A randomized controlled trial of surf and hike therapy for U.S. active duty service members with major depressive disorder

BACKGROUND

Major depressive disorder (MDD) is the most prevalent mental health disorder worldwide, including among U.S. service members. In addition to evidence-based treatments, activity-based approaches have been shown to effectively treat depressive symptoms, particularly when they occur in the natural environment.

METHODS

This study compared two activity-based interventions, Surf Therapy and Hike Therapy, on depression outcomes among 96 active duty service members with MDD. Participants were randomized to 6 weeks of Surf or Hike Therapy. Clinician-administered and self-report measures were completed at preprogram, postprogram, and 3-month follow-up. A brief depression/anxiety measure was completed before and after each activity session.

RESULTS

Multilevel modeling results showed that continuous depression outcomes changed significantly over time (ps < .001). Although service members in Hike Therapy reported higher average depression scores than those in Surf Therapy, the trajectory of symptom improvement did not significantly differ between groups. Regarding MDD diagnostic status, there were no significant differences between the groups at postprogram (p = .401), but Surf Therapy participants were more likely to remit from MDD than were those in Hike Therapy at the 3-month follow-up (p = .015).

LIMITATIONS

The sample consisted of service members, so results may not generalize to other populations. Most participants received concurrent psychotherapy or pharmacotherapy, and, although statistically accounted for, results should be interpreted in this context.

CONCLUSIONS

Both Surf and Hike Therapies appear to be effective adjunctive interventions for service members with MDD. Research is needed to examine the effectiveness of these therapies as standalone interventions.

TRIAL REGISTRATION

Clinical trials registration number NCT03302611; First registered on 05/10/2017.

Associations between Active Mobility Index and objectively measured physical activity among older adults

BACKGROUND

Active mobility index (AMI) is a questionnaire to assess going-out behavior with physical and social activity. The association between AMI scores and objectively measured physical activity (PA) in older adults is unknown.

METHODS

Community-dwelling older adults aged ≥ 70 years participated in an examination and wore a triaxial accelerometer for seven or more days. The accelerometer measured the time of moderate-to-vigorous intensity PA (MVPA) and light intensity PA (LPA), and step counts. The AMI assessed life space (distance from the respondent's home: < 1, 1-10, or > 10 km) and related activities during the previous month. The AMI total, physical, and social scores were calculated.

RESULTS

The analyzed data were 2499 participants (mean age: 75.5 ± 4.0 years; 54.4% female). Comparing PA among quartile groups of each AMI score, higher AMI total and physical score groups were associated with higher MVPA, LPA, and step counts (all P < 0.01). The Q4 group of AMI social scores showed significantly higher LPA and step counts than the Q1 and Q2 groups (P < 0.01). The logistic regression model showed higher score groups of AMI total and physical scores associated with increased adjusted odds ratio (aOR) of meeting recommended PA, ≥ 150 min/week of MVPA.

CONCLUSIONS

Older adults with higher AMI total and physical scores, engaged in more PA. Future studies can use the present findings when estimating PA in older adults from AMI scores and examining the association between AMI scores and health outcomes.

Understanding risks of refractive error among Chinese children amidst pandemic disruptions: results from a rapid survey

BACKGROUND

Despite effectiveness in delaying the spread of the pandemic, frequent and extended disruption to children's livelihoods have fomented new norms in which learning routines encounter immense change. In particular, increased sedentary e-learning engagement with electronic screens and exposure to stressful circumstances are likely to pose adverse risks for children's vision development.

METHODS

This present study examines the link between near-sighted refractive error, and sedentary exposure to electronic screens, psychosocial stress level, and outdoor activities. A Rapid Survey Methodology (RSM) design was utilized to collect information on subject's vision condition, sedentary electronic screen use, and level of psychosocial stress, in addition to detailed socio-demographic background characteristics.

RESULTS

This study involves 2234 subjects enrolled in 1st to 6th grade in primary schools. Every 1 diopter hour increase in electronic screen use per day is associated with 1.036 OR (95% CI =1.024-1.047, p-value< 0.050), while every 1 h • W m^- 2 sr^- 1 of illuminance-weighted electronic screen use per day is associated with 2.285 OR (95% CI =1.829-2.855, p-value< 0.050) increased likelihood of near-sighted refractive error. Higher level of psychosocial stress is associated with 2.441 OR (95% CI =1.870-3.187, p-value< 0.050) and 2.403 OR (95% CI =1.839-3.141, p-value< 0.050) increased likelihood of near-sighted refractive error. Frequency of outdoor activity is not significantly associated with increased likelihood of near-sighted refractive error (p-value> 0.050).

CONCLUSIONS

Findings in this study show that many factors, including grade level and prior vision condition, contribute to increased risks of near-sighted refractive error during the COVID-19 pandemic. More strikingly, pandemic-related behavioral modifications such as lengthy sedentary electronic screen use and elevated levels of psychosocial stress are two critical channels affecting children's eye health.

Prevalence Trend of Myopia after Promoting Eye Care in Preschoolers: A Serial Survey in Taiwan before and during the Coronavirus Disease 2019 Pandemic

PURPOSE

To report the prevalence of preschool myopia after implementing a policy intervention promoting outdoor activities and the secular trend of myopia before and during the coronavirus disease 2019 (COVID-19) pandemic in a Taiwan preschool population.

DESIGN

Repeated countywide population-based, cross-sectional surveys based on the Yilan Myopia Prevention and Vision Improvement Program (YMVIP).

PARTICIPANTS

Among 23 930 kindergarteners 5 to 6 years of age from 7 school-year cohorts in Yilan County from 2014 through 2020, a total of 21 761 children (90.9%) were included for analysis.

METHODS

Since launching the YMVIP in August 2014, myopia prevention strategies, such as increasing outdoor activities (2 hours/weekday), have been promoted in all kindergartens, and countywide school-based eye examinations, including cycloplegic autorefraction, and caregiver-administered questionnaires have been carried out annually for all participants.

MAIN OUTCOME MEASURES

The prevalence of myopia (spherical equivalent, ≤ -0.5 D in either eye) in each of the 7 school-year cohorts of preschoolers 5 to 6 years of age.

RESULTS

The prevalence of myopia continuously decreased for 2 years after implementing the YMVIP: 2014 cohort, 15.5% (95% confidence interval [CI], 14.2%-16.8%); 2015 cohort, 13.5% (95% CI, 12.3%-14.7%); and 2016 cohort, 8.4% (95% CI, 7.4%-9.4%). Subsequent cohorts were exposed maximally to these school-based myopia prevention strategies, and the prevalence of myopia remained relatively stable, between 8.5% and 10.3%, even during the COVID-19 pandemic. Multivariate logistic regression analysis showed a dose-dependent association between the duration of exposure to preventive strategies and the prevalence of myopia (up to 1-year YMVIP exposure, odds ratio, 0.86 [95% CI, 0.74-0.99]; up to 2-year YMVIP exposure, odds ratio, 0.56 [95% CI, 0.50-0.63]) after controlling other myopigenic factors.

CONCLUSIONS

This population-based evidence showed high prevalence of preschool myopia and an L-shaped decline after introducing strategies to promote outdoor activities in kindergartens. With undisrupted school-based preventive strategies, the prevalence of myopia can be kept stable, even during the COVID-19 pandemic.

Association of serum 25-Hydroxyvitamin D with Vitamin D intervention and outdoor activity among children in North China: an observational study

Background

Living at high latitudes is one of the risk factors for vitamin D deficiency in children. However, evidence on vitamin D improvement for this pediatric population to date is limited. This study aims at evaluating the association of different vitamin D intervention methods and outdoor activity on the vitamin D status of children in North China.

Methods

In this observational study, a total of 55,925 children aged 1 month to 18 years old were recruited from pediatric outpatient departments from July 2016 to June 2017. Data on demographics, anthropometric measurements, vitamin D intervention (either prescribed by physicians or given by parents) and outdoor activity were recorded. The serum levels of 25-hydroxycholecalciferol (25(OH)D) were determined by high performance liquid chromatography tandem–mass spectrometry. Logistic regression analysis was performed to assess the association of vitamin D intervention or outdoor activity with blood vitamin D status, adjusted for age, gender, BMI for age, and seasons.

Results

The overall rate of hypovitaminosis D was 65.60%. Of the children’s outdoor activity, 35.63, 31.95, and 32.42% were below 30 min/d, 30–60 min/d and over 60 min/d, respectively. Furthermore, the proportion of therapeutic intervention, supplementation intervention and no vitamin D intervention among the children was 16.48, 32.87, and 50.65%, respectively. After adjusted for confounding factors, vitamin D intervention was associated with a lower risk of hypovitaminosis D, with OR (95% CI) of 0.191 (0.180, 0.202) in children with therapeutic doses and 0.423 (0.404, 0.443) in those with supplementation doses, compared with children without vitamin D intervention. In addition, longer outdoor time was associated with a lower risk of hypovitaminosis D [0.479 (0.456, 0.504) for 60 min/d, 0.737 (0.701, 0.776) for 30–60 min/d], independent of vitamin D intervention.

Conclusions

High prevalence of vitamin D deficiency was found in children living at high latitudes. Vitamin D intervention and outdoor activity are all negatively associated with children’s vitamin D deficiency. Routine vitamin D intervention combined with increased outdoor time might be an effective approach to prevent hypovitaminosis D among children, especially those at school, living at high latitudes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-020-02435-9.

Associations of outdoor activity and screen time with adiposity: findings from rural Chinese adolescents with relatively low adiposity risks

Background

Whether and to what extent outdoor activity and screen time are relevant to adiposity among rural adolescents remain largely unknown as most of relevant evidence was generated from high-income countries and urban areas. This study aimed to investigate associations of outdoor activity and screen time with adiposity among early adolescents living in rural southwest China.

Methods

In this cross-sectional study, seventh graders (n = 2264) were recruited from 10 middle schools of a rural county. Overweight and obesity was assessed using adolescents’ body mass index and waist circumference. Adolescents’ outdoor activity and screen time were measured using self-reported daily time spending on outdoor activity, watching TV, playing video games, and computers on weekdays and weekends, respectively.

Results

The prevalence of overweight/obesity and high waist circumferences were 8.0 and 4.9% and were higher among those from one-child families and with parents having high school or higher education and whose fathers were not farmers. Adolescents who did not have ≥1 h outdoor activity on weekdays were more likely to be overweight/obese (OR: 1.86, 95% CI: 1.30, 2.66) and have high waist circumferences (OR: 2.22, 95%CI: 1.39, 3.57). Adolescents who had > 2 h screen time on weekends were more likely to have high waist circumferences (OR: 2.08, 95% CI: 1.14, 3.80). Lack of outdoor activity and excessive screen time also showed synergistic effects on overweight/obesity (OR: 1.93. 95% CI: 1.15, 3.24) and high waist circumferences (OR: 3.02, 95% CI: 1.54, 5.94).

Conclusions

Lack of outdoor activity and excessive screen time were relevant to adiposity among rural Chinese adolescents even when the obesity prevalence was low. Efforts to promote active lifestyles may help prevent rural adolescents from losing their advantage in the era of the global obesity epidemic.

Perceived impact of meteorological conditions on the use of public space in winter settlements

This study aimed to assess the impact of meteorological conditions on the use of public space in Scandinavia and Canada. Between September 21 and December 18, 2017, a cross-sectional online survey 'EAMQ-Climate: space' was distributed via web-based platforms. Survey responses were received from 361 residents (258 people from Scandinavia and 103 from Canada). The relative impact of the meteorological determinants on the use of public space was calculated, and a factor analysis was performed. Disparities between Canada and Scandinavia as well as between the climate zones represented were analysed using ANOVA. Overall results showed that the most significant meteorological enablers for the use of outdoor public spaces in winter were solar gain, snowfall and snow-covered surfaces. The main barriers were slush-covered and icy surfaces, rainfall and darkness. Wind and cold were conditions with less influence. The impact of rain and ice, however, differed between climatic zones. It was also established that, when addressing the meteorological impact on avoiding the use of public spaces in winter, it is vital to discriminate between conditions related to a) the ground surface and b) ambient conditions, as well as the particular significance of c) snow and sun, and d) darkness. For the design of public space in winter cities, we conclude that designers need to focus on a wider range of weather conditions than sun, wind and cold, and include snow, rainfall, slushy and icy ground and poor visibility. The study suggests that winter public space has a higher climatic design requirement to be successful than streets and pathways that are mainly used for soft mobility.

Significance of Outdoor Time for Myopia Prevention: A Systematic Review and Meta-Analysis Based on Randomized Controlled Trials

BACKGROUND

Myopia, especially high myopia, would cause damage in the choroid, retina and sclera, thereby leading to vision loss. Although refractive error correction can help improve visual acuity, the pathology of myopia, a global issue, remains unclear and myopia progression, as well as concomitant fundus progression, remains uncontrolled. Under such circumstances, prevention of myopia is of great significance and thus should be prioritized.

OBJECTIVE

To explore whether outdoor time has positive significance for myopia prevention.

SEARCH METHODS

Databases of Pubmed, Science Direct, the Cochrane Library, the Chinese National Knowledge Infrastructure and the Wanfang Database were searched. The following terms or their combinations were used: myopia, prevention, control, random, randomized, randomization, intervention, outdoor. The full search strategy was shown in the Appendix below. The databases were last searched on -October 24, 2018.

SELECTION CRITERIA

Randomized controlled trials (RCTs) that participants accepted outdoor activity as an intervention measure for myopia prevention were included.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed the risk of bias for included studies. A fixed-effects model was applied, given that the heterogeneity among included studies was small.

MAIN RESULTS

Five RCTs with 3,014 subjects were included. Subjects' age ranged from 6 to 12 years, and the follow-up duration ranged from 9 to 36 months. Spherical equivalent error (SER) of the outdoor group was larger than that of the control group, and the pooled mean difference (MD) was 0.15 (95% CI 0.06-0.23) diopter (D). The change in SER of the outdoor group was smaller than that of the control group, with a pooled MD of 0.17 (95% CI 0.16-0.18) D. New myopia cases in the outdoor group were fewer than that of the control group, and the pooled risk ratio was 0.76 (95% CI 0.67-0.87). The change in axial length of the outdoor group was smaller than that of the control group, and the pooled MD was -0.03 (95% CI -0.03 to -0.03) mm. For all analyzed outcomes, there was no heterogeneity across included studies (I2 = 0%) and there was no publication bias either.

CONCLUSION

Outdoor time helps slow down the change of axial length and reduce the risk of myopia.

Urinary concentrations of benzophenone-3 and reproductive outcomes among women undergoing infertility treatment with assisted reproductive technologies

Benzophenone-3 is used in a variety of cosmetic products as a sunscreen, and has shown weak estrogenic and antiandrogenic activity in animal and in vitro studies. Few studies have evaluated whether benzophenone-3 is associated with reproductive outcomes among women. We studied 304 women undergoing infertility treatment (2007-2017) in the prospective Environment and Reproductive Health cohort study and who underwent 449 treatment cycles (n = 788 urines). Generalized linear mixed models were used with random intercepts to account for multiple cycles, and adjusting for confounders including physical activity. Analyses were also stratified by self-reported moderate/heavy outdoor work. The cycle-specific median (IQR) urinary benzophenone-3 concentration was 147 (58, 462) μg/L, and 98% samples had detectable concentrations. Self-reported sunscreen use, physical activity, and time spent on moderate/heavy outdoor work were positively associated with urinary benzophenone-3. Adjusted probabilities of implantation, clinical pregnancy and live birth were higher in increasing quartiles of benzophenone-3, but these associations were restricted to women who reported spending time outdoors performing moderate/heavy work. Specifically, among these women, those in the highest quartile of benzophenone-3 concentrations had 51% higher implantation (p,trend = 0.02), 68% higher clinical pregnancy (p,trend = 0.01) and 75% higher live birth (p,trend = 0.02) adjusted probabilities than women in the lowest quartile. Benzophenone-3 was unrelated to these outcomes among women who did not report doing moderate/heavy work outdoors. These results confirm that sunscreen use is a source of benzophenone-3 exposure, and show positive associations between benzophenone-3 and pregnancy outcomes, especially among women who reported engaging in outdoor work. Since these associations may be subject to important residual confounding by lifestyle factors, further research is needed to confirm these novel results in other populations, and to investigate whether other factors may be affecting the relation of benzophenone-3 with fertility and other health outcomes.

The association of physical growth and behavior change with Preschooler's physical fitness: From 10- years of monitoring data

Background

This study examined the trends of physical fitness among children aged 3–6 years old and identified the factors associated with the change of children's physical fitness.

Methods

Datum were from two cross-sectional surveys in 2005 and 2015. Children aged 3–6 years old in China Macao were recruited from 6 kindergartens. 6 kindergartens were selected from North, South and Central districts, and two kindergartens in each district using random cluster sampling in 2005. The same 6 kindergartens were selected in 2015. Physical fitness testing and a survey on children behavior were conducted for all children.

Results

Standing long jump, shuttle run, sit and reach, and continuous jump of children in Macao improved significantly in some age groups from 2005 to 2015 (P < 0.05). Results of general linear model showed that: (1) The effect of height and weight on physical fitness was less than test year effect (standing long jump: partial η2 of height = 4.5%, partial η2 of time = 8.5%); (2) after adjusted age, gender and parental education level, participating in sports clubs was associated with standing long jump(β = 5.827,p = 0.048) and shuttle run (β = −0.759, p = 0.042) in 2015. Less sedentary entertainment time and participating in sports club were two Interactive protecting factors of improving throwing ability (β = 1.862, p = 0.045).

Conclusions

The changes in height and weight were not the whole reason for the change of physical fitness among Macao preschoolers. The behaviors, including participating in sports clubs and the less time of watching TV were associated with children's running, jumping and throwing.

Severe hypovitaminosis D in active tuberculosis patients and its predictors

BACKGROUND & AIMS

Tuberculosis (TB) patients have a significant vitamin D deficiency (VDD) endemic, which may be closely related to the onset and progress of the disease. The comorbidity of diabetes (DM) and TB has posed an increasing challenge in recent years. However, the influence of DM on TB and the possible mechanism are still uncertain. We carried out this study to identify the nutritional status of vitamin D (VD) in TB patients in a northern city in China (latitude 36° N) and investigate the possible predictors of severe vitamin D deficiency (SVDD).

METHODS

A cross-sectional study including 461 active TB patients (192 with and 269 without DM) were randomly selected from Qingdao Chest Hospital from June 2015 to August 2016. We measured serum 25 hydroxyvitamin D [25(OH)D], and investigated the association between sociodemographic, dietary intake, DM, body mass index (BMI), severity of initial TB signs and symptoms (TB score) and VD status. Multivariate logistic regression analysis was used to define the possible predictors of SVDD.

RESULTS

The median serum 25(OH)D concentration was 8.50 ng/mL. Of the 461 TB patients included, 383 (83.1%) had VDD [25(OH)D < 20 ng/mL], and 217 (47.1%) had SVDD [25(OH)D < 8 ng/mL]. The variables associated with serum 25(OH)D concentrations were DM, outdoor activity level, TB score and BMI (p < 0.05). Patients with severe TB score had nearly 5 fold higher risk of having SVDD compared with those in mild subgroup [OR (95% CI) = 4.919 (2.644-9.150), p < 0.001]. Low outdoor activity level also increased the odds of SVDD, while DM and high fish consumption showed protect effects.

CONCLUSIONS

Severe hypovitaminosis D is prevalent in active TB patients, and the main predictors of SVDD were severe TB score, low outdoor activity, inadequate fish consumption. Lowered serum 25(OH)D may be associated with increased risk of TB in DM.

Smartphone use is a risk factor for pediatric dry eye disease according to region and age: a case control study

Background

In 2014, the overall rate of smartphone use in Korea was 83 and 89.8 % in children and adolescents. The rate of smartphone use differs according to region (urban vs. rural) and age (younger grade vs. older grade). We investigated risk and protective factors associated with pediatric dry eye disease (DED) in relation to smartphone use rate according to region and age.

Methods

We enrolled 916 children and performed an ocular exam that included slit lamp exam and tear break-up time. A questionnaire administered to children and their families consisted of video display terminal (VDT) use, outdoor activity, learning, and modified ocular surface disease index (OSDI) score. DED was defined based on the International Dry Eye Workshop guidelines (Objective signs: punctate epithelial erosion or short tear break-up time; subjective symptoms: modified OSDI score) We performed statistical analysis of risk factors and protective factors in children divided into groups as follows: DED vs. control, urban vs. rural, younger grade (1st to 3rd) vs. older grade (4th to 6th).

Results

A total of 6.6 % of children were included in the DED group, and 8.3 % of children in the urban group were diagnosed with DED compared to 2.8 % in the rural group (P = 0.03). The rate of smartphone use was 61.3 % in the urban group and 51.0 % in the rural group (P = 0.04). In total, 9.1 % of children in the older-grade group were diagnosed with DED compared to 4 % in the younger-grade group (P = 0.03). The rate of smartphone use was 65.1 % in older-grade children and 50.9 % in younger-grade children (P < 0.001). The mean daily duration of smartphone use was longer in the DED group than controls (logistic regression analysis, P < 0.001, OR = 13.07), and the mean daily duration of outdoor activities was shorter in the DED group than controls (logistic regression analysis, P < 0.01, OR = 0.33). After cessation of smartphone use for 4 weeks in the DED group, both subjective symptoms and objective signs had improved.

Conclusions

Smartphone use in children was strongly associated with pediatric DED; however, outdoor activity appeared to be protective against pediatric DED. Older-grade students in urban environments had DED risk factors (long duration of smartphone use), and a short duration of outdoor activity time. Therefore, close observation and caution are needed when older children in urban areas use smartphones.

Electronic supplementary material

The online version of this article (doi:10.1186/s12886-016-0364-4) contains supplementary material, which is available to authorized users.

The influence of near work on myopic refractive change in urban students in Beijing: a three-year follow-up report

PURPOSE

To investigate the influence of daily activities on myopic refractive change and myopic onset in Chinese urban students.

METHODS

The Beijing Myopia Progression Study was a 3-year cohort study. Cycloplegic refraction and a daily activity questionnaire were assessed at baseline and at follow-up examinations. Refractive change was defined as the difference in cycloplegic spherical equivalent (SE) between the final follow-up and baseline. 386 students were initially enrolled in the baseline study.

RESULTS

At the final follow-up, 222 students (57.5 %) with completed refractive error and daily activity data were analyzed. These students spent 0.32 ± 2.33 h/day more on near work (p = 0.04), and 0.21 ± 1.31 h/day less on outdoor leisure (p = 0.02), than they did at baseline. In the multivariate analysis, the younger among the secondary students (β = 0.06, p < 0.001), and those with more near work hours at baseline (β = -0.028, p = 0.033), exhibited more myopic refractive change. However, myopic refractive change was not found to be significantly associated with near work hours in the primary students, or with time spent outdoors, in either school level. After stratifying the activity hours into quartile groups, students with a greater near work load at baseline (trend P = 0.03) exhibited a greater myopic refractive change and had a higher risk to develop myopia (hazard ratio, 95 % confidence interval: 5.19, 1.49-18.13), after adjusting for the confounders. However, no significant association was found related to outdoor activity.

CONCLUSIONS

In this cohort, children with a greater near work load at baseline exhibited more myopic refractive change and were also more likely to develop myopia. The protective effect of outdoor activity on myopic refractive change was not observed.

Inverse associations of outdoor activity and vitamin D intake with the risk of Parkinson's disease

Early studies had suggested that vitamin D intake was inversely associated with neurodegenerative diseases, such as Alzheimer's disease and multiple sclerosis. However, the associations of vitamin D intake and outdoor activities with Parkinson's disease (PD) are still unclear, so this study is to evaluate these relationships from a case-control study in elderly Chinese. The study population involved 209 cases with new onsets of PD and 210 controls without neurodegenerative diseases. The data on dietary vitamin D and outdoor activities were collected using a food-frequency questionnaire and self-report questionnaire. Multivariable logistic regressions were used to examine the associations between dietary outdoor activities, vitamin D intake and PD. Adjustment was made for sex, age, smoking, alcohol use, education, and body mass index (BMI). Adjusted odds ratios (ORs) for PD in quartiles for outdoor physical activity were 1 (reference), 0.739 (0.413, 1.321), 0.501 (0.282, 0.891), and 0.437 (0.241, 0.795), respectively (P=0.002 for trend). Adjusted ORs for PD in quartiles for total vitamin D intake were 1 (reference), 0.647 (0.357, 1.170), 0.571 (0.318, 1.022), and 0.538 (0.301, 0.960), respectively (P=0.011 for trend). Our study suggested that outdoor activity and total vitamin D intake were inversely associated with PD, and outdoor activity seems to be more significantly associated with decreased risk for PD.