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Medico-Social Implications of Pregnancy in Teenager Mothers
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Background and objective: For most teenagers, pregnancy brings insecurity, problems, fear and many questions. The main objective of this research is to determine the outlined profile of the pregnant teenager and the medical implications associated with pregnancy in mothers under 18 years of age.

Materials and methods

A cross-sectional questionnaire-based study was carried out in 2019 and 2020 in Ploiesti, Romania. A total of 200 childbearing women who gave birth at the Hospital of Obstetrics and Gynaecology with ages between 13- 42 years participated voluntarily in this study with given informed consent. Out of them 100 were under 18 years of age (group A). The group B (control group) consisted of 100 childbearing women with ages over 18 years. The questionnaire was composed of 29 closed questions, administered by the same investigator in a face-to-face interview, contained general data of childbearing women, (age, marital status, place of residence, number of children, occupation, level of education, ability to understand medical terms – health literacy- by applying the Sahl test) and aspects related to the family environment, (parental education, parental occupation , characteristics of the dwelling, number of siblings). Beside the questionnaire, data about the obstetrical profile of the childbearing woman, data about the birth and the new-born baby were collected. The resulting data were centralized in a database, gathering all the data from the questionnaire and as well as from the observation sheets.

Results

Teenager childbearing women (mothers under 18 years of age) from group A had an average age of 16.56 ± 1.65. The highest frequency of births was at 17 years of age. The percentage of births in very young girls (13-15 years old) accounts for 28% (N=28). The analysis of the two groups showed that only 40 mothers under 18 years of age came from families whose parents have a registered marriage (P= 0.011 as compared to the control group). We found that in 65 teenagers the beginning of sexual life took place at an earlier age (under 14 years). Regarding pregnancy monitoring, expressed by the number of medical checkouts and examinations, there are significant differences between the studied groups (P<0.001). The lack of health education and knowledge of medical terms is evident in the group of teenage childbearing women. The application of the Sahl test to both groups showed a low level of health literacy in the group of teenager childbearing women, 84 cases vs. 35 cases in the control group.

When studying the number of medical investigations performed during pregnancy, we found significant differences (P<0.001): only 116 childbearing women from both groups performed medical investigations during pregnancy and only 42 were teenagers from these 116. Of 95 childbearing women from both groups who had hospitalizations during pregnancy, 56 were from the group of teenager mothers compared to 39 from the control group (p = 0.016). Teenager childbearing women gave birth to children with low weight for their gestational age (P<0.001 compared with the control group): in group A there were 14% and in group B only 4%. Regarding the gestational age, in the case of teenage mothers we had an average of 37.88 ± 2.13 weeks of gestation with a median of 38 weeks, compared to the gestational age in the control group of 38.41 ± 1.57 weeks, median of 39 weeks.

Conclusions

In Romania there are teenagers that became mothers at early ages. A pregnancy at an age between 13-15 years may come with medical implications, both physically and mental, thus medical supervision is important. Sexual and contraceptives' education in school and in the family may help the teenagers to control the possibility of becoming pregnant at such an early age. Therefore such type of educational programs must exist in rural and urban schools and communities. The midwife may play an essential role in the rural communities. A better management and multidisciplinary approach is needed.

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Mortality in Patients with Rheumatoid Arthritis: A Retrospective Cohort Study and Systematic Review

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Background and Objectives: Mortality rates among patients with rheumatoid arthritis (RA) have been reported to be higher than in the general population. The long-term prognosis of RA has improved in recent years due to early diagnosis as well as effective pharmacological treatment and may be able to diminish the excess mortality risk. This study was designed to investigate mortality (a) in patients with RA in a retrospectively defined national RA cohort in comparison with the general Lithuanian population and (b) to conduct a systematic review of the literature from different countries and meta-analysis.

Material and methods: In this national retrospective cohort study patients with the first-time diagnosis of RA during the period between 1 January 2013 and 31 December 2017 were identified from the Lithuanian Compulsory Health Insurance Information System database SVEIDRA. All cases were cross-checked with Health Information center at the Institute of Hygiene, for the vital status of these patients and date of death if the fact of death was documented. The standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) obtained for all-cause mortality in patients with RA adjusted for age, sex, and calendar year, were calculated. The search for published studies by a combination of keywords “rheumatoid arthritis AND standardized mortality ratio” was performed in MEDLINE (via PubMed, OVID and EBSCO), Science Direct, Tylor & Francis, Springer databases. Studies were selected according to described inclusion and exclusion criteria listed in the paper and a meta-analysis was conducted. A random-effect meta-analysis model was used to compute the pooled standardized mortality ratios (meta-SMRs).

Results: Overall, 4 623 patients with newly diagnosed RA during the 2013–2017 period were identified and enrolled in the Lithuanian population-based cohort. The mean age of patients at the time of RA diagnosis was 58.7 (standard deviation (SD) 15.1) years, and 77.1% of the patients were women. The estimated SMR for all-cause mortality was 1.15 (95% CI 1.02, 1.29). The SMR for men (SMR 1.14, 95% CI 0.94, 1.39) was higher than for women (SMR 1.03, 95% CI 0.89, 1.19). A systematic literature search revealed 12 studies meeting the inclusion criteria, starting from 2010 to 2020, representing 50 072 patients. The meta-SMR in patients with RA for all-cause mortality was 1.41 (95% CI 1.29, 1.55). All-cause mortality risk was higher for men (meta-SMR 1.53, 95% CI 1.31, 1.78) than for women (meta-SMR 1.46, 95% CI 1.2, 1.77).

Conclusions: In a retrospectively defined population-based national RA cohort a 15% excess risk of death was observed among patients with RA compared to the general Lithuanian population. Patients with RA have a higher mortality risk than the general population. Published data indicate that the risk of mortality is increased by 41% in patients with RA compared to the general population. Excessive all-cause mortality risk is higher in males than in women. National data showed lower standardized mortality if compared to literature data.

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The Effect of Post-ICU Physiotherapy on Respiratory and Physical Functioning Status in Patients with COVID-19: A Pilot Study
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Background and Objectives: According to the recent physiotherapy recommendations (WHO, WCPT, 2020) for patients with COVID-19, after discharge from ICU, they are expected to experience respiratory, physical, cognitive, and psychological problems due to the duration and nature of the immobilization and sedation, ventilation duration, and underlying morbidity. Moreover, only patients with a limitation in physical capacity and/or physical activity have an indication for physiotherapy. However, little is known about the effect of physiotherapy treatment on the functional capacity of patients with COVID-19.

Purpose: The aim of the present study was to provide information for the effectiveness of physiotherapy intervention on the respiratory and physical functional status of patients with COVID-19, since there will be a great demand for physiotherapy treatment for these people soon.

Materials and Methods: The Ethics Committee of the AHEPA University Hospital, School of Medicine, Health Sciences Faculty, Aristotle University of Thessaloniki, Greece granted approval for this study. This pilot clinical study was conducted from March to June 2020. The sample consisted of 11 patients with COVID-19, discharged form ICU and hospitalized in the COVID-19 clinic of AHEPA University Hospital. All participants had indication for physiotherapy, according to the recommendations, and medical referral as well. The duration of their hospitalization ranged from two to six weeks. Among participants, there were seven males and four females, aged from 44 to 75 yrs, five smokers and six nonsmokers, four obese and seven nonobese. According to the recommendations, physiotherapy intervention was tailored to the patients’ needs and goals. Breathing exercises, early mobilization and self-management for daily living were performed once a day, for five days a week, as tolerated.

Measurement tools: Pulse Oximeter (SpO2), Respiratory Rate (RR), Borg scale (intensity of dyspnea), Medical Research Council scale for disability (MRCd), clinical evaluation for dysfunctional breathing (DB), Medical Research Council scale for muscle strength (MRCms), Berg balance scale, Sit to Stand test (leg strength and endurance), Time Up and Go test (TUG) (general mobility), 1 minute walk test (1MWT) (aerobic capacity) and Barthel Index (BI) (performance in daily activities). For the purposes of the study, two measurements were conducted: at admission and at discharge from the COVID-19 clinic.

Results: Dependent samples tests showed a significant effect (p <0.001) for the recommended physiotherapy treatment on respiratory variables: 6.9(1.4) % for SpO2, 3.4(0.9) breaths for Respiratory Rate, 5.0(1.3) for Borg scale score. Significant improvements (p <0.001) were additionally noted for physical functioning: 25.3(13.0) for Berg balance scale, 18.5(11.2) for MRCms score, 3(1.3) s for Sit to Stand and 40.4(40.6) s for TUG efforts, 44.1(25.5) s for 1MWT and 65.9(20.2) for BI. All patients displayed DB at admission to the COVID-19 clinic, while nine of them adopted a diaphragmatic breathing pattern at discharge. At admission to the COVID-19 clinic, all patients were at level 5 disability (MRCd), whereas at discharge 10 out of 11 patients improved (three at level 4, four at level 3 and three at level 2).

Conclusion: The present pilot study provided a first evidence for the effectiveness of the WHO and WCPT physiotherapy recommendations on the respiratory and physical functioning status of patients with COVID-19. Further studies are needed to support these early findings.

  • Open access
  • 37 Reads
Diagnosis of Psychosocial Risk Determinants and the Prioritization of Organizational Intervention Objects Among Medical Occupational Groups in a Public Healthcare
Institution
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Background and Objectives: As the work environment is one of the most significant sources of stress, employers in the European Union are obliged to identify psychosocial risk determinants and take preventive measures to improve workers' health and well-being while at work. The aim of this study was to determine which medical occupational group is the most exposed to stress and where any differences lie between medical occupational groups regarding the perception of psychosocial risk determinants and organizational intervention objects in the Lithuanian public healthcare institution.

Material and Methods: Using a cross-sectional study design, paper questionnaires were delivered to all health workers (n = 690) of the Lithuanian public healthcare institution; the response rate 68% (n = 467). The questionnaire consisting of three parts was completed for the survey. It covers 14 psychosocial risk determinants, 10 organizational intervention objects, sociodemographic data of health workers.

Results: The results showed that perceived stress had mean rank scores differing statistically significant (p-value <0.05) across occupational groups. The highest stress rating was given by a doctors’ group. Regarding psychosocial risk determinants, there were statistically significant differences (p-value <0.05) in work overload scores among doctors, heads of units, other health workers; in overtime scores and in tight deadlines scores between doctors and other health workers; in unclear role scores among all medical occupational groups; in being under-skilled for a job scores between nurses and doctors; in responsibility for decision making scores among heads of units, doctors, other health workers. Concerning organizational intervention objects, there were statistically significant differences (p-value <0.05) in work-life balance scores, ensuring skills/abilities matching to the job demands scores, social support scores, organizational support scores, participation in decision-making scores, justice of reward scores, manager feedback scores, variety of tasks scores among heads of units, doctors, nurses, other health workers.

Conclusions: The results of the study confirmed that different occupational groups emphasized different psychosocial risk determinants and organizational intervention objects. The findings suggest that focusing on the average worker do not have practical value, and that it is important to understand the differential effects of different job characteristics on work outcomes considering occupational status while developing coping strategies in the institution. The risk group with the most exposed to stress were doctors in the healthcare institution.

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Five Year Follow-Up of Cryptogenic Stroke Patients Following Pfo Closure
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Background and Objectives: According to guidelines PFO closure is recommended for secondary stroke prevention in patients with cryptogenic stroke [1]. Paradoxial embolism from PFO mediated right to left shunt has been described as the mechanism of stroke in these cases [2]. The aim of the study is to follow-up patients after PFO closure and determine the long-term effectiveness on reccurent stroke risk reduction. Materials and Methods: A total of 103 patients were enrolled in a retrospective study and followed-up by phone up to five years after PFO closure. Standardized survey was conducted about their well-being, recurrent cerebrovascular events, and the use of prescribed medication. Patients were also followed up for residual shunts 24 h, 30 days, 1 and 2 years after PFO. The pathogenic ischemic stroke subtypes are determined using CCS (Causative Classification System for Ischemic Stroke). Results: 43.7% (n = 45) of patients were male. The mean age – 44.4 ± 13 (18–75). 53.4% (n = 55) of patients with possible cardio-aortic embolism the most probable cause for cryptogenic stroke was PFO. Residual shunts were mostly observed in patients with Amplatzer occluder – 87.5% (n = 14). There was correlation between residual shunt and increased risk of transient ischemic attack recurrence (p = 0.067). Five-years after PFO closure recurrent cerebrovascular events were reported in only 5.1% (n = 5) of patients, this difference is statistically relevant (p < 0.001). Out of 51 patient presented with complaints before PFO closure, 25.5% (n = 13) did not present with any complaints after PFO closure. Conclusions: PFO can be considered a possible risk factor for cryptogenic stroke. PFO closure is effective in reducing recurrent cerebrovascular events. Residual shunt after PFO closure increases the risk of transient ischemic attack recurrence. Amplatzer occluder device is associated with a higher risk for residual shunts after PFO closure. PFO closure can be associated with improvement of complaints.

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The association of the cardiovascular disease with the T3111C polymorphism in the CLOCK gene

Cardiovascular diseases (CVDs) are among the leading causes of death worldwide, although CVDs mortality has decreased in developed countries. Numerous pathophysiological processes lead to the development of CVDs. The circadian rhythm coordinates many physiological processes, and its disruption can lead to many pathophysiological changes. One of the significant circadian rhythm genes is the CLOCK gene, whose polymorphisms are associated with CVD risk factors. Research findings of the association between CLOCK gene polymorphism and CVDs and its comorbidities are not consistent. This meta-analysis was conducted to quantify the associations between T3111C polymorphism and the risk of CVDs. The PubMed and Scopus databases were searched for studies reporting on the association between T3111C (rs1801260) in the circadian CLOCK gene and cardiovascular disease and its comorbidities such as obesity, hypertension, insulin resistance, and coronary artery disease. A fixed-effect model was used to calculate the pooled odds ratio and 95% confidence interval by comprehensive meta-analysis software. Five independent studies, including case-control, cross-sectional, and cohort research methods, were analyzed with 3,123 subjects in total. The meta-analysis revealed a significant association between T3111C polymorphism and cardiovascular disease (OR = 1.32, 95% CI: 1.16–1.50, p < 0.001) with significant heterogeneity (I2 = 91.1%, p < 0.001) and no publication bias. The subgroup analysis on comorbidity related to CVDs revealed that hypertension was associated with T3111C polymorphism (OR = 2.02, 95% CI: 1.60–2.54, p < 0.001). Our meta-analysis based on available studies using a fixed model shows that T3111C polymorphism in the CLOCK gene is associated with CVDs susceptibility. This research was funded by a grant from the Croatian Ministry of Science and Education and dedicated to multi-year institutional financing of scientific activity at the Josip Juraj Strossmayer University of Osijek, Osijek, Croatia grant number IP8-FDMZ-2020.

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  • 96 Reads
Patient Demographics, Characteristics and Intrahospital Mortality of Different Ischemic Stroke Subtypes in a Tertiary Hospital During Five-Year Period
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Published: 21 June 2021 by MDPI in 1st International Electronic Conference on Medicine session Neurology

Background and Objectives. Ischemic stroke (IS) is one of the leading causes of disability, morbidity, and mortality worldwide. The aim of this study was to evaluate patient demographics, characteristics and intrahospital mortality among patients with different IS subtypes.

Materials and Methods. An observational non-randomized study was conducted using IS patient data from a single center from 2016 to 2020 with the diagnosis of acute IS confirmed by head computed tomography (CT). The pathogenetic IS subtypes were determined using Causative Classification System for IS (CCSIS).

Results. There was a slight female predominance among our study population, as 2673 (56.2%) patients were females. In our study group, most common IS subtypes were cardioembolic stroke (CS), 2252 (47.4%), and atherothrombotic stroke (AS), 1304 (27.4%). CS patients were significantly more severely disabled on admission, 1828 (81.4%), and on discharge, 378 (16.8%), p<0.05. Moreover, patients with CS demonstrated the highest rate of comorbidities and risk factors (p<0.05). Differences between the total patient count with no atrial fibrillation (AF), paroxysmal AF, permanent AF and different IS subtypes among our study population demonstrated not only statistical significance, but also a strong association (Cramer’s V = 0.53). Majority of patients in our study group were treated conservatively, 3389 (71.3%). Reperfusion therapy was significantly more often performed among CS patients (n=770, 34.2%; p<0.05). The overall intrahospital mortality among our study population was 570 (12.0%) with the highest intrahospital mortality rate noted among CS patients (n=378, 66.3%; p<0.05). No statistically significant difference was observed between acute myocardial infarction and adiposity (p>0.05).

Conclusions. In our study, CS and AS were the most common IS subtypes. CS patients were significantly older with slight female predominance. CS patients demonstrated the greatest disability, risk factors, comorbidities, reperfusion therapy and intrahospital mortality.

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Correlation of Inflammation, Lipidogram and Clinical Readings in Chronic Heart Failure Patients
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Background. While myocardial damage in heart failure (HF) patients with reduced ejection fraction (HFrEF) has been shown to be driven by oxidative stress, inflammation is a recognized factor in disease progression in both HFrEF and HF with preserved ejection fraction (HFpEF). Inflammation is presented as regulated by platelet-induced activation of blood leukocytes. Neutrophils take part in maintaining of pro-inflammatory state in HF. Hypercholesterolemia is stated to heighten neutrophil production, which contributes to accelerated cardiovascular inflammation. HF pathogenesis differences in the different HF phenotypes remain to be investigated.

Aim: to determine differences in complete blood count, C-reactive protein (CRP) concentration, lipidogram and clinical readings between chronic HF (CHF) without previous myocardial infarction (MI) groups according to EF and between HFrEF groups according to MI presence in CHF development history and correlations between these readings.

Methods. Four groups of patients (n = 266) were analyzed. 208 patients diagnosed with CHF who had had no documented history of previous MI were separated into two groups according to left ventricular ejection fraction (LVEF): LVEF ≥ 50%, n = 117; LVEF < 50%, n = 91. Additionally, 149 HFrEF patients were separated into two additional groups: those who had had no MI (n = 91) and those with MI (n = 58). Laboratory and clinical readings were taken from the patients’ medical histories.

Results. MCHC was lower and RDW-CV was higher in the lower EF group without a history of MI (337.32 (10.60) and 331.46 (13.13), p=0.004; 13.6 (11.5-16.9) and 14.7 (12.6-19.1), p=0.001). Lymphocyte percentage and lymphocyte-to-monocyte ratio (LYM/MON) were lower in the lower EF group without a history of MI (30.48 (10.87), 26.98 (9.08), p=0.045; 3.33 (1.22-9.33), 3 (0.44-6.5), p=0.011). CRP concentration (6.9 (1.46-62.97), 7 (1-33.99), p=0.012) was higher in HFrEF with MI in comparison with the group without MI. Neutrophil count correlated with PLT (rs=0.278, p=0.001) and weight (rp=0.196, p=0.024). Lymphocyte count correlated with PLT and RDW-CV (rs=0.200, p=0.018; rs=-0.223; p=0.032) and body mass index (rp=0.186, p=0.032). RDW-CV and monocyte count correlated with NT-proBNP and serum creatinine (rs=0.358, p=0.034; rs=0.424, p<0.001 and rs=0.354, p=0.012; rs=0.205, p=0.018 respectively). Total cholesterol concentration correlated with LYM/MON, monocyte percentage, lymphocyte percentage and count (rs=0.534, p<0.001; rs=-0.312, p=0.029; rs=0.355, p=0.012; rs=0.397, p=0.004 respectively). EF correlated with MCHC and RDW-CV (rs=0.273, p=0.001; rs=-0.404, p<0.001). Total cholesterol concentration correlated with LYM/MON (rs=0.534, p<0.001). HDL cholesterol concentration was lower in the HFrEF with MI group (0.96 (0.44-2.2); 0.92 (0.56-1.97, p=0.010). Uric acid concentration correlated with platelet-to-lymphocyte and lymphocyte-to-monocyte ratio (rs=0.321, p=0.032; rs=-0.341, p=0.023). Creatinine concentration correlated with monocyte percentage and count (rp=0.312, p=0.001; rp=0.287, p=0.003).

Conclusion: 1) MCHC and lymphocyte percentage were lower and RDW-CV was higher in the HFrEF group without MI; CRP concentration was higher in HFrEF with MI in comparison with the group without MI; 2) HDL cholesterol concentration was lower and CRP concentration was higher in the HFrEF group with MI in comparison with the group without MI; total cholesterol concentration correlated with LYM/MON; 3) monocyte, lymphocyte count and their ratio correlated with patients’ condition reflected readings NT-proBNP, serum creatinine, uric acid concentrations.

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Impact of Selected Factors on Effects of Hand Rehabilitation in Stroke Patients – A Pilot Study
Published: 30 June 2021 by MDPI in 1st International Electronic Conference on Medicine session Neurology

Background: The study aimed to assess recovery of hand function in patients after stroke and to determine impact of selected factors, i.e., age, sex and time from stroke onset, on effects of hand therapy.

Material and methods: The study involved a group of 17 patients after ischemic stroke. The assessments were performed in a Rehabilitation Hospital at a health resort in south-eastern Poland. The examinations were carried out upon the patients’ admission to the Hospital (before the start of the program – Exam I) and upon completion of the three-week rehabilitation program (Exam II). The function and spasticity of the paretic hand were assessed respectively, using Box and Blocks test and Ashworth scale.

Results: The findings show a negative correlation between scores on Ashworth scale and Box and Blocks test, both before (rho=-0.667; p=0.0034), and at the end of the rehabilitation program (rho=-0.585; p=0.0136). Higher scores on Rankin scale correspond to lower Box and Blocks index in the dominant hand before the therapy program (rho=-0.523; p=0.0313). Furthermore, it was shown that the patients who had higher scores in Box and Blocks test in the non-dominant hand prior to the rehabilitation also had lower scores on Rankin scale (rho=-0.485; p=0.0484). The score in Box and Blocks test was affected by the time from stroke (p=0.0431). On the other hand, no statistically significant relationships were found in the case of the patients’ age and sex.

Conclusions: It was shown that a change in the function of the paretic hand was affected by the degree of disability and severity of spasticity. Additionally, better effects of the rehabilitation program were found in patients up to two years from stroke onset. The findings showed no relationship between the selected factors, i.e., age and sex, and effects of hand rehabilitation. Given the fact that this was a pilot study, the findings should be validated by further research taking into account a larger group of patients with stroke.

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Comparison of the level of physical activity in young adults before and during the Covid-19 pandemic - a longitudinal study

Background and objective: The frequency with which people leave their homes and the time they spend in recreational places is significantly reduced at the time of the pandemic, particularly during the lockdown, due to which it is significantly more difficult for them to be active. The aim of the study was to assess to what extent the outbreak of the Covid-19 pandemic has affected young adults’ physical activity (PA). Methods: A total of 506 people aged 18 to 34 ( 24.67 years ± 4.23 years), who filled a restrospective-pre-post online survey, were qualified for the study. The survey began 12 days after the epidemic was announced at the site of the study, i.e. between weeks 2 and 4 of obligatory lockdown, including significant restriction of movement. The levels of physical activity and sedentary time were measured using 7-item International Physical Activity Questionnaire - Short Form (IPAQ – SF). The respondents provided two answers to each question, i.e., information relating to the last 7 days during the pandemic (lockdown), and to a period of 7 days before the pandemic. Results: During the pandemic, young adults spent significantly less time performing physical activity showed as median [Q1-Q3]: Me=8752.5 [5403.0-11820.0] vs. 5483.0 [2380.0-9009.0] metabolic equivalents (MET) min/week (p<0.001) and they spent more time engaging in sedentary behaviours, Me=240 [120.0-360.0] vs. 300 [180.0-420.0] min/day (p<0.001). During the pandemic, respondents spent less energy engaging in vigorous PA from Me=480.00 [0.0- 1920.0] vs. 0.00 [0.0-1920.0] (MET) min/week, 100% decline, (p<0.001); or in moderate PA from Me=360.00 [0.0- 840.0] vs. 240.00 [0.0-720.0] (MET) min/week, 33.34% decline, and they walked much less from Me= 6930.0 [3762.0-9702.0] vs. 3861.0 [1485.0-7260.0] (MET) min/week, 44.29% decline (p<0.001). Conclusions: During the Covid-19 pandemic young adults are significantly less involved in PA, which adversely affects their health status, including their physical and mental condition. The importance of sufficient PA should be highlighted during this specific period, particularly among young people.

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