Association of childcare arrangement with overweight and obesity in preschool-aged children: a narrative review of literature.

The time children spend in childcare overlaps with daily meals and opportunities to be active. Thus these environments have the opportunity to promote-or hinder-healthy weight gain among children who attend them. The purpose of this narrative review was to compile findings from studies examining childcare type and weight outcomes among preschool-age children. A literature search was conducted using PubMed, PsychInfo and ERIC. Inclusion criteria were infant- to 5-year-old children exposed to any type of childcare with a cross-sectional or longitudinal weight outcome. Among 385 studies screened, 18 were included. For comparison across studies, type of childcare was categorized as: childcare center, Head Start, nanny/babysitter, non-relative care/family childcare home and relative care. Four studies found no association with childcare type and obesity, and 10 studies reported mixed results by type of care or subpopulation analyses. Two studies found an overall positive association, and two reported an inverse association. There were differences in direction of associations and findings by type of care arrangement. For Head Start, three of eight studies demonstrated a negative relationship with obesity; none demonstrated a positive association. No other childcare type demonstrated this inverse association. Informal types of care (relative and non-relative care in a home) were positively associated with child obesity in 3 of 10 studies. This association was less commonly reported among formal childcare centers (2 of 15 studies). The majority of studies, however, reported mixed findings or no association by childcare type. Results suggested no consistent evidence for a relationship between childcare and obesity risk, except Head Start. This review exposed the need for a consistent definition of childcare type and the exploration of unmeasured confounders, such as the nutrition and physical activity environment of childcare settings, to understand how they contribute to or protect against the development of overweight/obesity among children.

A comparison of parent and childcare provider's attitudes and perceptions about preschoolers' physical activity and outdoor time.

BACKGROUND: Young children depend on adult caregivers to provide opportunities for physical activity. Research has focused on barriers and facilitators to children's physical activity while in childcare, but parental influences remain largely unknown. This study examines parent's attitudes about preschoolers' physical activity and outdoor time, compares them with those of childcare providers and determines the association between parental attitudes and preschoolers' measured activity. METHODS: Parents and childcare providers from 30 childcare centres were surveyed regarding attitudes towards preschoolers' physical activity and outdoor time. Children's moderate-to-vigorous physical activity was determined by using 24-h accelerometry. Parent and childcare providers' responses were compared. Mixed-effect linear regression examined moderate-to-vigorous physical activity and sedentary time as outcomes with parental attitudes as predictors, family demographics as covariates and centre as a random effect. RESULTS: Three hundred eighty-eight parents and 151 childcare providers participated. On average, children were 4.3 (0.7) years old. Parents and childcare providers both considered daily physical activity important for preschoolers, but providers rated the importance of daily outdoor time higher on a 10-point scale (8.9 vs. 7.6, P < 0.001). More parents than providers believed that children would get sick by playing outside in the cold (25 vs. 11%, P < 0.05). Parents were more comfortable with their child playing outside at childcare compared with outside at home (8.9 vs. 6.9, P < 0.001). Lower income parents felt less comfortable than higher income parents with their child playing outside either near home or at childcare. Neither home nor total child activity levels were associated with most parental attitudes queried. CONCLUSIONS: While parents and childcare providers value daily physical activity for children, some parents expressed discomfort about their young children engaging in outdoor play, especially around home and in cold weather. These findings highlight the importance of childcare-based interventions to promote preschoolers' physical activity and outdoor play.

Galactic cosmic radiation exposure of pregnant flight crewmembers.

BACKGROUND: In recommending the occupational dose limit of ionizing radiation for pregnant women, the International Commission on Radiological Protection apparently assumes that the dose to the conceptus from ionizing radiation exposure is about half the dose at the surface of the mother's abdomen. METHODS: To test this assumption with respect to galactic cosmic radiation, calculations were made using FAA computer program CARI-LF2, which calculates equivalent doses from galactic cosmic rays at selected depths in soft tissue at any specified location in the atmosphere or on user-entered flight profiles. RESULTS: The calculations showed that the equivalent dose of galactic radiation was almost the same at all depths. CONCLUSIONS: Thus the assumption of considerable shielding of the conceptus being provided by the woman's body is not correct with respect to galactic cosmic radiation, the principal type of radiation to which aircrews are exposed. The effective dose as calculated with FAA computer program CARI-5E, which calculates effective dose in an anthropomorphic phantom at any specified location in the atmosphere or on user-entered flight profiles, was found to be a good estimate of the equivalent dose at the depth of the conceptus.

The impact of variable tint optics (Transitions Gray) on vision-related quality of life in normal volunteers: a randomized clinical comparison in a warm climate.

PURPOSE: A randomized crossover comparison of Transitions Gray variable tint optics (VTO) vs clear and fixed-tint lenses was undertaken to evaluate the impact of VTO on vision-related quality of life (VRQOL) in a warm climate. METHODS: Fifty-nine patients were randomized to one of four lens crossover groups: Transitions-->clear; clear-->Transitions; Transitions-->fixed-tint; fixed-tint-->Transitions. Each lens was worn for 30 days. VRQOL was measured using a newly developed and validated questionnaire instrument-the Transitions VRQOL. Changes in visual acuity were assessed by functional exam. RESULTS: Overall, Transitions was associated with the greatest improvement in VRQOL relative to clear and fixed-tint lenses without compromise in acuity. Transitions proved statistically superior to clear lenses, most notably in vision comfort both indoors and outdoors. Seventy percent of all patients selected Transitions as their primary lens at the end of the study. CONCLUSIONS: Transitions brand VTO offer patients significant and clinically meaningful improvements in VRQOL superior to clear lenses. VRQOL assessments provide clinicians with valuable information above and beyond visual acuity to help optimize lens product selection and enhance patient satisfaction.

The perceived availability, quality, and cost of long-term care services in America.

This study gathered primary data on the patterns and predictors of home-based, community-based, and institutional long-term care services for older adults residing in the United States. A stratified random sample of policymakers and agency representatives (n = 153; response rate 67.1%) completed a comprehensive mail survey to provide detailed information on the perceived availability, quality, and costs of long-term care services in their community settings. Descriptive analyses revealed that there are significant differences in perceived access, use, quality, and costs of care by service type and agency affiliation. The results present an interesting dilemma for policymakers as many of the services found to be most widely available and of the highest quality were considered too costly. Implications for public policy and suggestions for further research are highlighted.

Prospects for childhood immunization registries in public health assessment and assurance: initial observations from the All Kids Count initiative projects.

This article offers an overview of selected evaluation findings from the initial implementation year of the Robert Wood Johnson Foundation's All Kids Count childhood immunization initiative in which demonstration projects were funded to develop community-based immunization registry and follow-up systems in 14 sites throughout the United States. The basic components of these systems, the process through which these registries were developed, efforts to secure the participation of private sector providers, the prospects for system success at the community level, and the potential for these immunization programs to influence other aspects of primary health care for children are addressed.