Secular Trends in Gross Motor Coordination: A Study of Peruvian Children Living at High Altitude.

PURPOSE: To (1) describe secular trends in gross motor coordination (GMC) scores by sex and age; (2) investigate GMC trends adjusted for concomitant secular trends in height, weight, and overall physical fitness; and (3) examine trends in children's frequencies within different GMC categories. METHOD: The sample comprises 1562 Peruvian children (690 in 2009 and 872 in 2019), aged 6-11 years, from Junín (a high-altitude region). GMC was assessed with the KörperkoordinationsTest für Kinder. Physical fitness was assessed with handgrip strength, standing long jump, and shuttle-run test. Height and weight were measured with standardized protocols. Analysis of variance, covariance, and logistic regression were used. RESULTS: A negative secular trend in GMC (based on raw scores) for boys and girls aged 6-8 years was observed. However, a positive trend was observed at 11 years of age but only in boys. Finally, there were no significant changes in the likelihood of children having below-normal GMC from 2009 to 2019. CONCLUSIONS: Secular trends in GMC were negative in Peruvian children, especially at 6-8 years of age. Further, body size and physical fitness trends did not affect the negative secular trend. A high prevalence of children had below-normal GMC in both 2009 and 2019.

Translation and Adaptation of the Adult Developmental Coordination Disorder/Dyspraxia Checklist (ADC) into Asian Uzbekistan.

Developmental Coordination Disorder (DCD) is a neurodevelopmental condition that emerges in childhood and its symptoms continue through adulthood. The Adult Developmental Coordination Disorders/Dyspraxia Checklist was the first instrument used to screen adults with possible DCD. The psychometric characteristics of the Uzbek version of the scale were explored. An independent translation of the questionnaire from the original version into the Uzbek language was made. The sample comprised 301 Uzbekistan adults, aged between 17 and 42 years old (M = 20.66; SD = 2.26). Analyses were performed using R software (4.1.0). Descriptive analysis, exploratory factor analysis, and evidence of reliability in terms of internal consistency were assessed using the psych package (2.1.6), intraclass correlation coefficients were assessed using the irr package (0.84.1), and weighted Kappa were assessed using vcd package (1.4-10). To analyse the factor structure of the ADC scale, when applied to an Uzbekistan sample, exploratory factor analysis (EFA) was performed. In the Uzbek version, a one-factor structure was identified, and moderated psychometric properties were found, which makes it a possible alternative to the original scale when applied to adults. This Uzbek version reduces respondents' fatigue since it is smaller than the original one. More studies are needed to confirm the cut-off scores of this new version.

Sibling Resemblance in Physical Activity Levels: The Peruvian Sibling Study on Growth and Health.

Physical activity is associated with a host of positive health outcomes and is shaped by both genetic and environmental factors. We aim to: (1) estimate sibling resemblance in two physical activity phenotypes [total number of steps∙day-1 and minutes for moderate steps per day (min∙day-1)]; and (2) investigate the joint associations of individual characteristics and shared natural environment with intra-pair sibling similarities in each phenotype. We sampled 247 biological siblings from 110 nuclear families, aged 6-17 years, from three Peruvian regions. Physical activity was measured using pedometers and body mass index was calculated. In general, non-significant variations in the intraclass correlation coefficients were found after adjustment for individual characteristics and geographical area for both phenotypes. Further, no significant differences were found between the three sib-ship types. Sister-sister pairs tended to take fewer steps than brother-brother (ß = -2908.75 ± 954.31). Older siblings tended to walk fewer steps (ß = -81.26 ± 19.83), whereas body mass index was not associated with physical activity. Siblings living at high-altitude and in the Amazon region had higher steps/day (ß = 2508.92 ± 737.94; ß = 2213.11 ± 776.63, respectively) compared with their peers living at sea-level. In general, we found no influence of sib-types, body mass index, and/or environment on the two physical activity phenotypes.

Modeling the Dynamics of Children's Musculoskeletal Fitness.

This study models children's musculoskeletal fitness (MSF) developmental trajectories and identifies individual differences related to effects of time-invariant, as well as time-varying covariates. A total of 348 Portuguese children (177 girls) from six age cohorts were followed for three years. MSF tests (handgrip strength, standing long jump and shuttle run), age, body mass index (BMI), socioeconomic status (SES), gross motor coordination (GMC) and physical activity (PA) were assessed. Data were analyzed using multilevel models. Between 5 and 11 years of age, boys outperformed girls in all three MSF tests (p < 0.05). Birth weight was positively associated with shuttle run performance (ß = -0.18 ± 0.09, p < 0.05). BMI was positively associated with handgrip strength (ß = 0.35 ± 0.04, p < 0.001) and shuttle run performance (ß = 0.06 ± 0.01, p < 0.001), but negatively associated with standing long jump performance (ß = -0.93 ± 0.23, p < 0.001). GMC was positively associated (p < 0.001) with all three MSF tests, while PA was associated with standing long jump (ß = 0.08 ± 0.02, p < 0.05) and shuttle run (ß = -0.003 ± 0.002, p < 0.05) performance only. No school environment effects were found, and SES was not related to any MSF tests. Children's MSF development showed a curvilinear shape with increasing age, with boys outperforming girls. Weight status and physical behavior characteristics predicted MSF development, while environmental variables did not. Examining potential longitudinal predictors of MSF across multiple dimensions is important to gain a more holistic understanding of children's physical development as well as to future interventions.

Secular Trends in Physical Fitness of Peruvian Children Living at High-Altitude.

The physical fitness of children is an important marker of health, and monitoring its temporal changes provides important information for developing interventions. We aimed to: (1) describe secular trends in physical fitness across age, within each sex, in Peruvian schoolchildren; and (2) verify if these trends are also present when adjusted for changes in height and weight. We sampled 1590 children (707 in 2009; 883 in 2019), aged 6-11 years. Physical fitness was assessed with four tests from the EUROFIT battery. ANOVA and ANCOVA statistical models were used. Results showed that with increasing age, girls and boys were significantly stronger in all PF tests, except for the case of flexibility in girls. In 2019, girls were stronger (handgrip) and more flexible than in 2009; but lower values were evident in standing long jumps in both sexes. Age-by-year interactions were statistically significant for agility in both sexes, with significant differences occurring at different ages. These trends did not change when adjusted for temporal changes in height and weight. Our research provides important data for local governments to implement public policies and practices to improve physical fitness levels in children.

Sustainability of a Given Ten-Week Motor Skills Training Program for Children with Developmental Coordination Disorder.

The aim of this research was to determine the sustainability of a given ten-week motor skills training program for children with developmental coordination disorder (DCD). Children with DCD in four kindergartens in the Khorezm region of Uzbekistan were selected to take part in the study. Participants were 24 children between 4 and 6 years old (5.25 ± 0.13 years), assigned to an intervention group (IG: 17 children; 10 boys) and a control group (CG: 7 children; 4 boys). The Movement Assessment Battery for Children (MABC-2) was used to assess motor competence pre-intervention, post-intervention, and retention test measurement after 18 months. The retention test results for the IG indicated a decline in all three motor domains of MABC-2. Despite this, the results that were acquired during the retention test came out to be better than the results that were achieved during the pre-test. At the same time, children who were allocated to the CG maintained their performance. The findings suggest that a preschool-based motor skill training program has the potential to increase motor skills in children with DCD. However, the positive benefits produced by the intervention may decrease over the course of time if the intervention is not continued.

Correlates of the Physical Activity Decline during Childhood.

PURPOSE: This study aimed to describe longitudinal trends in children's moderate-to-vigorous physical activity (MVPA) and to investigate associations with individual, familial, and school characteristics. METHODS: A sample of 341 Portuguese children age 5-10 yr (173 girls) from six age cohorts was followed over 3 yr using a mixed-longitudinal design. Physical activity, body mass index (BMI), gross motor coordination, and musculoskeletal fitness were assessed annually. Information on socioeconomic status and school characteristics was collected and analyzed with mixed models. RESULTS: MVPA shows a similar declining trend in both sexes, but on average, boys exceeded the World Health Organization recommendations of 60 min·d -1 . The best model showed that boys spend, on average, more time in MVPA than girls. Children with lower BMI are less prone to the decline in MVPA, whereas higher levels of musculoskeletal fitness were associated with lower declines in MVPA. Of all school characteristics, only playground dimension was related to MVPA decreasing trajectories. CONCLUSIONS: MVPA systematically declines from 5 to 10 yr of age in both boys and girls, but boys remained more active than girls across the age range. The best predictors of MVPA decline are sex, BMI, musculoskeletal fitness, and school playground dimension.

Sibling Resemblances in Physical Fitness in Three Distinct Regions in Peru: The Peruvian Sibling Study on Growth and Health.

We estimated sibling resemblance in health-related physical fitness (PF) and examined how individual characteristics and shared natural environment accounted for sibling similarities. The sample comprised 656 sibling pairs and 102 triplets (6-15 years of age), from three geographical areas of Peru. PF components included morphological (waist circumference, sum of skinfolds), muscular (handgrip strength, standing long jump), and motor (shuttle-run). Body mass index (BMI) and somatic maturation were also assessed. In general, sibling intraclass correlations differed significantly across sib-ship types for waist circumference and handgrip strength but were the same for sum of skinfolds, standing long jump, and shuttle-run. Further, in general, both individual characteristics and geographical area of residence significantly influenced the magnitude of sibling resemblance as well as the mean levels of PF. In conclusion, individual characteristics and shared natural environment jointly influenced the expression of PF in Peruvian siblings, revealing the importance of these features when designing individualized programs promoting fitness.

A Ten-Week Motor Skills Training Program Increases Motor Competence in Children with Developmental Coordination Disorder.

The present study aimed to investigate the effect of a motor skills training program in children with DCD considering their gender. The Movement Assessment Battery for Children (MABC-2) classified the children and assessed their skill changes over time. The study was implemented at four kindergartens in the Khorezm region of Uzbekistan. In the study, all the children suffered from DCD (5.17 ± 0.70 years; 10 girls), and all the indicators of MABC-2 were less than 16%. The participants were divided into an experimental group (n = 17), receiving ten weeks of motor skills training program for 45 min twice per week; and a control group (n = 7), which proceeded with exercises of everyday living. The ANCOVA showed differences between the groups in the post-test concerning each domain: manual dexterity (F (1, 20) = 18.703, p < 0.001; η2 = 0.471); aiming and catching (F (1, 20) = 9.734, p = 0.005; η2 = 0.317); balance (F (1, 20) = 35.140, p = 0.000; η2 = 0.626); and total MABC-2 test score (F (1, 20) = 66.093, p < 0.001; η2 = 0.759), with all the children in the EG exhibiting better results. The Wilcoxon test revealed statistically significant differences for the EG between moments for all the variables (p < 0.001) but not for the CG (p > 0.050). The effectiveness of the intervention program was similar across both genders. The study suggests that a 10 week motor skills training program can increase the quality of children's motor competence and represent a valuable procedure for physical education specialists to enhance motor competence for children with DCD.

Biological and environmental influences on motor coordination in Peruvian children and adolescents.

This study investigated the associations between biological and environmental factors and gross-motor coordination (GMC) in Peruvian children and adolescents. The sample comprised 7401 boys and girls, aged 6-14 years, recruited from three geographical regions: sea-level, Amazon and high-altitude. Biological variables included age, sex, height, BMI, physical fitness, stunting, and maturational status. Environmental influences included geographical region and school characteristics. Gross-motor coordination was tested with the Körperkoordinationstest für Kinder and the data analyzed by multilevel logistic regression. Results showed a high prevalence of below normal GMC scores. Sex, age, geographical area, biological maturation, BMI (normal versus overweight/obesity), and stunting were all significant predictors of GMC. There was also an interaction between age, sex, and geographical area indicating that older girls who lived at sea-level and high-altitude were more likely to display below normal GMC scores. The school context was less important in predicting GMC problems than the interplay between biological characteristics and geographical region. These results suggest that early identification, as well as educational and pediatric care interventions, are of importance in reducing below normal GMC among Peruvian children and adolescents.

[Guideline for the Treatment and Prevention of Infections Associated with Immunosuppressive Therapy for Autoimmune Diseases]. / Protocolo de Prevenção e Tratamento de Infeções Associadas à Terapêutica Imunossupressora de Doenças Autoimunes.

We propose a guideline about the risk, prevention and treatment of infection in the patient under immunomodulatory or immunosuppressive therapy in the context of autoimmune or autoinflammatory disease. It is divided into three sections: drugs and associated risk of infection; immunizations; risk, prevention, and treatment of specific infections. The treatment of autoimmune diseases involves the use of immunosuppressive or immunomodulatory therapies, with an increasing number of new drugs being used. It is associated with an increased risk of infection, which may be present globally or only for specific agents, varying widely depending on the pharmacological class and even within the same class. The prevention strategy and clinical management need to be individually tailored and there are several key factors: characterization of the disease that prompts the immunosuppression, understanding of the mechanism of action of the immunosuppressive drug, knowledge of previous infections, recognition of risk factors, laboratory test results, vaccine administration, monitoring of clinical signs and symptoms and patient education.

O presente protocolo aborda o risco, prevenção e tratamento da infeção no doente sob terapêutica imunomoduladora ou imunossupressoraem contexto de doença autoimune ou autoinflamatória. Subdivide-se nas seguintes secções: fármacos e risco associado de infeção; imunizações; risco, prevenção e tratamento de infeções específicas. Com um número crescente de novos fármacos em utilização nos últimos anos, o tratamento de doenças autoimunes envolve a utilização de terapêuticas imunossupressoras ou imunomoduladoras e associa-se a aumento do risco de infeção, que pode estar presente de uma forma global ou apenas para infeções por agentes específicos, variando amplamente consoante a classe farmacológica e mesmo dentro desta. Na estruturação da estratégia preventiva são fundamentais a caracterização da patologia que motiva a imunossupressão, a compreensão do mecanismo de ação do imunossupressor, a aferição de infeções prévias, o reconhecimento de fatores de risco, a realização de rastreios laboratoriais, a administração de vacinas, a educação do doente e a monitorização de sintomas e sinais clínicos, na dependência de uma gestão clínica necessariamente individualizada.

A multilevel analysis of gross motor coordination of children and adolescents living at different altitudes: the Peruvian Health and Optimist Growth Study.

BACKGROUND: Gross motor coordination (GMC) is a potential correlate of lifestyle behaviours and health outcomes in childhood and adolescence. AIMS: The aim of this study was to examine how sex, age, biological maturation, overweight, stunting, and physical fitness are associated with GMC in children and adolescents from Peru, and to examine associations between geographical area of residence, school-level characteristics, and GMC. SUBJECTS AND METHODS: The sample included 7408 subjects, aged 6-14 years, from sea level, Amazon and high-altitude regions of Peru. A composite marker of total coordination was derived by the sum of scores from each test (GMCT). Overweight was identified using BMI, and biological maturation, physical fitness, and stunting were assessed. School characteristics were obtained via an objective audit. RESULTS: Boys (ß = 12.23 ± 0.90) and older children (ß = 13.37 ± 0.64) had higher GMCT than girls and younger children, respectively. Overweight was associated with lower GMCT (ß = -5.23 ± 0.80), whereas fitness was positively associated with GMCT (ß = 6.30 ± 0.25). Biological maturation was not a predictor; however, stunting was negatively associated with GMCT (ß = -3.71 ± 1.56). Subjects living in the Amazon had higher GMCT than those at sea level (ß = 16.57 ± 4.73). Five of nine school-level predictors (number of students, playground area with obstacles, multi-sports roofed, frequency and duration of Physical Education classes) were significant predictors of GMCT. CONCLUSIONS: Child- and school-level variables were significantly associated with GMCT in this sample. These findings are important for the Peruvian community, especially school principals, councils and physical education teachers, helping them to define more efficient strategies and action plans to increase motor coordination in children.

A multivariate multilevel analysis of youth motor competence. The Peruvian Health and Optimist Growth Study.

We use a multivariate multilevel model to study the links between physical fitness (PF) and gross motor coordination (GMC) and investigate the influence of predictors affecting their levels across age. We sampled 7918 Peruvians, aged 6-15 years, from sea-level, Amazon region and high-altitude. Composite markers of GMC and PF were derived (GMCz and PFz , respectively). BMI, biological maturation, and stunting were assessed. School characteristics were obtained via an objective audit. School contexts explained 35% of the associations between PFz and GMCz , whereas children's characteristics explained 65% of the total variation. On average, with increasing age, there was a greater increase in GMCz (ß = 0.79 ± 0.04, P < .001) than in PFz (ß = 0.15 ± 0.03, P < .001); boys outperformed girls (PFz , ß = 3.25 ± 0.08, P < .001; GMCz , ß = 1.58 ± 0.09, P < .001); those with lower BMI and ahead in their maturation had higher PFz (ß = -0.13 ± 0.01, P < .001; ß = 1.09 ± 0.05, P < .001, respectively) and GMCz (ß = -0.18 ± 0.01, P < .001; ß = 0.39 ± 0.06, P < .001, respectively) levels. Stunting was negatively related to PFz (ß = -0.30 ± 0.07; P < .001) and GMCz (ß = -0.30 ± 0.08, P < .001) and high-altitude Peruvians had significantly lower GMCz (ß = -0.93 ± 0.33, P < .001), and those living in the Amazon region had significantly higher PFz (ß = 1.21 ± 0.58, P < .001) compared to those living at sea level. A higher number of students was negatively related to PFz (ß = -0.016 ± 0.006, P < .001) and positively with GMCz (ß = 0.005 ± 0.003, P < .001); the duration of physical education classes was positively associated with PFz (ß = 0.70 ± 0.32, P < .001) and GMCz (ß = 0.46 ± 0.15, P < .001); and the existence of policies for physical activity was only negatively associated with GMCz (ß = -1.17 ± 0.34, P < .001). In conclusion, PFz and GMCz were positively correlated and child- and school-level traits predicted their levels.

Infection and colonization by Corynebacterium pseudodiphtheriticum: a 9-year observational study in a university central hospital.

Despite constituting part of the human commensal flora, Corynebacterium pseudodiphtheriticum has been recognized as a potentially infectious agent, most frequently in immunocompromised patients or individuals with other morbidity factors, but significant association to comorbid states remains unproven. This study's purpose was to assess clinical significance, risk factors for infection and antimicrobial susceptibility of C. pseudodiphtheriticum isolates. A retrospective observational study was conducted. Relevance of isolation was determined by clinical, laboratory, and imaging criteria. Forty-nine isolates occurred in 47 episodes. Colonization was assumed in 12% and infection in 78%, of which 51% were nosocomial. Patients with infection were older, with male predominance; both age and gender were statistically significant (p < 0.05) between infection and colonization groups. Although dyslipidemia (58%), arterial hypertension (58%), invasive procedures (56%), and chronic lung disease (50%) were prevalent in the infection group, no comorbidity was a significant risk factor for infection compared with colonization. Charlson comorbidity index showed no statistically difference between groups. Mortality rate was 14% in infection. Respiratory samples were the main isolation product; all tested strains were susceptible to amoxicillin/clavulanate and vancomycin. Resistant strains were observed for clindamycin (77%) and erythromycin (48%). C. pseudodiphtheriticum isolation was associated with infection in most cases. Despite the high prevalence of comorbidities and invasive procedures, no factors other than age and gender were significantly associated with infection. Although C. pseudodiphtheriticum may constitute a contaminant or colonizer in clinical samples, positive cultures in patients with signs and symptoms consistent with infection should not be neglected.

Stunting and Physical Fitness. The Peruvian Health and Optimist Growth Study.

Stunting, defined as linear growth retardation, is a serious public health problem in developing countries. We aimed to (1) describe the prevalence of stunting in Peruvian youth living in three geographical regions, and to (2) determine height and physical fitness (PF) differences between stunted and normal-growth children across age and sex. We sampled 7918 subjects (7074 normal-growth and 844 stunted), aged 6-15 year, from sea-level, Amazon and high-altitude regions of Peru. PF was assessed with standardized tests, and stunting was computed following World Health Organization (WHO) standards. A two-factor analysis of variance (ANOVA) model was used. Results showed that stunting prevalence increased with age (from 6% at 6 year to 18.4% at 15 year in girls, and 9.3% at 6 year to 16.4% at 15 year in boys); was higher in boys (12.3%) than in girls (9.3%), and was higher in the Amazon region (25.3%), followed by high-altitude (24.3%) and sea-level (8.1%). Stunting had a negative overall impact on girls' and boys' statures. Further, the age-by-stunting interactions were statistically significant for both sexes, and significant differences in height varied to some degree across age. Stunted children performed worse in handgrip and standing long jump, but outperformed their normal-growth peers in shuttle-run (only boys), and in 12 min run. Further, significant differences in the age-by-stunting interaction occurred in all PF tests, varying to some degree across age. In conclusion, stunting significantly affects Peruvian youth's PF levels, and this influence is sex-, age- and PF test-specific.

Why are children different in their moderate-to-vigorous physical activity levels? A multilevel analysis / Por que as crianças são diferentes em seus níveis de atividade física de intensidade moderada a vigorosa? Uma análise multinível

Abstract Objective: Children's differences in moderate-to-vigorous physical activity levels are not at random. This study investigates the relevance of individual- and school-level characteristics in explaining these differences. Methods: In total, 307 children (154 girls) aged 5-10 years, from 19 Portuguese schools, were sampled. Height and weight were measured, and body mass index was calculated. Time spent in moderate-to-vigorous physical activity was measured by accelerometry. Gross motor coordination was assessed with the KörperkoordinationsTest für Kinder battery and socio-economic status was obtained via the school social support system. School characteristics were obtained with an objective school audit. A multilevel analysis was used as implemented in Stata 15. Results: Schools explained 18.2% of the total variance in moderate-to-vigorous physical activity, with the remainder being ascribed to children's distinct characteristics. Boys were more active (β = 29.59 ± 11.52, p < 0.05), and having higher gross motor coordination levels (β = 0.11 ± 0.04, p < 0.05) was positively associated with daily moderate-to-vigorous physical activity, whereas being older (β = −5.00 ± 1.57, p < 0.05) and having higher socio-economic status (β = −7.89 ± 3.12, p < 0.05) were negatively related with moderate-to-vigorous physical activity. From the school-level correlates, only playground dimension was significantly associated with moderate-to-vigorous physical activity levels. Children from schools with medium (40 m2 to 69 m2) and large playground dimensions (≥70 m2) were less active than children with smaller playground dimensions (10 m2 to 39 m2). Conclusions: Variation in school children's moderate-to-vigorous physical activity is mostly explained by their individual characteristics; school characteristics also play a role but to a smaller degree. Future intervention programs to change this behavior should be more personalized, emphasizing mostly individual-level characteristics.

Resumo Objetivo As diferenças entre crianças na atividade física moderada a vigorosa não são aleatórias. Este estudo investiga a relevância das características em níveis individuais e escolares para explicar essas diferenças. Métodos Foram amostradas 307 crianças (154 meninas) entre 5 e 10 anos, de 19 escolas portuguesas. A estatura e o peso foram medidos e o índice de massa corporal foi calculado. O tempo gasto em atividade física moderada a vigorosa foi medido por acelerometria. A coordenação motora grossa foi avaliada com a bateria do Körperkoordinationstest für Kinder e o status socioeconômico foi obtido através do sistema de apoio social da escola. As características da escola foram obtidas através de uma auditoria escolar objetiva. Uma análise multinível foi utilizada como implantada no Stata 15. Resultados As escolas explicaram 18,2% da variância total da atividade física moderada a vigorosa, com o restante atribuído às diferentes características das crianças. Os meninos foram mais ativos (β = 29,59 ± 11,52, p < 0,05) e o fato de ter níveis mais altos de coordenação motora grossa (β = 0,11 ± 0,04, p < 0,05) foi positivamente associado com a atividade física moderada a vigorosa diária. Os mais velhos (β = -5,00 ± 1,57, p < 0,05) e com maior status socioeconômico (β = -7,89 ± 3,12, p < 0,05) foram negativamente relacionados com a atividade física moderada a vigorosa. Com base nos correlatos a nível escolar, apenas a dimensão da área recreativa foi significativamente associada aos níveis de atividade física moderada a vigorosa. As crianças das escolas com área recreativa média (40 m2 a 69 m2) e grande (≥ 70 m2) foram menos ativas do que as crianças com áreas recreativas com menores dimensões (10 m2 a 39 m2). Conclusões A variação na atividade física moderada a vigorosa de escolares é explicada principalmente por suas características individuais; as características da escola também desempenham um papel, mas em menor grau. Futuros programas de intervenção para mudar esse comportamento devem ser mais personalizados, enfatizar principalmente as características em nível individual.

Why are children different in their moderate-to-vigorous physical activity levels? A multilevel analysis.

OBJECTIVE: Children's differences in moderate-to-vigorous physical activity levels are not at random. This study investigates the relevance of individual- and school-level characteristics in explaining these differences. METHODS: In total, 307 children (154 girls) aged 5-10 years, from 19 Portuguese schools, were sampled. Height and weight were measured, and body mass index was calculated. Time spent in moderate-to-vigorous physical activity was measured by accelerometry. Gross motor coordination was assessed with the KörperkoordinationsTest für Kinder battery and socio-economic status was obtained via the school social support system. School characteristics were obtained with an objective school audit. A multilevel analysis was used as implemented in Stata 15. RESULTS: Schools explained 18.2% of the total variance in moderate-to-vigorous physical activity, with the remainder being ascribed to children's distinct characteristics. Boys were more active (ß=29.59±11.52, p<0.05), and having higher gross motor coordination levels (ß=0.11±0.04, p<0.05) was positively associated with daily moderate-to-vigorous physical activity, whereas being older (ß=-5.00±1.57, p<0.05) and having higher socio-economic status (ß=-7.89±3.12, p<0.05) were negatively related with moderate-to-vigorous physical activity. From the school-level correlates, only playground dimension was significantly associated with moderate-to-vigorous physical activity levels. Children from schools with medium (40m2 to 69m2) and large playground dimensions (≥70m2) were less active than children with smaller playground dimensions (10m2 to 39m2). CONCLUSIONS: Variation in school children's moderate-to-vigorous physical activity is mostly explained by their individual characteristics; school characteristics also play a role but to a smaller degree. Future intervention programs to change this behavior should be more personalized, emphasizing mostly individual-level characteristics.

First report of concomitant cryptococcal meningitis and anti-NMDAR encephalitis.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder, seen most often in young adults and children, triggered by tumors or infections. We report a case of cryptococcal meningitis in a patient with sarcoidosis, presenting prominent neuropsychiatric symptoms, electroencephalographic features of autoimmune encephalitis and positive anti-NMDAR antibodies in the cerebrospinal fluid, raising the hypothesis of an infectious immune-mediated mechanism triggering the production of anti-NMDAR antibodies. Since anti-NMDAR encephalitis is potentially fatal and has significant morbidity, further descriptions of its etiological associations are essential to early identification and prompt treatment.

Nontravel-related invasive Entamoeba histolytica infection with probable heterosexual transmission.

INTRODUCTION: In industrialized countries, amebiasis usually occurs in migrants and travelers returning from areas where the disease is endemic, primarily by ingestion of contaminated food or water. Person-to-person transmission can occur, mainly by fecal-oral contact, but sexual transmission has also been described [1,[3], [4], [5]]. PRESENTATION OF CASE: We report a man with Entamoeba histolytica colitis and a large liver abscess (16.5 × 14 cm) in Portugal, who had no relevant travel history and whose only risk factor was his heterosexual partner. The abscess required drainage of 1950 mL of "chocolate-milk" purulent fluid, with rapid symptomatic improvement. The diagnosis was established by real-time reverse transcription PCR for Entamoeba histolytica in the liver aspirate, with positive IgG antibodies. He received a total of 16 days of ceftriaxone and metronidazole followed by 7 days of paromomycin. CONCLUSION: As enteric infections may be sexually transmitted, in industrialized countries, even in the absence of travel, sexual history should not be neglected.

Growth velocity curves and pubertal spurt parameters of Peruvian children and adolescents living at different altitudes. The Peruvian health and optimist growth study.

OBJETIVE: To estimate the growth parameters of Peruvian children and adolescents living at different altitudes. METHODS: The sample comprised 10 795 Peruvian children and adolescents (5781 girls, aged 6-7 years) from sea level, the Amazon region, and high altitude. Height was measured with standardized techniques. Mathematical and biological growth parameters were estimated using the Preece-Baines growth model I. RESULTS: Sea-level children and adolescents experienced peak height velocity (PHV) at an earlier age (girls, 8.56 ± 2.37 years; boys, 12.03 ± 0.58 years) were taller at the time of PHV (girls, 144.1 ± 1.9 cm; boys, 154.3 ± 1.4 cm), had higher PHV (girls, 6.23 ± 3.87 cm/year; boys, 7.52 ± 2.31 cm/year), and had a taller estimated final height (girls, 154.2 ± 0.3 cm; boys, 166.3 ± 1.0 cm) compared to those living at high altitude (girls, 152.7 ± 0.7 cm; boys, 162.8 ± 0.8 cm) or in the Amazon region (152.1 ± 0.4 cm; boys, 162.2 ± 0.6 cm). Across all geographical areas, PHV occurred approximately 2 years earlier in girls (9.68 ± 0.99 years) than in boys (12.61 ± 0.42 years), their estimated PHV was 5.88 ± 1.92 cm/year vs 6.45 ± 1.09 cm/year, their size at PHV was 142.2 ± 1.4 cm vs 152.8 ± 0.7 cm, and their final adult height was estimated to be 153.1 ± 0.3 cm vs 164.2 ± 0.7 cm. CONCLUSIONS: Peruvian children and adolescents' physical growth timing and tempo were influenced by their living altitudes. Those living at sea level experienced an earlier age at PHV were taller at time of PHV, had a higher PHV, and had a taller estimated final height compared to those living at higher altitudes. Girls and boys also differed significantly in their growth parameters.