = 4.3) hr wear time per day compared with 16.3 (SD = 2.2) hr using Method 2 (n = 282) (p <.0001). With Method 1, participants took 7,436 (SD = 3,543) steps per day compared with 7,298 (SD = 3,501) steps per day with Method 2 (p =.64). The proposed algorithm represents a novel approach to standardizing data generated by physical activity trackers. Future studies are needed to improve the accuracy of physical activity data sets. [ABSTRACT FROM AUTHOR]

Abstract Background The current research aimed to evaluate the relationship between fruit, vegetable (FV), and dairy consumption with the odds of developing hypertension based on nationwide Stepwise approach to surveillance (STEPS) data in Iran. Methods This cross-sectional study was accomplished by the research center of non-communicable diseases (NCDs) in Tehran. In total, 29,378 individuals’ data were analyzed. Participants were classified into normal, elevated BP, stage I, and stage II hypertension according to systolic blood pressure (SBP) and diastolic blood pressure (DBP) examinations. Based on the STEPS questionnaire, the consumption of FVs and dairy products was evaluated. Multinomial logistic regression was applied to assess the relationship between the consumption of FVs and dairy products with hypertension. Results The findings revealed that only fruit consumption (≥ 2 servings/day) was negatively related to stage I hypertension (odds ratio (OR) = 0.81; 95% confidence interval (CI): 0.69–0.95) in two servings per day and OR = 0.81; 95% CI: 0.68–0.96 in > two servings per day) in the adjusted model. There was no significant relationship between consuming vegetables and dairy products with elevated BP and hypertension. Conclusion Our study showed that increasing fruit consumption was related to reducing hypertension odds. Regarding the consumption of dairy products and vegetables, no significant relationship was found with the odds of hypertension. More studies, especially cohorts, are needed to evaluate the impacts of FV and dairy products on the risk of hypertension.

Abstract Background Multiple lifestyle risk factors exhibit a stronger association with non-communicable diseases (NCDs) compared to a single factor, emphasizing the necessity of considering them collectively. By integrating these major lifestyle risk factors, we can identify individuals with an overall unhealthy lifestyle, which facilitates the provision of targeted interventions for those at significant risk of NCDs. The aim of this study was to evaluate the socio-demographic correlates of unhealthy lifestyles among adolescents and adults in Ethiopia. Methods A national cross-sectional survey, based on the World Health Organization's NCD STEPS instruments, was conducted in Ethiopia. The survey, carried out in 2015, involved a total of 9,800 participants aged between 15 and 69 years. Lifestyle health scores, ranging from 0 (most healthy) to 5 (most unhealthy), were derived considering factors such as daily fruit and vegetable consumption, smoking status, prevalence of overweight/obesity, alcohol intake, and levels of physical activity. An unhealthy lifestyle was defined as the co-occurrence of three or more unhealthy behaviors. To determine the association of socio-demographic factors with unhealthy lifestyles, multivariable logistic regression models were utilized, adjusting for metabolic factors, specifically diabetes and high blood pressure. Results Approximately one in eight participants (16.7%) exhibited three or more unhealthy lifestyle behaviors, which included low fruit/vegetable consumption (98.2%), tobacco use (5.4%), excessive alcohol intake (15%), inadequate physical activity (66%), and obesity (2.3%). Factors such as male sex, urban residency, older age, being married or in a common-law relationship, and a higher income were associated with these unhealthy lifestyles. On the other hand, a higher educational status was associated with lower odds of these behaviors. Conclusion In our analysis, we observed a higher prevalence of concurrent unhealthy lifestyles. Socio-demographic characteristics, such as sex, age, marital status, residence, income, and education, were found to correlate with individuals' lifestyles. Consequently, tailored interventions are imperative to mitigate the burden of unhealthy lifestyles in Ethiopia.

IntroductionPhysical activity has significant positive effects on health. Accelerometers can be used to track daily physical activity. The Fitbit Inspire 3 is a commercially available health and fitness tracker, but its validity for tracking steps among individuals with transtibial amputation has not been examined. Therefore, the purpose of this study was to evaluate the concurrent validity of the Fitbit Inspire 3 for assessing free-living daily steps in adults with transtibial amputation.MethodsParticipants (n = 79) completed a general health survey and were provided with a Fitbit Inspire 3 and activPAL 3 accelerometer to wear concurrently for seven days in their home environment. Relationships between the activPAL and Fitbit Inspire 3 were examined using Pearson's Correlation. Paired samples t-tests, mean difference, mean absolute difference, and equivalence testing were used to compared daily step counts between Fitbit Inspire 3 and activPAL 3.ResultsAverage step counts were 5,768 ± 3,750 (mean ± SD) and 4,674 ± 3,081 by the Fitbit Inspire 3 and activPAL, respectively. A high correlation (r = 0.93) but significant mean difference was found between the activPAL 3 and Fitbit Inspire 3 (p

Background: Diabetes as the leading cause of mortality and morbidity, have been increased by about 35% from 2011 to 2015 worldwide. The objective of this study was to assess the trend and pattern of diabetes and prediabetes prevalence in Iran and also evaluate the diagnosis and status of diabetes management. Methods: The results of this study are extracted from the National Stepwise approach to non-communicable disease risk factor surveillance (STEPS), conducted in 2007, 2011, 2016, and 2021 in Iran. We evaluated all obtained data by questionnaires (demographic, epidemiologic, risk-related behavioral data), physical measurements, and laboratory measures. Results: The prevalence of diabetes almost doubled from 2007 to 2021 among adults 25 years old and above. Diabetes prevalence increased from 10.85% (95% CI:10.30–11.40) in 2016 to 14.15% (13.42–14.87) in 2021. Prediabetes prevalence increased from 18.11% (17.46- 18,76) in 2016 to 24.81% (23.88–25.74) in 2021. Diabetes diagnosis stayed constant hence; diabetes coverage improved from 56.87% (54.21–59.52) to 65.04% (62.40- 67.69). Despite an enhancement in diabetes diagnosis and coverage, diabetes effective care did not improve significantly during 2016 and 2021, with a number of 35.98% (32.60- 39.36) in 2016 and 31.35% (28.20- 34.51) in 2021. Conclusion: The prevalence of diabetes and prediabetes in Iran is almost doubled during the past 14 years. Although, several health policies had been developed to improve the screening and quality of diabetes care; there are still significant gaps in the effective control of diabetes. Accordingly, the current care plan should be reviewed. [ABSTRACT FROM AUTHOR]

This article discusses Malaysia's foreign policy towards the People's Republic of China (PRC) during the rule of Tun Abdul Razak, which is from 1970 to 1976. The issue discussed in this article is the foreign policy introduced by Tun Abdul Razak which is seen as different from the foreign policy of Tunku Abdul Rahman who held the reins of government before. Tunku Abdul Rahman is a leader who does not maintain relations with the People's Republic of China and is highly pro-West. During the rule of Tun Abdul Razak, he acted to establish diplomatic relations with the communist People's Republic of China (PRC), even though at that time Malaysia was still facing the communist threat which was the country's main threat. The main focus of this article is to analyze the steps taken by Tun Abdul Razak in strengthening the relations between Malaysia and China. Relations between the People's Republic of China (PRC) and Malaysia began to be established during the era of Tun Abdul Razak's rule. In conjunction with the historic event, the Malaysian side has held meetings and visited the communist country several times informally through economic visits and sports events. This development ended when Tun Abdul Razak made an official visit to China in May 1974 at the invitation of the PRC government. At the end of his visit, a Joint Communique was issued stating that Malaysia and the PRC had agreed to establish relations between the two countries. The event is a very important historical milestone in the relations between the two countries because on the one hand it symbolizes the end of a phase in Malaysia's foreign policy which is colored by anti-communist, anti-China and highly pro-Western attitudes. [ABSTRACT FROM AUTHOR]

Background: Smoking is a modifiable risk factor for six of the eight leading causes of death. Despite the great burden, there is lack of data regarding the trend of cigarette smoking in Iran. We described the national and provincial prevalence of cigarette smoking and its 12-year time trend utilizing six rounds of Iranian stepwise approach for surveillance of non-communicable disease (STEPS) surveys. Methods: We gathered data from six STEPS surveys done in 2005, 2007, 2008, 2009, 2011, and 2016 in Iran. To estimate the data of missing years, we used two separate statistical models including the mixed model and spatio-temporal analysis. Results: The overall prevalence rate of cigarette smoking was 14.65% (12.81-16.59) in 2005 and 10.63% (9.00-12.57) in 2016 in Iran. The prevalence of cigarette smoking in 2005 and 2016 was 25.15% (23.18-27.11) and 19.95% (17.93%-21.97%) for men and 4.13% (2.43-6.05) and 1.31% (0.06-3.18) for women, respectively. The prevalence of smoking in different provinces of Iran ranged from 20.73% (19.09-22.47) to 9.67% (8.24-11.34) in 2005 and from 15.34% (13.68-17.12) to 6.41% (5.31-7.94) in 2016. The overall trend of smoking was downward, which was true for both sexes and all 31 provinces. The declining annual percent change (APC) of the prevalence trend was -2.87% in total population, -9.91% in women, and -2.08% in men from 2005 to 2016. Conclusion: Although the prevalence of smoking had a decreasing trend in Iran, this trend showed disparities among sexes and provinces and this epidemiological data can be used to modify smoking prevention programs. [ABSTRACT FROM AUTHOR]

Background: Physical activity benefits have been extensively studied. However, the public health guidelines seem unclear about the relationships between steps and movements with healthy biomarkers for people with (PWD) and without disabilities (PWOD), respectively. While public health guidelines illustrate types of exercise (eg, running, swimming), it is equally important to provide data-driven recommended amounts of daily steps or movements to achieve health biomarkers and further promote a physically active lifestyle. Methods: Data from the National Health and Nutrition Examination Survey 2003–2006 were used. The authors conducted sensitivity, specificity, and receiver-operating-characteristic curve analyses regarding cut points from ActiGraph 7164 of daily steps and movements for health biomarkers (eg, body mass index, cholesterol) in PWD (2178 participants) and PWOD (4414 participants). The authors also examined the dose relationships of steps, movements, and healthy biomarkers in each group. Results: The authors found significant differences in the cut points of daily steps and movement for health biomarkers in PWD and PWOD. For daily steps, cut points of PWD were ranged from 3222 to 8311 (area under the receiver-operating-characteristic curve [AUC] range = 0.52–0.93) significantly lower than PWOD's daily steps (range = 5455–14,272; AUC = 0.58–0.87). For daily movement, cut points of PWD were ranged from 115,451 to 430,324 (AUC = 0.53–0.91) significantly lower than the PWOD's daily movements (range = 215,288–282,307; AUC = 0.60–0.88). The authors found strong but different dose relationships of many biomarkers in each group. Conclusions: PWD need fewer daily steps or movement counts to achieve health biomarkers than PWOD. The authors provided data-driven, condition-specific recommendations on promoting a physically active lifestyle. [ABSTRACT FROM AUTHOR]

Background: The literature is unclear as to whether children and adolescents with chronic respiratory diseases (CRDs) differ from their healthy peers in physical activity (PA). Objective: To determine the PA levels measured through accelerometers in children and adolescents with CRDs. Methods: The authors conducted a systematic review using five databases. The authors included studies that assessed the PA measured by accelerometers in children and adolescents with CRDs. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence. Results: From 11,497 reports returned by the initial search, 29 articles reporting on 4381 patients were included. In the sensitivity analysis, the authors found that children and adolescents with CRDs had a moderate-to-vigorous PA (MVPA) of -0.08 hours per day (95% confidence interval [CI], -0.12 to -0.03 h/d; P = .001), which was lower than the healthy controls; the values for sedentary time (mean difference -0.47 h/d; 95% CI, -1.29 to 0.36 h/d; P = .27) and steps/d (mean difference 361 steps/d; 95% CI -385 to 1707 steps/d; P = .45) were similar for both. Conclusion: Children and adolescents with CRDs have a slight reduction in MVPA in comparison with healthy controls, but sedentary time and steps/d were similar for both. [ABSTRACT FROM AUTHOR]

The nutritional value of grasslands declines as the season progresses, negatively impacting cattle nutrition. Protein supplementation may reverse this trend, although high rates of ruminal proteolysis reduce the efficiency of N utilization. Tannins decrease protein degradability in the rumen, although they are also plant defenses with potential to influence animal behavior. The objective of this study was to determine in proteinsupplemented cows grazing meadow bromegrass (MB) the influence of tannins on blood urea nitrogen (BUN), and on behavioral levels of activity. Twenty-four Black Angus cow [body weight (BW) = 614 ± 20 kg]-calf (BW = 244 ± 4 Kg) pairs were allotted to six 9-acre paddocks (4 pairs/paddock); animals in the Control (Ctrl; n = 3) and Tannin treatments (TT; n = 3) grazed meadow bromegrass (MB) and had a supplement of dried distillers grains with solubles (DDGS; (1 kg. cow- 1. d-1), with the addition of a mix of condensed (2/3): hydrolizable tannins(1/3; SilvaTeam) at 0.4% of the diet for TT. Grazing occurred from July to September 2023 with four experimental periods of 15 d each, the first being the adaptation period (no tannins; Baseline). Data were analyzed as a mixed-effects model with repeated measures and paddock as the experimental unit. Cows were fitted with accelerometers on their left back leg to determine activity, and blood samples were collected from all animals at the end of each period to estimate BUN. Representative samples of grass and supplement were collected from each period and paddock and analyzed for CP and fiber content. Herbage availability (DM basis) in each paddock was assessed before and post-grazing during each period using a rising plate meter and calibration curves. neutral detergent fiber (NDF) (62.9 to 65.1 ± 0.5%) and and acid detergent fiber (ADF) (38.7 to 43.9 ± 0.3%) increased, whereas CP (6.8 to 3.9 ± 0.1%) declined from Period 1 to 4 (P < 0.05). Initial biomass was 5,272 ± 211 Kg/ ha and it declined after grazing (Period 4) to 2,319 ± 94 Kg/ha (P < 0.05) with no differences between treatments (P > 0.05). No differences between treatments were observed on motion index, number of steps taken per day, and the proportional percentage of time cows spent standing (9,379 ± 740, 2,611 ± 300, and 54.9 ± 0.02%, respectively; P > 0.05), suggesting that cows in TT did not invest extra time in searching activities or resting relative to Ctrl. It was only detected a greater percentage of transitions from lying to standing in TT than in Ctrl (7 to 3.4 ± 0.003%; P < 0.001). Values for BUN did not differ between treatments (P > 0.05), although they declined from Baseline to Period 4 by 28 % (8.2 to 5.9 ± 0.2mg/dL) in TT and by 2.6 % (5.75 to 5.6 ± 0.01 mg/dL) in Ctrl (P < 0.05). These results suggest that the addition of low levels of tannins to a protein supplement in cows grazing a low-quality grass diet reduces ruminal proteolysis without adversely influencing biomass removal or animals’ levels of activity. [ABSTRACT FROM AUTHOR]

Background: In Uganda, the implementation of the nursing process among nurses is still a very big challenge, especially in many government hospitals. Failure to use the nursing process has led to a lack of continuity of patient care hence delaying the recovery process and outcomes. The purpose of the study was to determine the factors affecting the implementation of the nursing process among nurses at Entebbe Regional Referral Hospital, Wakiso district. Methodology: The study used a descriptive cross-sectional study design that used quantitative data collection methods. A convenience sampling method was used to select 32 respondents who responded to semi- structured questionnaires. Data was analyzed and presented using Microsoft Excel Programs that presented it in the form of frequency tables, pie charts, and graphs. Results: Nurse-related factors were; 25(78.1%) knew less than three steps involved in the nursing process, 18(56.3%) strongly disagreed that the nursing process should be mandatory and 30(93.7%) did not have enough time to use the nursing process. Institutional factors were; 24(75%) did not have policies regarding the use of the nursing process, 27(84.4%) were never supported during the use of the nursing process and 32(100%) reported the absence of designed forms for the nursing process. Conclusion: Nurse-related factors ranging from lack of awareness of steps involved in the nursing process, time inadequacy, and negative perceptions towards the nursing process negatively affected the implemen- tation of the nursing process. Institutional factors that hindered the implementation of the nursing process were the absence of designed nursing process forms, lack of motivation, and absence of policies. Recommendations: The Ministry of Health should design and supply standard nursing process documentation sheets and Entebbe Regional Referral Hospital should develop policies pertaining implementation of the nursing process, supervision, and motivation of nurses.

Summary: Background: WHO introduced the STEPwise approach to surveillance (STEPS) to monitor trends in non-communicable diseases. For arterial hypertension, the STEPS protocol takes the average of the last two out of three standard blood pressure measurements (SBPM). This study assesses the diagnostic accuracy of SBPM, same-day and next-day unattended automated measurement (uABP), with 24 h ambulatory measurement (24 h-ABPM) as reference. Methods: This diagnostic accuracy study was done within a population-based household survey on cardiovascular risk factors in two districts in Northern Lesotho. Adults (aged ≥ 18 years) with elevated SBPM (defined as ≥140/90 mmHg), and 2:1 age- and sex-matched participants with normal SBPM during the survey were recruited. Following SBPM, first uABP readings were obtained on survey day. Afterwards, participants received a 24 h-ABPM device. Second uABP readings were taken 24 h later, after retrieval of the 24 h-ABPM. The main outcome was overall diagnostic accuracy of all screening measurements (SBPM, first uABP, and second uABP), determined using area under the receiver operating characteristic curve (AUROC), with 24 h-ABPM as a reference. Findings: Between November 2, 2021 and August 31, 2022, 275 participants (mean age 58 years (SD: 16 years), 163 (59%) female) were enrolled, 183 of whom had elevated and 92 had normal SBPM. Mean difference between systolic daytime 24 h-ABPM and screening measurements was highest for SBPM (mean difference: −13 mmHg; 95% CI: −14 to −11). Mean difference between diastolic daytime 24 h-ABPM and diastolic SBPM was −2 mmHg (95% CI: −4 to −1), whereas no difference was found for mean diastolic first uABP (mean difference: −1 mmHg; 95% CI: −2.0 to 0.3); and mean diastolic second uABP (mean difference: 1.0 mmHg; 95% CI: −0.4 to 2.3). White coat hypertension was highest with SBPM (55 [20%]), followed by first uABP (27 [9.8%]), and second uABP (18 [6.5%]). Using systolic daytime 24 h-ABPM as a reference, the uABPs had higher AUROC (first uABP: 87% [95% CI: 83–91]; second uABP: 88% [95% CI: 84–92]); SBPM: (79% [95% CI: 74–85]). This difference was significant between first uABP and SBPM (P = 0.0024), and between second uABP and SBPM (P = 0.0017). Interpretation: uABP had better diagnostic performance than SBPM. Integration of uABP into STEPS protocol should be considered. Funding: Swiss Agency for Development and Cooperation under the ComBaCaL project, and the World Diabetes Foundation.

Background: The current research aimed to evaluate the relationship between fruit, vegetable (FV), and dairy consumption with the odds of developing hypertension based on nationwide Stepwise approach to surveillance (STEPS) data in Iran. Methods: This cross-sectional study was accomplished by the research center of non-communicable diseases (NCDs) in Tehran. In total, 29,378 individuals' data were analyzed. Participants were classified into normal, elevated BP, stage I, and stage II hypertension according to systolic blood pressure (SBP) and diastolic blood pressure (DBP) examinations. Based on the STEPS questionnaire, the consumption of FVs and dairy products was evaluated. Multinomial logistic regression was applied to assess the relationship between the consumption of FVs and dairy products with hypertension. Results: The findings revealed that only fruit consumption (≥ 2 servings/day) was negatively related to stage I hypertension (odds ratio (OR) = 0.81; 95% confidence interval (CI): 0.69–0.95) in two servings per day and OR = 0.81; 95% CI: 0.68–0.96 in > two servings per day) in the adjusted model. There was no significant relationship between consuming vegetables and dairy products with elevated BP and hypertension. Conclusion: Our study showed that increasing fruit consumption was related to reducing hypertension odds. Regarding the consumption of dairy products and vegetables, no significant relationship was found with the odds of hypertension. More studies, especially cohorts, are needed to evaluate the impacts of FV and dairy products on the risk of hypertension. [ABSTRACT FROM AUTHOR]

Background: Multiple lifestyle risk factors exhibit a stronger association with non-communicable diseases (NCDs) compared to a single factor, emphasizing the necessity of considering them collectively. By integrating these major lifestyle risk factors, we can identify individuals with an overall unhealthy lifestyle, which facilitates the provision of targeted interventions for those at significant risk of NCDs. The aim of this study was to evaluate the socio-demographic correlates of unhealthy lifestyles among adolescents and adults in Ethiopia. Methods: A national cross-sectional survey, based on the World Health Organization's NCD STEPS instruments, was conducted in Ethiopia. The survey, carried out in 2015, involved a total of 9,800 participants aged between 15 and 69 years. Lifestyle health scores, ranging from 0 (most healthy) to 5 (most unhealthy), were derived considering factors such as daily fruit and vegetable consumption, smoking status, prevalence of overweight/obesity, alcohol intake, and levels of physical activity. An unhealthy lifestyle was defined as the co-occurrence of three or more unhealthy behaviors. To determine the association of socio-demographic factors with unhealthy lifestyles, multivariable logistic regression models were utilized, adjusting for metabolic factors, specifically diabetes and high blood pressure. Results: Approximately one in eight participants (16.7%) exhibited three or more unhealthy lifestyle behaviors, which included low fruit/vegetable consumption (98.2%), tobacco use (5.4%), excessive alcohol intake (15%), inadequate physical activity (66%), and obesity (2.3%). Factors such as male sex, urban residency, older age, being married or in a common-law relationship, and a higher income were associated with these unhealthy lifestyles. On the other hand, a higher educational status was associated with lower odds of these behaviors. Conclusion: In our analysis, we observed a higher prevalence of concurrent unhealthy lifestyles. Socio-demographic characteristics, such as sex, age, marital status, residence, income, and education, were found to correlate with individuals' lifestyles. Consequently, tailored interventions are imperative to mitigate the burden of unhealthy lifestyles in Ethiopia. [ABSTRACT FROM AUTHOR]

Several factors affect muscle protein synthesis (MPS) in the postabsorptive state. Extreme physical inactivity (e.g., bedrest) may reduce basal MPS, whereas walking may augment basal MPS. We hypothesized that outpatients would have a higher postabsorptive MPS than inpatients. To test this hypothesis, we conducted a retrospective analysis. We compared 152 outpatient participants who arrived at the research site the morning of the MPS assessment with 350 Inpatient participants who had an overnight stay in the hospital unit before the MPS assessment the following morning. We used stable isotopic methods and collected vastus lateralis biopsies 2 to 3 h apart to assess mixed MPS. MPS was 12% higher (P < 0.05) for outpatients than inpatients. Within a subset of participants, we discovered that after instruction to limit activity, outpatients (n = 13) took 800 to 900 steps in the morning to arrive at the unit, seven times more steps than inpatients (n = 12). We concluded that an overnight stay in the hospital as an inpatient is characterized by reduced morning activity and causes a slight but significant reduction in MPS compared with participants studied as outpatients. Researchers should be aware of physical activity status when designing and interpreting MPS results. [ABSTRACT FROM AUTHOR]

Introduction: Undiagnosed hypertension (HTN) increases the risk of severe consequences such as chronic kidney disease (CKD), hypertensive retinopathy, heart failure, and stroke. Population-based screening can be used to expose the hidden diseased mass with active disease. Thus, a screening survey was conducted to estimate the proportion of people with HTN among apparently healthy adults of age ≥30 years residing at the urban field practice area (UHTC) of AIIMS, Raipur, and also determine the predictors of undiagnosed HTN among the study participants. Methodology: This was a community-based cross-sectional study conducted over 2 months duration in the Ramnagar area, which comes under the urban field practice area of AIIMS Raipur using the STEPS tool is an acronym of study tool provided by WHO i.e. STEPwise approach to NCD risk factor surveillance consisting of three steps viz. questionnaire for behavioural risk factors, physical measurements and biochemical measurements. Results: In this study, 24.2% (95%, confidence interval [CI]: 20.1-28.2) of participants screened positive for HTN. The proportion of males who screened positive for HTN was 28.8% (95% CI: 22.6-35), whereas the proportion of females who screened positive for HTN was 19.6% (95% CI: 14.3-25). In this study, elderly (>60 years), male gender, daily tobacco use, greater waist circumference (male >90 cm and female >80 cm), and daily salt intake of more than 5 g were found to have higher odds of having HTN. Conclusion: The prevalence of undiagnosed HTN in the UHTC of AIIMS Raipur was quite high. [ABSTRACT FROM AUTHOR]

Enzymatic one-pot synthesis procedures in a one-step and two-step monomers addition were developed to obtain poly(glycerol adipate) macromers with methacrylate end-functional groups under the presence of 1 and 3 wt% of Candida antarctica lipase B (CALB). Glycerol, divinyl adipate, and vinyl methacrylate were enzymatically reacted (vinyl methacrylate was either present from the beginning in the monomers solution or slowly dropped after 6 h of reaction) in tetrahydrofuran (THF) at 40 °C over 48 h. Macromers with a methacrylate end groups fraction of ≈52% in a simple one-pot one-step procedure were obtained with molecular weights (Mn) of ≈7500–7900 g/mol. The obtained products under the one-pot one-step and two steps synthesis procedures carried out using 1 and 3 wt% of a CALB enzymatic catalyst were profusely characterized by NMR (1H and 13C), MALDI-TOF MS, and SEC. The methacrylate functional macromers obtained with the different procedures and 1 wt% of CALB were combined with an Irgacure® 369 initiator to undergo homopolymerization under UV irradiation for 10 and 30 min, in order to test their potential to obtain amorphous networks within minutes with similar properties to those typically obtained by complex acrylation/methacrylation procedures, which need multiple purification steps and harsh reagents such as acyl chlorides. To the best of our knowledge, this is the first time that it has been demonstrated that the obtention of methacrylate-functional predominantly linear macromers based on poly(glycerol adipate) is able to be UV crosslinked in a simple one-step procedure. [ABSTRACT FROM AUTHOR]

Purpose: Metastatic breast cancer (MBC) patients are living longer at the cost of several side effects, affecting their physical and mental health. Physical activity can help women with MBC to improve their wellbeing. Technology-based exercise interventions have shown promising outcomes; however, studies that document their benefits on health behaviors are lacking. Therefore, we aimed to document the impact of virtual assistant technology on enhancing daily step counts in women with MBC. Methods: A total of 38 women with MBC participated in the 90-day Nurse AMIE (Addressing Metastatic Individuals Everyday) for Amazon Echo Show study, an artificial intelligence-based supportive care intervention. Each day, Nurse AMIE asked four symptom questions (sleep, pain, fatigue, and distress) and daily step counts. Based on participants' answers, an algorithm provided an activity to assist with symptom management. Results: During the first week of the intervention, mean step counts per day were 4935 ± 2884, and during the last week of the intervention, mean step counts per day were 1044 steps higher, for an average of 5979 ± 2651 steps. Non-significant differences were observed between the first and last week (p = 0.211) and between the first and last day (p = 0.099), despite an improvement of 21.2% over time and significant differences between baseline and the other days. Conclusion: Women with MBC benefited from the Nurse AMIE for Amazon Echo Show intervention. Despite improvements over time (> 20%), we cannot conclude that the intervention significantly enhanced participants' daily step counts. Larger studies using virtual assistant technologies are required, and this study should be considered a first step in this direction. [ABSTRACT FROM AUTHOR]

Pulmonary arterial hypertension (PAH) patients have low activity. Activity intensity or duration could be a measure of clinical status or improvement. We aimed to determine whether standard or novel actigraphy measures could detect increases in activity after adding therapy. This was a prospective, single‐center observational study evaluating activity after adding therapy in Group 1 PAH; we also report a validation cohort. For our study, two different accelerometers were used, a wrist (ActiGraph) and chest (MC10) device. Patients were analyzed in two groups, Treatment Intensification (TI, adding therapy) or Stable. Both groups had baseline monitoring periods of 7 days; the TI group had follow‐up at 3 months, while Stables had follow‐up within 4 weeks to assess stability. Activity time and steps were reported from both devices' proprietary algorithms. In ActiGraph only, steps in 1‐min intervals throughout the day were ranked (not necessarily contiguous). Average values for each week were calculated and compared using nonparametric testing. Thirty patients had paired data (11 Stable and 19 TI). There was no between‐group difference at baseline; we did not observe therapy‐associated changes on average daily steps or activity time/intensity. The top 5 min of steps (capacity) increased after adding therapy; there was no difference in the stable group. This key finding was validated in a previously reported randomized trial studying a behavioral intervention to increase exercise. Total daily activity metrics are influenced by both disease and non‐disease factors, making therapy‐associated change difficult to detect. Peak minute steps were a treatment‐responsive marker in both a pharmacologic and training intervention. [ABSTRACT FROM AUTHOR]

Background: People with prediabetes or type 2 diabetes (T2D) need to be physically active, including moderate-to-vigorous intensity physical activity (MVPA) and light-intensity physical activity (LIPA) and reduce time in sedentary behaviour (SB). Few studies have evaluated the effect of randomised controlled trials taking all movement behaviours into account. This study aimed to investigate the effects of a 2-year pedometer-based intervention in people with prediabetes or T2D on relative time in movement behaviours. Methods: Secondary analysis of longitudinal data on individuals with prediabetes or T2D from a three-armed randomised controlled trial, the Sophia Step Study, was conducted. The three groups were (1) a multi‑component group (self‑monitoring of steps with a pedometer plus counselling), (2) a single‑component group (self‑monitoring of steps with a pedometer, without counselling), and (3) a standard care group (control). The three behaviours MVPA, LIPA and SB during waking hours were measured with an ActiGraph GT1M accelerometer at baseline, 6, 12, 18 and 24 months. Relative time in MVPA, LIPA and SB for each participant at each time point was calculated and used as outcome measures. Linear mixed models assessed the effect of the intervention over time. Results: In total 184 participants with mean (SD) age 64.3 (7.6) years and 41% female was included. In the multi-component group, compared to the control group, a significant group-by-time interaction effect for relative time in all three behaviours was found at 6 and 18 months and for MVPA and SB at 24 months. In the single-component group, compared to the control group, an effect occurred in the MVPA and SB behaviours at 6 months and MVPA and LIPA at 24 months. The estimated marginal means ranged from 0.9 to 1.5% of more MVPA, 1.9–3.9% of less LIPA and from 0.5% of less SB to 1.7 more SB in the intervention groups compared to the control group. Conclusions: The findings show a beneficial effect on all behaviours over time in the two intervention groups compared to the control group. A more pronounced effect occurred in the multi-component intervention compared to the single-component intervention, implicating the importance of counselling in pedometer-based interventions. Trial registration ClinicalTrials.gov, NCT02374788 [ABSTRACT FROM AUTHOR]

Objective: The primary goals of our research were to explore pharmacists' perception of breastfeeding friendly pharmacy (BFPh) requirements and factors associated with their awareness about these requirements. Methods: A cross-sectional study design was conducted using a self-administered survey. A convenience sample (n=381) of community pharmacists, was recruited through social media resources. Data were entered and analyzed using SPSS software version 35. The frequency or percentages were used for categorical variables while means and standard deviations were used for continuous variables. Also, linear regression analysis was used to evaluate factors affecting pharmacists' awareness about BFPh requirements. Results: The majority of recruited pharmacists were female (n=329, 86.4%), aged between 23 to 30 years of age (78.7%, n=300). The most common steps to describe a pharmacy as a BFPh from the perspective of surveyed pharmacists were training all pharmacy staff to develop the necessary skills (n=239, 62.7%)) followed by informing all pregnant women about the benefits of breastfeeding (n=225, 59.1%)) and having a written policy on feeding infants and young children according to the recommendations of the WHO and in compliance with the international code (n=209, 54.9%)). Furthermore, pharmacists aging 40 years or less showed a significantly higher awareness about BFPh requirements compared to those aging above 40 years (beta=-0.013, p= 0.045). In addition, 37% (n=142) of pharmacists perceived that answering general questions or concerns on general medication intake while breastfeeding babies is their major role in breastfeeding support. Conclusion: Breastfeeding support is a promising area for promoting professional pharmacy services. Training all pharmacy staff and informing all pregnant about the benefit of breastfeeding are the most common two steps to describe a pharmacy as BFPh. Additionally, the awareness of BFPh requirement was associated with pharmacists age. Future focus should be placed on implementing BFPh project in Jordanian pharmacies, where the steps of this project are modified in line with the capabilities of pharmacies in Jordan within governmental pharmaceutical control. [ABSTRACT FROM AUTHOR]

Purpose: Non-communicable diseases (NCDs) have become a global health priority with a great need for prompt evidence-based preventing and managing interventions. Here, we describe the development of a comprehensive cohort study that provides the most accurate results for NCDs' risk factors, named the Iran Cohort Study (ICS) to estimate the effect size of the risk factors associated with major NCDs. Methods: This cohort is an observational prospective study, which its baseline data was gathered through the Iran STEPwise Approach to NCD Risk Factor Surveillance (STEPs) survey in 2016. Following the STROBE criteria, the protocols for investigation of several areas were developed. The follow-up phase began through telephone calls to estimate the effect size of socio-demographic, behavioral, and metabolic risk factors on the incidence of or death due to major NCDs during the three years of study period. Delinerables: The main deliverables of ICS are planned to be as following; a comprehensive bank of primary data and follow-up data, national and subnational reports on estimation of the effect size of various risk factors, and a policy brief on the policy options and recommendations for promotion of ongoing programs and designing new interventions. Also, the collected data on the individuals' health status will be sent to the participants as an electronic health record. Conclusion: The present study is the first comprehensive national and sub-national representative cohort study on NCDs' risk factors in Iranian adults. The results could be used for promotion of health planning and also future complementary studies and programs. [ABSTRACT FROM AUTHOR]

(1) Background: Regular physical activity has multiple benefits. Therefore, school recess is a key tool to provide opportunities for schoolchildren to engage in extracurricular physical activity, have fun, play and interact with their peers. The aim is to provide reference data to quantify the number of steps that children and adolescents perform in a school recess using smart bands according to age range and sex. (2) Method: A descriptive cross-sectional study was carried out in 494 schoolchildren aged 6 to 17 years (292 males and 202 females). Weight, standing height and waist circumference (WC) were evaluated. The body mass index (BMI) was calculated. The quantification of the number of steps during school recess was performed using a smart band. (3) Results: Percentiles were constructed for the number of steps (number of steps/recess). The cut-off points considered were p75 (above average). The median values in both sexes decreased as the age range increased. Youth who walked fewer steps during recess (