How to get children moving? The effectiveness of school-based interventions promoting physical activity in children and adolescents - A systematic review and meta-analysis of randomized controlled- and controlled studies.

This systematic review and meta-analysis summarizes the effectiveness of school-based physical activity (PA) interventions on children's and adolescents' PA. As no robust empirical evidence exists regarding what seems to characterize the school-based PA interventions that are most effective, we further aimed to map key factors of particular importance when trying to increase PA in early stages of life through school-based strategies. Intervention effects were calculated as standardized between-group (i.e., intervention vs. control) mean differences (SMD) in PA from baseline to follow-up. In total, 189 publications were included. Few studies (7%) were of high quality. Our results demonstrate that school-based interventions only have a small positive effect on children's and adolescents' PA levels. Compared to the effect observed during total day (SMD = 0.27, p < 0.001), a slightly larger effect was observed during school hours (SMD = 0.37, p < 0.001), while no intervention effect was observed during leisure time (SMD = 0.07, p = 0.20). There was a tendency for interventions to be more effective if theoretical frameworks for behavior changes were used in the design phase. The largest effect size was observed when experts from outside school delivered the program (SMD = 0.56, p = 0.01), but training of personnel involved in delivery was the determining factor for program effectiveness as no effect was observed if interventions were delivered primarily by schools' untrained staff (SMD = 0.06, p = 0.61). Intervention effects where larger if parents were involved in the intervention program (parents involved: SMD = 0.35, p < 0.001; parents not involved: SMD = 0.16, p = 0.02). Small positive intervention effects were sustained at long-term follow-up after end of intervention. Overall, the certainty of the evidence of the findings is rated as low.

Prevalence and outcomes of pregnancies in women with HIV over a 20-year period.

OBJECTIVE: To evaluate time trends in pregnancies and pregnancy outcomes among women with HIV in Europe. DESIGN: European multicentre prospective cohort study. METHODS: EuroSIDA has collected annual cross-sectional audits of pregnancies between 1996 and 2015. Pregnancy data were extracted and described. Odds of pregnancy were modelled, adjusting for potential confounders using logistic regression with generalized estimating equations. RESULTS: Of 5535 women aged 16 to <50 years, 4217 (76.2%) had pregnancy information available, and 912 (21.6%) reported 1315 pregnancies. The proportions with at least one pregnancy were 28.1% (321/1143) in East, 24.5% (146/596) in North, 19.8% (140/706) in West/Central, 19.3% (110/569) in Central East and 16.2% (195/1203) in South Europe. Overall 319 pregnancies (24.3%) occurred in 1996-2002, 576 (43.8%) in 2003-2009 and 420 (31.9%) in 2010-2015. After adjustment, the odds of pregnancy were lower in 1996-2002, in South, Central East and East compared to West/Central Europe, in older women, those with low CD4+ cell count or with prior AIDS, and higher in those with a previous pregnancy or who were hepatitis C virus positive.Outcomes were reported for 999 pregnancies in 1996-2014, with 690 live births (69.1%), seven stillbirths (0.7%), 103 spontaneous (10.3%) and 199 medical abortions (19.9%). CONCLUSIONS: Around 20% of women in EuroSIDA reported a pregnancy, with most pregnancies after 2002, when more effective antiretroviral therapy became available. Substantial differences were seen between European regions. Further surveillance of pregnancies and outcomes among women living with HIV is warranted to ensure equal access to care.