The Mediating Effect of Pupils' Physical Fitness on the Relationship Between Family Socioeconomic Status and Academic Achievement in a Danish School Cohort

Patient characteristics, treatment patterns, and prognosis in drug-use-associated infective endocarditis in Denmark from 1999 to 2018

BACKGROUND

While the proportion of drug-use-associated infective endocarditis (DU-IE) has been increasing during the opioid crisis in the United States, it is unknown whether this is seen in Denmark, where several preventive means have been implemented. We aimed to assess the temporal proportion of DU-IE and examine the rate of IE recurrence and mortality.

METHODS

This nationwide cohort study identified all patients with first-time infective endocarditis in 1999-2018. Drug use was defined using ICD-8/10 codes or prescription filling of medication for opioid use disorder. Long-term mortality was examined with a Kaplan-Meier estimator and a multivariate Cox model. The recurrence of IE was examined with the Aalen-Johansen method and a multivariate cause-specific hazard model.

RESULTS

We included 8,843 patients with IE: 407 with DU-IE (60.7% male, median age 43.8 years) and 8,436 with non-DU-IE (65.8% male, median age 71.5 years). The proportion of DU-IE decreased from 5.9% to 3.8% during our study period. The one-year cumulative incidence of all-cause mortality was 16.9% (CI 12.9%-20.8%) for patients with DU-IE and 17.3% (CI 16.4%-18.2%) for patients with non-DU-IE. Drug use was associated with higher one-year mortality (adjusted HR 1.64 (CI 1.23%-2.21%)). The 1-year cumulative incidence of IE recurrence was 12.8% (CI 9.3%-16.3%) in patients with DU-IE and 4.3% (CI 3.8%-4.8%) in patients with non-DU-IE. Drug use was associated with a higher 1-year recurrence of IE (adjusted HR 3.39 (CI 2.35-4.88)).

CONCLUSION

In Denmark, the proportion of patients with DU-IE fell by one-third from 1999 to 2018. DU-IE was associated with higher mortality and recurrence rates than non-DU-IE.

Time From Distress Call to Percutaneous Coronary Intervention and Outcomes in Myocardial Infarction

Background

Early percutaneous coronary intervention (PCI) is recommended for ST-segment elevation myocardial infarction (STEMI) treatment. Delays in time-to-PCI, kept within guideline recommendations, have seldom been investigated.

Objectives

The purpose of this study was to investigate the consequences of delay, due to system factors or hospital distance, for the time between last patient distress call and PCI.

Methods

Registry-based cohort study including times of first call to medical services, admission and PCI for patients admitted with STEMI in Copenhagen, Denmark (2014-2018). The main combined outcome included death, recurrent myocardial infarction, or heart failure estimated at 30 days and 1 year from event. Outcomes according to time from call to PCI (system delay) and door-to-balloon time were standardized to the STEMI population using multivariate logistic regression.

Results

In total, 1,822 STEMI patients (73.5% male, median age 63.3 years [Q1-Q3: 54.6-72.9 years]) called the emergency services ≤72 hours before PCI (1,735, ≤12 hours). The combined endpoint of 1-year cumulative incidence was 13.9% (166/1,196) for patients treated within 120 minutes of the call and 21.2% (89/420) for patients treated later. Standardized 30-day outcomes were 7.33% (95% CI: 5.41%-9.63%) for patients treated <60 minutes, and 11.1% (95% CI: 8.39%-14.2%) for patients treated >120 minutes.

Conclusions

The risk of recurrent myocardial infarction, death, and heart failure following PCI treatment of STEMI increases rapidly when delay exceeds 1 hour. This indicates a particular advantage of minimizing time from first contact to PCI.

Exploring the mediating role of promoting school physical activity on the relationship between low socioeconomic status and academic achievement and school climate: evidence from 4,990 Chilean schools

There is evidence that promoting school physical activity (PSPA) benefits children and adolescents, but little is understood about how this promotion may relate to academic achievement and school climate across varying levels of socioeconomic status (SES). Hence, the study aimed to address this knowledge gap by examining two main objectives: (1) determining the association between PSPA and academic achievement and school climate according to schools' SES and (2) exploring the potential mediating role of PSPA in the relationship between schools' SES and academic achievement and school climate. This cross-sectional study at the school level focused on 4,990 schools (including public, subsidized, and private schools) that participated in the National Educational Study 2018 (Chile), which was applied to primary schoolchildren (4th grade, aged 8-10 years). Schools were divided into non-PSPA (n = 4,280) and PSPA (n = 710) during the year 2018. Changes in academic achievement from 2017 to 2018 and school climate were considered. PSPA was associated with improvements in maths (low-SES OR: 1.80, p < 0.001) and reading (middle-SES OR: 1.45, p = 0.029; low-SES OR: 1.47, p < 0.001). The indirect effect (IE) showed that PSPA partially mediated the relationship between SES and academic achievement in reading (IE = 1.017; SE = 0.12; 95%CI, -1.27, -0.77), maths (IE = -1.019; SE = 0.12; 95%CI, -1.25, -0.78), and school climate (IE = -0.46; SE = 0.52; 95%CI, -0.56, -0.35). In conclusion, PSPA was linked to positive changes in academic achievement, especially among low SES, and PSPA presented a potential mediating role in the relationship between SES of schools and academic achievement and school climate.

Arterial Thromboembolism in Patients With Atrial Fibrillation and CHA2DS2-VASc Score 1: A Nationwide Study

BACKGROUND

Oral anticoagulation is suggested in patients with atrial fibrillation and a CHA2DS2-VASc score ≥1 (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, and sex score). To assess granular differences within CHA2DS2-VASc 1, the incidence of arterial thromboembolism according to CHA2DS2-VASc 1 subgroups was examined.

METHODS

The Danish National Patient Registry and the Danish Prescription Registry were linked on a nationwide level to identify patients with atrial fibrillation from 2000 to 2021 without oral anticoagulation and categorized according to CHA2DS2-VASc score: CHA2DS2-VASc 0 (male and female subjects); CHA2DS2-VASc 1 (hypertension, heart failure, diabetes, vascular disease, and age 65-74 years); or CHA2DS2-VASc 2 (age ≥75 years without other risk factors). Female sex was not considered a risk factor in any risk group. The outcome was arterial thromboembolism (ischemic stroke, embolism of extremity, or transient cerebral ischemia). Study groups were compared using Cox regression analysis.

RESULTS

We included 26 701 patients with a CHA2DS2-VASc 0 score; 22 915 with CHA2DS2-VASc 1 (1483 patients with heart failure, 9066 with hypertension, 843 with diabetes, 770 with vascular disease, and 10 753 who were 65 to 74 years of age); and 14 525 patients with CHA2DS2-VASc 2 (≥75 years of age without other risk factors). With a median of 1 year of observation time, the cumulative incidence of arterial thromboembolism was 0.6% (n=154 [95% CI, 0.6%-0.8%]), 1.4% (n=16 [95% CI, 0.8%-2.2%]), 1.9% (n=141 [95% CI, 1.6%-2.2%]), 1.7% (n=12 [95% CI, 0.9%-2.9%]), 2.0% (n=13 [95% CI, 1.1%-3.4%]), 2.3% (n=187 [95% CI, 2.0%-2.7%]), and 4.4% (n=533 [95% CI, 4.1%-4.8%]) for CHA2DS2-VASc 0, heart failure, hypertension, diabetes, vascular disease, age 65 to 74 years (CHA2DS2-VASc 1), and age ≥75 years (CHA2DS2-VASc 2), respectively. No statistically significant difference was identified among subgroups of CHA2DS2-VASc 1 (P=0.15 for difference).

CONCLUSIONS

For patients with atrial fibrillation, all subgroups of CHA2DS2-VASc 1 were associated with lower incidence of arterial thromboembolism compared with age ≥75 years without other risk factors (ie, CHA2DS2-VASc 2) and a higher incidence compared with CHA2DS2-VASc 0. No statistically significant difference was identified between the subgroups of CHA2DS2-VASc 1. These findings support current recommendations that patients within this intermediate risk group could be identified with a similar risk of arterial thromboembolism.

Ambulance response times and 30-day mortality: a Copenhagen (Denmark) registry study

BACKGROUND AND IMPORTANCE

Ensuring prompt ambulance responses is complicated and costly. It is a general conception that short response times save lives, but the actual knowledge is limited.

OBJECTIVE

To examine the association between the response times of ambulances with lights and sirens and 30-day mortality.

DESIGN

A registry-based cohort study using data collected from 2014-2018.

SETTINGS AND PARTICIPANTS

This study included 182 895 individuals who, during 2014-2018, were dispatched 266 265 ambulances in the Capital Region of Denmark.

OUTCOME MEASURES AND ANALYSIS

The primary outcome was 30-day mortality. Subgroup analyses were performed on out-of-hospital cardiac arrests, ambulance response priority subtypes, and caller-reported symptoms of chest pain, dyspnoea, unconsciousness, and traffic accidents. The relation between variables and 30-day mortality was examined with logistic regression.

RESULTS

Unadjusted, short response times were associated with higher 30-day mortality rates across unadjusted response time quartiles (0-6.39 min: 9%; 6.40-8.60 min: 7.5%, 8.61-11.80 min: 6.6%, >11.80 min: 5.5%). This inverse relationship was consistent across subgroups, including chest pain, dyspnoea, unconsciousness, and response priority subtypes. For traffic accidents, no significant results were found. In the case of out-of-hospital cardiac arrests, longer response times of up to 10 min correlated with increased 30-day mortality rates (0-6.39 min: 84.1%; 6.40-8.60 min: 86.7%, 8.61-11.8 min: 87.7%, >11.80 min: 85.5%). Multivariable-adjusted logistic regression analysis showed that age, sex, Charlson comorbidity score, and call-related symptoms were associated with 30-day mortality, but response time was not (OR: 1.00 (95% CI [0.99-1.00])).

CONCLUSION

Longer ambulance response times were not associated with increased mortality, except for out-of-hospital cardiac arrests.

Clustering of Multilevel Factors Among Children and Adolescents: Associations With Health-Related Physical Fitness

BACKGROUND

To identify the clustering characteristics of individual-, family-, and school-level factors, and examine their associations with health-related physical fitness.

METHODS

A total of 145,893 Chinese children and adolescents aged 9-18 years participated in this cross-sectional study. The 2-step cluster analysis was conducted to identify clusters among individual-, family-, and school-level factors. Physical fitness indicator was calculated through sex- and age-specific z scores of forced vital capacity, standing long jump, sit-and-reach flexibility, body muscle strength, endurance running, and body mass index.

RESULTS

Three, 3, and 5 clusters were automatically identified at individual, family, and school levels, respectively. Students with low physical fitness indicator were more likely to be in the "longest sedentary time and skipping breakfast" cluster (odds ratio [OR] = 1.18; 95% confidence interval [CI], 1.12-1.24), and "physical inactivity and insufficient protein consumption" cluster (OR = 1.07; 95% CI, 1.02-1.12) at individual level, the "single children and high parental education level" cluster (OR = 1.15; 95% CI, 1.10-1.21), and "no physical activity support and preference" cluster (OR = 1.30; 95% CI, 1.25-1.36) at family level, and the "physical education occupied" cluster (OR = 1.06; 95% CI, 1.01-1.11), and "insufficient physical education frequency" cluster (OR = 1.16; 95% CI, 1.08-1.24) at school level. Girls were more vulnerable to individual- and school-level clusters, while boys were more susceptible to family clusters; the younger students were more sensitive to school clusters, and the older students were more susceptible to family clusters (P-interaction < .05).

CONCLUSIONS

This study confirmed different clusters at multilevel factors and proved their associations with health-related physical fitness, thus providing new perspective for developing targeted interventions.

Mortality and Heart Failure Admission After Mitral Valve Surgery for Mitral Regurgitation in Patients With Versus Without a History of Atrial Fibrillation: A Nationwide Study

This study aimed to examine the associated rate of 3-year mortality and heart failure (HF) admission in patients who underwent mitral valve replacement/repair (MVR) for mitral regurgitation (MR) with and without a history of atrial fibrillation (AF). Using Danish nationwide registries, we categorized adult patients who underwent MVR for MR from 2000 to 2018 according to history of AF. The cumulative incidence of all-cause mortality and HF admission with a maximum of 3 years of follow-up were examined using Kaplan-Meier and the Aalen Johansen estimator, respectively. The adjusted rates were computed using the multivariable Cox regression analysis. We included 4,480 patients: 1,685 with a history of AF (37.6%) (median age 70 years, 66.1% men) and 2,795 (without AF 62.4%) (median age 64 years, 67.6% men). The 3-year mortality was 13.8% for patients with AF and 8.2% for patients without AF. The adjusted analysis yielded no statistically significant difference in the associated rate of mortality between the study groups (hazard ratio 1.16, 95% confidence interval 0.95 to 1.43, reference: no AF). The cumulative 3-year incidence of HF admission was 23.7% for patients with AF and 14.6% for patients without AF. The adjusted analysis yielded an associated higher rate of HF admission for patients with a history of AF (hazard ratio 1.19, 95% confidence interval 1.02 to 1.39). In conclusion, 37.6% of patients who underwent MVR for MR had a history of AF before surgery and we found no statistically significant difference in the mortality between the study groups but found a higher associated rate of HF admission in patients with a history of AF.

Recurrence of bacteremia and infective endocarditis according to bacterial species of index endocarditis episode

PURPOSE

In patients surviving infective endocarditis (IE) recurrence of bacteremia or IE is feared. However, knowledge is sparse on the incidence and risk factors for the recurrence of bacteremia or IE.

METHODS

Using Danish nationwide registries (2010-2020), we identified patients with first-time IE which were categorized by bacterial species (Staphylococcus aureus, Enterococcus spp., Streptococcus spp., coagulase-negative staphylococci [CoNS], 'Other' microbiological etiology). Recurrence of bacteremia (including IE episodes) or IE with the same bacterial species was estimated at 12 months and 5 years, considering death as a competing risk. Cox regression models were used to compute adjusted hazard ratios of the recurrence of bacteremia or IE.

RESULTS

We identified 4086 patients with IE; 1374 (33.6%) with S. aureus, 813 (19.9%) with Enterococcus spp., 1366 (33.4%) with Streptococcus spp., 284 (7.0%) with CoNS, and 249 (6.1%) with 'Other'. The overall 12-month incidence of recurrent bacteremia with the same bacterial species was 4.8% and 2.6% with an accompanying IE diagnosis, while this was 7.7% and 4.0%, respectively, with 5 years of follow-up. S. aureus, Enterococcus spp., CoNS, chronic renal failure, and liver disease were associated with an increased rate of recurrent bacteremia or IE with the same bacterial species.

CONCLUSION

Recurrent bacteremia with the same bacterial species within 12 months, occurred in almost 5% and 2.6% for recurrent IE. S. aureus, Enterococcus spp., and CoNS were associated with recurrent infections with the same bacterial species.

All-cause mortality among Danish nursing home residents before and during the COVID-19 pandemic: a nationwide cohort study

A substantial part of mortality during the COVID-19-pandemic occurred among nursing home residents which caused alarm in many countries. We investigate nursing home mortality in relation to the expected mortality prior to the pandemic. This nationwide register-based study included all 135,501 Danish nursing home residents between 2015 until October 6, 2021. All-cause mortality rates were calculated using a standardization method on sex and age distribution of 2020. Survival probability and lifetime lost for 180 days was calculated using Kaplan Meier estimates. Of 3,587 COVID-19 related deaths, 1137 (32%) occurred among nursing home residents. The yearly all-cause mortality rates per 100,000 person-years in 2015, 2016, and 2017 were 35,301 (95% CI: 34,671-35,943), 34,801 (95% CI: 34,180-35,432), and 35,708 (95% CI: 35,085-36,343), respectively. Slightly elevated mortality rates per 100,000 person-years were seen in 2018, 2019, 2020, and 2021 of 38,268 (95% CI: 37,620-38,929), 36,956 (95% CI: 36,323-37,600), 37,475 (95% CI: 36,838-38,122), and 38,536 (95% CI: 37,798-39,287), respectively. For SARS-CoV-2-infected nursing home residents, lifetime lost difference was 42 days (95% CI: 38-46) in 2020 versus non-infected in 2018. Among vaccinated in 2021, lifetime lost difference was 25 days (95% CI: 18-32) for SARS-CoV-2-infected versus non-infected. Even though a high proportion of COVID-19 fatalities took place in nursing homes and SARS-CoV-2-infection increased the risk of individual death, the annual mortality was only slightly elevated. For future epidemics or pandemics reporting numbers of fatal cases in relation to expected mortality is critical.

Consequences of COVID-19-related lockdowns and reopenings on emergency hospitalizations in pediatric patients in Denmark during 2020-2021

There is a considerable burden of children being hospitalized due to infectious diseases worldwide. The COVID-19 pandemic provided a unique opportunity to examine effects of worldwide efforts to control spread of infection. We aimed to investigate overall age-specific hospitalizations due to viral and bacterial infections and diseases triggered by respiratory tract infections during and after lockdown. This nationwide register-based observational study included children from 29 days to 17 years old hospitalized in all Danish pediatric emergency departments during the years 2015-2021. Main outcomes were ICD-10 diagnoses for infectious diseases and infection triggered illnesses. Fluctuations in hospitalization events were explored using figures with weekly events per 100,000. Total events followed a predictable pattern during 2015-2019. In 2020-2021, there was a drop in hospital encounters after lockdowns and surge after reopenings. In 2021, there was a surge of hospital encounters in the late summer due to respiratory syncytial virus infections and asthmatic bronchitis mostly in infants from 29 days to 2 years. For the infectious diseases, there was a dramatic decrease in events after lockdowns and immediate increase in cases that followed the same pattern of previous years after reopenings. Bacterial infections, like urinary tract infections, sepsis, and meningitis followed a steady pattern throughout all calendar-years.

CONCLUSIONS

Nationwide efforts to minimize infectious disease spread like lockdowns have a preventative and period lasting effect but reopenings/reunions result in surges of infectious diseases. This might be due to children not getting immunized steadily thereby increasing the pool of possible hosts for potential viral infections.

WHAT IS KNOWN

• There is a seasonal fluctuation in viral/respiratory infections in children with higher infection rates in the winter and lower rates in the summer. • RSV infection is a major source of concern.

WHAT IS NEW

• Major lockdowns and reopenings disrupt the seasonal fluctuations which can result in high surges in infections that increases the burden of children emergency departments and the risk of serious complications.

Prevalence and Mortality of Infective Endocarditis in Community-Acquired and Healthcare-Associated Staphylococcus aureus Bacteremia: A Danish Nationwide Registry-Based Cohort Study

BACKGROUND

Staphylococcus aureus bacteremia (SAB) can be community-acquired or healthcare-associated, and prior small studies have suggested that this mode of acquisition impacts the subsequent prevalence of infective endocarditis (IE) and patient outcomes.

METHODS

First-time SAB was identified from 2010 to 2018 using Danish nationwide registries and categorized into community-acquired (no healthcare contact within 30 days) or healthcare-associated (SAB >48 hours of hospital admission, hospitalization within 30 days, or outpatient hemodialysis). Prevalence of IE (defined from hospital codes) was compared between groups using multivariable adjusted logistic regression analysis. One-year mortality of S aureus IE (SAIE) was compared between groups using multivariable adjusted Cox proportional hazard analysis.

RESULTS

We identified 5549 patients with community-acquired SAB and 7491 with healthcare-associated SAB. The prevalence of IE was 12.1% for community-acquired and 6.6% for healthcare-associated SAB. Community-acquired SAB was associated with a higher odds of IE as compared with healthcare-associated SAB (odds ratio, 2.12 [95% confidence interval {CI}, 1.86-2.41]). No difference in mortality was observed with 0-40 days of follow-up for community-acquired SAIE as compared with healthcare-associated SAIE (HR, 1.07 [95% CI, .83-1.37]), while with 41-365 days of follow-up, community-acquired SAIE was associated with a lower mortality (HR, 0.71 [95% CI, .53-.95]).

CONCLUSIONS

Community-acquired SAB was associated with twice the odds for IE, as compared with healthcare-associated SAB. We identified no significant difference in short-term mortality between community-acquired and healthcare-associated SAIE. Beyond 40 days of survival, community-acquired SAIE was associated with a lower mortality.

External validation of the simple NULL-PLEASE clinical score in predicting outcomes of out-of-hospital cardiac arrest in the Danish population - A nationwide registry-based study

AIM

The NULL-PLEASE score (Nonshockable rhythm, Unwitnessed arrest, Long no-flow or Long low-flow period, blood pH < 7.2, Lactate > 7.0 mmol/L, End-stage renal disease on dialysis, Age ≥85 years, Still resuscitation, and Extracardiac cause) may identify patients with out-of-hospital cardiac arrest (OHCA) unlikely to survive. We aimed to validate the NULL-PLEASE score in a nationwide setting.

METHODS

We used Danish nationwide registry data from 2001 to 2019 and identified OHCA survivors with return of spontaneous circulation (ROSC) or ongoing cardiopulmonary resuscitation at hospital arrival. The primary outcome was 1-day mortality. Secondary outcomes were 30-day mortality and the combined outcome of 1-year mortality or anoxic brain damage. The risks of outcomes were estimated using logistic regression with a NULL-PLEASE score of 0 as reference (range 0-14). The predictive ability of the score was examined using the area under the receiver operating characteristics (AUCROC) curve.

RESULTS

A total of 3,881 patients were included in the analyses. One-day mortality was 35%, 30-day mortality was 61%, and 68% experienced the combined outcome. For a NULL-PLEASE score ≥9 (n = 244) the absolute risks were: 1-day mortality: 80.7% (95% confidence interval [CI]: 75.8-85.7%); 30-day mortality: 98.0% (95% CI: 96.2-99.7%); and the combined outcome: 98.4% (95% CI: 96.8-100.0%). Corresponding AUCROC values were 0.800 (95% CI: 0.786-0.814) for 1-day mortality, 0.827 (95% CI: 0.814-0.840) for 30-day mortality, and 0.828 (95% CI: 0.815-0.841) for the combined outcome.

CONCLUSIONS

In a nationwide OHCA-cohort, AUCROC values for the predictive ability of NULL-PLEASE were high for all outcomes. However, some survived even with high NULL-PLEASE scores.

Duration of Resuscitation and Long-Term Outcome After In-Hospital Cardiac Arrest: A Nationwide Observational Study

BACKGROUND

Prior studies have investigated the association between duration of resuscitation and short-term outcomes following in-hospital cardiac arrest (IHCA). However, it remains unknown whether there is an association between duration of resuscitation and long-term survival and functional outcomes.

METHOD

We linked data from the Danish in-hospital cardiac arrest registry with nationwide registries and identified 8,727 patients between 2013 and 2019. Patients were stratified into four groups (A-D) according to quartiles of duration of resuscitation. Standardized average probability of outcomes was estimated using logistic regression.

RESULTS

Of 8,727 patients, 53.1% (n=4,604) achieved return of spontaneous circulation. Median age was 74 (1^st-3^rd quartile [Q1-Q3] 65-81 years) and 63.1% were men. Among all IHCA patients the standardized 30-day survival was 62.0% (95% CI 59.8%-64.2%) for group A (< 5 minutes), 32.7% (30.8%-34.6%) for group B (5-11 minutes), 14.4% (12.9%-15.9%) for group C (12-20 minutes) and 8.1% (7.0%-9.1%) for group D (21 minutes or more). Similarly, 1-year survival was also highest for group A (50.4%; 48.2%-52.6%) gradually decreasing to 6.6% (5.6%-7.6%) in group D. Among 30-day survivors, survival without anoxic brain damage or nursing home admission within one-year post-arrest was highest for group A (80.4%; 78.2%-82.6%), decreasing to 73.3% (70.0%-76.6%) in group B, 67.2% (61.7%-72.6%) in group C and 73.3% (66.9%-79.7%) in group D.

CONCLUSION

Shorter duration of resuscitation attempt during an IHCA is associated with higher 30-day and 1-year survival. Furthermore, we found that the majority of 30-day survivors were still alive 1-year post-arrest without anoxic brain damage or nursing home admission despite prolonged resuscitation.

Food purchases in households with and without diabetes based on consumer purchase data

OBJECTIVES

Dietary recommendations for individuals with diabetes are easy to provide, but adherence is difficult to monitor. The objective of this study was to investigate whether there was a difference in grocery purchases between households with and without diabetes.

STUDY DESIGN

Cohort study.

METHODS

Consumer purchase data in 2019 was collected from 6662 households donating their supermarket receipts via a receipt collecting service. Of these households, 718 included at least one individual with diabetes. The monetary percentages spent on specific food groups were used to characterize households using all purchases in 2019. A probability index model was used to compare households with diabetes to households without diabetes.

RESULTS

We included 405,264 shopping trips in 2019 attributed to 6662 households. Both households with and without diabetes spent the highest monetary percentage on sweets (with diabetes: 9.3%, without diabetes: 8.8%), with no statistically significant difference detected. However, compared to households without diabetes, households with diabetes had a significantly higher probability of spending a higher monetary percentage on butter, oil and dressings; non-sugary drinks; processed red meat and ready meals as well as a significantly lower probability of spending a higher monetary percentage on accessory compounds; alcoholic beverages; eggs; grains; rice and pasta, and raw vegetables.

CONCLUSIONS

Households with diabetes spent a relatively higher monetary value on several unhealthy foods and less on several healthy groceries compared to households without diabetes. There is a need for more diabetes self-management education focused on including more healthy dietary choices in their household grocery purchases.

Could Physical Fitness Be Considered as a Protective Social Factor Associated with Bridging the Cognitive Gap Related to School Vulnerability in Adolescents? The Cogni-Action Project

The first aim was to compare differences between school vulnerability groups, fitness levels, and their combination in adolescent cognitive performance. The second aim was to determine the mediation role of fitness in the association between school vulnerability and cognitive performance. A total of 912 Chilean adolescents aged 10–14 years participated in this study. The school vulnerability index (SVI) assigned by the Chilean Government was categorized into high-, mid-, or low-SVI. Adolescents were classified as fit or unfit according to their global fitness z-score computed from their cardiorespiratory (CRF), muscular (MF), and speed/agility fitness (SAF) adjusted for age and sex. A global cognitive score was estimated through eight tasks based on a neurocognitive battery. Covariance and mediation analyses were performed, adjusted for sex, schools, body mass index, and peak high velocity. Independent analyses showed that the higher SVI, the lower the cognitive performance (F_(6,905) = 18.5; p < 0.001). Conversely, fit adolescents presented a higher cognitive performance than their unfit peers (F_(5,906) = 8.93; p < 0.001). The combined analysis found cognitive differences between fit and unfit adolescents in both the high- and mid-SVI levels (Cohen’s d = 0.32). No differences were found between fit participants belonging to higher SVI groups and unfit participants belonging to lower SVI groups. Mediation percentages of 9.0%, 5.6%, 7.1%, and 2.8% were observed for the global fitness score, CRF, MF, and SAF, respectively. The mediation effect was significant between low- with mid-high-SVI levels but not between mid- and high-SVI levels. These findings suggest that an adequate physical fitness level should be deemed a protective social factor associated with bridging the cognitive gap linked to school vulnerability in adolescents. This favourable influence seems to be most significant in adolescents belonging to a more adverse social background.

Physical Fitness Plays a Crucial Mediator Role in Relationships Among Personal, Social, and Lifestyle Factors With Adolescents' Cognitive Performance in a Structural Equation Model. The Cogni-Action Project

Background: The beneficial relationship between physical fitness and cognitive performance is affected and modulated by a wide diversity of factors that seem to be more sensitive during the development stage, particularly during early adolescence. This study aimed to examine the role of physical fitness considering the multivariate association between age, health-related quality of life (HRQOL), school vulnerability index (SVI), body mass index z-score (BMIz), physical activity, and sleep problems with the cognitive performance in boys and girls. Method: Participants were 1,196 adolescents aged 10-14 years (50.7% of boys) from Chile. Three physical fitness components and eight cognitive tasks were measured. BMIz was determined using growth references by age and sex, whereas questionaries were used to assess sleep problems, physical activity, and HRQOL. SVI was established according to the score given by the Chilean Government to educational establishments. We performed a structural equation model (SEM) to test multivariate associations among study' variables by sex. Results: Fitness was positively associated with boys' and girls' cognitive performance (β = 0.23 and β = 0.17; p = 0.001, respectively). Moreover, fitness presented a significant mediator role in the relationships between BMIz, SVI, and physical activity with cognitive performance (indirect effect). Additionally, SVI showed a negative association both direct and indirect effect in all three fitness components and all cognitive tasks, being this relationship stronger in girls than in boys. Conclusion: Our findings suggest that physical fitness and all its components play a crucial mediator role in the associations between several factors associated with adolescents' cognitive performance. Thereby, educational and health strategies should prioritise improving physical fitness through physical activity. They also should address other factors such as school vulnerability, obesity, and the early gender gap in a comprehensive approach boosting cognitive performance among early adolescents. Trial registration: Research Registry (ID: researchregistry5791).

The Mediation Effect of Self-Report Physical Activity Patterns in the Relationship between Educational Level and Cognitive Impairment in Elderly: A Cross-Sectional Analysis of Chilean Health National Survey 2016-2017

The aims of this cross-sectional study were (i) to determine the association of educational level attained with cognitive impairment and (ii) to investigate the mediating effect of different self-report physical activity (PA) patterns in a large sample of older Chileans. A sample of 1571 older adults from the National Chilean Survey (2016-2017) was included. The educational level attained, PA levels, mode of commuting, sedentary time, and leisure-time PA were self-reported through validated questionnaires. Cognitive impairment was determined by Mini-Mental State Examination (modified version). Association between educational level attained and cognitive impairment was examined using logistic regression models. Counterfactual mediation models were used to test the mediating effect of self-reported PA patterns. A lower educational level was consistently associated with higher odds of cognitive impairment (OR range 2.846 to 2.266, all p < 0.001), while leisure-time PA was the only PA pattern that partially mediated this association (proportion mediated 8.0%). In conclusion, leisure-time PA was the solely PA pattern that partially mediated the association between the educational level and cognitive impairment. The rest self-reported PA patterns did not modify this association.