Presleep activities and time of sleep onset in children

OBJECTIVE: Presleep activities have been implicated in the declining sleep duration of young people. A use-of-time approach may be used to describe the presleep period. The study aims were to describe the activities undertaken 90 minutes before sleep onset and to examine the association between activities and time of sleep onset in New Zealand young people. METHODS: Participants (N = 2017; 5-18 years) self-reported their time use as part of a national survey. All activities reported in the 90 minutes before sleep were extracted. The top 20 activities were grouped into 3 behavioral sets: screen sedentary time, nonscreen sedentary time, and self-care. An adjusted regression model was used to estimate presleep time spent in each behavioral set for 4 distinct categories of sleep onset (very early, early, late, or very late), and the differences between sleep onset categories were tested. RESULTS: In the entire sample, television watching was the most commonly reported activity, and screen sedentary time accounted for ∼30 minutes of the 90-minute presleep period. Participants with a later sleep onset had significantly greater engagement in screen time than those with an earlier sleep onset. Conversely, those with an earlier sleep onset spent significantly greater time in nonscreen sedentary activities and self-care. CONCLUSIONS: Screen sedentary time dominated the presleep period in this sample and was associated with a later sleep onset. The development of interventions to reduce screen-based behaviors in the presleep period may promote earlier sleep onset and ultimately improved sleep duration in young people.

The non-advertising effects of screen-based sedentary activities on acute eating behaviours in children, adolescents, and young adults. A systematic review.

Sedentary screen time may be an important determinant of childhood obesity. A number of potential mechanisms to explain the link between screen time and increased bodyweight have been proposed; however, the relationship appears to be best explained by the effects on dietary intake, which is attributed to either food advertising or effects independent of food advertising. Technological advances have allowed for greater accessibility and exposure to advertisement-free screen-based media. This review was conducted to systematically synthesise the evidence from laboratory based studies which have investigated the non-advertising effects of screen time (TV viewing, sedentary video games, and computer use) on dietary intake in children, adolescents, and young adults. MEDLINE, PubMed, PsychInfo, CINAHL, and Embase were searched from inception through 5 July 2013. Ten trials met the inclusion criteria and were included in the review. Risk of study bias was judged to range from low to high. Screen time in the absence of food advertising was consistently found to be associated with increased dietary intake compared with non-screen behaviours. Suggested explanations for this relationship included: distraction, interruption of physiologic food regulation, screen time as a conditioned cue to eat, disruption of memory formation, and the effects of the stress-induced reward system. Due to the limited number of high-quality studies available for this review, our findings are preliminary. More work is required to better establish the link between dietary intake and advertisement-free screen time and assess whether differences exist between the different screen-based activities.

Objectively measured sedentary behaviour and health and development in children and adolescents: systematic review and meta-analysis

Sedentary behaviour has emerged as a unique determinant of health in adults. Studies in children and adolescents have been less consistent. We reviewed the evidence to determine if the total volume and patterns (i.e. breaks and bouts) of objectively measured sedentary behaviour were associated with adverse health outcomes in young people, independent of moderate-intensity to vigorous-intensity physical activity. Four electronic databases (EMBASE MEDLINE, Ovid EMBASE, PubMed and Scopus) were searched (up to 12 November 2015) to retrieve studies among 2- to 18-year-olds, which used cross-sectional, longitudinal or experimental designs, and examined associations with health outcomes (adiposity, cardio-metabolic, fitness, respiratory, bone/musculoskeletal, psychosocial, cognition/academic achievement, gross motor development and other outcomes). Based on 88 eligible observational studies, level of evidence grading and quantitative meta-analyses indicated that there is limited available evidence that the total volume or patterns of sedentary behaviour are associated with health in children and adolescents when accounting for moderate-intensity to vigorous-intensity physical activity or focusing on studies with low risk of bias. Quality evidence from studies with robust designs and methods, objective measures of sitting, examining associations for various health outcomes, is needed to better understand if the overall volume or patterns of sedentary behaviour are independent determinants of health in children and adolescents.

Use of active video games to increase physical activity in children: a (virtual) reality?

There has been increased research interest in the use of active video games (in which players physically interact with images onscreen) as a means to promote physical activity in children. The aim of this review was to assess active video games as a means of increasing energy expenditure and physical activity behavior in children. Studies were obtained from computerized searches of multiple electronic bibliographic databases. The last search was conducted in December 2008. Eleven studies focused on the quantification of the energy cost associated with playing active video games, and eight studies focused on the utility of active video games as an intervention to increase physical activity in children. Compared with traditional nonactive video games, active video games elicited greater energy expenditure, which was similar in intensity to mild to moderate intensity physical activity. The intervention studies indicate that active video games may have the potential to increase free-living physical activity and improve body composition in children; however, methodological limitations prevent definitive conclusions. Future research should focus on larger, methodologically sound intervention trials to provide definitive answers as to whether this technology is effective in promoting long-term physical activity in children.

Service use in children aged 6-8 years with attention deficit hyperactivity disorder

OBJECTIVE: This study investigated prevalence, types and predictors of professional service use in families of children identified with attention deficit hyperactivity disorder (ADHD) in the community.

DESIGN: SETTING: children with ADHD were identified through 43 schools using parent and teacher screening questionnaires (Conners 3 ADHD Index) followed by case confirmation using the Diagnostic Interview Schedule for Children Version IV. Parents completed a survey about professional service use in the last 12 months.

MAIN OUTCOME MEASURES: data on variables potentially associated with service use were collected from parents (interview and questionnaires), teachers (questionnaires) and children (direct assessment). Logistic regression was used to examine predictors of service use in univariate and multivariable analyses.

RESULTS: The sample comprised 179 children aged 6-8 years with ADHD. Over one-third (37%) had not received professional services in the last 12 months. The strongest predictors of service use were older child age (adjusted OR=3.0, 95% CI 1.0 to 8.9, p=0.05), and the degree to which the child's behaviour impacted on the family (adjusted OR=2.0, 95% CI 1.3 to 3.3, p=0.007), after controlling for ADHD subtype and severity, externalising comorbidities, academic achievement and parent-reported impairment.

CONCLUSIONS: A substantial proportion of children with ADHD are not accessing professional services. Our findings suggest that the child's age and the impact of the child's behaviour on the family are the strongest predictors of service use. Given the demonstrated benefits from various interventions in ADHD, there is a need to improve case identification and referral for services.

Correlates of gross motor competence in children and adolescents: a systematic review and meta-analysis

BACKGROUND: Gross motor competence confers health benefits, but levels in children and adolescents are low. While interventions can improve gross motor competence, it remains unclear which correlates should be targeted to ensure interventions are most effective, and for whom targeted and tailored interventions should be developed.

OBJECTIVE: The aim of this systematic review was to identify the potential correlates of gross motor competence in typically developing children and adolescents (aged 3-18 years) using an ecological approach.

METHODS: Motor competence was defined as gross motor skill competency, encompassing fundamental movement skills and motor coordination, but excluding motor fitness. Studies needed to assess a summary score of at least one aspect of motor competence (i.e., object control, locomotor, stability, or motor coordination). A structured electronic literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Six electronic databases (CINAHL Complete, ERIC, MEDLINE Complete, PsycINFO(®), Scopus and SPORTDiscus with Full Text) were searched from 1994 to 5 August 2014. Meta-analyses were conducted to determine the relationship between potential correlates and motor competency if at least three individual studies investigated the same correlate and also reported standardized regression coefficients.

RESULTS: A total of 59 studies were identified from 22 different countries, published between 1995 and 2014. Studies reflected the full range of age groups. The most examined correlates were biological and demographic factors. Age (increasing) was a correlate of children's motor competence. Weight status (healthy), sex (male) and socioeconomic background (higher) were consistent correlates for certain aspects of motor competence only. Physical activity and sport participation constituted the majority of investigations in the behavioral attributes and skills category. Whilst we found physical activity to be a positive correlate of skill composite and motor coordination, we also found indeterminate evidence for physical activity being a correlate of object control or locomotor skill competence. Few studies investigated cognitive, emotional and psychological factors, cultural and social factors or physical environment factors as correlates of motor competence.

CONCLUSION: This systematic review is the first that has investigated correlates of gross motor competence in children and adolescents. A strength is that we categorized correlates according to the specific ways motor competence has been defined and operationalized (object control, motor coordination, etc.), which enables us to have an understanding of what correlates assist what types of motor competence. Indeed our findings do suggest that evidence for some correlates differs according to how motor competence is operationalized.

Factors associated with accidental injuries in children with ADHD-combined type: more than a motor problem?

OBJECTIVE: We explored the relationship between accidental injuries, motor impairment, and co-occurring autism spectrum disorder (ASD) symptoms in children with ADHD-combined type (ADHD-CT).

METHOD: Participants were 32 male children diagnosed with ADHD-CT and 23 typically developing male children (7-12 years, full scale IQ [FSIQ] > 80). Parents completed a customized questionnaire on the occurrence of accidental injuries (e.g., bruises, cuts) their child experienced in the past 12 months. Motor proficiency was assessed using the Movement ABC-2 (MABC-2). Parents rated motor, ADHD-CT, ASD, and anxiety symptoms.

RESULTS: Children with ADHD-CT had significantly increased parent-reported accidental injuries compared with typically developing children. Among children with ADHD-CT, Spearman's rho rank correlations revealed no association between increased accidental injuries and MABC-2 score, but significant associations with increased hyperactivity/impulsivity, ASD, and anxiety symptoms.

CONCLUSION: Although these findings require validation, they suggest a need for further research investigating the contribution of co-occurring ASD and anxiety symptoms to accidental injuries in children with ADHD-CT.

Validity of short food questionnaire items to measure intake in children and adolescents: a systematic review

BACKGROUND: Short food questions are appealing to measure dietary intakes. METHODS: A review of studies published between 2004 and 2016 was undertaken and these were included in the present study if they reported on a question or short item questionnaire (≤50 items, data presented as ≤30 food groups) measuring food intake or food-related habits, in children (aged 6 months to 18 years), and reported question validity or reliability. Thirty studies met the inclusion criteria. RESULTS: Most questions assessed foods or food groups (n = 29), with the most commonly assessed being fruit (n = 22) or vegetable intake (n = 23), dairy foods and discretionary foods (n = 20 studies each). Four studies assessed food habits, with the most common being breakfast and meal frequency (n = 4 studies). Twenty studies assessed reliability, and 25 studies determined accuracy and were most commonly compared against food records. Evaluation of question performance relied on statistical tests such as correlation. CONCLUSIONS: The present study has identified valid and reliable questions for the range of key food groups of interest to public health nutrition. Questions were more likely to be reliable than accurate, and relatively few questions were both reliable and accurate. Gaps in repeatable and valid short food questions have been identified that will provide direction for future tool development.

Physical activity guidelines and cardiovascular risk in children: a cross sectional analysis to determine whether 60 minutes is enough

BACKGROUND: Physical activity reduces cardiovascular mortality and morbidity. The World Health Organisation (WHO) recommends children engage in 60 min daily moderate-to-vigorous physical activity (MVPA). The effect of compliance with this recommendation on childhood cardiovascular risk has not been empirically tested. To evaluate whether achieving recommendations results in reduced composite-cardiovascular risk score (CCVR) in children, and to examine if vigorous PA (VPA) has independent risk-reduction effects.

METHODS: PA was measured using accelerometry in 182 children (9-11 years). Subjects were grouped according to achievement of 60 min daily MVPA (active) or not (inactive). CCVR was calculated (sum of z-scores: DXA body fat %, blood pressure, VO2peak, flow mediated dilation, left ventricular diastolic function; CVR score ≥ 1SD indicated 'higher risk'). The cohort was further split into quintiles for VPA and odds ratios (OR) calculated for each quintile.

RESULTS: Active children (92 (53 boys)) undertook more MVPA (38 ± 11 min, P < 0.001), had greater VO2peak (4.5 ± 0.8 ml/kg/min P < 0.001), and lower fat % (3.9 ± 1.1 %, P < 0.001) than inactive. No difference were observed between active and inactive for CCVR or OR (P > 0.05). CCVR in the lowest VPA quintile was significantly greater than the highest quintile (3.9 ± 0.6, P < 0.05), and the OR was 4.7 times higher.

CONCLUSION: Achievement of current guidelines has positive effects on body composition and cardiorespiratory fitness, but not CCVR. Vigorous physical activity appears to have beneficial effects on CVD risk, independent of moderate PA, implying a more prescriptive approach may be needed for future VPA guidelines.

Dietary sodium intake and overweight and obesity in children and adults: a protocol for a systematic review and meta-analysis.

BACKGROUND: Overweight and obesity in children and adults is a major public health concern. Emerging evidence suggests dietary sodium intake may be associated with obesity. This systematic review and meta-analysis will aim to (i) assess the relation between dietary sodium intake and measures of adiposity in children and adults and (ii) examine the relation between sodium intake and sugar-sweetened beverage (SSB) consumption, which is a known risk factor for obesity. METHODS/DESIGN: An electronic search will be conducted using Medline Complete, CINAHL, Scopus, Embase and Cochrane central register of controlled trials (CENTRAL). The search strategy will identify published peer-reviewed articles that report on dietary sodium and either a marker of adiposity or SSB consumption. Only human studies (ages >1 year) in English will be included, and no limits will be placed on publication date. No restrictions will be placed on the method of sodium intake assessment. Cross-sectional, prospective studies, and randomised controlled trials with a duration of ≥ 3 months will be included. Studies with participants with renal disease, cancer, type 1 diabetes or heart failure or who are pregnant will be excluded. To assess the quality of studies, the Cochrane's Collaboration tool for assessing risk of bias in randomised trials will be used for randomised controlled trials (RCTs), and the modified Newcastle-Ottawa Scale will be used for cross-sectional and prospective studies. Meta-analysis will be used to assess the relation of sodium intake with two primary outcomes: (i) BMI and body weight in adults and BMI z-score in children and (ii) weight category (i.e. healthy weight vs. overweight/obese). For any outcomes in which meta-analysis is not possible, we will present data as a systematic review. Findings will be grouped and reported separately for children and adolescents (ages 1-17 years) and adults (ages >18 years). DISCUSSION: This review and meta-analysis will provide insight into the relation between dietary sodium intake and overweight and obesity. This information can be used to inform public health policies which target population sodium consumption.

Developing family businesses through ongoing learning: case studies of Chinese urban and rural family businesses under market-oriented reforms

This study advances organisational learning research by exploring how and why learning patterns differ between different family businesses at different layers of China’s marketoriented transformation. The focus is the locational difference, namely the separate urban and rural environments and outcomes. Combining case studies and in-depth interviews, the study investigated how family businesses interact with their institutional environment and consequently build learning patterns. Learning initiatives undertaken by relevant and motivated family members are found to reflect a dynamic process involving personal learning, business growth, and business innovation. Family conflicts and business growth were also found to impact learning in family businesses. Implications for organisational learning are discussed at the end of the paper.