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Abstract Background Existing sedentary behaviour guidelines for children and youth target overall sedentary behaviour and recreational screen time, without any specific recommendations regarding school-related sedentary behaviours (i.e., sedentary behaviours performed during the school day, or within the influence of school). The purpose of this paper is to describe the development of international evidence-based recommendations for school-related sedentary behaviours for children and youth, led by the Sedentary Behaviour Research Network (SBRN). Methods A panel of international experts was convened by SBRN in November 2020 to guide the development of these recommendations for children and youth aged ~ 5–18 years. The recommendations were informed by 1) age-relevant existing sedentary behaviour guidelines, 2) published research on the relationship between overall sedentary behaviour and health, 3) a de novo systematic review on the relationship between school-related sedentary behaviours and health and/or academic outcomes, and 4) a de novo environmental scan of the grey literature to identify existing recommendations for school-related sedentary behaviours. Draft recommendations were presented to the Expert Panel in June 2021. Following thorough discussion and modifications, updated recommendations were distributed for stakeholder feedback from July 9–26. Feedback was received from 148 stakeholders across 23 countries, leading to additional updates to the recommendations. Following further rounds of discussion and updates with the Expert Panel in August and September 2021, consensus was achieved on the final recommendations. Results A healthy day includes breaking up extended periods of sedentary behaviour and incorporating different types of movement into homework whenever possible, while limiting sedentary homework. School-related screen time should be meaningful, mentally or physically active, and serve a specific pedagogical purpose that enhances learning. Replacing sedentary learning activities with movement-based learning activities, and replacing screen-based learning activities with non-screen-based learning activities, can further support students’ health and wellbeing. Discussion This paper presents the first evidence-based recommendations for school-related sedentary behaviours for children and youth. These recommendations will support the work of parents, caregivers, educators, school system administrators, policy makers, researchers and healthcare providers interested in promoting student health and academic success. more...

Abstract Background The purpose of this systematic review was to examine the associations between school-related sedentary behaviours and indicators of health and well-being in children and youth (~ 5–18 years) attending school. Methods This review was conducted to inform the development of School-Related Sedentary Behaviour Recommendations. Peer-reviewed, published, or in-press articles in English were included. Reviews, meta-analyses, and case studies were excluded; all other study designs were eligible. Further, articles had to meet the a priori study criteria for population, intervention, comparator (PROSPERO ID: CRD42021227600). Embase, MEDLINE® ALL, and PsycINFO were searched. Risk of bias was assessed for individual experimental studies using the Cochrane risk of bias assessment tool, and in observational studies based on the GRADE framework and in line with previous systematic reviews examining sedentary behaviours in children. Overall quality of evidence was assessed using the GRADE framework for each outcome category and study design. Results were synthesized narratively, grouped by study design and outcome category. Further, several high-level summaries were conducted to help interpret results. Results Evidence was synthesized from 116 reports, including 1,385,038 participants and 1173 extracted associations. More school-related sedentary behaviour was favourably associated with nearly one-third of extracted associations for cognitive (33%) and social-emotional (32%) indicators (e.g., less anxiety), but unfavourably associated with other movement behaviours (e.g., less physical activity) (35%). Active lessons were favourable (72%), compared to more school-related sedentary behaviours, when examining associations for all health and well-being indicators. More homework was favourable across all health and well-being indicators in 4% of extracted associations for primary school children, and 25% of extracted associations for secondary school children. However, ≥2 h/day of homework appeared to be unfavourable for health and well-being. Limitations for synthesized studies included generally low quality of evidence and a lack of studies in South American, African, or low-middle income countries. Conclusions Findings can help inform policy makers, schools, and teachers, regarding the amount of homework assigned and the introduction of active lessons into the classroom to enhance health and well-being of children. More research is needed examining school-related sedentary behaviours and indicators of health and well-being in low- and middle-income countries. more...

Physical activity (PA) and sedentary behaviour (SED) have been linked to the mental health of children and adolescents, yet the timing of behaviours may play a role in this relationship and clarifying this could inform interventions. We explored cross-sectional associations of PA and SED in varying time segments throughout the school day with the mental health of school-aged children and adolescents from rural Northeastern Ontario, Canada. A total of 161 students (56% female, M = 10.3 years old) wore accelerometers for 8 days (7 nights) and completed a self-report survey (parent reported for children younger than 11). Mental health was measured using the Strengths and Difficulties Questionnaire. Accelerometer-measured SED, light PA (LPA), and moderate and vigorous PA (MVPA) were estimated in the time-segments before school (06:00–08:44), school time (08:45–15:04), after school (15:05–16:59), and evenings (17:00–21:59). Associations were tested with multilevel linear regressions while adjusting for confounding factors. Students spent 72.6 min in MVPA, 209.0 min in LPA, and 621.0 min in SED per day. Daily SED was associated with less conduct problems (β = −0.27, p more...

Children who are physically active and involved in organized sport report having the unhealthiest diets. Research suggests excessive calories may be attributed to the prevalence of fast food and candy which are often provided as rewards in sport. This study explored the use of food as a reward in youth sport and the perceived impact it has on children’s motivation to participate in recreational soccer and ice hockey. A multiple instrumental case study approach was utilized. Children aged 4–12 (n = 64), parents (n = 30), and coaches (n = 18) were recruited within central and northeastern Ontario, Canada to participate in focus groups and individual interviews. Transcribed audio recordings underwent inductive thematic analysis. Key themes included: Fun and fast: The culture of food in youth soccer and hockey; (Un)importance of food rewards: The how and why of motivating children in sport; and Youth sport is expensive: Gratitude for sponsorship in youth sport. Themes explain the role of food and food rewards as an element of the youth sport culture as well as the importance of sponsors, regardless of food affiliation, in youth sport. Overall, children’s participation and effort would continue without food rewards; however, they continue to be offered food to motivate and celebrate performance in youth sport. Findings highlight the need to increase knowledge and awareness among parents and coaches on what truly motivates children to help foster healthier strategies for celebrating success and supporting lifelong physical activity. more...

Abstract Background Physical literacy is the foundation of a physically active lifestyle. Sedentary behaviour displays deleterious associations with important health indicators in children. However, the association between sedentary behaviour and physical literacy is unknown. The purpose of this study was to identify the aspects of physical literacy that are associated with key modes of sedentary behaviour among Canadian children participating in the RBC-CAPL Learn to Play study. Methods A total of 8,307 children aged 8.0-12.9 years were included in the present analysis. Physical literacy was assessed using the Canadian Assessment of Physical Literacy, which measures four domains (Physical Competence, Daily Behaviour, Motivation and Confidence, Knowledge and Understanding). Screen-based sedentary behaviours (TV viewing, computer and video game use), non-screen sedentary behaviours (reading, doing homework, sitting and talking to friends, drawing, etc.) and total sedentary behaviour were assessed via self-report questionnaire. Linear regression models were used to determine significant (p more...

Abstract Background Quality physical education (PE) contributes to the development of physical literacy among children, yet little is known about how teacher training relates to this development. We assessed the association between teacher training, and the likelihood that children met recommended achievement levels for components of physical literacy as defined by the Canadian Assessment of Physical Literacy (CAPL). Methods Canadian children (n = 4189; M = 10.72 years, SD = 1.19) from six provinces completed the CAPL. Logistic regression was used to examine the relationship between teacher training (generalist/PE specialist), adjusting for children’s age and gender, and physical competence protocols (sit and reach, handgrip, plank, Progressive Aerobic Cardiovascular Endurance Run [PACER], body mass index [BMI], waist circumference, Canadian Agility and Movement Skill Assessment [CAMSA]), the four CAPL domain scores, and the total CAPL score. Results Teacher training, in addition to children’s age and gender, explained only a very small proportion of variance in each model (all R2 more...

Abstract Background Physical literacy is a complex construct influenced by a range of physical, behavioural, affective, and cognitive factors. Researchers are interested in relationships among these constituent factors. The purpose of this study was to investigate how age, gender, and physical competence components of physical literacy relate to a child’s adequacy in and predilection for physical activity. Methods A sample of 8530 Canadian youth (50% girl) aged 8.0 to 12.9 years participated in the study. Participants completed the Canadian Assessment of Physical Literacy (CAPL) protocol, which assesses physical literacy in four domains: Physical Competence, Daily Behaviour, Motivation and Confidence, and Knowledge and Understanding. Stepwise multiple regression analyses were conducted to investigate the relationship between physical competence components of physical literacy (Progressive Aerobic Cardiovascular Endurance Run [PACER], Canadian Agility and Movement Skill Assessment [CAMSA], sit and reach, handgrip, plank, and body mass index) and children’s perceived adequacy and predilection toward physical activity as measured by subscales from the Children’s Self-Perceptions of Adequacy in and Predilection for Physical Activity scale (CSAPPA). Results The variable most strongly associated with adequacy and predilection was the PACER shuttle run score. The PACER accounted for 10.9% of the variance in adequacy and 9.9% of the variance in predilection. Participants’ age was inversely related to adequacy (β = − 0.374) and predilection (β = − 0.621). The combination of other variables related to adequacy brought the total variance explained to 14.7%, while the model for predilection explained a total of 13.7%. Conclusions Results indicate an association between cardiorespiratory fitness and measures of physical activity adequacy and predilection. These findings suggest that practitioners should consider the physiological and psychological makeup of the child, and ways to enhance adequacy and predilection among children with limited cardiorespiratory fitness, in order to create the best possible environment for all children to participate in physical activity. more...

Abstract Background The current physical literacy level of Canadian children is unknown. The Royal Bank of Canada (RBC) Learn to Play – Canadian Assessment of Physical Literacy (CAPL) project, which is anchored in the Canadian consensus statement definition of physical literacy, aimed to help establish the current physical literacy level of Canadian children. Methods The CAPL was used to assess the physical literacy (and component domains: Daily Behaviour, Physical Competence, Knowledge and Understanding, and Motivation and Confidence) of Canadian children aged 8–12 years. Data were collected from 11 sites across Canada, yielding a sample of 10,034 participants (5030 girls). Descriptive statistics by age and gender were calculated and percentile distributions of physical literacy scores, including each domain and individual measure, were derived. Results The mean age of participants was 10.1 ± 1.2 years. Total physical literacy scores (out of 100) were on average 63.1 ± 13.0 for boys and 62.2 ± 11.3 for girls. For boys and girls respectively, domain scores were 19.9 ± 4.7 and 19.3 ± 4.1 (out of 32) for Physical Competence; 18.6 ± 7.9 and 18.5 ± 7.4 (out of 32) for Daily Behaviour; 12.7 ± 2.8 and 12.2 ± 2.6 (out of 18) for Motivation and Confidence; and 11.8 ± 2.8 and 12.2 ± 2.6 (out of 18) for Knowledge and Understanding. Physical Competence measures were on average 28.1 ± 8.4 cm (sit-and-reach flexibility), 33.5 ± 9.4 kg (grip strength, right + left), 23.4 ± 14.1 laps (Progressive Aerobic Cardiovascular Endurance Run [PACER] shuttle run), 61.8 ± 43.8 s (isometric plank), 19.0 ± 3.8 kg/m2 (body mass index), 67.3 ± 10.8 cm (waist circumference), and 20.6 ± 3.9 out of 28 points for the Canadian Agility and Movement Skill Assessment (CAMSA), with scores for boys higher than girls and older children higher than younger children for grip strength, PACER, plank, and CAMSA score. Girls and younger children had better scores on the sit-and-reach flexibility than boys and older children. Daily pedometer step counts were higher in boys than girls (12,355 ± 4252 vs. 10,779 ± 3624), and decreased with age. Conclusions These results provide the largest and most comprehensive assessment of physical literacy of Canadian children to date, providing a “state of the nation” baseline, and can be used to monitor changes and inform intervention strategies going forward. more...

Abstract Background Physical literacy is an emerging construct in children’s health promotion, and may impact their lifelong physical activity habits. However, recent data reveal that only a small portion of Canadian children are regularly physically active and/or meet sedentary behaviour guidelines. To our knowledge, no study has investigated the association between physical literacy and movement behaviour guidelines. Therefore, the purpose of this study was to examine the relationship between physical literacy scores in Canadian children who meet or do not meet physical activity and sedentary behaviour guidelines. Methods Children (n = 2956; 56.6% girls) aged 8–12 years from 10 Canadian cities had their physical literacy levels measured using the Canadian Assessment of Physical Literacy, which consists of four domains (Physical Competence; Daily Behaviour; Knowledge and Understanding; and Motivation and Confidence) that are aggregated to provide a composite physical literacy score. Physical activity levels were measured by pedometers, and sedentary behaviour was assessed through self-report questionnaire. Analyses were conducted separately for each guideline, comparing participants meeting versus those not meeting the guidelines. Comparisons were performed using MANOVA and logistic regression to control for age, gender, and seasonality. Results Participants meeting physical activity guidelines or sedentary behaviour guidelines had higher physical literacy domain scores for Physical Competence and for Motivation and Confidence compared to those not meeting either guideline (both p more...

Abstract Background The associations between cardiorespiratory fitness (CRF) and physical literacy in children are largely unknown. The aim of this study was to assess the relationships between CRF, measured using the 20-m shuttle run test (20mSRT), and components of physical literacy among Canadian children aged 8–12 years. Methods A total of 9393 (49.9% girls) children, with a mean (SD) age of 10.1 (±1.2) years, from a cross-sectional surveillance study were included for this analysis. The SRT was evaluated using a standardized 15 m or 20 m protocol. All 15 m SRTs were converted to 20mSRT values using a standardized formula. The four domains of physical literacy (Physical Competence, Daily Behaviour, Motivation and Confidence, and Knowledge and Understanding) were measured using the Canadian Assessment of Physical Literacy. Tertiles were identified for 20mSRT laps, representing low, medium, and high CRF for each age and gender group. Cohen’s d was used to calculate the effect size between the low and high CRF groups. Results CRF was strongly and favourably associated with all components of physical literacy among school-aged Canadian children. The effect size between low and high CRF tertile groups was large for the Physical Competence domain (Cohen’s d range: 1.11–1.94) across age and gender groups, followed by moderate to large effect sizes for Motivation and Confidence (Cohen’s d range: 0.54–1.18), small to moderate effect sizes for Daily Behaviour (Cohen’s d range: 0.25–0.81), and marginal to moderate effect sizes for Knowledge and Understanding (Cohen’s d range: 0.08–0.70). Conclusions This study identified strong favourable associations between CRF and physical literacy and its constituent components in children aged 8–12 years. Future research should investigate the sensitivity and specificity of the 20mSRT in screening those with low physical literacy levels. more...

Abstract Background Physical inactivity is one of the leading causes of chronic disease in Canadian adults. With less than 50% of Canadian adults reaching the recommended amount of daily physical activity, there is an urgent need for effective programs targeting this risk factor. HealtheSteps™ is a healthy lifestyle prescription program, developed from an extensive research base to address risk factors for chronic disease such as physical inactivity, sedentary behaviour and poor eating habits. HealtheSteps™ participants are provided with in-person lifestyle coaching and access to eHealth technologies delivered in community-based primary care clinics and health care organizations. Method/Design To determine the effectiveness of Healthesteps™, we will conduct a 6-month pragmatic randomized controlled trial with integrated process and economic evaluations of HealtheSteps™ in 5 clinic settings in Southwestern Ontario. 110 participants will be individually randomized (1:1; stratified by site) to either the intervention (HealtheSteps™ program) or comparator (Wait-list control). There are 3 phases of the HealtheSteps™ program, lasting 6 months each. The active phase consists of bi-monthly in-person coaching with access to a full suite of eHealth technology supports. During the maintenance phase I, the in-person coaching will be removed, but participants will still have access to the full suite of eHealth technology supports. In the final stage, maintenance phase II, access to the full suite of eHealth technology supports is removed and participants only have access to publicly available resources and tools. Discussion This trial aims to determine the effectiveness of the program in increasing physical activity levels and improving other health behaviours and indicators, the acceptability of the HealtheSteps™ program, and the direct cost for each person participating in the program as well as the costs associated with delivering the program at the different community sites. These results will inform future optimization and scaling up of the program into additional community-based primary care sites. Trial registration NCT02413385 (Clinicaltrials.gov). Date Registered: April 6, 2015. more...

Precocious puberty has traditionally been defined as the onset of secondary sexual characteristics occurring before age 8 years in girls and 9 years in boys. This earlier onset of puberty may have significant physical and psychological consequences if left untreated. Moreover, it should be excluded that pubertal signs are not secondary to malignancies, other organic aetiologies or associated syndromic phenotypes. Initial assessment involves a thorough medical history and physical examination; a hand and wrist X-ray to determine bone age, and hormonal tests might be indicated to confirm the diagnosis and to determine the origin of hormonal production. Treatment options depend on the underlying cause. Given the complexity of the differential diagnosis, this article aims to familiarise clinicians with the different steps that can be taken when precocious puberty is suspected., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.) more...

Parents and caregivers may seek help with different questions or concerns on how to handle the diverse gender expressions of their children. Sometimes the issue may be evident while seeking medical advice for other concerns. Because of the many uncertainties around this topic, clinicians need to know what to say and what can be done to provide the best possible care for gender-diverse children., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.) more...

Competing Interests: Competing interests: None declared.

Competing Interests: Competing interests: None declared.

Many low-income countries still encounter high mortality rates. The use of maternal health care services is known to be a key intervention in reducing maternal death. Despite investment in the healthcare sector, in 2015 Ghana did not meet the Millennium Development Goal 5 of reducing maternal mortality (MM). The Volta Region registered the highest rate of MM, the lowest percentage of antenatal care (ANC) coverage and the lowest percentage of skilled delivery. This is a qualitative study that used focus group discussions and key-informant interviews to explore the views on pregnancy among rural communities in the Volta Region, identify the barriers in accessing ANC and skilled attendance birth and collect views on how to improve the access to maternal care services.Overall, the study argues that members of the community of the rural villages acknowledge the benefits of ANC and skilled delivery, and the potential risk related to home delivery. However, pregnant women in the Volta Region still encounter different kinds of obstacles that prevent them from seeking maternal health care. These obstacles are driven by social and economic constraints, and by the fact that women may still lack voice in the decision-making process, and by low males' participation. more...

Zika virus (ZIKV) is an emergent flavivirus transmitted mainly through Aedes spp. mosquitoes that is posing challenge to healthcare services in countries experiencing an outbreak. Usually ZIKV infection is mild, but in some cases it has been reported to progress into neurological diseases such as microcephaly in infants and Guillain-Barré syndrome (GBS) in adults. GBS is a debilitating autoimmune disorder that affects peripheral nerves. Since ZIKV caused massive outbreaks in South America in the past few years, we aimed to systematically review the literature and perform a meta-analysis to estimate the prevalence of GBS among ZIKV-infected individuals. We searched PubMed and Cochrane databases and selected three studies for a meta-analysis. We estimated the prevalence of ZIKV-associated GBS to be 1.23% (95% CI=1.17-1.29%). Limitations include paucity of data regarding previous flavivirus infections and ZIKV-infection confirmation issues. Our estimate seems to be low, but cannot be ignored, since ZIKV outbreaks affects an overwhelming number of individuals and GBS is a life-threatening debilitating condition, especially in pregnant women. ZIKV infection cases must be closely followed to assure prompt care to reduce the impact of GBS associated-sequelae on the quality of life of those affected., (Copyright © 2018 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda. All rights reserved.) more...

Preliminary experience on total quality program in access surgery for dialysis is described; this kind of "border-line" surgery requires peculiar standards, documents and quality indexes. The use of a quality index based on a minimum success rate of 90% in elective access surgery is proposed. In addition, a "cross-index", suitable for quality evaluation of different dialysis sectors at the same time, is expressed. First interventions aimed at the optimal use of resources are described. more...