Mapping the evidence for monitoring fluoride exposure in community prevention programmes for oral health using nail clippings and spot urine samples: a scoping review.

BACKGROUND: There is an increased interest in identifying practical and accurate biomarkers for fluoride exposure. Due to the narrow 'dose-gap' between the benefit of caries reduction and the risk of dental fluorosis, monitoring of fluoride exposure is vital when introducing any fluoridation programme for the prevention of dental caries. This scoping review aimed to ascertain the nature and extent of the available evidence on how spot urine and nail clippings are used to measure fluoride intake/exposure, by using a unique approach of mapping the studies according to population, setting, type of study design, methodology and analytical approach in community prevention programmes. METHODS: Multiple relevant databases were searched up to July 2021 for any study designs, including randomised controlled studies, quasi-experimental studies, surveys, retrospective and prospective cohort studies, case studies, phenomenological studies, and expert opinions. RESULTS: The search retrieved 9,222 studies of which 155 met the inclusion criteria. A high proportion of the studies (25.2%) originated from Latin America and the Caribbean continent subregion. However, per country, China recorded the highest number, followed by India and Mexico. The majority (62.6%) employed a cross-sectional study design, and 65.8% combined participants from different age groups. Of the included studies, 82.6% used spot urine samples as a biomarker for assessing fluoride intake/exposure. Water fluoride concentration was reported in 66.5% of the studies with 46.6% of all included studies reporting a water fluoride concentration of > 1.2 mg/L. The methods used in assessing oral hygiene and dietary intake were not reported in 72.3% and 71.0% of the included studies, respectively. Only 35.5% of the included studies assessed the relationship between fluoride exposure and excretion. CONCLUSIONS: This review revealed a large variability in the way in which spot urine samples and/or nail clippings are used to measure fluoride exposure in different settings and situations. Particularly, there are inconsistencies in the methodologies and the analytical approaches used in assessing fluoride exposure. Therefore, there is a need for more rigorous primary research studies using standardised approaches to determine the suitability of spot urine samples and nail clipping as biomarkers for monitoring fluoride exposure.

The school playground environment as a driver of primary school children's physical activity behaviour: A direct observation case study.

The school playground can promote PA for large numbers of children. This study identifies areas of the playground that children visited at break-times, the decisions according to gender and the influence of contextual and environmental variables on PA levels. The playground of a culturally diverse primary school was observed during morning break-times and lunchtimes. Counts of sedentary, LPA, and MVPA episodes, and the contexts in which they occurred were recorded using the system for observing play and leisure in youth (SOPLAY). Ball sports areas had higher counts of boys (mean ± SD; 9.9 ± 4.8) compared to girls (2.0 ± 3.5); areas promoting climbing and social interaction had higher counts of girls (7.9 ± 7.2) compared to boys (3.5 ± 2.9). The proportion of MVPA episodes during break-times was 34% ± 26%. Areas of the playground with organised activities had 2.70 (95%CI: 1.87 to 3.91) times higher MVPA counts than areas "not organised". Areas with "supervision" were associated with higher MVPA counts (1.34; 1.18 to 1.53) compared with "not supervised" areas. Organisation and supervision might influence PA choices and PA levels of children in the primary school playground. Further investigation is required to explore different playgrounds settings, and context and gender preferences.

Impact of obesity on central processing time rather than overall reaction time in young adult men.

BACKGROUND AND PURPOSE: The association between weight status with simple cognitive tasks such as reaction time (RT) may not be observed in young people as cognitive functioning development has reached its peak. In the present study, we aimed to examine the association between overall and central adiposity with overall and central processing of RT in a sample of young adult men with different weight status from Ardabil, Iran. METHODS: Eighty-six young males between June-July 2018 completed RT tests as well as premotor time (PMT) using surface electromyography changes in isometric contraction response to an audio stimulus. RESULTS: No significant associations were observed between RT and PMT and different body mass index categories (underweight, normal weight, overweight and obese), as well as fat mass and fat to skeletal muscle mass ratio quartiles (Q). However, participants with greater waist to height ratio (WHtR) had longer PMT (but not RT) than their peers with lower WHtR (Q3 than Q2 and Q1 groups; p < 0.05, d = 1.23). Participants in the skeletal muscle mass quartile Q2 tended to have longer RT than participants in Q3 in an adjusted comparison model (p = 0.05, d = 0.72). CONCLUSIONS: Although the association between weight status and RT might be elusive in young adults, our results show that higher central adiposity is negatively associated with PMT in young adults. Longitudinal studies are needed to explore the changes in obesity indexes and process speed in longer terms. LEVEL OF EVIDENCE: Level I, experimental study.

Association Between Weight Status and Executive Function in Young Adults.

Background and objectives: To explore the association between weight status and executive function in young adults. Materials and Methods: Ninety-seven young males (age 17-26 years) underwent adiposity and body composition measurements using body composition analyzer. Inhibitory control and working memory were measured using the Cambridge Neuropsychological Test Battery (CANTAB). Results: Multiple linear regression using both unadjusted and adjusted analyses revealed no association between adiposity and body composition variables with executive tasks, apart from a significant association between skeletal muscle mass (SMM) and mean reaction time on go trial (standardized B = -0.28; p = 0.02). Multivariate analysis of covariance (MANCOVA) revealed that underweight participants presented inferior working memory compared to their normal weight (p = 0.001) or overweight peers (p = 0.008). However, according to the percentage fat quartiles (Q) participants with the highest quartile (Q4) were inferior in inhibitory control than their peers with Q2 (p = 0.04), and participants with the lowest quartile (Q1) were inferior in working memory compared with their peers with Q2 (p = 0.01) or Q3 (p = 0.02). A worse inhibitory control was observed for participants with the highest fat/SMM (Q4) compared to participants in Q3 (p = 0.03), and in contrast worse working memory was observed for participants with the lowest fat/SMM (Q1) compared to participants in Q2 (p = 0.04) or Q3 (p = 0.009). Conclusions: Low adiposity is associated with worse working memory, whereas high adiposity is associated with worse inhibitory control. Therefore, our findings show that normal adiposity, but greater SMM may have a positive impact on executive function in young adults.

Association between Physical and Motor Fitness with Cognition in Children.

Background and objective: There is an increased interest in exploring the association between fitness components with cognitive development in children in recent years. One of the scopes is to find the best exercise prescription to enhance health and cognition. Most of the studies so far have focused on cardiorespiratory fitness with little evidence on other fitness components. The present study aimed to explore the association between physical fitness (PF) and motor fitness (MF) with cognitive performance in children. Methods: Two hundred and six schoolboys (11.0 ± 0.8 y) underwent a battery of tests to measure information processing speed (i.e., simple and choice reaction time) and inhibitory control (i.e., Simon task). PF components (i.e., flexibility, muscular strength, and endurance) and MF components (speed and agility) were measured. Results: Multiple linear regression analysis adjusted for potential confounders (i.e., age, socioeconomic status, %fat and physical activity) revealed no relationship between flexibility, speed, muscular strength, and endurance with either information processing tasks or inhibitory control tasks. However, a positive association was observed between agility with both congruent reaction time and incongruent reaction time. Conclusions: No relationship was observed between the underlying fitness components with either information processing or inhibitory control. However, an association was observed between agility with inhibitory control.

Association between physical fitness and cognitive performance in 19-24 year old males.

The present study aimed to explore the association between physical fitness (PF) and cognitive performance in a sample of 19-24 year old males. Two hundred and eleven young males (20.2±1.5 years) participated in the study. Cognitive functioning tasks including information processing speed and inhibitory control were measured in addition to PF and motor fitness components such as aerobic fitness, static strength, explosive strength, agility and speed. Regression analysis showed that after adjustment for potential confounders (e.g. age, socioeconomic status, adiposity and physical activity), aerobic fitness (represented by shorter time in the one-mile run) was positively associated with composite inhibitory control scores (standardized ß=0.17; p=0.04) and negatively associated with ∆ Simon (standardized ß= -0.21; p=0.04). Explosive strength was negatively associated with composite information processing scores (standardized ß= -0.24; P=0.01), and composite inhibitory control scores (standardized ß= -0.22; p=0.02). Speed of movement, agility and static strength were not associated with any of the cognitive tests. In conclusion, aerobic fitness and explosive strength but not speed, agility or static strength might be indicators of underlying cognitive functioning tasks in 19-24 year old males.

Diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years.

BACKGROUND: Adolescent overweight and obesity has increased globally, and can be associated with short- and long-term health consequences. Modifying known dietary and behavioural risk factors through behaviour changing interventions (BCI) may help to reduce childhood overweight and obesity. This is an update of a review published in 2009. OBJECTIVES: To assess the effects of diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years. SEARCH METHODS: We performed a systematic literature search in: CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS, and the trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of identified studies and systematic reviews. There were no language restrictions. The date of the last search was July 2016 for all databases. SELECTION CRITERIA: We selected randomised controlled trials (RCTs) of diet, physical activity and behavioural interventions for treating overweight or obesity in adolescents aged 12 to 17 years. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed risk of bias, evaluated the overall quality of the evidence using the GRADE instrument and extracted data following the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. We contacted trial authors for additional information. MAIN RESULTS: We included 44 completed RCTs (4781 participants) and 50 ongoing studies. The number of participants in each trial varied (10 to 521) as did the length of follow-up (6 to 24 months). Participants ages ranged from 12 to 17.5 years in all trials that reported mean age at baseline. Most of the trials used a multidisciplinary intervention with a combination of diet, physical activity and behavioural components. The content and duration of the intervention, its delivery and the comparators varied across trials. The studies contributing most information to outcomes of weight and body mass index (BMI) were from studies at a low risk of bias, but studies with a high risk of bias provided data on adverse events and quality of life.The mean difference (MD) of the change in BMI at the longest follow-up period in favour of BCI was -1.18 kg/m2 (95% confidence interval (CI) -1.67 to -0.69); 2774 participants; 28 trials; low quality evidence. BCI lowered the change in BMI z score by -0.13 units (95% CI -0.21 to -0.05); 2399 participants; 20 trials; low quality evidence. BCI lowered body weight by -3.67 kg (95% CI -5.21 to -2.13); 1993 participants; 20 trials; moderate quality evidence. The effect on weight measures persisted in trials with 18 to 24 months' follow-up for both BMI (MD -1.49 kg/m2 (95% CI -2.56 to -0.41); 760 participants; 6 trials and BMI z score MD -0.34 (95% CI -0.66 to -0.02); 602 participants; 5 trials).There were subgroup differences showing larger effects for both BMI and BMI z score in studies comparing interventions with no intervention/wait list control or usual care, compared with those testing concomitant interventions delivered to both the intervention and control group. There were no subgroup differences between interventions with and without parental involvement or by intervention type or setting (health care, community, school) or mode of delivery (individual versus group).The rate of adverse events in intervention and control groups was unclear with only five trials reporting harms, and of these, details were provided in only one (low quality evidence). None of the included studies reported on all-cause mortality, morbidity or socioeconomic effects.BCIs at the longest follow-up moderately improved adolescent's health-related quality of life (standardised mean difference 0.44 ((95% CI 0.09 to 0.79); P = 0.01; 972 participants; 7 trials; 8 comparisons; low quality of evidence) but not self-esteem.Trials were inconsistent in how they measured dietary intake, dietary behaviours, physical activity and behaviour. AUTHORS' CONCLUSIONS: We found low quality evidence that multidisciplinary interventions involving a combination of diet, physical activity and behavioural components reduce measures of BMI and moderate quality evidence that they reduce weight in overweight or obese adolescents, mainly when compared with no treatment or waiting list controls. Inconsistent results, risk of bias or indirectness of outcome measures used mean that the evidence should be interpreted with caution. We have identified a large number of ongoing trials (50) which we will include in future updates of this review.

Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years.

BACKGROUND: Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and long-term health consequences. This is an update of a Cochrane review published first in 2003, and updated previously in 2009. However, the update has now been split into six reviews addressing different childhood obesity treatments at different ages. OBJECTIVES: To assess the effects of diet, physical activity and behavioural interventions (behaviour-changing interventions) for the treatment of overweight or obese children aged 6 to 11 years. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of studies and systematic reviews. We did not apply any language restrictions. The date of the last search was July 2016 for all databases. SELECTION CRITERIA: We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions (behaviour-changing interventions) for treating overweight or obese children aged 6 to 11 years, with a minimum of six months' follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity. DATA COLLECTION AND ANALYSIS: Two review authors independently screened references, extracted data, assessed risk of bias, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information. We carried out meta-analyses according to the statistical guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS: We included 70 RCTs with a total of 8461 participants randomised to either the intervention or control groups. The number of participants per trial ranged from 16 to 686. Fifty-five trials compared a behaviour-changing intervention with no treatment/usual care control and 15 evaluated the effectiveness of adding an additional component to a behaviour-changing intervention. Sixty-four trials were parallel RCTs, and four were cluster RCTs. Sixty-four trials were multicomponent, two were diet only and four were physical activity only interventions. Ten trials had more than two arms. The overall quality of the evidence was low or very low and 62 trials had a high risk of bias for at least one criterion. Total duration of trials ranged from six months to three years. The median age of participants was 10 years old and the median BMI z score was 2.2.Primary analyses demonstrated that behaviour-changing interventions compared to no treatment/usual care control at longest follow-up reduced BMI, BMI z score and weight. Mean difference (MD) in BMI was -0.53 kg/m2 (95% confidence interval (CI) -0.82 to -0.24); P < 0.00001; 24 trials; 2785 participants; low-quality evidence. MD in BMI z score was -0.06 units (95% CI -0.10 to -0.02); P = 0.001; 37 trials; 4019 participants; low-quality evidence and MD in weight was -1.45 kg (95% CI -1.88 to -1.02); P < 0.00001; 17 trials; 1774 participants; low-quality evidence.Thirty-one trials reported on serious adverse events, with 29 trials reporting zero occurrences RR 0.57 (95% CI 0.17 to 1.93); P = 0.37; 4/2105 participants in the behaviour-changing intervention groups compared with 7/1991 participants in the comparator groups). Few trials reported health-related quality of life or behaviour change outcomes, and none of the analyses demonstrated a substantial difference in these outcomes between intervention and control. In two trials reporting on minutes per day of TV viewing, a small reduction of 6.6 minutes per day (95% CI -12.88 to -0.31), P = 0.04; 2 trials; 55 participants) was found in favour of the intervention. No trials reported on all-cause mortality, morbidity or socioeconomic effects, and few trials reported on participant views; none of which could be meta-analysed.As the meta-analyses revealed substantial heterogeneity, we conducted subgroup analyses to examine the impact of type of comparator, type of intervention, risk of attrition bias, setting, duration of post-intervention follow-up period, parental involvement and baseline BMI z score. No subgroup effects were shown for any of the subgroups on any of the outcomes. Some data indicated that a reduction in BMI immediately post-intervention was no longer evident at follow-up at less than six months, which has to be investigated in further trials. AUTHORS' CONCLUSIONS: Multi-component behaviour-changing interventions that incorporate diet, physical activity and behaviour change may be beneficial in achieving small, short-term reductions in BMI, BMI z score and weight in children aged 6 to 11 years. The evidence suggests a very low occurrence of adverse events. The quality of the evidence was low or very low. The heterogeneity observed across all outcomes was not explained by subgrouping. Further research is required of behaviour-changing interventions in lower income countries and in children from different ethnic groups; also on the impact of behaviour-changing interventions on health-related quality of life and comorbidities. The sustainability of reduction in BMI/BMI z score and weight is a key consideration and there is a need for longer-term follow-up and further research on the most appropriate forms of post-intervention maintenance in order to ensure intervention benefits are sustained over the longer term.

Diet, physical activity, and behavioural interventions for the treatment of overweight or obesity in preschool children up to the age of 6 years.

BACKGROUND: Child overweight and obesity has increased globally, and can be associated with short- and long-term health consequences. OBJECTIVES: To assess the effects of diet, physical activity, and behavioural interventions for the treatment of overweight or obesity in preschool children up to the age of 6 years. SEARCH METHODS: We performed a systematic literature search in the databases Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, and LILACS, as well as in the trial registers ClinicalTrials.gov and ICTRP Search Portal. We also checked references of identified trials and systematic reviews. We applied no language restrictions. The date of the last search was March 2015 for all databases. SELECTION CRITERIA: We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions for treating overweight or obesity in preschool children aged 0 to 6 years. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed risk of bias, evaluated the overall quality of the evidence using the GRADE instrument, and extracted data following the Cochrane Handbook for Systematic Reviews of Interventions. We contacted trial authors for additional information. MAIN RESULTS: We included 7 RCTs with a total of 923 participants: 529 randomised to an intervention and 394 to a comparator. The number of participants per trial ranged from 18 to 475. Six trials were parallel RCTs, and one was a cluster RCT. Two trials were three-arm trials, each comparing two interventions with a control group. The interventions and comparators in the trials varied. We categorised the comparisons into two groups: multicomponent interventions and dietary interventions. The overall quality of the evidence was low or very low, and six trials had a high risk of bias on individual 'Risk of bias' criteria. The children in the included trials were followed up for between six months and three years.In trials comparing a multicomponent intervention with usual care, enhanced usual care, or information control, we found a greater reduction in body mass index (BMI) z score in the intervention groups at the end of the intervention (6 to 12 months): mean difference (MD) -0.3 units (95% confidence interval (CI) -0.4 to -0.2); P < 0.00001; 210 participants; 4 trials; low-quality evidence, at 12 to 18 months' follow-up: MD -0.4 units (95% CI -0.6 to -0.2); P = 0.0001; 202 participants; 4 trials; low-quality evidence, and at 2 years' follow-up: MD -0.3 units (95% CI -0.4 to -0.1); 96 participants; 1 trial; low-quality evidence.One trial stated that no adverse events were reported; the other trials did not report on adverse events. Three trials reported health-related quality of life and found improvements in some, but not all, aspects. Other outcomes, such as behaviour change and parent-child relationship, were inconsistently measured.One three-arm trial of very low-quality evidence comparing two types of diet with control found that both the dairy-rich diet (BMI z score change MD -0.1 units (95% CI -0.11 to -0.09); P < 0.0001; 59 participants) and energy-restricted diet (BMI z score change MD -0.1 units (95% CI -0.11 to -0.09); P < 0.0001; 57 participants) resulted in greater reduction in BMI than the comparator at the end of the intervention period, but only the dairy-rich diet maintained this at 36 months' follow-up (BMI z score change in MD -0.7 units (95% CI -0.71 to -0.69); P < 0.0001; 52 participants). The energy-restricted diet had a worse BMI outcome than control at this follow-up (BMI z score change MD 0.1 units (95% CI 0.09 to 0.11); P < 0.0001; 47 participants). There was no substantial difference in mean daily energy expenditure between groups. Health-related quality of life, adverse effects, participant views, and parenting were not measured.No trial reported on all-cause mortality, morbidity, or socioeconomic effects.All results should be interpreted cautiously due to their low quality and heterogeneous interventions and comparators. AUTHORS' CONCLUSIONS: Muticomponent interventions appear to be an effective treatment option for overweight or obese preschool children up to the age of 6 years. However, the current evidence is limited, and most trials had a high risk of bias. Most trials did not measure adverse events. We have identified four ongoing trials that we will include in future updates of this review.The role of dietary interventions is more equivocal, with one trial suggesting that dairy interventions may be effective in the longer term, but not energy-restricted diets. This trial also had a high risk of bias.

Promoting physical activity with a school-based dance mat exergaming intervention: qualitative findings from a natural experiment.

BACKGROUND: Physical activity is critical to improving health and well-being in children. Quantitative studies have found a decline in activity in the transition from primary to secondary education. Exergames (active video games) might increase physical activity in adolescents. In January 2011 exergame dance mat systems were introduced in to all secondary schools across two local authority districts in the UK. We performed a quasi-experimental evaluation of a natural experiment using a mixed methods design. The quantitative findings from this work have been previously published. The aim of this linked qualitative study was to explore the implementation of the dance mat scheme and offer insights into its uptake as a physical activity intervention. METHODS: Embedded qualitative interviews at baseline and 12 month follow-up with purposively selected physical education teachers (n = 20) and 25 focus groups with a convenience sample of pupils (n = 120) from five intervention schools were conducted. Analysis was informed by sociology of translation approach. RESULTS: At baseline, participants (both teachers and pupils) reported different expectations about the dance mats and how they could be employed. Variation in use was seen at follow-up. In some settings they were frequently used to engage hard to reach groups of pupils. Overall, the dance mats were not used routinely to increase physical activity. However there were other unanticipated benefits to pupils such as improved reaction time, co-ordination and mathematic skills. The use of dance mats was limited in routine physical education classes because of contextual issues (school/government policy) technological failures (batteries/updates) and because of expectations about how and where they could be used. CONCLUSIONS: Our linked quantitative study (previously published) suggested that the dance mats were not particularly effective in increasing physical activity, but the qualitative results (reported here) show that the dance mats were not used routinely enough to show a significant effect on physical activity of the intervention. This research demonstrates the benefit of using mixed methods to evaluate complex physical activity interventions. Those planning any intervention for promoting physical activity in schools need to understand the distinction between physical activity and physical education.

The effect of dance mat exergaming systems on physical activity and health-related outcomes in secondary schools: results from a natural experiment.

BACKGROUND: Exergaming has been proposed as an innovative method for physical activity promotion. However, large effectiveness studies are rare. In January 2011, dance mat systems were introduced in secondary schools in two districts in England with the aim of promoting an innovative opportunity for physical activity. The aim of this natural experiment was to examine the effect of introducing the dance mat exergaming systems on physical activity and health-related outcomes in 11-13 year old students using a non-randomised controlled design and mixed methods. METHODS: Participants were recruited from five schools in intervention districts (n = 280) and two schools in neighbouring control districts (n = 217). Data on physical activity (accelerometer), anthropometrics (weight, BMI and percentage of body fat), aerobic fitness (20-m multistage shuttle run test), health-related quality of life (Kidscreen questionnaire), self-efficacy (children's physical activity self-efficacy survey), school attendance, focus groups with children and interviews with teachers were collected at baseline and approximately 12 months follow-up. RESULTS: There was a negative intervention effect on total physical activity (-65.4 cpm CI: -12.6 to -4.7), and light and sedentary physical activity when represented as a percentage of wear time (Light: -2.3% CI: -4.5 to 0.2; Sedentary: 3.3% CI: 0.7 to 5.9). However, compliance with accelerometers at follow-up was poor. There was a significant positive intervention effect on weight (-1.7 kg, 95% CI: -2.9 to -0.4), BMI (-0.9 kg/m2, 95% CI: -1.3 to -0.4) and percentage of body fat (-2.2%, 95% CI: -4.2 to -0.2). There was also evidence of improvement in some health-related quality of life parameters: psychological well-being (2.5, 95% CI: 0.1 to 4.8) and autonomy and parent relation (4.2, 95% CI: 1.4 to 7.0). CONCLUSIONS: The implementation of a dance mat exergaming scheme was associated with improvement in anthropometric measurements and parameters of health-related quality of life. However, the mechanisms of these benefits are unclear as there was insufficient data from physical activity to draw robust conclusions. Qualitative findings suggest that there was declining support for the initiative over time, meaning that potential benefits may not have been achieved.

Early Years Physical Activity and Motor Skills Intervention-A Feasibility Study to Evaluate an Existing Training Programme for Early Years Educators.

A lack of fundamental motor skills (FMS) in the early years can lead to lower engagement with physical activity (PA), and track into adulthood. This study aimed to test the feasibility of an existing intervention for Early Years Educators ("Educators") designed to increase knowledge, confidence and the ability to increase PA and FMS of children in a deprived area of England. Non-randomised design with wait-list control. Sixty-seven settings in Middlesbrough, North East England were invited. Recruitment target: 10 settings, 2 Educators per setting, four children per Educator. INTERVENTION: one-day training course "Physical Literacy in the Early Years", an age-appropriate theoretical and practical training course to support the development of physical literacy. PRIMARY OUTCOMES: recruitment, retention, acceptability of intervention and outcome measures. SECONDARY OUTCOMES: change in Educators' knowledge, intentions and behaviour, and change in children's BMI z-score, PA and FMS. Eight settings were recruited; all Intervention Educators completed the training. Six settings participated at follow-up (four Intervention, two Control). The target for Educator recruitment was met (two per setting, total n = 16). Questionnaires were completed by 80% of Intervention Educators at baseline, 20% at follow-up. Control Educators completed zero questionnaires. No Educators took part in a process evaluation interview. Forty-eight children participated at baseline, 28 at follow-up. The intervention was deemed acceptable. The recruitment, retention and acceptability of measurements were insufficient to recommend proceeding. Additional qualitative work is needed to understand and surmount the challenges posed by the implementation of the trial.

App-based oral health promotion interventions on modifiable risk factors associated with early childhood caries: A systematic review.

Background: Early childhood caries (ECC) is a preventable chronic disease. Parents' knowledge and attitudes toward oral healthcare have been associated with higher caries experience in their children. Mobile apps within the context of mHealth interventions are a potential tool for raising awareness and informing parents about their children's oral health. Objectives: The aim of this systematic review was to examine the effectiveness of mobile health apps, targeted at parents and caregivers, for the prevention of ECC. Data sources: A systematic search was carried out in five scientific databases; Embase, CINAHL, MEDLINE, PsycINFO and Web of Science. Study selection and data extraction: Original studies, delivering oral health interventions to parents of children <6 years via smartphones, were included. Both quantitative and qualitative findings from the included studies were extracted. Synthesis: A convergent segregated approach was used to integrate the quantitative and qualitative evidence, followed by side-by-side display and narrative synthesis. Results: Out of 5,953 retrieved articles, five met the inclusion criteria and were included in the review. Three articles reported quantitative findings, while two reported both quantitative and qualitative findings. Four studies reported that a mobile app can be an effective tool to improve the oral health knowledge of parents/caregivers, aiding them in incorporating good oral health habits into their children's daily routines. Conclusion: This review demonstrated that oral health promotion programs delivered through mobile apps to parents could be effective in improving child oral health awareness among parents. There is a need for more high-quality studies with a large number of participants to find out which features of mHealth interventions with parents could effectively be employed to reduce the prevalence of ECC. Further studies and apps should be developed based on evidence-based behaviour change techniques and incorporate features such as gamification to increase the effectiveness and engagement of the target population. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?], identifier [CRD42021268331].

A socio-ecological examination of the primary school playground: Primary school pupil and staff perceived barriers and facilitators to a physically active playground during break and lunch-times.

Using Brofenbrenner's socio-ecological model as a conceptual framework, the objective of this study was to determine playground users (primary school staff and pupils) perceptions of the barriers and facilitators to a physically active school playground at an intra-personal (individual), inter-personal (social), environmental and policy level. Results from a series of qualitative interactions with children (n = 65) from years five and six (9 to 11 years old), and structured interviews with adult teachers (n = 11) revealed key differences in the child and adult perceptions of the playground and the purpose of break-times. A number of inter-related environmental boundaries and school policies were identified as restrictive to children's explorations and activity levels during 'free play' periods, which centred on resource availability, accessibility and health and safety. Further, traditional playground hierarchies act to promote and prevent physical activity engagement for different groups (e.g. gender and age). Finally, differences between the adult and child perception of the primary school playground were observed. Playground physical activity, during break-times appears to be affected by a number of variables at each level of the socio-ecological model. This study provides an opportunity for primary schools to reflect on primary school playground strategies and practices that are implemented at each level of the socio-ecological model to encourage a more effective use of the playground during school break-times.

The Relationship between Fluoride Exposure and Cognitive Outcomes from Gestation to Adulthood-A Systematic Review.

Chronic exposure to high levels of fluoride may cause health concerns, including in cognitive function. This study reviewed the evidence on the association between fluoride exposure and cognitive outcomes in children from gestation up to 18 years old. A literature search was conducted for studies on pregnant women and children below 18, exposed to any source of fluoride, and assessed with a validated cognitive tool. The data were analyzed using a systematic narrative synthesis approach and by subgroup: study design, age of participants, levels of fluoride exposure and methodological quality. Our search retrieved 15,072 articles, of which 46 met the inclusion criteria. Only 6 of the studies had a longitudinal design; the remainder were cross-sectional. The levels of fluoride exposure were ≥2 mg/L in 27 studies and <2 mg/L in 13 studies; 6 studies did not report levels of fluoride exposure. Only 1 of 5 studies graded as excellent quality showed a negative association between fluoride exposure and cognitive outcomes, whereas 30 of 34 poor and fair quality studies reported a negative association. The overall evidence from this review suggests that high fluoride exposure might be associated with negative cognitive outcomes in children. However, more longitudinal studies with high methodological quality are needed on this topic.

The effectiveness of e-health interventions for the treatment of overweight or obesity in children and adolescents: A systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to examine the effectiveness of e-health interventions for the treatment of children and adolescents with overweight or obesity. Databases were searched up to November 2020. Studies were randomized controlled trials where interventions were delivered via e-health (e.g., computers, tablets, and smartphones, but not phone calls). Studies should target the treatment of overweight or obesity in children or their agent of changes and report body mass index (BMI) or BMI z-score. A meta-analysis using a random-effects model was conducted. Nineteen studies met the inclusion criteria, and 60% were of high quality. The narrative review revealed variation in behavior change strategies and modes of delivery. The pooled mean reduction in BMI or BMI z-score showed evidence for a nonzero effect (standardized mean difference = -0.31, 95% confidence interval -0.49 to -0.13), with moderately high heterogeneity between studies (I2 = 74%, p < 0.001). Subgroup analysis revealed high heterogeneity in studies with a high or unclear risk of bias. E-health interventions can be effective in treating children and adolescents with overweight and obesity and should be considered by practitioners and policymakers. However, an understanding of the most effective and acceptable intervention components, long-term benefits, and sustainability should be further studied.

Effect of Physical Exercise and Genetic Background on Glucose Homeostasis and Liver/Muscle Proteomes in Mice.

We compared the parameters related to glucose homeostasis, and liver and muscle proteomes in fluorosis-susceptible (A/J; S) and fluorosis-resistant (129P3/J; R) mice in response to fluoride (F) exposure and exercise. Ninety male mice (45 R-mice and 45 S-mice) were randomized into three groups: (SI; RI) No-F, No-Exercise, (SII; RII) 50 ppm F, No-Exercise, (SIII; RIII) 50 ppm F, Exercise. Overall, mean F concentrations in the plasma and femur were significantly higher in R-mice compared with S-mice. In R-mice, exercise resulted in an increase in F accumulation in the femur. In S-mice, the mean plasma glucose level was significantly higher in Group II compared with Groups I and III. There was an increase in liver proteins involved in energy flux and antioxidant enzymes in non-exercise groups (I, II) of S-mice in comparison with the corresponding groups of R-mice. The results also showed a decrease in muscle protein expression in Group I S-mice compared with their R-mice counterparts. In conclusion, the findings suggest an increased state of oxidative stress in fluorosis-susceptible mice that might be exacerbated by the treatment with F. In addition, fluorosis-susceptible mice have plasma glucose levels higher than fluorosis-resistant mice on exposure to F, and this is not affected by exercise.

The Association between Physical Activity, Motor Skills and School Readiness in 4-5-Year-Old Children in the Northeast of England.

The benefits of being physically active, possessing good motor skills and being school-ready are well documented in early years. Nevertheless, the association between physical activity and motor skills with school readiness remains unknown. Therefore, the aim of this cross-sectional study was to explore the relationship between these variables. We collected data on 326 four to five-year-old children from the northeast of England. Children's PA (ActiGraph GT1M accelerometers), motor skills (MABC-2 and the locomotor section of the TGMD-2) and school readiness (EYFSP) were measured, and associations between these variables were examined. This study found that, on average, children engaged in more MVPA (99.6 min/day) and less sedentary behaviour (261 min/day) than documented in previous research. Motor-skill scores were consistent with existing literature in early years. A higher percentage of children in the sample (79.6%) achieved school readiness than the average for England. Regression analyses found that motor-skill variables and sedentary behaviour were significantly predictive of school readiness, whereas physical activity was not. Motor skills and sedentary behaviour significantly predict school readiness. Therefore, promoting motor skills and developmentally appropriate sedentary behaviour activities may increase the number of children achieving school readiness.

Pharmacokinetics of fluoride in human adults: The effect of exercise.

The literature is sparse in terms of the effect of exercise on the pharmacokinetics of fluoride (F) in humans. In a 4-treatment repeated measures cross-over study, we investigated F pharmacokinetics following no exercise (control) and three exercise intensity conditions (light, moderate and vigorous) in healthy adults. At a pre-experimental session, 8 participants (18-30y) residing in a non-fluoridated-area, underwent a VO2 max test to guide the three exercise intensities for the experimental sessions. Participants were on a F-free regime one week before and throughout the four experimental weeks. We measured urinary F excretion (UFE), maximum plasma concentration (Cmax), lag time of Cmax (Tmax), and Area Under the Curve (AUC) for plasma F concentration against time, following F ingestion then no, light, moderate and vigorous exercise. Results showed no statistically significant difference in Tmax among all sessions; whereas Cmax for moderate exercise (226.2 ng/ml) was significantly higher than for no (27.0 ng/ml; p < 0.001), light (105.6 ng/ml; p = 0.016) and vigorous (94.2 ng/ml; p = 0.008) exercise. Mean AUC over 0-90 min following F ingestion was also significantly higher in moderate exercise than for no (p < 0.001), light (p = 0.004) and vigorous (p = 0.001) exercise. Mean UFE over 0-14h was 638.8, 718.7, 574.6 and 450.5  µg for no, light, moderate and vigorous exercise, with no statistically significant differences among different sessions. In conclusion, this human experimental study suggests that moderate exercise may increase the fraction of F absorbed systemically which is therefore available to produce a biological effect. Future studies should be conducted with larger samples, different age groups and using different F doses.

Process Evaluation of Project FFAB (Fun Fast Activity Blasts): A Multi-Activity School-Based High-Intensity Interval Training Intervention.

Introduction: Over the last decade, research into the impact of school-based high-intensity interval training (HIIT) on young people's health has markedly increased. Despite this, most authors have focused on the outcomes of their intervention, rather than the process of how the study was conducted. The aim of our study, therefore, was to conduct a mixed methods process evaluation of Project FFAB (Fun Fast Activity Blasts), a school-based HIIT intervention for adolescents. The objectives were to explore study recruitment, reach, intervention dose, fidelity, participants' experiences, context, and future implementation. Methods: Recruitment was assessed by comparing the number of students who received study information, to those who provided consent. Reach was described as the number of participants who completed the intervention. Dose was reported via the number of HIIT sessions delivered, total exercise time commitment, HIIT exercise time, and session attendance. Post-intervention focus groups were conducted with intervention participants (n = 33; aged 14.1 ± 0.3 years; mean ± standard deviation). These discussions explored aspects of intervention fidelity (extent that the intervention was delivered as intended); participants' experiences of the HIIT sessions; context (exploration of the nuances of school-based HIIT); and ideas for future implementation. Results: Recruitment, reach, and dose data indicate that Project FFAB was largely delivered as planned. Focus group data identified a mismatch between perceived vs. prescribed work: rest ratio for the multi-activity HIIT drills. Generally, the HIIT drills were well-received; participants often reported they were fun to complete, and the use of heart rate monitors was helpful for interpreting exercise intensity. Some participants stated that greater variety in the HIIT drills would be preferable. The timing and structure of the HIIT sessions that took place outside of physical education lessons received mixed responses. Conclusion: Collectively, our study supports the use of school-based HIIT and provides valuable insights into how such interventions can be implemented. Project FFAB could be modified to account for individuals' preferences on when the exercise sessions took place. In addition, a wider range of activities could be included, and the prescribed work: rest ratio of the HIIT drills could be better communicated.