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Strategies for controlling hypertension include reducing excess fat and increasing muscle mass. However, the effects of exercise interventions on hypertension in adolescents have been little investigated. The purpose was to evaluate the effect of 12 weeks of aerobic exercise on systolic blood pressure (SBP) and diastolic blood pressure (DBP) and the cardiometabolic profile of overweight hypertensive and non-hypertensive boys. The sample included 107 boys diagnosed as overweight, aged between 12 and 17, divided into two non-hypertension groups, one control (GCN, n = 14) and one with exercise (GEN, n = 55), as well as two groups of hypertensives, one control (GCH, n = 12) and one with exercise (GEH, n = 26). The boys were assessed at the study baseline and after 12 weeks in terms of anthropometric parameters, biological maturation, SBP, DBP and mean blood pressure (MBP), lipid, and metabolic profile. The aerobic training programs lasted 12 weeks and were carried out in three weekly sessions at different intensities. The high-intensity interval training session lasted around 35 min at an intensity of 80-100% of the reserve heart rate, and the moderate-intensity of continuous training session lasted 60 min at an intensity of 35-75% of the reserve heart rate. Caloric expenditure was equivalent between the exercises (p = 0.388). CGN and CGH participated only in school physical activities. Repeated measures analysis of variance and clinical effect analysis using Cohen's effect size were used, with a significance level established at p < 0.05. After 12 weeks, all groups increased their height (p < 0.05), but only the exercise groups showed a reduction in anthropometric variables (p < 0.05), with a possibly beneficial effect in GEN (d =  - 0.203; p = 0.003). No differences were found in the variables for the GCN. The GCH and GEH groups reduced SBP (p < 0.05), but only GEH showed a reduction in DBP (p = 0.005) and MBP (p = 0.001). In relation to the lipid profile, GEH maintained HDL-c close to baseline values, while GCH showed a reduction in HDL-c (p = 0.021). Regarding the clinical effect of exercise on hypertension, GEH showed a large and very beneficial effect size on DBP (d =  - 0.916; p = 0.006) and MBP (d =  - 0.926; p = 0.005).Conclusion: Hypertensive boys who practiced physical exercise showed greater effects in reducing blood pressure, indicating the importance of non-drug therapeutic management in overweight adolescents.Trial registration:Brazilian Registry of Clinical Trials RBR-4v6h7b / RBR-6343y7., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The importance of movement behaviors for health is well-known, although few studies have examined the compliance with movement guidelines in preschoolers from different living contexts. This study reported the compliance with the 24-h movement behaviors guidelines among low-income Brazilian preschoolers from rural and urban areas, according to age., Methods: A total of 453 preschoolers (n = 222 urban), aged between 3 and 5 years, provided physical activity (PA) data (Actigraph wGT3X). Sleep duration, and screen time were parent-reported. Preschoolers were classified as compliant/non- compliant with the 24-h movement guidelines, according to age. The association between prevalence of compliance with the recommendations and the children's living setting were estimated (SPSS; 27.0)., Results: Preschoolers were active (mean = 299.19 ± 76.42; and 369.76 ± 95.56 min/day in urban and rural areas, respectively), though moderate-to-vigorous physical activity (MVPA) time was below the 60 daily minutes recommended in both urban and rural settings (mean = 38.39 ± 21.36; and 47.32 ± 24.28, respectively). None of the urban children complied with the three recommendations simultaneously, while in the rural area, only 2.6% were compliant. Single movement behaviors compliances in the urban setting were 6.8%, 28.8% and 5.4% for PA, sleep, and screen time, respectively; while for rural settings were 16.5%, 21.2%, and 7.4%. Living in the rural area was related to the compliance with PA recommendation for the 5-year-old preschoolers., Conclusion: In both urban and rural Brazilian areas, very few preschoolers are compliant with the guidelines, and more than one third of the children do not comply with any of the recommendations. Strategies and programs to promote compliance with movement behaviors guidelines should consider children's living setting and their age groups., (© 2024 Wiley Periodicals LLC.)

Diagnosing and characterizing biliary strictures (BS) remains challenging. Artificial intelligence (AI) applied to digital single-operator cholangioscopy (D-SOC) holds promise for improving diagnostic accuracy in indeterminate BS. This multicenter study aimed to validate a convolutional neural network (CNN) model using a large dataset of D-SOC images to automatically detect and characterize malignant BS. D-SOC exams from three centers-Centro Hospitalar Universitário de São João, Porto, Portugal (n = 123), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (n = 18), and New York University Langone Hospital, New York, USA (n = 23)-were included. Frames were categorized based on histopathology. The CNN's performance in detecting tumor vessels, papillary projections, nodules, and masses was assessed. The dataset was split into 90% training and 10% validation sets. Performance metrics included AUC, sensitivity, specificity, PPV, and NPV. Analysis of 96,020 images from 164 D-SOC exams (50,427 malignant strictures and 45,593 benign findings) showed the CNN achieved 92.9% accuracy, 91.7% sensitivity, 94.4% specificity, 95.1% PPV, 93.1% NPV, and an AUROC of 0.95. Accuracy rates for morphological features were 90.8% (papillary projections), 93.6% (nodules), 93.2% (masses), and 78.1% (tumor vessels). AI-driven CNN models hold promise for enhancing diagnostic accuracy in suspected biliary malignancies. This multicenter study contributes diverse datasets to ongoing research, supporting further AI applications in this patient population., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics and consent to participate declarations: The study was performed following approval from the ethics committees of Centro Hospitalar Universitário de São João/Faculdade de Medicina da Universidade do Porto (CE 41/2021), Hospital Universitario Puerta de Hierro Majadahonda (PI 153/22) and New York University Langone Hospital (IRB 03845978/2023). This was a retrospective non interventional study conducted in accordance with the Declaration of Helsinki. Therefore, there was not a need to obtain written informed consent from each subject, after evaluation by the ethics committee of each institution., (© 2025. The Author(s).)

Objectives: To verify the moderating role of screen time in the relationship between body mass index (BMI) and sleep duration in children and adolescents., Methods: This cross-sectional study involved 1,338 children and adolescents (aged 6-17 years old; 761 girls) recruited from a municipality in south Brazil. Body weight and height were assessed to calculate BMI. Information regarding screen time, sleep duration, age, sex, sexual maturation, housing area, and socioeconomic status was obtained through a self-reported questionnaire. Moderation was tested using multiple linear regression modelling through an SPSS program extension. All models were adjusted for sex, age, sexual maturation, housing area, and socioeconomic status., Results: No association was found between BMI and sleep duration (β=0.830; 95 % CI=-0.943; 2.603). However, when the role of screen time was considered, it was observed that this variable significantly moderated the relationship between BMI and sleep duration (β=-0.006; 95 % CI=-0.011; -0.001). Specifically, children and adolescents who spent more than 360 min per day in front of the screens presented higher BMI and shorter sleep durations., Conclusions: The more time children and adolescents spend in front of screens, the higher the likelihood it will negatively affect their BMI and sleep duration. These findings emphasize the need for interventions that promote healthy screen habits and encourage behaviors that support optimal sleep duration to mitigate the potential negative effects on body weight and overall health., (© 2025 Walter de Gruyter GmbH, Berlin/Boston.)

This study analyzed associations between physical activity (PA), sedentary behaviors (SB), sleep, and mental health indicators in young adults during the COVID-19 lockdown (15 January-19 April 2021). The participants were 549 Portuguese university students (18-30 years, 57.7% male). Mental health was assessed using the DASS-21 for depression, anxiety, stress, and DASS-21 total score (DASSt). Physical activity (vigorous, moderate, walking) was measured with the IPAQ, while SB (e.g., sitting, screen time) and sleep were evaluated using self-reported measures and the Pittsburgh Sleep Quality Index (PSQI). Multiple linear regressions showed that sleep quality (β = 2.116), sitting time (ST; β = 0.451), vigorous PA (VPA; β = -0.005), and computer use for work/study (β = 0.444) were significantly associated with overall mental health, DASSt ( R 2 = 0.358). Sleep quality, sitting, and VPA were also linked to depression ( R 2 = 0.308), anxiety ( R 2 = 0.275), and stress ( R 2 = 0.338). Computer use for work/study was additionally associated with anxiety and stress. Overall, poor sleep quality, increased sitting, and computer use for work/study, alongside lower VPA, showed significant associations with poorer mental health outcomes. These findings highlight the importance of sleep, PA, and limiting sedentary behaviors, particularly during lockdowns, in mitigating mental health issues among Portuguese young adults.

Introduction: The classroom environment is ideal for promoting physical activity interventions since children spend most of their day there but often engage in sedentary behavior. Given this context, an emerging trend to promote physical activity is active breaks at school. This systematic review evaluated the effects of school-based physical activity interventions involving active breaks on children and adolescents' classroom behavior, executive functions, and physical fitness., Methods: This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search was conducted using PubMed, Web of Science, Scopus, and EBSCOhost. Studies published between January 2010 and August 31, 2023, including participants aged 5 to 18, were included. Interventions involving active breaks and outcomes related to classroom behavior, executive functions, and physical fitness were considered., Results: Initially, 145 studies were identified, with 22 duplicates excluded. After screening 123 articles by title and abstract, 86 were excluded. Subsequently, 37 articles underwent full-text screening, resulting in 22 included studies. Six studies showed positive effects on classroom behavior; five studies showed improvements in executive functions, and only two studies indicated increases in physical fitness., Discussion: This review suggests incorporating active breaks during school hours can improve classroom behavior in children and adolescents. However, the effects of active breaks on executive functions and physical fitness are unclear. More research is needed to fully understand the benefits of implementing active break programs in the classroom., Systematic Review Registration: PROSPERO, CRD42023448267, available from: https://www.crd.york.ac.uk/prospero/display&#95;record.php?ID=CRD42023448267., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Reyes-Amigo, Salinas-Gallardo, Mendoza, Ovalle-Fernández, Ibarra-Mora, Gómez-Álvarez, Carrasco-Beltrán, Páez-Herrera, Hurtado-Almonácid, Yañez-Sepúlveda, Zapata-Lamana, Sepúlveda-Figueroa, Olivares-Arancibia and Mota.)

Background: The growing Latino population is 1.5 times more likely to develop Alzheimer's Disease (AD) and Related Dementias (ADRD) than non-Latino Whites. Interventions that can reduce the risk of ADRD are needed. Older Latinos face many barriers to the incorporation of physical activity (PA) into their daily lives given a lack social support, caregiving responsibilities, and lacking resources to maintain PA. Walking and dancing are the two most frequently reported forms of PA among older Latinos, and indoor PA programs conducted in a community location or at home can overcome barriers to participation., Methods: C.E.R.E.B.R.O. (Cognitive Enhancement and Risk-reduction through Exercise for Brain-Related Outcomes; meaning "brain" in English) is testing two remote intervention programs, the BAILAMOS™ dance program and ¡En Forma y Fuerte! (Fit & Strong!), a PA/behavior change program. Participants are randomly assigned to either study condition. The BAILAMOS™ dance program is a 6-month long dance program, in which participants learn different Latin dances including Merengue, Cha Cha Cha, Bachata, Salsa, Cumbia, and Kizomba. Trained CEREBRO staff also lead monthly discussions. Persons randomized to the 3-month long ¡En Forma y Fuerte! program participate in flexibility and aerobic exercise, strength training, and health education. All classes are held live via Zoom. Trained study staff assist participants with technology-related issues. Data are collected through remote testing at baseline, 12 weeks, and 24 weeks after the start of the interventions. Outcomes include PA, cognition, quality of life, social connectedness, and cost-effectiveness., Conclusion: CEREBRO has the potential to provide evidence regarding the advantages of providing remote intervention programs to reduce PA barriers in the older Latino community., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper The author is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for Contemporary Clinical Trials and was not involved in the editorial review or the decision to publish this article., (© 2025 The Authors.)

This study analyze the effect of a single functional neurology session on sports performance, pain perception, fatigue perception and thermographic muscular response in an international female weightlifting athlete with incapacity to tolerate weight. Functional neurology is a discipline leveraging neuroplasticity for non-invasive recovery and performance optimization. We found how a single session of functional neurology improved load tolerance, enabling her to lift weights at pre-injury levels after just a single session of functional neurology and reduced pain perception from 80 to 0 and fatigue perception from 90 to 20 on a 100-point scale while thermographic data showed up to a 15% decrease in body temperature indicating reduced inflammation and improved muscle recovery. Then, we found how a single functional neurology intervention produced an improve in sports performance, pain and fatigue perceptions, and peripheral vascular response in an inter-national female weightlifting athlete with an initial incapacity to tolerate weight. This supports the incorporation of functional neurology into sports rehabilitation, under-scoring its potential in optimizing athletes' health and performance., Competing Interests: GE-C and JR-M are affiliated with ®NeuroReEvolution. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2025 Rey-Mota, Escribano-Colmena, Navarro Jiménez, Laborde-Cárdenas, Yáñez-Sepúlveda and Clemente-Suárez.)

Background: Several artificial intelligence systems based on large language models (LLMs) have been commercially developed, with recent interest in integrating them for clinical questions. Recent versions now include image analysis capacity, but their performance in gastroenterology remains untested. This study assesses ChatGPT-4's performance in interpreting gastroenterology images. Methods: A total of 740 images from five procedures-capsule endoscopy (CE), device-assisted enteroscopy (DAE), endoscopic ultrasound (EUS), digital single-operator cholangioscopy (DSOC), and high-resolution anoscopy (HRA)-were included and analyzed by ChatGPT-4 using a predefined prompt for each. ChatGPT-4 predictions were compared to gold standard diagnoses. Statistical analyses included accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC). Results: For CE, ChatGPT-4 demonstrated accuracies ranging from 50.0% to 90.0%, with AUCs of 0.50-0.90. For DAE, the model demonstrated an accuracy of 67.0% (AUC 0.670). For EUS, the system showed AUCs of 0.488 and 0.550 for the differentiation between pancreatic cystic and solid lesions, respectively. The LLM differentiated benign from malignant biliary strictures with an AUC of 0.550. For HRA, ChatGPT-4 showed an overall accuracy between 47.5% and 67.5%. Conclusions: ChatGPT-4 demonstrated suboptimal diagnostic accuracies for image interpretation across several gastroenterology techniques, highlighting the need for continuous improvement before clinical adoption.

High-resolution anorectal manometry (HR-ARM) is the gold standard for anorectal functional disorders' evaluation, despite being limited by its accessibility and complex data analysis. The London Protocol and Classification were developed to standardize anorectal motility patterns classification. This proof-of-concept study aims to develop and validate an artificial intelligence model for identification and differentiation of disorders of anal tone and contractility in HR-ARM. A dataset of 701 HR-ARM exams from a tertiary center, classified according to London Classification, was used to develop and test multiple machine learning (ML) algorithms. The exams were divided in a training and testing dataset with a 80/20% ratio. The testing dataset was used for models' evaluation through its accuracy, sensitivity, specificity, positive and negative predictive values and area under the receiving-operating characteristic curve. LGBM Classifier had the best performance, with an accuracy of 87.0% for identifying disorders of anal tone and contractility. Different ML models excelled in distinguishing specific disorders of anal tone and contractility, with accuracy over 90.0%. This is the first worldwide study proving the accuracy of a ML model for differentiation of motility patterns in HR-ARM, demonstrating the value of artificial intelligence models in optimizing HR-ARM availability while reducing interobserver variability and increasing accuracy., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: The association between physical fitness and autistic traits in adolescents remains under explored, especially in adolescents. Understanding this relationship can provide strategies to improve the quality of life of these people., Objective: To identify the association between cluster characteristics derived from levels of self-perceived physical fitness and the occurrences of individual levels of autistic traits in Brazilian adolescents., Method: This descriptive study employed an analytical, quantitative approach involving 515 adolescents aged 11 to 18 (245 boys and 270 girls). Autistic traits were assessed using the Autism Quotient (AQ50), while physical fitness was measured with the Self-Reported Physical Fitness Questionnaire (QAPA). Cluster analysis using descriptive statistics with bootstrapping and generalized estimating equations was performed., Results: Boys reported higher physical fitness levels than girls, with significant differences in General Power Strength (QAPA 4) and Physical Fitness in Sports (QAPA 7). Girls scored slightly higher on social skills. AQ50 scores indicated that girls had higher aggregated difficulties in imagination, attention, communication, and social skills compared to boys. Higher self-perceived physical fitness was associated with lower levels of autistic traits in both genders. Girls with higher QAPA scores showed significant decreases in autistic traits related to social skills and overall AQ50 scores. Boys with higher physical fitness demonstrated reduced autistic traits in the domains of imagination and communication. Age-adjusted analyses confirmed these findings., Conclusion: There is a significant association between self-perceived physical fitness and autistic traits in adolescents. Higher physical fitness levels are linked to fewer autistic traits, highlighting the importance of promoting physical fitness to mitigate challenges associated with autistic traits and improve adolescents' well-being., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

The present study aimed at describing and comparing the physical activity (PA) patterns of adolescents from a middle-income country over a 4-year period. This is a longitudinal observational study (four waves of data collection, 2014-2017) with 668 adolescents aged 10-13 years in 2014 (mean age of 11.8 ± 0.8 years), of both sexes (53.3% girls), from public schools in João Pessoa, Paraíba state, Brazil. PA was measured using a questionnaire and pattern operationally defined based on the following indicators: type, frequency, duration, and PA recommendations. The most practiced physical activities during the study period were active commuting, games, dancing, cycling, soccer, and futsal. There was a linear trend to a decline in the number of adolescents engaging in nearly all the physical activities, in the duration of activities and the proportion that met the PA recommendations (52.8% in 2014 to 32.2% in 2017). The adolescents engaged in different physical activities, but these declined over the years., (© 2024 The Author(s). European Journal of Sport Science published by Wiley‐VCH GmbH on behalf of European College of Sport Science.)

Background: Preschools may provide opportunities for children to engage in physical activity (PA), to benefit their health, although little is known when concerning low-income preschoolers. This study aimed (1) to describe time spent in PA among low-income children during preschool hours and (2) to analyse how many children meet the PA recommendations during preschool hours., Methods: A total of 204 low-income preschoolers (4.51 ± 0.79 years) from João Pessoa/Brazil provided valid accelerometer (Actigraph, WGT3-X) data during the preschool period. Children were grouped in quartiles of PA in counts per minute, according to sex and age. The General Linear Model Univariate was used to examine the differences in PA intensities between the quartiles and the time spent in total PA (TPA) and moderate-to-vigorous PA (MVPA) by quartiles, according to age. An hour-by-hour description of children's PA was presented., Results: TPA during preschool hours ranged from 68.33% to 113.89% of the recommended and from 28.34% to 81.68% of the MVPA recommendations. Among 5-year-old children, those in the highest quartile met the PA recommendations. All children were more active outdoors than indoors. For the less actives, preschool time corresponded to 30% of the recommended daily MVPA., Conclusion: The current results reinforce the importance of preschool settings for promoting preschoolers' PA and provide particularly important and useful information for tailoring preschool-based interventions focused on those who need it most. Strategies to increase children's MVPA should be prioritized during free-play time., (© 2024 John Wiley & Sons Ltd.)

This study examined the associations between age, adiposity, physical activity, sedentary behavior, and elevated blood pressure (BP) in 2901 Portuguese children and adolescents aged 2-18. BP, body mass index (BMI), waist-to-height ratio (WHtR), physical activity, and sedentary behavior were measured. Elevated BP was defined as a BP above the 90th percentile for age, sex, and height. Multivariable analyses assessed the prevalence ratios (PR) of elevated BP across age groups, BMI, WHtR, physical activity, and sedentary behavior. Results showed that older age, especially among middle schoolers, was associated with a 1.8 times higher risk of elevated BP than preschoolers. Participants with a higher BMI (overweight/obese) and a WHtR ≥ 0.50 had a 1.49- and 1.4-times higher risk of elevated BP, respectively. Those who did not meet the recommended 60 min of moderate-to-vigorous physical activity (MVPA) per day showed a 1.63 times higher risk of elevated BP, whereas the association between sedentary behavior and BP was not significant after adjustment. These findings highlight age, higher BMI, central obesity, and insufficient physical activity as key factors associated with elevated BP, underscoring the need for early monitoring and intervention to prevent hypertension in this population.

This study aimed to analyze the effect of different intervention strategies in physical education classes on the reduction of sedentary time. This is a randomized, school-based intervention with factorial characteristics, carried out with freshmen high school students from 11 full-time schools, allocated in three intervention situations: (A) schools with two extra physical education classes per week; (B) schools with training and engagement actions for physical education teachers; (C) Schools with both A and B strategies; and (D) a group of control schools. Accelerometry was used to obtain the effect measure of the main outcome (sedentary behavior). Linear regression was used to analyze the time variation in sedentary behavior between baseline and post-intervention, as well as to analyze potential mediating factors of the relation between exposure and outcome. A total of 1,295 students participated in the study. Intervention B significantly reduced the time in sedentary behavior of boys (61.5 minutes, p < 0.01) and girls (34.8 minutes, p = 0.04) when compared to the control group, showing respectively medium (0.61) and small (0.32) effect size. The reduction in time in sedentary behavior among students in group B was significantly mediated by reduced lack of motivation (AMO) (boys c: -0.402, and girls c: -0.376). The offer of continuing training for physical education teachers proved to be a fundamental strategy to reduce the sedentary time of adolescents, which was mediated by the AMO reduction for physical education classes.

Background/objectives: Hepatocellular carcinoma (HCC) is the sixth most common cause of cancer worldwide. More than 90% of cases occur in cirrhotic patients, with the degree of fibrosis being the main risk factor for the development of HCC. Liver biopsy is the gold-standard for fibrosis assessment, but it is an invasive procedure. Liver stiffness measurement (LSM) has shown high accuracy for diagnosing liver cirrhosis, as well as for predicting decompensation and HCC development. More recently, spleen stiffness measurement (SSM) has presented excellent results for ruling in/out high-risk varices and the presence of clinical significant portal hypertension. The aim of our study was to evaluate the relationship between LSM and SSM and the risk of hepatocellular carcinoma., Methods: A prospective study on cirrhotic patients was performed in a tertiary center from January 2020 to May 2024. All patients were submitted to liver and spleen elastography (with a new probe of 100 Hz) by the same blinded operator and were treated in the same institution for the development of hepatocellular carcinoma., Results: We included 299 cirrhotic patients, 75.9% male, with a mean age of 61.8 years (±10.0). The median value of LSM was 25.7 kPa [4.5-75.0] and that of SSM was 44.6 kPa [7.9-100.0]. The median follow-up time was 505 days [114.0-1541.0]. During this period, 18 patients developed HCC, with a median time to HCC diagnosis after LSM and SSM of 321 days [63.0-1227.0]. LSM was the only factor associated with the development of HCC ( p = 0.002) with an AUC of 0.715. On the other hand, SSM was not associated with the development of HCC., Conclusions: We found that the risk of developing HCC is associated with liver fibrosis but not with portal hypertension (assessed using SSM).

Deletions of the GSTT1 and GSTM1 are associated with chemical carcinogenesis and genitourinary malignancies like bladder cancer, where they correlate with increased tumor aggressiveness. In uterine cervical lesions, GSTT1 and GSTM1 deletions have also been suggested to facilitate the persistence of human papillomavirus (HPV) infection and HPV-induced carcinogenesis. This work addresses the hypothesis that GSTT1/GSTM1 deletions are associated with presence of HPV DNA and aggressiveness in penile cancer, a rare malignancy with HPV+ and HPV- subtypes. Tumor DNA samples and medical records from HPV+ and HPV- penile cancer patients were analyzed. Each sample was screened for GSTT1 and GSTM1 deletions and for the presence of HPV DNA using PCR-based techniques. 74.5 % of samples contained HPV DNA. 61.8 % of cases showed T2 and T3 staging. There were no differences in the frequencies of GSTT1/GSTM1 genotypes between HPV+ and HPV- cases (p>0.05). GSTT1 wt /GSTM null patients were more likely to have higher TNM stages compared with other genotypes (p=0.012), but no differences were observed concerning perineural invasion nor lymphovascular invasion. These findings indicate that GSTT1 and GSTM1 deletions are common in HPV+ and HPV- penile cancers. GSTM1 deletions in the presence of wild-type GSTT1 seems to be associated with tumor progression, and additional studies are warranted to confirm its potential as a prognostic marker in penile cancer., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier GmbH. All rights reserved.)

Background/Objectives: This study aimed to assess and compare the effects of an adapted taekwondo (TKD) program, multicomponent training (MCT), walking exercise (WE), and inactive control group (CG) on blood pressure, morphological variables, frequency of food consumption, cognitive status, health-related quality of life (HRQoL), physical fitness tests, and postural balance in independent older females. Methods: A randomized controlled trial study was conducted with the following groups: TKD (n = 13), MCT (n = 12), WE (n = 12), and CG (n = 14), considering three/weekly 60-min/sessions for 16-weeks. A two-factor mixed analysis of the variance model with repeated measures was performed. Results: TKD improved significantly more in phonetic fluency ( p = 0.021; ES = 1.89) than WE and in general health ( p = 0.033; ES = 1.11) than CG. Both TKD and MCT improved significantly more than CG in the 30 s chair stand, arm curl, chair sit-and-reach, timed up-and-go, maximal isometric handgrip strength, and postural balance for the eyes closed condition in the area and anteroposterior velocity ( p < 0.05). Conclusions: Only TKD improved the area ( p = 0.008; ES = 1.00) and mediolateral velocity ( p = 0.019; ES = 0.79) for the eyes open condition, and mediolateral velocity ( p = 0.021; ES = 1.57) for the eyes closed condition. Blood pressure, morphological variables, and food consumption frequency showed no significant intragroup or intergroup interactions. TKD equivalently improved HRQoL and physical fitness to MCT, with better postural balance in older females.

This study introduces a quantitative risk assessment (QRA) model aimed at evaluating the risk of invasive listeriosis linked to the consumption of ready-to-eat (RTE) smoked and gravad fish. The QRA model, based on published data, simulates the production process from fish harvest through to consumer intake, specifically focusing on smoked brine-injected, smoked dry-salted, and gravad fish. In a reference scenario, model predictions reveal substantial probabilities of lot and pack contamination at the end of processing (38.7% and 8.14% for smoked brined fish, 34.4% and 6.49% for smoked dry-salted fish, and 52.2% and 11.1% for gravad fish), although the concentrations of L. monocytogenes are very low, with virtually no packs exceeding 10 CFU/g at the point of sale. The risk of listeriosis for an elderly consumer per serving is also quantified. The lot-level mean risk of listeriosis per serving in the elderly population was 9.751 × 10 -8 for smoked brined fish, 9.634 × 10 -8 for smoked dry-salted fish, and 2.086 × 10 -7 for gravad fish. Risk reduction strategies were then analyzed, indicating that the application of protective cultures and maintaining lower cold storage temperatures significantly mitigate listeriosis risk compared to reducing incoming fish lot contamination. The model also addresses the effectiveness of control measures during processing, such as minimizing cross-contamination. The comprehensive QRA model has been made available as a fully documented qraLm R package. This facilitates its adaptation for risk assessment of other RTE seafood, making it a valuable tool for public health officials to evaluate and manage food safety risks more effectively.

Latinos are one of the fastest growing minority groups of the older adult population. More culturally relevant forms of physical activity, such as dance are needed to engage the older Latino population. Dance is considered a type of physical activity and is fun, challenging, and socially engaging. Our research, among others, has shown that dance is an effective form of physical activity and has been shown to improve memory and overall health. Our research demonstrates the significance of culturally relevant physical activity interventions; and the importance of involving the perceptions and input of community members from the intended population., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study to examine associations between cardiorespiratory fitness (CRF), 24-hour movement components, and cardiometabolic risk factors in children from southern Brazil, emphasizing the critical variables in these relationships. The sample included 186 schoolchildren (6-11 years, 8.57±1.56). Waist circumference (WC) and CRF were assessed using PROESP-Br protocols, while physical activity (moderate to vigorous - MVPA, and light - LPA) was measured via accelerometers. Sleep and screen time were reported by parents, and fasting blood samples provided data on triglycerides, HDL cholesterol, glucose, insulin, and HOMA-IR. Network analysis highlight WC, systolic blood pressure, and MVPA as central variables with significant connectivity. MVPA emerged as central among 24-hour movement behaviors, with CRF playing an intermediary role. Results underscore WC and MVPA's relationship on cardiometabolic health, supporting interventions targeting MVPA to prevent early cardiometabolic risks in children.

A quantitative risk assessment (QRA) model was developed to evaluate the risk of invasive listeriosis from the consumption of non-ready-to-eat (non-RTE) frozen vegetables. On a lot basis, the QRA model simulates Listeria monocytogenes concentration and prevalence in a "Processing module" that comprises blanching, potential recontamination and packaging, any post-packaging inactivation treatment, and within-lot end-product testing and in a subsequent "Consumer's handling module" that encompasses portioning of frozen vegetables, defrosting, and cooking. Based on available published data, the model was coded in nine sequential R functions designed to assess the effectiveness of blanching, the improvement in processing environment hygiene, the implementation of sampling schemes at the end of processing, and improved consumer instructions on the product's package. In a reference scenario, the model estimated that 9.4% of 500 g packages of frozen vegetables would be contaminated, although at mean levels lower than 10 CFU/g, and assuming that 20% of the portions of frozen vegetables would be left to thaw at room temperature for 2 h, the lot-level mean risk of listeriosis in the susceptible population would be 2.935 × 10 -14 (median 5.446 × 10 -15 ) for uncooked 50 g servings and 2.765 × 10 -17 (median 5.184 × 10 -18 ) for cooked 50 g servings. Analysis of selected scenarios suggested that not cooking the non-RTE product contributes to the risk to a greater extent than the level of contamination in the incoming raw vegetables, the latter in turn being more influential than the level of contamination in the processing environment. The QRA model is freely available as an R package with full documentation and can be used as a tool to inform the consideration of strengthened risk management measures in view of the current changes in consumer behavior and new diet trends.

This study aimed to observe adolescents' changes and individual responses regarding the anthropometry, cardiometabolic profile, vitamin D concentrations, physical fitness, and motor competence upon immediate return and three months of school activities after lockdown., Methods: The study included 28 adolescents (14.8 ± 0.8 years) of both sexes. Anthropometric measures, body composition, cardiometabolic parameters, physical fitness, and motor competence were assessed. A paired t -test was used to compare the frequencies of respondents and the effect size of the results, considering significant p < 0.05., Results: After three months of school activities, adolescents changed their body composition, reducing % fat mass ( p = 0.008) and increasing fat-free mass ( p = 0.008). In terms of physical fitness, there was increased abdominal resistance ( p < 0.001; ES = -0.42) and motor performance, with reduction in supine-to-stand test time ( p < 0.001; ES = 0.53). There were very beneficial effects in reducing resting heart rate ( p ≤ 0.001; ES = 0.61) and increasing vitamin D concentrations ( p < 0.001; ES = -0.61). After three months of a school routine, the proportions of change in respondents were similar between girls and boys and eutrophic individuals and overweight individuals., Conclusions: Returning to school activities after lockdown was important for the recovery of vitamin D concentrations, physical fitness, and motor competence, whose responses were independent of the level of adiposity and sex of the adolescents.

Individuals with Post COVID-19 condition (PCC), or long COVID, experience symptoms such as fatigue, muscle weakness, and psychological distress, including anxiety, depression, or sleep disorders that persist after recovery from COVID-19. These ongoing symptoms significantly compromise quality of life and diminish functional capacity and independence. Multimodal digital interventions targeting behavioural factors such as nutrition and mindfulness have shown promise in improving health outcomes of people with chronic health conditions and may be beneficial for those with PCC. The BLEND study (weB-based pLatform to improve nutrition, mindfulnEss, and physical function, in patients with loNg COVID) study is an 8-week pilot randomized controlled trial evaluating the feasibility of a digital wellness platform compared to usual care among individuals with PCC. The web-based wellness platform employed in this study, My Viva Plan (MVP)®, integrates a holistic, multicomponent approach to promote wellness. The intervention group receives access to the digital health platform for 8 weeks with encouragement for frequent interactions to improve dietary intake and mindfulness. The control group receives general content focusing on improvements in dietary intake and mindfulness. Assessments are conducted at baseline and week 8. The primary outcome is the feasibility of platform use. Secondary and exploratory outcomes include a between-group comparison of changes in body composition, nutritional status, quality of life, mindfulness, physical activity, and physical performance after 8 weeks. Findings of this study will inform the development of effective web-based wellness programs tailored for individuals with PCC to promote sustainable behavioural changes and improved health outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper other then funding disclosures listed above., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Preschool children spend a large part of their day at school, and a large part of that time they spend in sedentary time. Although sedentary time negatively affects regions of the brain responsible for cognition, it is believed that the type of sedentary time performed can favor executive functions' performance. The present study explored the associations between sedentary time inside and outside preschools with executive function (EF) tasks in preschoolers. Seventy-three preschool children (60% girls; 55.0 ± 9.1 months of age) were objectively assessed for sedentary time and physical activity (PA) using accelerometers (wGT3X). EF was evaluated using the Go/No-Go paradigm through the Early Years Toolbox - YET. Go's inverse efficiency (IE) and the No-Go accuracy were analyzed. To establish possible associations between EF and sedentary time, a structural equation model was conducted after adjustments for sex, age, body mass index, and moderate-to-vigorous PA. A significant and positive association between sedentary time on weekend days and IE (b = 0.61; p  < .001) was observed. The general model explained 52% of the variation in IE and 2.1% in the accuracy of No-Go. The sedentary time on weekend days seems to be related to worse EI. This result emphasizes a context-dependent association between time being sedentary and preschoolers' EF. Further investigations should focus on exploring the type of sedentary behavior children are engaged in different contexts.

Background: Anastomotic pseudoaneurysms of interposition vein grafts are a rare entity that requires urgent management to prevent life-threatening complications, such as rupture and thromboembolism, especially when involving the carotid arteries. As these are rare complications and literature is sparse, we believe that this case report can aid the decision-making process in similar circumstances., Case Presentation: A 49-year-old Ukrainian male patient presented with a false aneurysm of both distal and proximal anastomosis of an interposition vein graft between the common carotid artery and the internal carotid artery, which was previously performed as a bailout procedure after the patient developed a complication of carotid surgery. The patient was successfully treated with extra-anatomical interposition of a vein graft from the subclavian artery to the remnant of extracranial internal carotid artery and en bloc excision of the previous vein graft with the false aneurysms., Conclusion: Mycotic anastomotic pseudoaneurysms following carotid endarterectomy represent a rare yet serious complication in vascular surgery that requires urgent treatment. While endovascular techniques could represent an alternative option, open surgical repair is still the standard of care for this pathology, offering advantages in preventing postoperative ischemic complications and ensuring optimal long-term outcomes. The open approach provides direct visualization of the pseudoaneurysm. It allows the meticulous debridement of the infected tissues and an accurate reconstruction of the arterial wall with autologous or synthetic grafts. In light of the substantial evidence supporting its superiority, open surgical repair should remain the preferred approach in addressing mycotic anastomotic pseudoaneurysms following carotid endarterectomy. Future research should continue to explore advancements in other surgical techniques and refine treatment strategies to enhance patient outcomes in this challenging clinical scenario., (© 2024. The Author(s).)

Background/Objectives : While human papillomavirus (HPV) is well known for its role in cervical cancer, it also affects vaginal cancers. Although colposcopy offers a comprehensive examination of the female genital tract, its diagnostic accuracy remains suboptimal. Integrating artificial intelligence (AI) could enhance the cost-effectiveness of colposcopy, but no AI models specifically differentiate low-grade (LSILs) and high-grade (HSILs) squamous intraepithelial lesions in the vagina. This study aims to develop and validate an AI model for the differentiation of HPV-associated dysplastic lesions in this region. Methods : A convolutional neural network (CNN) model was developed to differentiate HSILs from LSILs in vaginoscopy (during colposcopy) still images. The AI model was developed on a dataset of 57,250 frames (90% training/validation [including a 5-fold cross-validation] and 10% testing) obtained from 71 procedures. The model was evaluated based on its sensitivity, specificity, accuracy and area under the receiver operating curve (AUROC). Results : For HSIL/LSIL differentiation in the vagina, during the training/validation phase, the CNN demonstrated a mean sensitivity, specificity and accuracy of 98.7% (IC95% 96.7-100.0%), 99.1% (IC95% 98.1-100.0%), and 98.9% (IC95% 97.9-99.8%), respectively. The mean AUROC was 0.990 ± 0.004. During testing phase, the sensitivity was 99.6% and 99.7% for both specificity and accuracy. Conclusions : This is the first globally developed AI model capable of HSIL/LSIL differentiation in the vaginal region, demonstrating high and robust performance metrics. Its effective application paves the way for AI-powered colposcopic assessment across the entire female genital tract, offering a significant advancement in women's healthcare worldwide.

Therapeutic exercise has not been widely adopted in pediatric pulmonary hypertension (PH), despite adult data supporting its safety and efficacy. While physical limitations may prevent children with PH from participating in physical activity, other barriers to and facilitators of physical activity are unknown. Youth ages 8-18 years with World Symposium of PH diagnostic Groups 1-4, functional class I or II, and ambulatory status were prospectively enrolled in a cross-sectional study including separate 30-min participant and caregiver interviews regarding attitudes toward physical activity and a proposed exercise intervention in pediatric PH. Interview questions were guided by Social Cognitive Theory and explored autonomy, self-confidence, and self-efficacy. Interviews were transcribed, coded, and analyzed using an iterative process to determine themes and patterns. Demographics and relevant PH condition-specific data were abstracted from the medical record. Thirty PH participant/caregiver dyads were interviewed. Facilitators of physical activity included enjoyment/interest in the activity, socialization, incentivization, and feelings of safety and normalcy. Barriers to physical activity included lack of interest, fear/anxiety, and self-consciousness. Findings were similar in children and adults. Participants rarely reported restriction of activity by caregivers or medical providers. Attitudes toward engagement in a proposed exercise program were generally positive and reflected personal experiences with physical activity. Monitored exercise interventions that focus on patients' interests, cultivate confidence, respect limitations, and acknowledge the need for extrinsic incentivization may have benefits in pediatric PH. Future trials should test the impact of these characteristics on patient wellbeing and clinical outcomes., Competing Interests: The Authors declare that there is no conflict of interest., (© 2024 The Author(s). Pulmonary Circulation published by John Wiley & Sons Ltd on behalf of Pulmonary Vascular Research Institute.)

Adeno-associated viruses (AAV) are widely used as delivery vectors in clinical trials for in vivo gene therapy due to their unique features. Göttingen minipigs are a well-established animal model for several diseases and can be used for the efficacy and safety testing of AAV-based gene therapy. Pre-existing antibodies against AAV may influence the results of testing and, therefore, the animals should be tested for the presence of antibodies against relevant AAV serotypes. The detection of AAVs in pigs may be also important for the virus safety of xenotransplantation. In this study, we screened Göttingen minipigs from Ellegaard Göttingen Minipigs A/S, Denmark, and Marshall BioResources, USA, for antibodies against AAV1, AAV2, AAV6, AAV9 serotypes. Of the 20 animals tested, 18 had no neutralizing antibodies for all AAVs tested, none had antibodies against AAV9, only one had antibodies against AAV6, and the titers of antibodies against AAV1 and AAV2 were less than 1:100, with two exceptions. For total binding IgG, more individuals showed positivity for all the tested serotypes but, in general, the levels were low or zero. Three animals had no antibodies at all against the AAVs tested. Therefore, Göttingen minipigs could be considered an attractive animal model for gene therapy studies. Since some animals were negative for all AAVs tested, these may be selected and used as donor animals for xenotransplantation.

Respiratory alkalosis is associated with central nervous system (CNS) diseases, drugs, lung diseases and others. Safinamide is a recent anti-parkinsonian drug with anti-dyskinetic properties and a good adjunct to L-dopa therapy during the activation period, with no significant adverse effects described. The authors present a case of a 71-year-old woman, with Parkinson's disease treated with levodopa/benserazide, safinamide, amitriptyline, sertraline and diazepam. She made multiple visits to the emergency department due to progressive dyspnoea and asthenia, with primary respiratory alkalosis, which was thought to be caused by anxiety-induced hyperventilation and treated accordingly. After a comprehensive study, it was determined that the most probable cause of the respiratory alkalosis was pharmacological. There was a clinical and temporal agreement with the introduction of safinamide., Learning Points: Respiratory alkalosis is a multifactorial acid-base disorder, mostly associated with psychological factors and anxiety induced hyperventilation.Safinamide is a new drug for the treatment of Parkinson's disease with promising results in terms of efficacy and safety. However, there is only a limited number of studies on safinamide.Respiratory alkalosis could be an adverse effect of safinamide through several different mechanisms., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests., (© EFIM 2024.)

The aim of this study was to describe the goals, activities, and methods of EUMOVE project in developing a set of resources targeting both primary and secondary schools that allow the entire educational community to promote healthy lifestyles (HL). The EUMOVE project is an Erasmus+ program based in the Creating Active Schools (CAS) framework. The project lasted 3 years and was developed by 14 academic and non-governmental institutions from Spain, Portugal, France, Italy, and the UK. EUMOVE was divided into three phases. In the first phase, several work packages were carried out aimed to ensure the coordination/management of the project activities. In the second phase, seven educational resources strengthened by rigorous scientific research were developed to promote HL from schools. During the last phase, all the resources were disseminated through scientific seminars, workshops with families and teachers, and the online promotion by the non-governmental institutions of each country. The EUMOVE project developed and promoted a smartphone APP, video/activity repository of physically active lessons, active break virtual platform, learning units, and parent/teachers/school-leaders' guidelines to promote physical activity, active commuting, active school playgrounds, healthy diet, and sleep habits. To our knowledge, EUMOVE is the first European project to provide a set of practical tools based on scientific evidence to help schools or future school-wide interventions implement a paradigm shift based on the CAS framework for the promotion of HL. Future research will need to investigate the implementation, effectiveness, and scalability of this proposal., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Public Health Association.)

Aim: This study examined the association of low handgrip strength (HGS) for falls in middle-aged adults and older adults every half-decade of life., Methods: This cross-sectional study was conducted using the public data from the first wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil). The participants were allocated into seven age groups 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, and ≥ 80 years. Binary logistic regression analysis was performed to identify the odds ratio (OR) of low HGS to the falls regardless of confounding variables such as sex, balance, gait speed, and total number of health conditions., Results: A total of 8,112 participants aged 50-105 years (median = 62.0 years): 3,490 males (median = 60.0 years) and 4,622 females (median = 63.0 years) attended the study. Altogether, 21.5% of participants experienced at least one fall. HGS gradually decreases over each half-decade of life. In addition, low HGS presented a significative OR (p < 0.05) for falls for age groups, until 80 s, even when considering confounding variables., Conclusions: Low HGS is associated with falls in middle-aged adults over their 50 s and remained a strong measure of falls across each subsequent half-decade of life, until 80 s., (© 2024. The Author(s).)

Artificial intelligence (AI) has emerged as a transformative tool across several specialties, namely gastroenterology, where it has the potential to optimize both diagnosis and treatment as well as enhance patient care. Coloproctology, due to its highly prevalent pathologies and tremendous potential to cause significant mortality and morbidity, has drawn a lot of attention regarding AI applications. In fact, its application has yielded impressive outcomes in various domains, colonoscopy being one prominent example, where it aids in the detection of polyps and early signs of colorectal cancer with high accuracy and efficiency. With a less explored path but equivalent promise, AI-powered capsule endoscopy ensures accurate and time-efficient video readings, already detecting a wide spectrum of anomalies. High-resolution anoscopy is an area that has been growing in interest in recent years, with efforts being made to integrate AI. There are other areas, such as functional studies, that are currently in the early stages, but evidence is expected to emerge soon. According to the current state of research, AI is anticipated to empower gastroenterologists in the decision-making process, paving the way for a more precise approach to diagnosing and treating patients. This review aims to provide the state-of-the-art use of AI in coloproctology while also reflecting on future directions and perspectives.

Efforts are needed to better understand what are the effective pathways that can optimize success in school-based physical activity interventions. This study aimed to investigate the mediators of a school-based intervention in the practice of physical activity in Brazilian students. The Fortaleça sua Saúde [Strengthen Your Health] program followed 1,085 students (11-18 years) over a semester. This multi-component intervention included training teachers, offering physical activity opportunities, and health education. Self-reported moderate-to-vigorous physical activity and potential mediators (attitude, self-efficacy, social support, perceived neighborhood environment, and physical activity facilities at school) were assessed. The product of coefficient analysis was performed. The sample was composed of 1,085 students (51.5% boys). The total effect of the intervention was 0.706 (95%CI: 0.276; 1.136). A total of 40% of the intervention effect on moderate-to-vigorous physical activity was explained by attitude towards physical activity and social support from friends and teachers. Social support from friends was a significant mediator only among boys (ab: 0.113, 95%CI: 0.027; 0.256), and social support from teachers only among girls (ab: 0.135, 95%CI: 0.019; 0.328); indicating a statistically significant indirect effect of the program on moderate-to-vigorous physical activity via these mediators. A relevant part of the effect of a multicomponent intervention on physical activity among students from vulnerable areas is explained by changes via variables at different levels of the socioecological model, including social support from friends and teachers, and attitude towards physical activity. These results should be considered in public policies.

Colon capsule endoscopy (CCE) enables a comprehensive, non-invasive, and painless evaluation of the colon, although it still has limited indications. The lengthy reading times hinder its wider implementation, a drawback that could potentially be overcome through the integration of artificial intelligence (AI) models. Studies employing AI, particularly convolutional neural networks (CNNs), demonstrate great promise in using CCE as a viable option for detecting certain diseases and alterations in the colon, compared to other methods like colonoscopy. Additionally, employing AI models in CCE could pave the way for a minimally invasive panenteric or even panendoscopic solution. This review aims to provide a comprehensive summary of the current state-of-the-art of AI in CCE while also addressing the challenges, both technical and ethical, associated with broadening indications for AI-powered CCE. Additionally, it also gives a brief reflection of the potential environmental advantages of using this method compared to alternative ones.

Objectives . Associations between shift-work, musculoskeletal symptoms and absenteeism are poorly investigated in the manufacturing industry. This study aimed to investigate associations between working schedule, musculoskeletal symptoms and days of absenteeism among pulp and paper industry workers. Methods . Musculoskeletal symptoms of 904 workers were assessed through the Nordic Musculoskeletal Questionnaire. χ 2 tests assessed associations between being a day-worker or shift-worker, the prevalence of musculoskeletal symptoms and days of absenteeism. Results . A significant association was found between working schedule and symptoms in the lower back in the last 12 months, with shift-workers presenting higher prevalence than day-workers ( p  = 0.022). Significant associations were also found between days of absenteeism and symptoms in the shoulders ( p  = 0.002), which mostly led to absenteeism of 100-365 days; elbows ( p  < 0.001), wrists/hands ( p  = 0.045) and ankles/feet ( p  = 0.042), which produced absenteeism mostly of 25-99 days; and dorsal region ( p  = 0.001), which mainly led to absenteeism of 10-24 days. No associations were found between working schedule and days of absenteeism ( p  = 0.265). Conclusion . Shift-work is associated with increased prevalence of lower back symptoms, but seems not to influence days of absenteeism. Shoulders seem to be the region leading to higher days of absenteeism, followed by elbows, wrists/hands, ankles/feet and the dorsal region.

Muscle testing is an integral component in assessing musculoskeletal function and tailoring rehabilitation efforts. This study aimed i. to identify an objective evaluation system sensitive to analyze changes in different muscular conditions in different neuromuscular tests across a spectrum of professional experience levels; and ii. to analyze differences in objective parameters and clinical judgment between participants of different levels of expertise in different muscular conditions in different neuromuscular tests. Participants included 60 subjects with Level I to III expertise who performed blinded neuromuscular tests on the middle deltoid and rectus femoris muscles of 40 volunteer subjects. The methodology centered on standardizing test protocols to minimize variability, employing EMG to quantify muscle activity, thermography to capture thermographic muscular response, and digital dynamometry to measure muscular resistance. The findings revealed that while traditional methods like thermography and electromyography provide valuable insights, digital dynamometry stands out for its sensitivity in detecting muscle condition changes in neuromuscular test. Moreover, the data underscored the pivotal role of advanced training and expertise in enhancing the precision and accuracy of neuromuscular diagnostics, since there were significant differences in objective parameters and clinical judgment between participants of different levels of expertise in the different muscular conditions in Middle deltoid and Rectus femoris neuromuscular tests analyzed, presenting higher expertise participant clinical judgment like objective validated instrument., Competing Interests: Declaration of competing interest Guillermo Escribano-Colmena and Jorge Rey-Mota are affiliated with ®NeuroReEvolution., (Copyright © 2024. Published by Elsevier Inc.)

This case report examines the impact of a single session of functional neurology on a 35-year-old female patient diagnosed with lactose intolerance. The patient presented with severe gastrointestinal symptoms, including frequent diarrhea, bloating, and vomiting upon dairy consumption. The intervention aimed to reset dysfunctional neurological programs believed to contribute to her condition. The study utilized a standardized lactose intolerance breath test to measure the hydrogen and methane levels at various intervals before and after treatment. Post-treatment results showed symptomatic relief with the patient reporting normalized bowel movements and the absence of previous symptoms. Despite these improvements, the biochemical markers at higher time points (150 and 175 min) post-treatment remained similar to the pre-treatment values, indicating persistent lactose malabsorption and highlighting the variability of hydrogen measurements. This case report suggests that a single session of functional neurology can significantly alleviate the symptoms of lactose intolerance. However, the preliminary nature of these results underscores the need for further research involving larger sample sizes and long-term follow-up to fully understand the treatment's efficacy and underlying mechanisms.

Objective: This study aimed to ascertain the accuracy of measure arterial stiffness using the HUAWEI GT 3 Pro smartwatch and pOpmètre device against the SphygmoCor (algorithms: intersect tangent and maximum of the second derivate)., Methods: Twenty-three physically active postmenopausal women (age: 58.9 ± 3.2 years; body mass index: 26.3 ± 4.8 kg/m 2 ) were recruited. Carotid-femoral pulse wave velocity, finger-toe pulse wave velocity, and wrist-finger pulse wave velocity were obtained using SphygmoCor, pOpmètre and HUAWEI GT 3 Pro devices in a randomized order. Additionally, the pulse mean carotid-femoral and finger-toe pulse transit time was registered for SphygmoCor and pOpmètre, respectively., Results: Lower values of pulse wave velocity were recorded by HUAWEI in comparison with SphygmoCor with both algorithms, whereas no significant differences were detected between SphygmoCor and pOpmètre results. Pulse wave velocity values from SphygmoCor were positively correlated with pOpmètre results ( r = 0.464 and r = 0.451 using intersect tangent and second derivative algorithms), whereas this was not the case with those obtained from HUAWEI. Coefficients of bias of Lin's concordance coefficients close to 1 (0.832 and 0.831 for intersect tangent and second derivative algorithm, respectively) and mean bias close to 0 from Bland-Altman analysis suggested an acceptable agreement between pulse wave velocity obtained from SphygmoCor and pOpmètre., Conclusions: Our results suggest an acceptable concordance of pulse wave velocity values recoded by SphygmoCor and pOpmètre, whereas this was not the case for data obtained from HUAWEI GT 3 Pro smartwatch. Therefore, the pOpmètre may be a viable alternative for assessing arterial stiffness, but measurement via the smartwatch device cannot be recommended., Competing Interests: Financial disclosure/conflicts of interest: None reported., (Copyright © 2024 by The Menopause Society.)

Background: It is not known whether an intervention made mandatory as a physical education (PE) class assignment and aimed at promoting physical activity (PA) in adolescents can create a healthy walking habit, which would allow further improvements to be achieved after the mandatory and promoted intervention has been completed., Objective: The aims of this study were to (1) investigate whether, after a period of using a step tracker mobile app made mandatory and promoted as a PE class assignment, adolescents continue to use it when its use is no longer mandatory and promoted; (2) determine whether there are changes in the PA level, body composition, and fitness of adolescents when the use of the app is mandatory and promoted and when it is neither mandatory nor promoted; and (3) analyze whether the covariates maturity status, gender, and specific app used can have an influence., Methods: A total of 357 students in compulsory secondary education (age: mean 13.92, SD 1.91 y) participated in the study. A randomized controlled trial was conducted consisting of 2 consecutive 10-week interventions. Participants' PA level, body composition, and fitness were measured at baseline (T1), after 10 weeks of mandatory and promoted app use (T2), and after 10 weeks of nonmandatory and nonpromoted app use (T3). Each participant in the experimental group (EG) used 1 of 4 selected step tracker mobile apps after school hours., Results: The results showed that when the use of the apps was neither mandatory nor promoted as a PE class assignment, only a few adolescents (18/216, 8.3%) continued the walking practice. After the mandatory and promoted intervention period (T1 vs T2), a decrease in the sum of 3 skinfolds (mean difference [MD] 1.679; P=.02) as well as improvements in the PA level (MD -0.170; P<.001), maximal oxygen uptake (MD -1.006; P<.001), countermovement jump test (MD -1.337; P=.04), curl-up test (MD -3.791; P<.001), and push-up test (MD -1.920; P<.001) in the EG were recorded. However, the changes between T1 and T2 were significantly greater in the EG than in the control group only in the PA level and curl-up test. Thus, when comparing the measurements taken between T1 and T3, no significant changes in body composition (P=.07) or fitness (P=.84) were observed between the EG and the control group. The covariates maturity status, gender, and specific app used showed a significant effect in most of the analyses performed., Conclusions: A period of mandatory and promoted use of step tracker mobile apps benefited the variables of body composition and fitness in adolescents but did not create a healthy walking habit in this population; therefore, when the use of these apps ceased to be mandatory and promoted, the effects obtained disappeared., Trial Registration: ClinicalTrials.gov NCT06164041; https://clinicaltrials.gov/study/NCT06164041., (©Adrián Mateo-Orcajada, Raquel Vaquero-Cristóbal, Jorge Mota, Lucía Abenza-Cano. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 30.07.2024.)

The 24-h movement guidelines for children and adolescents comprise recommendations for adequate sleep, moderate to vigorous physical activity (MVPA) and sedentary behaviour (SB). However, whether adolescents who meet these 24-h movement guidelines may be less likely to have high blood pressure (HBP) has not been established. The present study assessed the association between meeting 24-h movement guidelines and HBP in a school-based sample of 996 adolescents between 10-17 years (13.2 ± 2.4 years, 55.4% of girls). Blood pressure was measured using a digital oscillometric device, while sleep, MVPA and SB were measured using the Baecke questionnaire. The association between the 24-h movement guidelines and HBP was performed using binary logistic regression adjusted for sex, age, socioeconomic status, and body mass index. It was observed that less than 1% of the sample meet the three 24-h movement guidelines. The prevalence of HBP was lower in adolescents who meet all three movement 24-h guidelines (11.1%) compared to those who did not meet any guidelines (27.2%). Individual 24-h movement guidelines analysis showed that adolescents with adequate sleep were 35% less likely to have HBP (OR = 0.65; 95% CI 0.46-0.91). Meeting sleep guidelines combined with meeting MVPA (OR = 0.69; 95% CI 0.50-0.95) or SB (OR = 0.67; 95% CI 0.48-0.94) was inversely associated with HBP. Adolescents who meet two or three 24-h movement guidelines were respectively 47% (OR = 0.53; 95% CI 0.29-0.98) and 34% (OR = 0.66; 95% CI 0.48-0.91) less likely to have HBP. In adolescents, meeting sleep and 24-h movement guidelines were inversely associated with HBP., (© 2024. The Author(s).)

This study aimed to investigate the resting metabolic rate (RMR) in cross-training practitioners (advanced and novice) using indirect calorimetry (IC) and compare it with predictive equations proposed in the scientific literature., Methods: A cross-sectional and comparative study analyzed 65 volunteers, both sexes, practicing cross-training (CT). Anthropometry and body composition were assessed, and RMR was measured by IC (FitMate PRO ® ), bioimpedance (BIA-InBody 570 ® ), and six predictive equations. Data normality was tested by the Kolgomorov-Smirnov test and expressed as mean ± standard deviation with 95% confidence intervals (CI), chi-square test was performed to verify ergogenic resources, and a Bland-Altman plot (B&A) was made to quantify the agreement between two quantitative measurements. One-way ANOVA was applied to body composition parameters, two-way ANOVA with Bonferroni post hoc was used to compare the RMR between groups, and two-way ANCOVA was used to analyze the adjusted RMR for body and skeletal muscle mass. The effect size was determined using Cohen's d considering the values adjusted by ANCOVA. If a statistical difference was found, post hoc Bonferroni was applied. The significance level was p < 0.05 for all tests., Results: The main results indicated that men showed a higher RMR than women, and the most discrepant equations were Cunningham, Tinsley (b), and Johnstone compared to IC. Tinsley's (a) equation indicated greater precision in measuring the RMR in CM overestimated it by only 1.9%, and BIA and the Harris-Benedict in CW overestimated RMR by only 0.1% and 3.4%, respectively., Conclusions: The BIA and Harris-Benedict equation could be used reliably to measure the RMR of females, while Tinsley (a) is the most reliable method to measure the RMR of males when measuring with IC is unavailable. By knowing which RMR equations are closest to the gold standard, these professionals can prescribe a more assertive diet, training, or ergogenic resources. An assertive prescription increases performance and can reduce possible deleterious effects, maximizing physical sports performance.

Objective: To verify the association between low self-reported sleep quality (LSQ) and fall in middle-aged and older adults every half-decade of life., Method: A cross-sectional study was conducted using data from the first wave (2015-2016) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is nationally representative. The sample consisted of 8,950 participants who were allocated into eight age groups: 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, and ≥ 85 years. The questionnaires used included self-reported sleep quality and the International Physical Activity Questionnaire short version. Fisher's exact test followed by binary logistic regression analysis was performed to identify the odds ratio of sleep quality for fall occurrence, controlled for confounding variables., Results: Individuals aged 50-105 years (63.6 ± 10.2 years), 57.0% females and 43.0% males, participated in this study. Overall, 21.5% of participants experienced at least one fall. The relative frequency of participants classified as having high or LSQ remained constant across each half-decade of life. The LSQ exhibited a statistically significant OR (p < 0.05) for falls across age groups up to 84, even after accounting for confounding variables., Conclusion: LSQ is significantly associated with an increased occurrence of fall in adults aged >50 years, but not for ≥ 85 years regardless of sex and physical activity level.

This study aimed to evaluate the effect and individual responsiveness after 12 weeks of high-intensity interval training (HIIT) and moderate-intensity of continuous training (MICT) on adiponectin, cardiometabolic risk factors and physical fitness in overweight adolescents. This study was participated by 52 adolescents, both sexes, 11 and 16 years old, separated into HIIT (n = 13), MICT (n = 15), and control group (CG, n = 24). Body mass, height, waist circumference (WC), fat mass (FM), fat-free mass (FFM), blood pressure, high-density lipoprotein (HDL-c), low-density lipoprotein (LDL-c), triglycerides, glucose, insulin, adiponectin, and C-reactive protein (CRP) were evaluated. Body mass index z-score (BMI-z), waist-to-height ratio (WHtR), insulin resistance, and insulin sensitivity were calculated. Resting heart rate (HR rest ), peak oxygen consumption (VO 2peak ), right handgrip strength (HGS-right), left handgrip strength (HGS-left), and abdominal resistance (ABD) was evaluated. HIIT session lasted around 35 min and MICT of 60 min of exercises on stationary bicycle, three times a weekday for 12 weeks. ANOVA, effect size, and prevalence of responders were used for statistical analysis. HIIT reduced BMI-z, WHtR, LDL-c, and CRP, while increased of physical fitness. MICT reduced HDL-c, while increased of physical fitness. CG reduced FM, HDL-c, and CRP, while increased FFM and HR rest . Frequencies of respondents in HIIT were observed for CRP, VO 2peak , HGS-right, and HGS-left. Frequencies of respondents in MICT were observed for CRP and HGS-right. Frequencies of no-respondents in CG were observed for WC, WHtR, CRP, HR rest , and ABD.  Conclusion: Interventions with exercises were effective to adiposity, metabolic health, and physical fitness improvements. Individual responses were observed in inflammatory process and physical fitness, important changes in overweight adolescent's therapy.  Trial registration number and date of registration: This study was registered with the Brazilian Registry of Clinical Trials (REBEC), the number RBR-6343y7, date of registration May 3, 2017. What is Known: • Effect of regular physical exercise positively affects overweight, comorbidities, and metabolic diseases, recommended mainly for children and adolescents. What is New: • Due to the great inter-individual variability, the same stimulus can provide different responses; adolescents who benefit from the stimulus are considered responsive. • Intervention of HIIT and MICT did not alter the concentrations of adiponectin; however, the adolescents presented responsiveness to the inflammatory process and physical fitness., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This investigation aimed to describe the current physical fitness (PF) status of Portuguese youth, compare secular trends from 2008 and 2018, and establish updated age- and sex-specific percentile values for distinct PF tests. In 2008 and 2018, 22 048 and 8960 children and adolescents (10-18 years) were included in two national cross-sectional investigations. PF was evaluated using the FITESCOLA® battery tests and the handgrip strength test. Independent sample t-tests and chi-squared tests were used to model the results. Weight smoothed percentile values were calculated using Cole's Lambda-Mu-Sigma (LMS) method. All analyses were weighted according to age, sex, and geographic region. In 2018, boys surpassed girls in the 20-m shuttle run, curl-ups, push-ups, standing long, and vertical jump tests, while girls performed better in the sit-and-reach (p < 0.05). The percentage of boys and girls meeting the healthy zone in the 20-min shuttle run test did not differ between 2008 and 2018 (p ≥ 0.05). In boys, a higher percentage fell in the healthy zone for the curl-up and push-up tests in 2018 compared to 2008 (85.8% vs. 83.4%, and 57.8% vs. 53.8%; p < 0.05). Girls improved their flexibility component (sit-and-reach test), with a higher percentage meeting the healthy zone in 2018 (32.6% vs. 36.9%; p < 0.05); an opposite trend was seen for boys (65.5% vs. 50.1%; p < 0.05). The present investigation provides new and updated PF percentile curves for Portuguese youth, which can be used as a general overview of the current PF state among the Portuguese young population., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Behavioral states such as sleep and wake are highly correlated with specific patterns of rhythmic activity in the cortex. During low arousal states such as slow wave sleep, the cortex is synchronized and dominated by low frequency rhythms coordinated across multiple regions. Although recent evidence suggests that GABAergic inhibitory neurons are key players in cortical state modulation, the in vivo circuit mechanisms coordinating synchronized activity among local and distant neocortical networks are not well understood. Here, we show that somatostatin and chondrolectin co-expressing cells (Sst-Chodl cells), a sparse and unique class of neocortical inhibitory neurons, are selectively active during low arousal states and are largely silent during periods of high arousal. In contrast to other neocortical inhibitory neurons, we show these neurons have long-range axons that project across neocortical areas. Activation of Sst-Chodl cells is sufficient to promote synchronized cortical states characteristic of low arousal, with increased spike co-firing and low frequency brain rhythms, and to alter behavioral states by promoting sleep. Contrary to the prevailing belief that sleep is exclusively driven by subcortical mechanisms, our findings reveal that these long-range inhibitory neurons not only track changes in behavioral state but are sufficient to induce both sleep-like cortical states and sleep behavior, establishing a crucial circuit component in regulating behavioral states., Competing Interests: Competing interests. The authors declare no competing interests.

This study aimed to describe a quantitative survey conducted with leaders to investigate effective and feasible actions that can be evaluated in computational models to inform policies to promote active mobility based in the city of São Paulo, Brazil. In 2022, an online survey was conducted during the Health Survey in São Paulo (Physical Activity and Environment study), which is monitored by representatives of nongovernmental organizations and public and private sector managers. A questionnaire was elaborated with three questions with 13 alternative answers about actions to promote walking and/or cycling. Leaders should select up to three alternatives based on their potential regarding: (1) effectiveness; (2) feasibility or ease of implementation; and (3) desire to verify tests in computational models to inform policies. The survey was answered by 18 leaders from 16 institutions, comprising 13 (72%) women and 12 (67%) representatives of the third sector, whose average age was 48 years and all had complete higher education. Reducing the speed of motor vehicles was the most cited option in all three questions. Other actions mentioned refer to controlling the traffic of vehicles in central areas, improving pedestrian safety, reducing the distances between homes and places of employment, conducting educational campaigns, and expanding and enhancing structures such as bicycle lanes and sidewalks. The results are relevant to support evidence-based decision-making in public management and to provide subsidies for the development of computational models with a view to promoting active mobility.

Background: Lifestyle and habits, cardiovascular risk factors (CRF), bone and mental health, dietary habits, physical activity, among others are developed in childhood and adolescence. Family environment has shown to play an important role in these outcomes. However, whether the parent-child relationship lifestyle habits and health parameters can be influenced by physical activity patterns still unclear. The objective of this study will be to monitor and investigate the associations between lifestyle habits between parents and their children longitudinally, as well as verify whether in more active parents, the possible associations with lifestyle habits are different from those of parents considered less active., Methods: The sample will consist of parents (father, mother, or both) and their children /adolescents. The participants will be recruited through public call by flyers spread across all the regions of the city and also through social media. The health parameters will include cardiovascular (cardiac autonomic modulation, blood pressure and resting heart rate), bone mineral density, anthropometric indices, handgrip strength, mental health (quality of life, anxiety and depression symptoms and stress), self-reported morbidities and musculoskeletal pain. Lifestyle habits will include physical activity levels, sedentary behavior, sleep parameters, eating patterns, smoking and alcohol consumption. Sociodemographic variables of age, sex, ethnicity and socioeconomic status will be considered as covariates. The follow-up visits of data collection will be scheduled after a period of 12 months from the baseline assessment during every twelve months., Discussion: The family environment has great potential to determine lifestyle habits in children and adolescents. Based on the results presented in the present study, we hope that health promotion actions can be better designed in the family environment., (© 2024. The Author(s).)

Background: There is a limited research on predictive models of fat mass ratio (FMR) in people living with human immunodeficiency virus (HIV) (PWH). This study aimed to develop models considering anthropometric and health-related factors to predict and validate FMR in PWH regardless of sex., Methods: One hundred and six Brazilian PWH (46.4±9.8 years) were evaluated for body composition using dual-energy X-ray absorptiometry (DXA), body circumference (BC), and skinfold thicknesses (SKs). FMR predictive models were developed using stepwise linear regression, and their agreement with DXA was assessed using Bland-Altman plots. Cross-validation was performed using the predicted residual error sum of squares (PRESS) method., Results: Six FMR estimation models were developed for PWH, with adjusted R 2 ranging from 0.43 to 0.72, standard error of the estimate (SEE) from 0.16% to 0.22%, and 95% confidence interval (CI) from 1.03 to 1.15. Model 6, including thigh SK, waist BC, therapy duration, subscapular SK, education years, and abdominal SK, exhibited the highest determination power (R 2 adjusted 0.72, SEE 0.16%, and 95% CI: 1.06-1.15). The agreement between DXA-based FMR and predictive models showed minimal bias (-0.03 to +0.04) and narrower limits of agreement, particularly for the top-performing model (-0.33 to +0.30). Model 6 exhibited a high adjusted Q 2 PRESS (0.70) and low SPRESS (0.17)., Conclusions: Our predictive models advance the study of body composition in PWH by consolidating the use of anthropometry for diagnosing and monitoring lipodystrophy regardless of sex., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-23-1946/coif). A.P.d.S. received a scholarship from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - (Finance Code 001, grant No. 88882.317622/2019-01), and from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (grant No. 201126/2022-2). Additionally, the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) will pay the article processing charges for this manuscript. The other authors have no conflicts of interest to declare., (2024 Annals of Translational Medicine. All rights reserved.)

There is some, albeit inconsistent, evidence supporting sex differences in preschoolers' motor competence (MC), with these observations not uniform when analyzed by age, and cultural groups. Thus, this study examined sex differences across ages in 3- to 5-year-old children's MC. A cross-country pooled sample of 6241 children aged 3-5 years (49.6% girls) was assessed for MC using the Test of Gross Motor Development-2nd/3rd edition, and children were categorized into groups of age in months. Multiple linear regression models and predictive margins were calculated to explore how sex and age in months affect scores of MC (i.e., locomotor and ball skills), with adjustments for country and BMI. The Chow's Test was used to test for the presence of a structural break in the data. Significant differences in favor of girls were seen at 57-59 and 66-68 months of age for locomotor skills; boys performed better in ball skills in all age periods, except for 42-44 and 45-47 months of age. The higher marginal effects were observed for the period between 45-47 and 48-50 months for locomotor skills (F = 30.21; and F = 25.90 for girls and boys, respectively), and ball skills (F = 19.01; and F = 42.11 for girls and boys, respectively). A significantly positive break point was seen at 45-47 months, highlighting the age interval where children's MC drastically improved. The identification of this breakpoint provides an evidence-based metric for when we might expect MC to rapidly increase, and an indicator of early delay when change does not occur at that age., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)