Twenty-four-hour movement guidelines during middle adolescence and their association with glucose outcomes and type 2 diabetes mellitus in adulthood

Purpose:The aim of the present study was to determine the association between adherence to the 24-h movement guidelines during middle adolescence and glucose outcomes(glycated hemoglobin and fasting glucose)and type 2 diabetes mellitus(T2DM)in adulthood,14 and 22 years later.Methods:We analyzed data from apparently healthy adolescents aged 12-18 years who participated in WavesⅠandⅡ(1994-1996,n=14,738),WaveⅣ(2008-2009,n=8913),and Wave V(2016-2018,n=3457)of the National Longitudinal Study of Adolescent to Adult Health(Add Health)in the United States.Physical activity,screen time,and sleep duration were measured using questionnaires,and the 24-h guidelines were defined as:5 or more times moderate-to-vigorous physical activity per week,≤2 h per day of screen time,and 9-11 h of sleep for 12-13 years and 8-10 h for 14-17 years.Capillary and venous whole blood was collected and analyzed to determine glycated hemoglobin and fasting glucose for WavesⅣandⅤ,respectively.Results:Only 2.1%of the adolescents met all the 3 guidelines,and 37.8%met none of them.In both wavesⅣandⅤ,adolescents who met physical activity and screen time guidelines had lower odds of T2DM in adulthood than those who did not meet any of these guidelines(WaveⅣ;prevalence ratio(PR)=0.57,95%confidence interval(95%CI):0.21-0.89;Wave V:PR=0.43,95%CI:0.32-0.74).Only for Wave V did adolescents who met all 3 guidelines have lower odds of T2DM at follow-up compared with those who did not meet any of these guidelines(PR=0.47,95%CI:0.24-0.91).Also,for each increase in meeting one of the 24-h recommendations,the odds of T2DM decreased by 18%(PR=0.82,95%CI:0.61-0.99)and 15%(PR=0.85,95%CI:0.65-0.98)in adulthood for WavesⅣandⅤ,respectively.Conclusion:Promoting all 24-h movement guidelines in adolescence,especially physical activity and screen time,is important for lowering the potential risk of T2DM in adulthood.

Non-School Day Catch-Up Sleep among Pupils in Japan

Backgrounds: Weekend catch-up sleep is the difference in sleep duration between the weekend and weekdays, and reflects sleep debt, whose significance is hypothesized to be altered by weekday sleep duration. This study aimed to assess this hypothesis. Methods: Multiple-comparison tests and multiple-regression analyses were conducted on questionnaires asking various lifestyle habits obtained from 2722 pupils in grades 5 to 12 and stratified by groups of pupils with shorter (≤7 hours) or longer (>7 hours) sleep duration on the nights before schooldays. Results: The percentage of pupils in negative non-school day catch-up sleep category was 6.6%, whereas that in non-school day catch-up sleep > 2 hours was 14.4%. In comparison with the reference category (non-school day catch-up sleep of zero), multiple comparison tests on lifestyle habits revealed significantly longer screen time in the shorter sleep-duration group of pupils with negative non-school day catch-up sleep and those with non-school day catch-up sleep > 2 hours. This analysis also demonstrated a significantly longer screen time in the longer sleep-duration group of pupils with non-school day catch-up sleep > 2 hours. Physical activity in pupils with negative non-school day catch-up sleep in the longer sleep-duration group was significantly longer, while that in pupils with non-school day catch-up sleep > 2 hours in the shorter sleep-duration group was significantly shorter. In the longer sleep-duration group, pupils with non-school day catch-up sleep > 2 hours showed poorer academic performance. Multiple regression analysis revealed that longer physical and after-school activities were significantly associated with non-school day catch-up sleep decrease in both the study groups. In the longer sleep-duration group, male gender, shorter screen time, and higher standardized body mass index were significantly associated with decreased non-school day catch-up sleep. Conclusions: Sleep duration before school days contributed differently to the non-school day catch-up sleep evaluation.

Meeting 24-h movement guidelines: Prevalence, correlates, and the relationships with overweight and obesity among Chinese children and adolescents

Background:Meeting 24-h movement guidelines by children and adolescents has been associated with improved indicators of health,although it has been under-studied in China.Hence,this study aimed to investigate the prevalence of meeting the 24-h movement guidelines,its correlates,and its relationships with body mass index in children and adolescents in China.Methods:Cross-sectional data from the 2017 Youth Study in China of 114,072 children and adolescents(mean age=13.75 years,49.18%boys)were used.Meeting 24-h movement guidelines(60 min of daily moderate-to-vigorous physical activity,2 h of daily leisure screen time,911 h and 810 h nightly sleep duration for 613-year-olds and 1417-year-olds,respectively)and height and weight of all participants were assessed.The prevalence of meeting the 24-h movement guidelines and World Health Organization weight status categories were determined.Generalized linear models were used to determine the correlates of meeting the 24-h movement guidelines and the relationships of meeting the 24-h movement guidelines with overweight(OW)and obesity(OB).Results:Only 5.12%of Chinese children and adolescents met the 24-h movement guidelines,and 22.44%were classified as OW/OB.Older children and adolescents were less likely to meet the 24-h movement guidelines.Parental education level and family income were positively related to meeting the 24-h movement guidelines.Children and adolescents meeting the 24-h movement guidelines showed lower odds ratios for OW/OB.Compared with participants meeting the 24-h movement guidelines,boys in 4th6th grades met none of the recommendations(OR=1.22,95%CI:1.061.40),met the screen time recommendation only(OR=1.13,95%CI:1.011.28),met the nightly sleep duration recommendation only(OR=1.14,95%CI:1.031.28),and had significantly higher odds ratios for OW/OB.Similar trends were observed for girls in 4th6th grades:meeting none of the guidelines(OR=1.35,95%CI:1.141.59),meeting sleep duration guidelines only(OR=1.23,95%CI:1.081.39),and meeting moderate-to-vigorous physical activity+nightly sleep duration guidelines(OR=1.24,95%CI:1.011.54).For girls in 7th9th grades,the following trend was observed:meeting none of the guidelines(OR=1.30,95%CI:1.011.67).Conclusion:Very few Chinese children and adolescents met the 24-h movement guidelines.Age(negatively correlated),parental education level,and family income(both positively correlated)were correlates of meeting the 24-h movement guidelines.Children and adolescents meeting the 24-h movement guidelines were more likely to have lower risks for OW/OB,especially in the youngest age group(Grades 46);and girls in the middle age group(Grades 79)were also more likely to have lower risks for OW/OB.Further research studies should explore additional correlates and determinants for meeting the 24-h movement guidelines.Also,future studies should use longitudinal or interventional designs to determine the relationships between meeting the 24-h movement guidelines and OW/OB and other health indicators,while taking sex and age differences into account.

Twelve weeks of dance exergaming in overweight and obese adolescent girls:Transfer effects on physical activity,screen time,and self-efficacy

Background: Given the low levels of physical activity(PA) among adolescent girls in the US, there is a need to identify tools to motivate increased PA. Although there is limited evidence that adolescents transfer PA from one context to another, exergames(i.e., video games that require gross motor activity) may act as a gateway to promote overall PA outside game play. The purpose of this study was to examine potential transfer effects(i.e., influences on external behaviors and psychological constructs) of a 12-week exergaming intervention on adolescent girls' PA, screen time,and self-efficacy toward PA, as well as the intrinsic motivation of exergaming.Methods: Participants were 37 girls aged 14–18 years(65% African American, 35% white) who were overweight or obese(body mass index ≥ 85 th percentile) and were recruited from the community via school, physicians, news media, and social media websites. Adolescents were randomly assigned to a 12-week group exergaming intervention(thirty-six 60 min sessions of group-based dance exergaming in a research laboratory using Kinect for Xbox360(Microsoft Corporation, Redmond, WA, USA)) or to a no-treatment control group. Outcome variables included objectively measured PA(total) and self-reported leisure-time PA(discretionary time only) 1 week before vs. 1 week after the intervention; selected type and intensity of PA when placed in a gym setting for 30 min("cardio free choice"); screen time; self-efficacy toward PA; and intrinsic motivation toward exergaming.Results: Attendance at the exergaming sessions was high(80%). Compared with the control group, the intervention group self-reported an increase in PA(p = 0.035) and fewer hours watching television or videos(p = 0.01) after the intervention, but there were no significant differences in sedentary, light, moderate, or vigorous PA measured by accelerometry. The intervention group significantly improved self-efficacy toward PA(p = 0.028). The intervention group highly rated intrinsic motivation toward exergaming.Conclusion: Exergaming for 12 weeks was associated with positive impacts on adolescent girls' self-reported PA, television viewing, self-efficacy,and intrinsic motivation. Future research is warranted to leverage exergames as an enjoyable, motivating, and effective PA tool.

Canadian children’s and youth’s adherence to the 24-h movement guidelines during the COVID-19 pandemic: A decision tree analysis

Purpose:The purpose of this study was to use decision tree modeling to generate profiles of children and youth who were more and less likely to meet the Canadian 24-h movement guidelines during the coronavirus disease-2019(COVID-19)outbreak.Methods:Data for this study were from a nationally representative sample of 1472 Canadian parents(Meanage=45.12,SD=7.55)of children(511 years old)or youth(1217 years old).Data were collected in April 2020 via an online survey.Survey items assessed demographic,behavioral,social,micro-environmental,and macro-environmental characteristics.Four decision trees of adherence and non-adherence to all movement recommendations combined and each individual movement recommendation(physical activity(PA),screen time,and sleep)were generated.Results:Results revealed specific combinations of adherence and non-adherence characteristics.Characteristics associated with adherence to the recommendation(s)included high parental perceived capability to restrict screen time,annual household income ofCAD 100,000,increases in children’s and youth’s outdoor PA/sport since the COVID-19 outbreak began,being a boy,having parents younger than 43 years old,and small increases in children’s and youth’s sleep duration since the COVID-19 outbreak began.Characteristics associated with non-adherence to the recommendation(s)included low parental perceived capability to restrict screen time,youth aged 1217 years,decreases in children’s and youth’s outdoor PA/sport since the COVID-19 outbreak began,primary residences located in all provinces except Quebec,low parental perceived capability to support children’s and youth’s sleep and PA,and annual household income ofCAD 99,999.Conclusion:Our results show that specific characteristics interact to contribute to(non)adherence to the movement behavior recommendations.Results highlight the importance of targeting parents’perceived capability for the promotion of children’s and youth’s movement behaviors during challenging times of the COVID-19 pandemic,paying particular attention to enhancing parental perceived capability to restrict screen time.

Exploring the impact of COVID-19 on the movement behaviors of children and youth:A scoping review of evidence after the first year

Purpose:The objective of this scoping review was to summarize systematically the available literature investigating the relationships between the coronavirus disease 2019(COVID-19)pandemic and movement behaviors(physical activity,sedentary behavior,and sleep)of school-aged children(aged 511 years)and youth(aged 1217 years)in the first year of the COVID-19 outbreak.Methods:Searches for published literature were conducted across 6 databases on 2 separate search dates(November 25,2020,and January 27,2021).Results were screened and extracted by 2 reviewers(DCP and KR)independently,using Covidence.Basic numeric analysis and content analysis were undertaken to present thematically the findings of included studies according to the associated impact on each movement behavior.Results:A total of 1486 records were extracted from database searches;of those,150 met inclusion criteria and were included for analysis.Of 150 articles,110 were empirical studies examining physical activity(n=77),sedentary behavior/screen time(n=58),and sleep(n=55).Results consistently reported declines in physical-activity time,increases in screen time and total sedentary behavior,shifts to later bed and wake times,and increases in sleep duration.The reported impacts on movement behaviors were greater for youth than for children.Conclusion:The COVID-19 pandemic is related to changes in the quantity and nature of physical activity,sedentary behavior,and sleep among children and youth.There is an urgent need for policy makers,practitioners,and researchers to develop solutions for attenuating adverse changes in physical activity and screen time among children and youth.

Spasm of the near reflex:a common diagnostic dilemma?

AIM:To report the clinical characteristics and diagnostic procedures used in patients with spasm of the near reflex(SNR),in order to present common investigation strategies and diagnostic pitfalls.METHODS:Retrospective case series of twenty-two patients,mainly children,with SNR or accommodation spasm(AS).AS was diagnosed on the basis of blurred vision and a difference of>2 dioptres between manifest and cycloplegic retinoscopy.If esotropia and miosis were present,the patients were diagnosed with SNR.All patients underwent visual acuity testing,orthoptic evaluation,assessment of refraction before and after cycloplegia,and dilated fundoscopy.Additional diagnostic investigations,such as neuroimaging,lumbar puncture(LP),electrophysiology and blood tests,were also recorded.Screen use among children was assessed in hours per day.RESULTS:There were 19 female and 3 male patients(age range 7-33 y,median=10 y).Seventeen patients had AS and 5 patients had SNR,with episodic blurry vision and headaches being the most common symptoms.Brain neuroimaging was performed in six patients(27%),although only one had a history of brain trauma.Two of those patients underwent visual evoked potentials and three also underwent LP and received intravenous steroid therapy.The majority of patients(90%)reported prolonged daily screen time(>2 h/d),and in 55%of cases there were concurrent social problems or psychological triggers.Treatment consisted of careful explanation of the condition,atropine1%eye drops and full cycloplegic correction by means of bifocal glasses.CONCLUSION:The diagnosis of SNR and AS may be challenging,because symptoms are usually intermittent and nonspecific,and a large number of patients are often subjected to redundant and potentially time-consuming examinations and treatment,that may exaggerate the underlying psychological disorder.Hence,detailed clinical testing and assessment of psychosocial profile is necessary,in order to avoid unnecessary investigations.Neuroimaging should be performed only in selected cases.Finally,due to prolonged screen use SNR and AS may become more frequent in the future.

Habitual physical activity levels and sedentary time of children in different childcare arrangements from a nationally representative sample of Canadian preschoolers

Background:Children spend substantial time in childcare,and the reasons parents choose a particular childcare type may differ by family.However,little is known about how childcare type influences habitual(full day)activity levels among children.Therefore,exploring patterns between childcare type and habitual physical activity(PA)(i.e.,light,moderate-to-vigorous PA(MVPA),and total PA)and sedentary time(ST)in young Canadian children is needed.Methods:A nationally representative sample of preschoolers from Cycles 3 and 4 of the Canadian Health Measures Survey was used in this cross-sectional study.Childcare type(e.g.,center-based childcare,home-based childcare,home with parent,kindergarten)was reported by parents.Preschoolers wore an Actical accelerometer for 7 days.Device and population-spcific cut-points were applied to delineate PA intensities and ST.Population means and sample totals were calculated to examine average daily and hourly rates of activity.Results:Preschoolers’rates of MVPA and total PA from the 4 childcare arrangements ranged from 65.99 min/day to 74.62 min/day(5.48-6.18 min/h)and 274.20 min/day to 281.66 min/day (22.69-23.21 min/h),respectively,while ST ranged from 443.13 min/day to 460.57 min/day(36.80-37.31 min/h).No significant differences were observed in daily or hourly rates of activity.Conclusion:This study provides a snapshot of the levels of PA and ST among preschoolers in various childcare settings at a national level,with no differences observed in habitual activity levels based on childcare enrollment.Additional research is needed to clarify the relationship between young children’s PA and childcare type,with consideration given to the quality of the childcare settings.

Association of Physical Activity, Screen Time and Sleep with Depressive Symptoms in Adolescents

Little is known on the association between movement behaviors including physical activity(PA),screen time(ST)and sleep(SLP)with depression in adolescents.This study aimed to explore the associations of PA,ST and SLP with depressive symptoms in adolescents.A total of 1,331 middle school students participated in this survey and provided valid data pertaining to the study variables.Self-reported questionnaires were used to collect information on participants’sociodemographic parameters.The Health Behavior in School-aged Children Questionnaire was used to assess the PA(days for moderate to vigorous PA),ST(daily hours of ST)and SLP(daily hours of SLP).Study participants’depressive symptoms were assessed using the Children’s Depression Inventory.Generalized linear models were used to estimate the associations of PA,ST and SLP with depressive symptoms.Of all the 1331 study participants,boys accounted for 51.31%and percentage of 7th,8th and 9th graders were 52.44%,23.22%and 24.34%,respectively.After controlling for sex,body mass index,grade,ethnicity,residence,siblings,perceived family affluence,father and mother educational level,only ST was positively associated with depressive symptoms(beta=0.17,p=0.005).This study suggests that excessive ST would be detrimental to depressive symptoms in adolescents.It may be effective to reduce ST for depression intervention or prevention.Future studies are encouraged to use an improved study design to confirm or negate this study’s researchfindings.

Specific Types of Screen-Based Sedentary Time and Depressive Symptoms in Adolescents

Purpose:Screen-based sedentary behavior(SSB)has been identified as risk factor for mental disorders in most of adolescents.However,there is little literature pertaining to the specific kinds of SSB and its connections with depressive symptoms in most of adolescents.In the present study,we are going tofind out the connections between specific types of SSB and depressive symptoms in Chinese adolescents.Methods:A cross-sectional data based on 996 study participants of middle school students in Guangdong Province.SSB was evaluated by distri-buting the questionnaire of Health Behavior in School-aged Children,while depressive symptoms were evaluated using Chinese version of Children’s Depressive symptoms Inventory(CDI).SSB was categorized into TV/movie time,video games time and other electronic devices-based time(e.g.,mobile phone,computer use).Generalized linear models was used to explore the connections between specific kinds of SSB and depressive symptoms.Results:After controlling for variables of sex,ethnicity,grade,residence,siblings,perceived family affluence,father educational level,mother educational background,body mass index(BMI),physical exercise,duration of sleep,other electronic devices-based time was positively correlated with depressive symptoms in Chinese adolescents(B=0.557%,95%CI:0.187–0.926,p=0.003).This significant connection was also found in girls(B=0.728%,95%CI:0.230–1.225,p=0.004)instead of boys(p>0.05).The other types of SSB were not signifi-cantly in relation to depressive symptoms in adolescents regardless of sex.Conclusion:This study suggested that it might be effective in reducing or preventing depressive symptoms through limiting electronic devices-based time,like computer use or mobile phone use time.This strategy would be particularly useful in girls.Future stu-dies should negate or replicate the research results by introducing more improved study design,which is beneficial to better understand the connections between SSB and depressive symptoms as well as then design more efficient interventions in adolescents.

Determinants of Sleepiness among Pupils in Kanto District of Japan

Backgrounds: Sleepiness is reported to predict sleep quality, academic performance and self-regulation. This study aimed to discover determinants of sleepiness. Methods: On 2722 questionnaires obtained from pupils in grades 5 - 12 in the Kanto district of Japan, lifestyle habits associated with sleepiness were analyzed using a multivariable logistic regression model. Results: The rate of sleepy pupils (who feel sleepy during class as often and always) increased from elementary school (6.3%) to senior high school (42.4%) via junior high school (17.1%). Higher grade (adjusted odds ratio [OR], 1.28;95% confidence interval [CI], 1.21 - 1.37;p < 0.001), later bedtime before school day (OR, 1.41;CI, 1.26 - 1.57;p < 0.001), longer non-school day screen time (OR, 1.27;CI, 1.16 - 1.40;p < 0.001), poor self-reported academic performance (OR, 1.41;CI, 1.24 - 1.60;p < 0.001), skipping breakfast (OR, 1.18;CI, 1.01 - 1.39;p = 0.041), earlier wake time on school day (OR, 0.84;CI, 0.71 - 0.98;p = 0.026), and higher after-school (OR, 1.03;CI, 1.02 - 1.04;p < 0.001) and physical activities (OR, 1.06;CL, 1.03 - 1.10;p < 0.001) were independently associated with sleepy pupils. Conclusions: To reduce adolescents’ sleepiness in the Kanto district of Japan, we recommend them to have adequate waking time, and to avoid late bedtime, breakfast skipping, excessive screen time, after-school activity, and physical activity. Further prospective studies are needed to confirm involvements of these recommended factors in sleepiness and both physical and mental health outcomes.

Establishment of Quick Testing Efficiency Evaluation Model and Analysis of Related Factors

Objective: “Rapid screening, targeted sampling, objective test” is an efficient test model. The factors affecting the efficiency include false screening rate, missing rate and rapid screening time. However, only missing rate and accuracy have been used as technical requirements to evaluate rapid screening method. In this study, efficiency was regarded as evaluation index of quick testing method. Method: The evaluation model of quick testing efficiency was established by comparing time of routine testing and quick testing. By simulation calculation, the effect factors such as rapid screening time, false screening rate, missing rate and defective rate were analyzed. Results: The calculation formula of efficiency was derived. Simulation results showed that the lower defective rate, the higher efficiency;the smaller missing rate, false screening rate, or screening time, the higher efficiency and the degree of improving efficiency is related to defective rate;sometimes, the screening time is the most important factor affecting the efficiency. In certain cases, if the false screening rate or missing rate is 50%, the efficiency can be increased by more than 10 times. Conclusions: Taken together, this study highlighted a role of efficiency which functioned as an index to evaluate rapid screening. Quick testing efficiency evaluation model can be used for the calculation efficiency, and can be used to analysis the relationship between efficiency and the influence factors, and can provide the theoretical foundation for rapid screening method development and evaluation.

Lifestyle behaviours of immigrant and Australian children:Evidence from a nationally representative sample

This study aimed to examine the prevalence of physical activity(PA),screen time(ST),sleep,and fruit and vegetable intake of children with low-and-middle-income countries(LMIC)parents,high-income countries(HIC),and Australian children,and whether these behaviours are associated with their immigrant status.Data for this study were from wave 7 of the Birth cohort(B cohort)of the Longitudinal Study of Australian Children.We used generalized estimating equations(GEE)to examine associations between health behaviours and immigrant status.The models were adjusted for a number of covariates.Children with LMIC parents had lower odds of meeting PA and sleep recommendations and higher odds ratio(OR)of meeting fruit and vegetable intake,and ST recommendations than Australian or HIC children.Children with LMIC parents had one-third the odds of meeting the PA recommendations(OR 0.39[95%CI 0.22–0.70])than Australian children.No significant differences were observed in lifestyle behaviours among children with HIC parents and Australian children.Lifestyle behaviours of children with LMIC parents differed from those of HIC and Australian children.However,children with HIC parents and Australian children had comparable lifestyle behaviours.Identified disparities in lifestyle behaviours among immigrant children can inform strategies to bring equity in Australian children's lifestyles.Our study underscores the importance of culturally appropriate targeted interventions to promote PA and sleep of children with LMIC parents.