Clustering of 24H movement behaviors associated with clinic blood pressure in older adults: a cross-sectional study.

Physical activity (PA), sedentary behavior (SB), and sleep duration are known to have an individual effect on clinic blood pressure (BP) of older adults. However, whether different patterns of these so-called movement behaviors over the 24h-cycle on BP remains poorly investigated. The study aimed to identify movement behavior patterns associated with clinic BP among older adults with chronic diseases. Cross-sectional study with 238 older adults (80.3% female; mean age 68.8 ± 6.6) with at least one chronic disease. PA, SB, and sleep duration were measured by a triaxial accelerometer. Clinic systolic BP (SBP) and diastolic BP (DBP) were obtained through an automated method following standard procedures. Non-hierarchical K-means cluster and linear regression modeling were employed to identify the clusters of movement behaviors and to examine the associations. Two clusters were identified [active and non-sedentary, n = 103 (i.e., sufficient sleep duration, higher LPA and MVPA, and lower SB) and sedentary and inactive, n = 135 (i.e., sufficient sleep duration, lower LPA and MVPA, and higher SB). Active and non-sedentary older adults presented lower systolic BP compared to sedentary and inactive ones, even after adjustments for sociodemographic and clinical characteristics (ß = 6.356; CI 95% from 0.932 to 11.779; P = 0.022). No associations were found for diastolic BP. In conclusion, higher PA and lower SB were associated with lower systolic BP in older adults with chronic diseases. However, sleep duration did not modify this association. Therefore, interventions focusing on concomitantly increasing PA levels and reducing SB should be the priority for controlling blood pressure.

Validity and reliability of the Baecke questionnaire against accelerometer-measured physical activity in community dwelling adults according to educational level.

Baecke questionnaire have been widely used to assess physical activity. However, the role of educational level on validity and reliability of Baecke questionnaire is still not stablished, being a factor that can potentially influence the accuracy of self-reported measures. The present study aimed to verify the validity and reliability of Baecke questionnaire for the measurement of physical activity in community dwelling adults according to education level. The sample included 251 adults (42.4±17.0 years, 55% of women). Physical activity was self-reported by Baecke questionnaire and objectively measured by accelerometer. The education level (EL) was classified by years of study into low (<8 years), medium (8-11 years) and high (>11 years). A 7-day test-retest reliability was analyzed by intraclass correlation coefficient. The relationship, agreement and validity of the Baecke questionnaire against accelerometry were analyzed by Spearman's correlation, Kappa index, and ROC curve, respectively. The reliability of Baecke questionnaire were r = 0.97 (high EL), r = 0.78 (medium EL), and r = 0.68 (low EL). Sensitivity and specificity were 77% and 71% in high EL, 54% and 80% in medium EL and 33% and 89% in the low EL. Baecke questionnaire proved to be reliable and a valid measurement of habitual physical activity in adults with medium and high EL.

The importance of body weight status on motor competence development: From preschool to middle childhood.

We evaluated the association between weight status and motor competence from preschool age (3-5 years of age) until middle childhood (7-9 years of age). Longitudinal study with three to five-year-old preschool children (n = 1155) enrolled in public and private preschools in Recife, Brazil. Children were followed twice (2010, 2012, and 2014) for four years. Köperkoordinationstest für kinder (KTK) assessed the children's motor competence (KTK Motor Quotient). Weight status (underweight, normal weight, overweight, and obesity) was classified according to the children's sex and age. Preschool children with normal weight exhibited higher motor competence at 5-7 years of age compared to preschool children with overweight (+3.73 MQ, P = .03) and obesity (+5.09 MQ, P < .01). Preschool children with normal weight presented higher motor competence at 7-9 years of age compared to their peers with overweight (+6.00 MQ, P = .03) and obesity (+5.88 MQ, P = .01). Children with normal weight at 5-7 years of age presented higher motor competence at 7-9 years of age compared to their peers with overweight (+3.33 MQ, P = .02) and obesity (+4.00 MQ, P = .02). Independent of the childhood phase and extension of the period evaluated (2- or 4-year period), children who had excessive weight (overweight or obesity) and changed their weight status to underweight or normal weight presented similar motor competence compared to children who continued underweight or normal weight. Weight status already at preschool age is an important predictor of the children's motor competence until middle childhood. Interventions improving the children's weight status, already at preschool age, might impact their motor competence development positively.

Lifestyle choices of Brazilian college students.

BACKGROUND: Lifestyle choices reflect the beliefs that individuals attribute to aspects of life. This construct can be assessed with the Individual Lifestyle Profile (PEVI) questionnaire, which measures elements of Nutrition, Physical Activity, Preventive Behaviors, Social Relationships and Stress Management. OBJECTIVE: The objective of this study was to estimate the psychometric properties of the PEVI applied to a sample of Brazilian university students, identifying the prevalence of each lifestyle component according to participants' age, sex, weight status, course area/field and economic stratum and to estimate the contribution of these characteristics on physical and psychological lifestyle. METHODS: The PEVI data was analyzed by confirmatory factor analysis, using the indexes chi-square per degrees of freedom ratio (χ2/df), Comparative Fit Index (CFI), Tucker-Lewis Index (TLI) and Root Mean Square Error of Approximation (RMSEA). First-order and second-order models (physical and psychological lifestyle) were tested. Prevalences of lifestyle components were calculated and compared by participants' age, sex, weight status, course area/field and economic stratum. A hypothetical causal structural model was elaborated to investigate the impact of sample characteristics on physical and psychological lifestyles. This model was evaluated considering the global fit to the data (χ2/df, CFI, TLI and RMSEA) and the hypothetical causal trajectories (ß) (α = 5%). RESULTS: A sample of 1,303 students was used. The mean age was 20.9 (standard deviation = 2.8) years, 66.8% of participants were females, 63.4% had weights in the normal range and 73.7% were students of the social and exact sciences. The PEVI data showed an adequate fit for both the first- (χ2/df = 2.03, CFI = 0.98; TLI = 0.97; RMSEA = 0.04) and second-order (χ2/df = 2.25; CFI = 0.97; TLI = 0.97; RMSEA = 0.04) models. There was a higher prevalence of unfavorable physical and psychological lifestyle choices among females, among underweight and obese individuals, in older students and in those with lower economic strata. Moreover, negative behaviors in physical lifestyle were more prevalent in students from human/social/exact sciences and worse psychological lifestyle was observed among health sciences students. These results were confirmed by a structural model. CONCLUSION: The PEVI data presented validity and reliability. Negative lifestyle choices had high prevalence among students. Moreover, individual characteristics had different impact on physical and psychological lifestyle choices.

Secular trends in suicidal ideation and associated factors among adolescents

Objectives: Suicide is one of the leading causes of death in adolescence, and the second most common cause of death among young people. The objective of this study was to identify trends in suicidal ideation by sex and ascertain factors associated with this outcome. Methods: Secular trend study with statewide coverage conducted at 5-year intervals, with 4,207 adolescents (2006), 6,264 adolescents (2011) and 6,026 adolescents (2016). Logistic regression was used to evaluate the secular trend of suicidal ideation. Multilevel logistic regressions evaluated the factors associated with suicidal ideation in the survey conducted in 2016. Results: There was a positive trend in suicidal ideation prevalence in 2016 compared to the prevalence in 2006 and 2011, in both boys and girls. Low social support, poor sleep quality, and low parental supervision were associated with suicidal ideation in boys and girls. Exposure to violence and bullying was associated with suicidal ideation only in girls. TV time and computer and videogame time were not associated with suicidal ideation in boys or girls. Conclusion: There is an alarming trend of increased suicidal ideation in adolescents. Several dimensions were associated with suicidal ideation in adolescents, especially social support, sleep quality, and parental supervision.

Secular trends in suicidal ideation and associated factors among adolescents.

OBJECTIVES: Suicide is one of the leading causes of death in adolescence, and the second most common cause of death among young people. The objective of this study was to identify trends in suicidal ideation by sex and ascertain factors associated with this outcome. METHODS: Secular trend study with statewide coverage conducted at 5-year intervals, with 4,207 adolescents (2006), 6,264 adolescents (2011) and 6,026 adolescents (2016). Logistic regression was used to evaluate the secular trend of suicidal ideation. Multilevel logistic regressions evaluated the factors associated with suicidal ideation in the survey conducted in 2016. RESULTS: There was a positive trend in suicidal ideation prevalence in 2016 compared to the prevalence in 2006 and 2011, in both boys and girls. Low social support, poor sleep quality, and low parental supervision were associated with suicidal ideation in boys and girls. Exposure to violence and bullying was associated with suicidal ideation only in girls. TV time and computer and videogame time were not associated with suicidal ideation in boys or girls. CONCLUSION: There is an alarming trend of increased suicidal ideation in adolescents. Several dimensions were associated with suicidal ideation in adolescents, especially social support, sleep quality, and parental supervision.

Dynamic Balance, but Not Precision Throw, Is Positively Associated with Academic Performance in Children.

We analyzed the longitudinal association between dynamic balance and throwing skill with academic performance and whether waist circumference mediated these relationships. The current one-year longitudinal study followed 1020 first (mean age 7.87 ± 0.34 years) through fifth grade (mean age 11.87 ± 0.37 years) children, measured twice in 2010 and 2011. Dynamic balance and precision throw were measures of motor competence. Waist circumference was measured with a measuring tape at the umbilicus level. Academic performance was assessed by a combined score of standardized Danish language and math tests. Structural equation modeling was used for analysis. All coefficients are standardized. Balance was associated with academic performance when both sexes were combined (ß = 0.126, 95% CI: 0.074 to 0.179), and waist circumference partially mediated the relationship (ß = 0.021, 95% CI: 0.008 to 0.034). For boys, balance was associated with academic performance, but waist circumference did not mediate the association. For girls, balance presented direct, mediated (via waist circumference), and total associations with academic performance. Dynamic balance is an important gross motor function that was longitudinally related to academic performance, and waist circumference partially mediated the relationship. Precision throw was not found to be associated with academic performance in both sexes combined or when analyzed separately.

Supervised, but Not Home-Based, Isometric Training Improves Brachial and Central Blood Pressure in Medicated Hypertensive Patients: A Randomized Controlled Trial.

Meta-analyses have shown that supervised isometric handgrip training reduces blood pressure in hypertensives. However, the mechanism(s) underlying these effects in medicated hypertensive patients, as well as the effects from home-based exercise training, is uncertain. The purpose of this study was to compare the effects of supervised and home-based isometric handgrip training on cardiovascular parameters in medicated hypertensives. In this randomized controlled trial, 72 hypertensive individuals (38-79 years old, 70% female) were randomly assigned to three groups: home-based, supervised isometric handgrip training or control groups. Home-based and supervised isometric handgrip training was completed thrice weekly (4 × 2 min at 30% of maximal voluntary contraction, with 1-min rest between bouts, alternating the hands). Before and after 12 weeks brachial, central and ambulatory blood pressures (BP), arterial stiffness, heart rate variability, vascular function, oxidative stress and inflammation markers were obtained. No significant (p > 0.05) effect was observed for ambulatory BP, arterial stiffness, heart rate variability, vascular function and oxidative stress and inflammatory markers in all three groups. Brachial BP decreased in the supervised group (Systolic: 132 ± 4 vs. 120 ± 3 mmHg; Diastolic: 71 ± 2 vs. 66 ± 2 mmHg, p < 0.05), whereas no significant differences were observed in the home-based (Systolic: 130 ± 4 vs. 126 ± 3 mmHg; diastolic: 73 ± 3 vs. 71 ± 3 mmHg) and control groups (p > 0.05). Supervised handgrip exercise also reduced central BP systolic (120 ± 5 vs. 109 ± 5 mmHg), diastolic (73 ± 2 vs. 67 ± 2 mmHg); and mean BP (93 ± 3 vs. 84 ± 3 mmHg), whereas no significant effects were found in the home-based (Systolic: 119 ± 4 vs. 115 ± 3 mmHg; Diastolic: 74 ± 3 vs. 71 ± 3 mmHg) and control groups (p > 0.05). In conclusion, supervised, but not home-based, isometric training lowered brachial and central BP in hypertensives.

Development of dental anxiety in schoolchildren: A 2-year prospective study.

AIM: To assess the development of high dental anxiety and the factors that are associated with it over a 2-year period. DESIGN: This longitudinal study focused on 416 Brazilian children aged 5-7 years over 2 years. Interviews were conducted with the children's parents to investigate the children's health-related behaviours. Additionally, the children's dental caries experience was clinically evaluated to obtain information about DMFT/dmft (decayed, filled and missing teeth) indices. Using the Dental Anxiety Question, children whose parents responded "yes" to the prompt "Is he/she very afraid of going to the dentist?" were classified as having high dental anxiety. Multilevel mixed-effects logistic regression was used to analyse factors to determine the extent to which they were associated with high dental anxiety longitudinally. RESULTS: The prevalence of high dental anxiety in children at baseline was 16.2%, whereas it was 19.8% at follow-up. Additionally, 38% of the children with high dental anxiety at baseline still had the condition after two years, although 62% of them no longer had high dental anxiety. The incidence of high dental anxiety at 2-year follow-up was 15.0%. Children who used medication chronically had a 2.1 times greater likelihood of having high dental anxiety. Furthermore, children whose parents reported high dental anxiety had a 2.6 times greater likelihood of having high dental anxiety themselves. A one-unit increase in a child's dmft score increased the risk of high dental anxiety by 1.1 times at follow-up. CONCLUSION: After two years, the incidence of high dental anxiety was 15.0%. Poor oral health, unstable general health and parents with high dental anxiety were factors that were associated with this type of anxiety in schoolchildren. It is important that dentists are aware of children's high dental anxiety and the associated factors so that they can appropriately intervene. Dentists fulfil an important role and should stimulate and promote good general hygiene habits that may prevent future problems.

Effects of isometric handgrip training in patients with cardiovascular disease: rationale and design of the ISOPRESS network

Meta-analytical studies have indicated that isometric handgrip training promotes significant reduction in blood pressure in hypertensive patients with similar or greater decreases in blood pressure than observed after aerobic and dynamic resistance training. However, several gaps in the literature still need to be addressed. Thus, we designed the ISOPRESS network group, which consists of a task force of different research groups aimed at analyzing the effects of isometric handgrip training on different contexts, parameters, and populations. Thus, the aim of this study was to describe the rationale and design behind the ISOPRESS, presenting the methods employed. The ISOPRESS questions involve whether isometric handgrip training is effective in hypertensives in different settings (ISOPRESS 1 - unsupervised training and ISOPRESS 2 - public health system), whether it works in patients with other cardiovascular diseases (ISOPRESS 3 - obstructive sleep apnea and ISOPRESS 4 - peripheral artery disease) and what are the mechanisms underlying the effects of isometric handgrip training in hypertensives (ISOPRESS 5 - neural mechanism). The study will yield information on the effectiveness of isometric handgrip training in different settings and patients with other cardiovascular diseases. Finally, it will help to understand the mechanisms involved in reducing blood pressure in hypertensives.(AU)

A new approach to define and diagnose cardiometabolic disorder in children.

The aim of the study was to test the performance of a new definition of metabolic syndrome (MetS), which better describes metabolic dysfunction in children. Methods. 15,794 youths aged 6-18 years participated. Mean z-score for CVD risk factors was calculated. Sensitivity analyses were performed to evaluate which parameters best described the metabolic dysfunction by analysing the score against independent variables not included in the score. Results. More youth had clustering of CVD risk factors (>6.2%) compared to the number selected by existing MetS definitions (International Diabetes Federation (IDF) < 1%). Waist circumference and BMI were interchangeable, but using insulin resistance homeostasis model assessment (HOMA) instead of fasting glucose increased the score. The continuous MetS score was increased when cardiorespiratory fitness (CRF) and leptin were included. A mean z-score of 0.40-0.85 indicated borderline and above 0.85 indicated clustering of risk factors. A noninvasive risk score based on adiposity and CRF showed sensitivity and specificity of 0.85 and an area under the curve of 0.92 against IDF definition of MetS. Conclusions. Diagnosis for MetS in youth can be improved by using continuous variables for risk factors and by including CRF and leptin.

Clustering of Physical Inactivity in Leisure, Work, Commuting, and Household Domains: Data From 47,477 Industrial Workers in Brazil.

BACKGROUND: Physical inactivity in each domain (leisure, work, commuting, and household) is not completely independent. This study aimed to describe the clustering of physical inactivity in different domains and its association with sociodemographic factors among Brazilian industrial workers. METHODS: This was a cross-sectional, population-based study using data from 23 Brazilian states and the Federal District collected via questionnaires between 2006 and 2008. Physical inactivity in each domain was defined as nonparticipation in specific physical activities. Clustering of physical inactivity was identified using the ratio of the observed (O) and expected (E) percentages of each combination. Multinomial logistic regression was used to identify sociodemographic factors with the outcome. RESULTS: Among the 44,477 interviewees, most combinations exceeded expectations, particularly the clustering of physical inactivity in all domains among men (O/E = 1.37; 95% CI: 1.30; 1.44) and women (O/E = 1.47; 95% CI: 1.36; 1.60). Physical inactivity in 2 or more domains was observed more frequently in women, older age groups, individuals living without a partner, and those with higher education and income levels. CONCLUSIONS: Physical inactivity tends to be observed in clusters regardless of gender. Women and workers with higher income levels were the main factors associated with to be physically inactive in 2 or more domains.

Improvements on Cardiovascular Diseases Risk Factors in Obese Adolescents: A Randomized Exercise Intervention Study.

BACKGROUND: It is unclear how different exercise intensities affect cardiovascular disease (CVD) risk factors in obese adolescents. The aim of this study was to compare the effects of high-intensity (HIT) vs. low-intensity (LIT) aerobic training on CVD risk factors in obese adolescents. METHODS: Forty-three obese adolescents (age: 15.7 ± 1.3 years, BMI: 34.3 ± 4.1 kg/m(2)) participated this study either HIT (corresponding to ventilatory threshold I; N = 20) or LIT (20% below ventilatory threshold I; N = 23) for 12 weeks. All sessions were isocaloric (350 kcal). All participants received the same nutritional, psychological, and clinical counseling. Subjects were assessed in fatness, fitness, lipid profile, and glucose at baseline and after 12 weeks. The CVD risk factors assessed were waist circumference (WC), total cholesterol (TC), high-density lipoprotein (HDL), glucose, and fitness, which were single and clustered analyzed (z scores sum). RESULTS: Body mass, Body Mass Index, fatness, and WC were improved (P < .001) in both groups. The sum of z scores (WC + TC + glucose-fitness-HDL) improved in both HIT (12 weeks = -2.16 SD; Cohen's d = .45) and LIT (12 weeks = -2.13 SD; Cohen's d = .60) without groups differences. Changes in fitness were associated with changes in WC (r = -.48; P = .003). CONCLUSION: HIT does not promote any additional improvements in CVD risk factors than LIT in obese adolescents.

Heart rate variability and cardiovascular risk factors in adolescent boys.

OBJECTIVE: To establish reference values of heart rate variability (HRV) measures in a cohort of adolescent boys and to determine the relationship between HRV and the clustering of risk factors (RFs) for cardiovascular disease. STUDY DESIGN: This cross-sectional study included 1152 adolescent boys (age: 16.6 ± 1.2 years old). Demographic data, health-related habits, obesity indicators, and blood pressure were evaluated. HRV measures of time (SD of all RR intervals, root mean square of the squared differences between adjacent normal RR intervals, and the percentage of adjacent intervals over 50 ms) and frequency domains were assessed (low [LF] and high [HF] frequency). RESULTS: The components of HRV were RR interval (827 ± 128 ms), SD of all RR intervals (61.9 ± 23.5 ms), root mean square of the squared differences between adjacent normal RR intervals (54.5 ± 29.4 ms), percentage of adjacent intervals over 50 ms (29.4 ± 20.4%), LF (53 ± 16 nu), HF (47 ± 16), and LF/HF (1.44 ± 1.08). Greater sympathetic and lower parasympathetic modulation at rest were associated with higher adiposity, higher blood pressure and physical inactivity. Adolescents with 2 or more RFs also presented lower HRV than subjects with no RFs (P < .001). CONCLUSIONS: The study has provided descriptive indicators that help the interpretation of HRV results in adolescents. Lower HRV measures are associated with the clustering of cardiovascular RFs.

The association between cardiovascular risk factors and high blood pressure in adolescents: a school-based study.

OBJECTIVE: Although previous studies have analyzed the association between cardiovascular risk factors and blood pressure in adolescents, few studies conducted in developing countries analyzed whether the aggregation of risk factors contributes to an increased risk of high blood pressure in adolescents. The objective of this study was to assess the association between cardiovascular risk factors (including general overweight, abdominal obesity, high consumption of foods rich in fats, and insufficient physical activity levels) and high blood pressure in adolescents. METHODS: This study was carried out from 2007 to 2008 with 1021 adolescents (528 girls) from primary schools located in the city of Londrina- Brazil. Blood pressure was assessed using an oscillometric device. General overweight was obtained through body mass index, abdominal obesity was assessed using waist circumference, and the consumption of foods rich in fat and physical activity were assessed using a questionnaire. The sum of these risk factors was determined. RESULTS: Adolescents with three or four aggregated risk factors were more likely to have higher values of systolic and diastolic blood pressure when compared with adolescents who did not have any cardiovascular risk factors (P = 0.001 for both). Logistic regression indicated that groups of adolescents with 2 (OR= 2.46 [1.11-5.42]; P = 0.026), 3 (OR= 4.97 [2.07-11.92]; P = 0.001) or 4 risk factors (OR= 6.79 [2.24-19.9]; P = 0.001) presented an increased likelihood of high blood pressure. CONCLUSIONS: The number of cardiovascular risk factors was found to be related to high blood pressure in adolescents.

Perceived environmental characteristics and psychosocial factors associated with physical activity levels in adolescents from Northeast Brazil: structural equation modelling analysis.

This study aimed to investigate the direct and indirect associations between perceived environmental characteristics and psychosocial factors and physical activity levels in adolescents from Northeast Brazil. The sample was composed of 2,361 adolescents aged 14-19 years (56.6% female). Physical activity was measured using a questionnaire and environmental (perceived environmental characteristics) and psychosocial (self-efficacy, social support from parents and friends for physical activity) factors with previously validated scales. Perceived environmental characteristics were not directly associated with the levels of physical activity, but exhibited significant indirect associations, mediated by self-efficacy in males. Self-efficacy and social support were positively and directly associated with physical activity levels, and part of the associations between social support and physical activity was mediated by self-efficacy. Perception of self-efficacy and social support, important factors associated with physical activity levels in adolescents, should be the target of interventions aimed at increasing physical activity. Favorable environments for physical activity also need to be considered, since they have a positive influence on the self-efficacy of adolescents.

Does self-reported physical activity associate with high blood pressure in adolescents when adiposity is adjusted for?

Studies show that both low physical activity (PA) and adiposity are associated with a higher risk of hypertension. However, the relationship between PA and blood pressure in adolescents is controversial and other studies have reported that no association was observed. Of particular interest is the evaluation of whether the association between PA and high blood pressure is independent of adiposity. A sample of 3764 Brazilian adolescents who attend high schools was selected using random cluster sampling. Data were collected using the Global School-based Student Health Survey, anthropometry, and blood pressure readings. The prevalence of high blood pressure was 14.6% (95% Confidence Interval (CI) 13.5-15.7), higher amongst males (20.0%; 95%CI 18.0-22.1) compared with females (10.9%; 95%CI 9.7-12.3). Sixty-six per cent of the adolescents were reported to be insufficiently active. The prevalence of high blood pressure was 12.8% (95%CI 11.0-14.7) amongst active compared with 15.4% (95%CI 14.0-16.9) amongst insufficiently active adolescents. The association between PA and high blood pressure was observed only amongst females after adjusting for waist circumference (odds ratio (OR) 1.67; 95%CI 1.21-2.31) and body mass index (OR 1.71; 95%CI 1.23-2.37). Notwithstanding levels of adiposity, higher PA levels are associated with a lower prevalence of high blood pressure amongst females, although not amongst males.

Post-dural (post-lumbar) puncture headache: risk factors and clinical features.

OBJECTIVE: This is an analytic, interventional, cross sectional study to evaluate the risk factors of post-dural (post-lumbar) puncture headache (PDPH) and the validity of the diagnostic criteria for PDPH from the ICHD II. METHODS: Six-hundred-and-forty patients (332 non-pregnant women and 308 men) aged 8-65 years underwent spinal anesthesia with Quincke 25G or 27G needles in elective surgery. RESULTS: Forty-eight (7.5%) of the patients developed PDPH. The binary logistic regression analysis identified as risk factors: gender [11.1% female vs. 3.6% male, OR 2.25 (1.07-4.73); p = 0.03], age [11.0% 31-50 years of age vs. 4.2% others, OR 2.21 (1.12-4.36); p = 0.02], previous history of PDPH [26.4% positive vs. 6.2% negative, OR 4.30 (1.99-9.31); p < 0.01] and bevel orientation [16.1% perpendicular vs. 5.7% parallel, OR 2.16 (1.07-4.35); p = 0.03]. The period of latency between lumbar puncture and headache onset range from 6 to 72 hours and the duration from 3 to 15 days. In 34/48 (71%) patients with PDPH, at least one of the following was present: neck stiffness, tinnitus, hypoacusia, photophobia, or nausea. CONCLUSION: In conclusion, 14/48 patients (29%) suffered none of the above-mentioned symptoms, indicating that a significant number of patients may suffer from PDPH in the absence of any symptoms apart from the headache itself. This suggests that a further analyses of existing studies should be made to determine if a criteria change may need consideration.

Enrollment in physical education is associated with health-related behavior among high school students.

BACKGROUND: Physical education (PE) plays a critical role in the healthy development of youth; however, the influence of PE classes in helping to provide students with health-related behavior patterns is not clear. This study aims to analyze whether participation in PE classes is associated with health-related behavior among high school students. METHODS: A total of 4210 students attending public high schools in Pernambuco (northeast of Brazil) were selected using random 2-stage cluster sampling. Data were collected by using the Global School-based Student Health Survey. The independent variable was the frequency of participation in PE classes, whereas physical activity, television viewing, smoking, and alcohol, fruit, vegetables and soda consumption were dependent variables. Logistic regressions were carried out to perform crude and adjusted analysis of the association between enrollment in PE classes and health-related behaviors. RESULTS: Sixty-five percent of students do not take part in PE classes, with a significantly higher proportion among females (67.8%). It was observed that enrollment in PE classes was positively associated with physical activity, TV viewing, and fruit consumption, but was negatively associated with soda drinking. The likelihood of reporting being active and eating fruit on a daily basis was 27% and 45% higher, respectively, among those who participate in at least 2 classes per week in comparison with those who do not. Students who participate in PE classes had 28-30% higher likelihood of reporting lower TV viewing during week days. CONCLUSIONS: Findings suggest that higher levels of enrollment in PE classes could play a role in the promotion of health-related behaviors among high school students.

Methods and participant characteristics of a randomized intervention to promote physical activity and healthy eating among brazilian high school students: the Saude na Boa project.

BACKGROUND: A cross-cultural, randomized study was proposed to observe the effects of a school-based intervention designed to promote physical activity and healthy eating among high school students in 2 cities from different regions in Brazil: Recife and Florianopolis. The objective of this article is to describe the methodology and subjects enrolled in the project. METHODS: Ten schools from each region were matched and randomized into intervention and control conditions. A questionnaire and anthropometry were used to collect data in the first and last month of the 2006 school year. The sample (n=2155 at baseline; 55.7% females; 49.1% in the experimental group) included students 15 to 24 years, attending nighttime classes. The intervention focused on simple environmental/organizational changes, diet and physical activity education, and personnel training. RESULTS: The central aspects of the intervention have been implemented in all 10 intervention schools. Problems during the intervention included teachers' strikes in both sites and lack of involvement of the canteen owners in schools. CONCLUSIONS: The Saude na Boa study provides evidence that public high schools in Brazil represent an important environment for health promotion. Its design and simple measurements increase the chances of it being sustained and disseminated to similar schools in Brazil.