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Schools are ideal settings to promote adolescent physical activity (PA), yet school-based interventions have shown limited long-term impact. This position paper presents key issues surrounding school-based PA interventions. Collaborative conceptual thinking drawing on multi-author expertise and available evidence advanced our understanding and opinion. Key arguments: 1) the adoption of a systems approach, which maximizes partnership action and leverages policy, is crucial for understanding the complexities of implementing whole-school programs; 2) a reorientation to an assets perspective optimizes existing strengths and resources allowing greater emphasis on the full range of physical, cognitive, emotional and social benefits that PA provides, and 3) a move beyond traditional positivist research designs to advance our knowledge of what works better, for whom and in what context is needed for greater progress We provide suggestions, specifically advocating for systems approaches, as a realistic way to improve how we support PA in schools in the future. [ABSTRACT FROM AUTHOR]

Abstract Background The health impact of the COVID-19 pandemic largely depends on the ability of the healthcare systems to develop effective and adaptable preparedness and mitigation strategies. A collaborative initiative (BRCCH-EDCTP COVID-19 Initiative) was set up between Lesotho and Zambia early on in the pandemic, to jointly conduct a project to investigate creating access to SARS-CoV-2 screening and testing through community-based COVID-19 case-finding. Methods Two different community case-finding strategies were deployed. In Lesotho, an approach was implemented whereby a community (village) health worker screened community members at their home or during community gatherings for COVID-19 signs and symptoms. All community members who screened positive were then offered SARS-CoV-2 testing. In Zambia, so-called community hubs, staffed by community health care workers, were set up at different locations in the community for people to walk in and get tested for SARS-CoV-2. Hubs changed location from week-to-week and targeted transmission hotspots. All persons visiting the hubs were offered testing for SARS-CoV-2 irrespective of self-reported signs and symptoms of COVID-19 though information was collected on occurrence of these. Testing in both approaches was done using SARS-CoV-2 rapid antigen tests. Results Setting up testing in the community setting was feasible in both countries. In Lesotho in the village health worker approach, over a period of 46 weeks, 7221 persons were screened, and 49 (11.4%) SARS-COV-2 cases identified among 428 COVID-19 screen positive participants. In the community hubs among 3150 people tested, 166 (5.3%) SARS-CoV-2 cases were identified in a period of 26 weeks. From the community hubs approach, where all seen were offered COVID-19 testing it was learned that people screening positive for COVID-19 signs and symptoms were more likely to test SARS-COV-2 positive, especially those reporting classic COVID-19 symptoms like loss of sense/smell for a short period of time (1–3 days). Conclusions In conclusion, in this project we learned that implementing COVID-19 screening and testing by lay health workers in the community is possible. Characteristics of the population screened, tested, and identified to have SARS-CoV-2 are described to help guide development of future testing strategies.

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: Asynchronous video directly observed therapy (VDOT) may reduce tuberculosis (TB) program costs and the burden on patients. We compared VDOT performance across three cities in the United States, each of which have TB incidence rates above the national average.METHODS: Patients aged ≥18 years who are currently receiving directly observed anti-TB treatment were invited to use VDOT for monitoring treatment. Pre- and post-treatment interviews and medical records were used to assess site differences in treatment adherence and patient characteristics and perceptions.RESULTS: Participants were enrolled in New York City, NY (n = 48), San Diego, CA (n = 52) and San Francisco, CA, USA (n = 49). Overall, the mean age was 41 years (range 18-87); 59% were male; most were Asian (45%) or Hispanic/Latino (30%); and 77% were foreign-born. The median fraction of expected doses observed (FEDO) was 88% (IQR 76-96). At follow-up, 97% thought VDOT was "very or somewhat easy to use" and 95% would recommend VDOT to other TB patients. Age, race/ethnicity, annual income, and country of birth differed by city (P < 0.05), but FEDO and VDOT perceptions did not.CONCLUSIONS: TB programs in three large US cities observed a high FEDO using VDOT while minimizing staff time and travel. Similar findings across sites support VDOT adoption by other large, urban TB programs.

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.)

BackgroundPersons who inject drugs (PWID) might be at increased risk for Mycobacterium tuberculosis infection and reactivation of latent tuberculous infection (LTBI) due to their injection drug use.ObjectivesTo determine prevalence and correlates of M. tuberculosis infection among PWID in San Diego, California, USA.MethodsPWID aged 18 years underwent standardized interviews and serologic testing using an interferon-gamma release assay (IGRA) for LTBI and rapid point-of-care assays for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections. Independent correlates of M. tuberculosis infection were identified using multivariable log-binomial regression.ResultsA total of 500 participants met the eligibility criteria. The mean age was 43.2 years (standard deviation 11.6); most subjects were White (52%) or Hispanic (30.8%), and male (75%). Overall, 86.7% reported having ever traveled to Mexico. Prevalence of M. tuberculosis infection was 23.6%; 0.8% were co-infected with HIV and 81.7% were co-infected with HCV. Almost all participants (95%) had been previously tested for M. tuberculosis; 7.6% had been previously told they were infected. M. tuberculosis infection was independently associated with being Hispanic, having longer injection histories, testing HCV-positive, and correctly reporting that people with 'sleeping' TB cannot infect others.ConclusionsStrategies are needed to increase awareness about and treatment for M. tuberculosis infection among PWID in the US/Mexico border region.

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.)