Correlates of preschool children's objectively measured physical activity and sedentary behavior: a cross-sectional analysis of the SPLASHY study

BACKGROUND

Identifying ways to promote physical activity and decrease sedentary time during childhood is a key public health issue. Research on the putative influences on preschool children's physical activity (PA) and sedentary behavior (SB) is limited and has yielded inconsistent results. Our aim was to identify correlates of PA and SB in preschool children.

METHODS

Cross-sectional data were drawn from the Swiss Preschoolers' Health Study (SPLASHY), a Swiss population-based cohort study. Of 476 two to six year old children, 394 (54% boys) had valid PA data assessed by accelerometry. Information on exposure data was directly measured or extracted from parental questionnaires. Multilevel linear regression modeling was used to separately assess associations between 35 potential correlates and total PA (TPA), moderate-to-vigorous PA (MVPA) and SB.

RESULTS

In total, 12 correlates from different domains were identified. TPA and MVPA were greater in boys than girls, increased with age and were positively associated with gross motor skills. Children from single parent families had a higher level of TPA and spent less time sedentary than those living with two parents. Time spent outdoors was positively associated with TPA and negatively with SB. The child's activity temperament was related all three outcomes, whereas parental sports club membership, living area per person and neighborhood safety were associated with SB only. Fixed and random factors in the final models accounted for 28%, 32% and 22% of the total variance in TPA, MVPA and SB, respectively. Variance decomposition revealed that age, sex and activity temperament were the most influential correlates of both, TPA and MVPA, whereas the child's activity temperament, time outdoors and neighborhood safety were identified as the most important correlates of SB.

CONCLUSIONS

A multidimensional set of correlates of young children's activity behavior has been identified. Personal factors had the greatest influence on PA, whereas environmental-level factors had the greatest influence on SB. Moreover, we identified a number of previously unreported, potentially modifiable correlates of young children's PA and SB. These factors could serve to define target groups or become valuable targets for change in future interventions.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN41045021 (date of registration: 21.03.14).

Social relationship correlates of major depressive disorder and depressive symptoms in Switzerland: nationally representative cross sectional study

BACKGROUND

The quality and quantity of social relationships are associated with depression but there is less evidence regarding which aspects of social relationships are most predictive. We evaluated the relative magnitude and independence of the association of four social relationship domains with major depressive disorder and depressive symptoms.

METHODS

We analyzed a cross-sectional telephone interview and postal survey of a probability sample of adults living in Switzerland (N=12,286). Twelve-month major depressive disorder was assessed via structured interview over the telephone using the Composite International Diagnostic Interview (CIDI). The postal survey assessed depressive symptoms as well as variables representing emotional support, tangible support, social integration, and loneliness.

RESULTS

Each individual social relationship domain was associated with both outcome measures, but in multivariate models being lonely and perceiving unmet emotional support had the largest and most consistent associations across depression outcomes (incidence rate ratios ranging from 1.55-9.97 for loneliness and from 1.23-1.40 for unmet support, p's<0.05). All social relationship domains except marital status were independently associated with depressive symptoms whereas only loneliness and unmet support were associated with depressive disorder.

CONCLUSIONS

Perceived quality and frequency of social relationships are associated with clinical depression and depressive symptoms across a wide adult age spectrum. This study extends prior work linking loneliness to depression by showing that a broad range of social relationship domains are associated with psychological well-being.

Intentional and unintentional non-adherence to medications following an acute coronary syndrome: a longitudinal study

OBJECTIVE

Non-adherence to medication is common among coronary heart disease patients. Non-adherence to medication may be either intentional or unintentional. In this analysis we provide estimates of intentional and unintentional non-adherence in the year following an acute coronary syndrome (ACS).

METHOD

In this descriptive prospective observational study of patients with confirmed ACS medication adherence measures were derived from responses to the Medication Adherence Report Scale at approximately 2 weeks (n=223), 6 months (n=139) and 12 months (n=136) following discharge from acute treatment for ACS.

RESULTS

Total medication non-adherence was 20%, 54% and 53% at each of these time points respectively. The corresponding figures for intentional non-adherence were 8%, 15% and 15% and 15%, 52% and 53% for unintentional non-adherence. There were significant increases in the levels of medication non-adherence between the immediate discharge period (2 weeks) and 6 months that appeared to stabilize between 6 and 12 months after acute treatment for ACS.

CONCLUSION

Unintentional non-adherence to medications may be the primary form of non-adherence in the year following ACS. Interventions delivered early in the post-discharge period may prevent the relatively high levels of non-adherence that appear to become established by 6 months following an ACS.

Effect of psychological interventions on depressive symptoms in long-term rehabilitation after an acquired brain injury: a systematic review and meta-analysis

OBJECTIVE

To summarize empirical studies on the effectiveness of psychological interventions in long-term rehabilitation after an acquired brain injury (ABI) in reducing depressive symptoms.

DATA SOURCES

A systematic literature search was conducted on MEDLINE, PsycINFO, Embase, and CINAHL to identify articles published between January 1990 and October 2011. Search terms included the 3 concepts (1) "brain injur*" or "stroke," (2) "psychotherap*" or "therapy" or "intervention" or "rehabilitation," and (3) "depress*."

STUDY SELECTION

Studies evaluating psychological interventions in patients after ABI were included. Time since injury was on average more than 1 year. Trials reported data on validated depression questionnaires before and after the psychological intervention.

DATA EXTRACTION

Two independent reviewers extracted information from the sample, the intervention, and the outcome of the included studies and calculated effect sizes (ESs) from depression questionnaires. Thirteen studies were included in a pre-post analysis. Seven studies were eligible for a meta-analysis of ESs in active interventions and control conditions.

DATA SYNTHESIS

Pre-post ESs were significant in 4 of 13 studies. The overall ES of .69 (95% confidence interval [CI], .29-1.09) suggests a medium effectiveness of psychological interventions on depressive symptoms compared with control conditions. Moderator analysis of the number of sessions and adequate randomization procedure did not show significant ES differences between strata. Studies with adequate randomization did not, however, suggest the effectiveness of psychological interventions on depressive symptoms after ABI.

CONCLUSIONS

Psychological interventions are a promising treatment option for depressive symptoms in long-term rehabilitation after ABI. Since only a few adequately randomized controlled trials (RCTs) exist, more RCTs are required to confirm this initial finding.

Cardiovascular stress reactivity and recovery in bulimia nervosa and binge eating disorder

OBJECTIVE

Stress plays a role in the pathology of bulimia nervosa and binge eating disorders, but it is unclear whether they involve similar disturbances of biological stress responses.

PATIENTS AND METHODS

We recruited 25 patients with binge eating behavior, 12 with bulimia nervosa (BN) and 13 with binge eating disorder (BED), and compared them with 13 obese non-binge eaters (NBED). We measured heart rate variability in response to mental stress tasks, and concentrations of leptin, glucose and insulin in the blood.

RESULTS

Heart rate stress reactivity was highest in BN patients. Heart rate variability did not change during mental stress in BN and BED patients, but reduced as expected in the NBED group. During post-stress recovery, heart rate variability decreased in BN, was maintained in BED and increased as expected only in the NBED group.

CONCLUSIONS

BN and BED patients exhibit limitations in autonomic stress reactivity and recovery capacity.

Inflammation and symptoms of depression and anxiety in patients with acute coronary heart disease

Depression following an acute coronary syndrome (ACS, including myocardial infarction or unstable angina) is associated with recurrent cardiovascular events, but the depressive symptoms that are cardiotoxic appear to have particular characteristics: they are 'incident' rather than being a continuation of prior depression, and they are somatic rather than cognitive in nature. We tested the hypothesis that the magnitude of inflammatory responses during the ACS would predict somatic symptoms of depression 3 weeks and 6 months later, specifically in patients without a history of depressive illness. White cell count and C-reactive protein were measured on the day after admission in 216 ACS patients. ACS was associated with very high levels of inflammation, averaging 13.23×10(9)/l and 17.06 mg/l for white cell count and C-reactive protein respectively. White cell count during ACS predicted somatic symptom intensity on the Beck Depression Inventory 3 weeks later (β=0.122, 95% C.I. 0.015-0.230, p=0.025) independently of age, sex, ethnicity, socioeconomic status, marital status, smoking, cardiac arrest during admission and clinical cardiac risk, but only in patients without a history of depression. At 6 months, white cell count during ACS was associated with elevated anxiety on the Hospital Anxiety and Depression Scale independently of covariates including anxiety measured at 3 weeks (adjusted odds ratio 1.08, 95% C.I. 1.01-1.15, p=0.022). An unpredicted relationship between white cell count during ACS and cognitive symptoms of depression at 6 months was also observed. The study provides some support for the hypothesis that the marked inflammation during ACS contributes to later depression in a subset of patients, but the evidence is not conclusive.

Physical activity and sedentary behavior in preschoolers: a longitudinal assessment of trajectories and determinants

BACKGROUND

Despite physical activity (PA) being recognized as a critically important factor for good physical and mental health already early in life and throughout the life course, prospective data on activity behavior during the preschool years remains scarce. This study examined trajectories and determinants of levels and change in total PA (TPA), moderate-to-vigorous PA (MVPA) and sedentary behavior (SB) in a representative sample of Swiss preschoolers.

METHODS

Data were drawn from the Swiss Preschoolers' Health Study (SPLASHY), a multi-site prospective cohort study including 555 children (53% boys) aged 2-to-6 years at baseline. A follow-up was conducted after 12 months. Activity behavior was measured using accelerometers. Information on 35 potential determinants from different socio-ecological domains was either directly measured or parent-reported. Trajectories of TPA, MVPA and SB over time were described for boys and girls. Linear mixed models were used to investigate factors that predicted levels and change in TPA, MVPA and SB.

RESULTS

All children were sufficiently physically active according to published recommendations for preschoolers. Trajectory profiles revealed a marked increase in TPA and MVPA in boys and girls whereas SB remained fairly stable over time. Mixed modeling demonstrated that variables most relevant to determining PA levels were sex, age and activity temperament (all positively associated). Together with gross motor skills, birth weight, family structure (only for TPA) and season (only for MVPA), these factors accounted for 26 and 32% of total variance explained in TPA and MVPA, respectively. Activity temperament emerged as the strongest determinant of SB (negative association) and explained with sex, season and family structure 20% of total variance in SB. The presence of older siblings was the only factor that predicted change in PA over time.

CONCLUSIONS

In this healthy physically active cohort of preschoolers, non-modifiable individual-level factors had the greatest influence on PA. The limited success of this and previous studies to identify modifiable determinants and the finding that most preschoolers were sufficiently active suggest that future attempts should provide insights into how preschoolers' activity levels can be maintained and fostered to prevent subsequent harmful declines attributable, amongst others, to educational transitions. Thus, good-quality longitudinal studies are needed.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN41045021 (date of registration: 21.03.14).

Television viewing, C-reactive protein, and depressive symptoms in older adults

There is emerging evidence for a link between sedentary behavior and mental health, although the mechanisms remain unknown. We tested if an underlying inflammatory process explains the association between sedentary behavior and depressive symptoms. We conducted a two year follow-up of 4964 (aged 64.5±8.9 years) men and women from the English Longitudinal Study of Ageing, a cohort of community dwelling older adults. Self-reported TV viewing time was assessed at baseline as a marker of leisure time sedentary behavior. The eight-item Centre of Epidemiological Studies Depression (CES-D) scale was administered to measure depressive symptoms at follow-up. At baseline, TV time was associated with C-reactive protein (CRP), adjusted geometric mean CRP values were 2.94 mg/L (<2 h/d TV); 3.04 mg/L (2-4 h/d TV); 3.29 mg/L (4-6 h/d TV); 3.23 mg/L (>6 h/d TV). We observed both a direct association of TV time on CES-D score at follow-up (B=0.08, 95% CI, 0.05, 0.10) and indirect effects (B=0.07, 95% CI, 0.05, 0.08). The indirect effects were largely explained through lack of physical activity, smoking, and alcohol, but not by CRP or body mass index.

Association between Body Composition and Motor Performance in Preschool Children

OBJECTIVE

Being overweight makes physical movement more difficult. Our aim was to investigate the association between body composition and motor performance in preschool children.

METHODS

A total of 476 predominantly normal-weight preschool children (age 3.9 ± 0.7 years; m/f: 251/225; BMI 16.0 ± 1.4 kg/m2) participated in the Swiss Preschoolers' Health Study (SPLASHY). Body composition assessments included skinfold thickness, waist circumference (WC), and BMI. The Zurich Neuromotor Assessment (ZNA) was used to assess gross and fine motor tasks.

RESULTS

After adjustment for age, sex, socioeconomic status, sociocultural characteristics, and physical activity (assessed with accelerometers), skinfold thickness and WC were both inversely correlated with jumping sideward (gross motor task β-coefficient -1.92, p = 0.027; and -3.34, p = 0.014, respectively), while BMI was positively correlated with running performance (gross motor task β-coefficient 9.12, p = 0.001). No significant associations were found between body composition measures and fine motor tasks.

CONCLUSION

The inverse associations between skinfold thickness or WC and jumping sideward indicates that children with high fat mass may be less proficient in certain gross motor tasks. The positive association between BMI and running suggests that BMI might be an indicator of fat-free (i.e., muscle) mass in predominately normal-weight preschool children.

The InterHerz project--a web-based psychological treatment for cardiac patients with depression: study protocol of a randomized controlled trial

Background

Patients with heart disease often suffer from difficulties in psychological adaptation during cardiac rehabilitation. Mood disorders such as depression are known to be highly prevalent in cardiac patients and to have a negative impact on the progression of coronary heart disease. However, cardiac patients have difficulties to get psychological treatments due to low availability and motivational difficulties. Web-based interventions have been proven to be effective in treating depressive symptoms. Deprexis is a promising web-based psychological treatment which was devised for depressed patients. The aim of the study InterHerz is to examine if Deprexis is an effective psychological treatment to reduce stress and depression in cardiac patients.

Methods/Design

The sample will consist of 80 depressed patients randomized to an intervention group or a waitlist (10 weeks). Patients are recruited via cardiologists, cardiac rehabilitation units and the website of the Swiss Heart Foundation. Patients have access to a guided self-help program in which they work themselves through several modules and receive feedback from a clinical psychologist. Pre- and post-assessments, and a six-month follow-up, are conducted using online questionnaires and diagnostic interviews.

Discussion

Deprexis is a new web-based treatment which has the potential to help depressed cardiac patients with limited access to psychological treatment to increase their mental health.

Trial registration

Current Controlled Trials ISRCTN45945396

Motor Competence and Physical Activity in Early Childhood: Stability and Relationship

Background: Normal motor development and adequate levels of physical activity engagement during the early years of life form the foundation of long-term psychological and physiological health. This is one of the very few studies that investigate the stability and relationships of motor competence and physical activity in preschool children.

Methods: Baseline and 12 month follow-up data of physical activity and motor competence of 550 preschool children aged 2–6 years from the Swiss Preschoolers' Health Study were used for this work. Physical activity data, expressed in counts per minute for total physical activity and minutes per day for time spent moderately-to-vigorously physically active, were collected over 1 week using accelerometers. Motor competence was assessed with the Zurich Neuromotor Assessment. Both motor competence and physical activity were age- and sex-adjusted. To examine the individual stability of physical activity and motor competence and reciprocal cross-sectional and longitudinal effects between these two domains, a latent variable cross-lagged panel model where motor competence was represented through a latent construct was examined using structural equation modeling.

Results: A weak cross-sectional correlation of motor competence with total physical activity (r = 0.24) and moderate-to-vigorous physical activity (r = 0.23) was found. Motor competence exhibited high stability (β = 0.82) in the preschool years and physical activity was moderately stable with estimates ranging from β = 0.37 for total physical activity to β = 0.48 for moderate-to-vigorous physical activity. In contrast to the autoregressive coefficients denoting individual stability, both cross-lagged effects were negligible indicating that physical activity was not a determinant of motor competence or vice versa.

Conclusions: Motor competence and physical activity developed independently of each other in early childhood. Although measures of quantity and intensity of physical activity were not related to motor development, specific movement experiences and practice—which are not reflected by accelerometry—may be needed for skill development. Future research should focus on examining what type of physical activity is important for motor development and how to assess it, and also whether the relationship between physical activity and motor competence evolves over time.

Clinical Trial Registration: Current Controlled Trials ISRCTN41045021 (date of registration: 21.03.14)

The Swiss Preschoolers' health study (SPLASHY): objectives and design of a prospective multi-site cohort study assessing psychological and physiological health in young children

Background

Children’s psychological and physiological health can be summarized as the child’s thinking, feeling, behaving, eating, growing, and moving. Children’s psychological and physiological health conditions are influenced by today’s life challenges: Thus, stress exposure and lack of physical activity represent important health challenges in older children. However, corresponding evidence for young children is scarce. The aim of Swiss Preschoolers’ Health Study (SPLASHY) is to examine the role of stress and physical activity on children’s psychological and physiological health, particularly on cognitive functioning, psychological well-being, adiposity and motor skills in children at an early stage of childhood. We will also assess the role of child and environmental characteristics and aim to define sensitive time points.

Methods/design

In a total of 84 child care centers, children at preschool age (2–6 years) are recruited and are assessed immediately and one year later. Assessments include direct measurements of the children in the child care centers and at home as well as assessments of children’s behavior and environmental factors through informants (parents and child care educators).

Discussion

SPLASHY is one of the first studies in early childhood aiming to investigate the influence of stress and physical activity on children’s psychological and physiological health in a community-based longitudinal design.

Trial registration

Current Controlled Trials ISRCTN41045021 (date of registration: 21.03.14)

Predictors of Executive Functions in Preschoolers: Findings From the SPLASHY Study

Executive functions (EFs) have been reported to play a crucial role in children's development, affecting their academic achievement, health, and quality of life. This study examined individual and interpersonal predictors for EFs in 555 typically developing preschool children aged 2-6 years. Children were recruited from 84 child care centers in the German- and French-speaking parts of Switzerland within the Swiss Preschoolers' Health Study (SPLASHY). A total of 20 potential predictors were assessed at the first measurement (T1). These included eight demographic/biological predictors, such as socioeconomic status, preterm birth, physical activity, and motor skills; six psychological predictors, such as hyperactivity, visual perception, and emotionality; and six interpersonal predictors, such as parenting style and stress, presence of siblings, and days spent in the child care center. The predictive value of these variables on EFs 1 year later (T2) was assessed using both standard multiple regression analysis and penalized regression to avoid overfitting due to the number of potential predictors. Female sex (β = 0.14), socio-economic status (β = 0.15), fine motor skills (β = 0.17), visual perception at T1 (β = 0.16), and EFs at T1 (β = 0.30) were all associated with EFs at T2, exhibiting small to medium effect sizes. All predictors together accounted for 31% of the variability in EFs. However, none of the interpersonal predictors were significant. Thus, we conclude that most of the factors that can predict EFs in preschool age are individual variables, and these tend to be more difficult to influence than interpersonal factors. In fact, children from families with low socio-economic status may be particularly vulnerable to poor EFs. Furthermore, encouraging fine motor skills early in life may support the development of EFs.

Relation of Heart Rate and its Variability during Sleep with Age, Physical Activity, and Body Composition in Young Children

Background: Recent studies have claimed a positive effect of physical activity and body composition on vagal tone. In pediatric populations, there is a pronounced decrease in heart rate with age. While this decrease is often interpreted as an age-related increase in vagal tone, there is some evidence that it may be related to a decrease in intrinsic heart rate. This factor has not been taken into account in most previous studies. The aim of the present study was to assess the association between physical activity and/or body composition and heart rate variability (HRV) independently of the decline in heart rate in young children.

Methods: Anthropometric measurements were taken in 309 children aged 2–6 years. Ambulatory electrocardiograms were collected over 14–18 h comprising a full night and accelerometry over 7 days. HRV was determined of three different night segments: (1) over 5 min during deep sleep identified automatically based on HRV characteristics; (2) during a 20 min segment starting 15 min after sleep onset; (3) over a 4-h segment between midnight and 4 a.m. Linear models were computed for HRV parameters with anthropometric and physical activity variables adjusted for heart rate and other confounding variables (e.g., age for physical activity models).

Results: We found a decline in heart rate with increasing physical activity and decreasing skinfold thickness. HRV parameters decreased with increasing age, height, and weight in HR-adjusted regression models. These relationships were only found in segments of deep sleep detected automatically based on HRV or manually 15 min after sleep onset, but not in the 4-h segment with random sleep phases.

Conclusions: Contrary to most previous studies, we found no increase of standard HRV parameters with age, however, when adjusted for heart rate, there was a significant decrease of HRV parameters with increasing age. Without knowing intrinsic heart rate correct interpretation of HRV in growing children is impossible.

Accelerometer-derived physical activity estimation in preschoolers - comparison of cut-point sets incorporating the vector magnitude vs the vertical axis

Background

ActiGraph accelerometers are a widely used tool to objectively measure physical activity (PA) behavior in young children and several validated cut-point sets exist to estimate time spent in different PA intensities (sedentary time, light PA, moderate-to-vigorous PA). Applying different cut-point sets leads to large and meaningful differences in results. So far, only cut-point sets validated for the vertical axis have been compared and only the influence on time spent in moderate-to-vigorous PA has been analyzed.

Methods

A range of validated cut-point sets with their respective epoch length was applied to analyze cross-sectional data of the Swiss Preschoolers’ Health Study (SPLASHY): 1) Vertical axis in combination with an epoch length of 15 s (VA-15), 2) Vertical axis in combination with an epoch length of 60 s (VA-60) and 3) Vector magnitude in combination with an epoch length of 60 s (VM-60). PA was measured for eight consecutive days using ActiGraph accelerometers (wGT3X-BT). Three days were required to be included in the analysis (minimum two weekdays and one weekend-day with at least ten hours recording per day).

Results

Four hundred forty-five preschoolers (mean age 3.9 ± 0.5 years; 46% girls) had valid accelerometer measurements. A longer epoch (VA-60 vs VA-15) resulted in 2% less sedentary time (ST), 18% more light PA (LPA) and 51% less moderate-to-vigorous PA (MVPA); using the vector magnitude compared to the vertical axis (VM-60 vs VA-60) resulted in 34% less ST, 27% more LPA and 63% more MVPA (all p ≤ 0.001). Comparing all three sets of cut-points, ST ranged from 4.0 to 6.2 h, LPA from 5.1 to 7.6 h and MVPA from 0.8 to 1.6 h.

Conclusions

Estimated time spent in different PA intensities was strongly influenced by the choice of cut-point sets. Both, axis selection and epoch length need to be considered when comparing different studies especially when they relate PA behavior to health. The differences in the prevalence of children fulfilling PA guidelines highlight the relevance of these findings.

Trial registration

Current Controlled Trials ISRCTN41045021 (date of registration: 21.03.2014).

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6837-7) contains supplementary material, which is available to authorized users.

Predicting premature termination within a randomized controlled trial for binge-eating patients

Understanding the dropout rates of efficacious forms of psychotherapy for patients with binge eating disorder (BED) is an unsolved problem within this increasing population. Up until now the role of psychotherapy process characteristics as predictors of premature termination has not been investigated in the BED literature. Within a randomized controlled trial (N=78) we investigated the degree to which early psychological process characteristics, such as components of the therapeutic relationship and the experiences of mastery and motivational clarification, predicted premature termination of treatment. We statistically controlled for the influences of covariates such as rapid response of treatment, treatment group, body mass index, Axis II disorder, and patients' preexisting generalized self-efficacy at baseline. Patients' postsession reports from Sessions 1 to 5 indicated that low self-esteem in-session experiences was a stable predictor of premature termination. Its predictive value persisted after controlling for the above-mentioned covariates. Exploratory analyses further revealed low self-esteem experiences, low global alliance, and low mastery and clarification experiences as predictors in those patients who explicitly specified discontentment with therapy as reason for premature termination. These results indicate that patients' self-esteem experiences may not be an epiphenomenon of their specific psychopathology but may represent general mechanisms on which remaining or withdrawing from psychotherapeutic treatment depends. Early psychotherapy process characteristics should therefore be considered in training and evaluation of psychotherapists carrying through BED treatments.

Cortisol levels and history of depression in acute coronary syndrome patients

BACKGROUND

Depressed mood following an acute coronary syndrome (ACS) is a risk factor for future cardiac morbidity. Hypothalamic-pituitary-adrenal (HPA) axis dysregulation is associated with depression, and may be a process through which depressive symptoms influence later cardiac health. Additionally, a history of depression predicts depressive symptoms in the weeks following ACS. The purpose of this study was to determine whether a history of depression and/or current depression are associated with the HPA axis dysregulation following ACS.

METHOD

A total of 152 cardiac patients completed a structured diagnostic interview, a standardized depression questionnaire and a cortisol profile over the day, 3 weeks after an ACS. Cortisol was analysed using: the cortisol awakening response (CAR), total cortisol output estimated using the area under the curve method, and the slope of cortisol decline over the day.

RESULTS

Total cortisol output was positively associated with history of depression, after adjustment for age, gender, marital status, ethnicity, smoking status, body mass index (BMI), Global Registry of Acute Cardiac Events (GRACE) risk score, days in hospital, medication with statins and antiplatelet compounds, and current depression score. Men with clinically diagnosed depression after ACS showed a blunted CAR, but the CAR was not related to a history of depression.

CONCLUSIONS

Patients with a history of depression showed increased total cortisol output, but this is unlikely to be responsible for associations between depression after ACS and later cardiac morbidity. However, the blunted CAR in patients with severe depression following ACS indicates that HPA dysregulation is present.

Childcare Correlates of Physical Activity, Sedentary Behavior, and Adiposity in Preschool Children: A Cross-Sectional Analysis of the SPLASHY Study

Background

The childcare (CC) environment can influence young children's physical activity (PA), sedentary behavior (SB), and adiposity. The aim of the study was to identify a broad range of CC correlates of PA, SB, and adiposity in a large sample of preschoolers.

Methods

476 preschool children (mean age 3.9 yrs; 47% girls) participated in the Swiss Preschoolers' Health Study (SPLASHY). PA and SB were measured by accelerometry. Outcome measures included total PA (TPA), moderate-to-vigorous PA (MVPA), SB, body mass index (BMI), and skinfold thickness (SF). PA measures consisted of both daily PA during CC attendance days and overall daily PA (CC and non-CC days).

Results

We identified the following CC correlates for higher TPA and/or higher MVPA or lower SB during CC attendance days: older age, sex (boys), more frequent child-initiated interactions during CC, mixing different ages within a group, and the presence of a written PA policy in the CC (all p ≤ 0.02). The CC correlates for overall TPA and/or MVPA or lower overall SB including both CC and non-CC days were the following: older age, sex (boys), more frequent child-initiated interactions during CC, mixing different ages within a group, less parental PA involvement in the CC, and having a larger surface area in CC (all p ≤ 0.046). Correlates for lower SF were sex (boys) and parental PA involvement in the CC (all p ≤ 0.02), and, for lower BMI, only increased age (p=0.001) was a correlate.

Conclusions

More frequent child-initiated interactions and mixing different ages in CC, the presence of a written PA policy, and a larger CC surface are correlates of PA and SB during CC attendance days and/or of overall PA. Parental involvement in CC PA projects was a correlate for reduced body fat. These novel factors are mostly modifiable and can be tackled/addressed in future interventions.

Psychological coping and recurrent major adverse cardiac events following acute coronary syndrome

BACKGROUND

Depressed mood and stress are associated with recurrent adverse outcomes following acute coronary syndrome (ACS), but the impact of psychological coping style has not been evaluated in detail.

AIMS

We tested the relationship between task-oriented coping and event-free survival following ACS.

METHOD

We followed 158 patients with ACS for an average of 59.8 months for major adverse cardiac outcomes. Psychological coping was assessed with the Coping Inventory of Stressful Situations.

RESULTS

Compared with patients in the lower half of the distribution, those reporting higher task-oriented coping had a reduced hazard of adverse cardiac events (hazard ratio (HR) = 0.28, 95% CI 0.11-0.68, P = 0.005) independently of demographic, clinical and behavioural covariates. The combination of low task-oriented coping and high depressive symptoms showed a strong association with adverse outcomes (HR = 6.25, 95% CI 1.88-20.82, P = 0.003).

CONCLUSIONS

The tendency to cope using task-oriented strategies may promote event-free survival following ACS.

Regional sociocultural differences as important correlate of physical activity and sedentary behaviour in Swiss preschool children

QUESTION

Regional differences in physical activity in school-aged children and adults even within one country with the same political and health care system have been observed and could not be explained by sociodemographic or individual variables. We analysed whether such differences were already present in preschool children.

METHODS

Swiss children from 84 childcare centres in five cantons (Aargau, Bern, Fribourg, Vaud, Zurich) comprising about 50% of the population of the country participated. Physical activity was quantified with accelerometers (ActiGraph, wGT3X-BT) and potential correlates were assessed with measurements at the childcare centre or questionnaires. Mixed regression models were used to test associations between potential correlates of total physical activity (TPA), moderate-to-vigorous physical activity (MVPA), light physical activity (LPA) or sedentary behaviour with a special focus on regional differences.

RESULTS

394 of 476 children (83%) provided valid physical activity data (at least 2 weekdays and 1 weekend day with 10 h recording; mean age 3.9 ± 0.7 years, 54% boys) with 26% and 74% living in the French- and German-speaking parts of Switzerland, respectively. Days consisted of (mean ± standard deviation) 1.5 ± 0.5 h MVPA, 5.0 ± 0.6 h LPA, and 6.3 ± 0.8 h sedentary behaviour with an average of 624 ± 150 counts/min TPA. TPA and MVPA (but not sedentary behaviour or LPA) increased with age, were higher in boys and children with better motor skills. Despite controlling for individual characteristics, familial factors and childcare exposure, children from the French-speaking part of Switzerland showed 13% less TPA, 14% less MVPA, 6% less LPA and 8% more sedentary behaviour than German-speaking children.

CONCLUSION

Beside motor skills and non-modifiable individual factors, the regional sociocultural difference was the most important correlate of phyical activity and sedentary behaviour. Therefore, regionally adapted public health strategies may be needed.

Lower diurnal HPA-axis activity in male hypertensive and coronary heart disease patients predicts future CHD risk

BACKGROUND

Coronary heart disease (CHD) and its major risk factor hypertension have both been associated with altered activity of the hypothalamus-pituitary-adrenal (HPA)-axis but the biological mechanisms underlying prospective associations with adverse disease outcomes are unclear. We investigated diurnal HPA-axis activity in CHD-patients, hypertensive (HT) and healthy normotensive men (NT) and tested for prospective associations with biological CHD risk factors.

METHODS

Eighty-three male CHD-patients, 54 HT and 54 NT men repeatedly measured salivary cortisol over two consecutive days. Prospective CHD risk was assessed by changes between baseline and follow-up in the prothrombotic factors D-dimer and fibrinogen, the pro-inflammatory measures interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), and acute phase protein C-reactive protein (CRP), as well as blood lipids in terms of total cholesterol (tChol)/high-density-lipoprotein cholesterol (HDL)-ratio. We aggregated coagulation and inflammatory measures to respective indices.

RESULTS

The groups differed in repeated daytime cortisol (dayCort) secretion (p=.005,η² _p=.03,f=0.18) and cortisol awakening response (CAR) (p=.006,η² _p=.03,f=0.18), with similarly lower overall dayCort and CAR in CHD-patients and HT, as compared to NT. The groups differed further in cortisol at awakening (p=.015,η² _p=.04,f=0.20) with highest levels in HT (p´s≤.050), and in diurnal slope between waking and evening cortisol (p=.033,η² _p=.04,f=0.20) with steepest slopes in HT (p´s≤.039), although in part not independent of confounders. Lower aggregated dayCort and CAR in terms of area-under-the-curve (AUC) independently predicted increases in future overall CHD risk (AUC_dayCort: p=.021,η² _p=.10,f=0.33;AUC_CAR: p=.028,η² _p=.09,f=0.31) 3.00 ± 0.06(SEM) years later, with risk prediction most pronounced in fibrinogen (AUC_dayCort: p=.017,ΔR ²= 0.12;AUC_CAR: p=.082).

CONCLUSION

We found evidence for an HPA-axis hypoactivity in CHD and HT with lower diurnal HPA-axis activity predicting increases in cardiovascular risk as evidenced by increases in circulating levels of biomarkers of atherothrombotic risk. Down-regulation of basal HPA-axis activity may contribute to the pathogenesis of atherosclerosis and thrombosis in CHD via effects on coagulation.

Association of physical activity with adiposity in preschoolers using different clinical adiposity measures: a cross-sectional study

BACKGROUND

More research is needed about the association between physical activity (PA), sedentary behaviour (SB), and adiposity in preschoolers, particularly using more direct clinical measures of adiposity. Therefore, the main objective of this study was to investigate the association between objectively measured PA and different clinical adiposity measures in a large sample of preschoolers.

METHODS

Four hundred sixty-three predominantly normal-weight (77%) 2-6-year-old preschool children participated in the Swiss Preschoolers' Health Study (SPLASHY). Physical activity was measured using accelerometers and was analyzed using 15-s (uni-axial) epoch length using validated cut-offs. Adiposity measures included body mass index (BMI), the sum of four skinfolds, and waist circumference (WC). Multilevel linear regression modeling, adjusted for age, sex and wear time, was used to assess the association between PA and SB with BMI, WC, and skinfold thickness.

RESULTS

Total PA and different PA intensities were positively and SB was inversely associated with BMI in the total sample and in the normal-weight children (p < 0.05). Total PA was inversely associated with skinfold thickness in overweight and obese children (p < 0.05), while there was only a weak association for vigorous PA (p > 0.05). Moderate and moderate-to-vigorous PA were positively, and SB was negatively associated with WC in the total sample and in the normal-weight children (p < 0.05). Additional adjustment for potential sociocultural and biological confounding variables attenuated some of the results.

CONCLUSIONS

In this very young and predominantly normal-weight population, PA is positively related to BMI and WC, but this relationship is not observed in overweight and obese children. In this latter population, PA is inversely, and SB is positively related to skinfold thickness. Skinfold thickness could represent a useful and simple clinical measure of body fat in preschoolers. The role of vigorous PA in the prevention of early childhood obesity should be further investigated in future studies.

TRIAL REGISTRATION

ISRCTN ISRCTN41045021 . Retrospectively registered 06 May 2014.