Nonpharmacological Interventions to Lengthen Sleep Duration in Healthy Children: A Systematic Review and Meta-analysis.

Importance: Adequate sleep duration is necessary for many aspects of child health, development, and well-being, yet sleep durations for children are declining, and effective strategies to increase sleep in healthy children remain to be elucidated. Objective: To determine whether nonpharmaceutical interventions to improve sleep duration in healthy children are effective and to identify the key components of these interventions. Data Sources: CENTRAL, MEDLINE, Embase, PsycINFO, Web of Science Core collection, ClinicalTrials.gov, and WHO trials databases were searched from inception to November 15, 2021. Study Selection: Randomized clinical trials of interventions to improve sleep duration in healthy children were independently screened by 2 researchers. A total of 28 478 studies were identified. Data Extraction and Synthesis: Data were processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guideline. Random-effects meta-analytic models were used to estimate pooled effect sizes. Main Outcomes and Measures: Difference in sleep duration, measured in minutes. Results: A total of 13 539 child participants from 45 randomized clinical trials were included. Of these, 6897 (50.9%) were in the intervention group and 6642 (49.1%) in the control group, and the mean age ranged from 18 months to 19 years. Pooled results indicate that sleep interventions were associated with 10.5 minutes (95% CI, 5.6-15.4) longer nocturnal sleep duration. There was substantial variation between trials. Sources of variation that were not associated with the study effect size included age group, whether the population was identified as having a sleep problem or being at a socioeconomic disadvantage (eg, coming from a low-income family or area), method of assessment of sleep duration (objective vs subjective), location of intervention delivery (home vs school), whether interventions were delivered in person or used parental involvement, whether behavioral theory was used, environmental change, or had greater or lower intensity. Interventions that included earlier bedtimes were associated with a 47-minute sleep extension (95% CI, 18.9-75.0; 3 trials) compared with remaining studies (7.4 minutes; 95% CI, 2.9-11.8; 42 trials) (P = .006 for group difference). Trials of shorter duration (6 months or less) had larger effects. Conclusions and Relevance: Interventions focused on earlier bedtimes may offer a simple, pragmatic, effective way to meaningfully increase sleep duration that could have important benefits for child health.

Facilitators and barriers to COVID-19 vaccination uptake among ethnic minorities: A qualitative study in primary care.

INTRODUCTION: COVID-19 vaccination effectively reduces severe disease and death from COVID-19. However, both vaccine uptake and intention to vaccinate differ amongst population groups. Vaccine hesitancy is highest amongst specific ethnic minority groups. There is very limited understanding of the barriers and facilitators to COVID-19 vaccine uptake in Black and South Asian ethnicities. Therefore, we aimed to explore COVID-19 vaccination hesitancy in primary care patients from South Asian (Bangladeshi/Pakistani) and Black or Black British/African/Caribbean/Mixed ethnicities. METHODS: Patients from the above ethnicities were recruited using convenience sampling in four London general practices. Telephone interviews were conducted, using an interpreter if necessary, covering questions on the degree of vaccine hesitancy, barriers and potential facilitators, and decision-making. Interviews were transcribed verbatim and thematically analysed. Data collection and analysis occurred concurrently with the iterative development of the topic guide and coding framework. Key themes were conceptualised through discussion with the wider team. RESULTS: Of thirty-eight interviews, 55% (21) of these were in Black or Black British/African/Caribbean/Mixed ethnicities, 32% (12) in Asian / British Asian and 13% (5) in mixed Black and White ethnicities. Key themes included concerns about the speed of vaccine roll-out and potential impacts on health, mistrust of official information, and exposure to misinformation. In addition, exposure to negative messages linked to vaccination appears to outweigh positive messages received. Facilitators included the opportunity to discuss concerns with a healthcare professional, utilising social influences via communities and highlighting incentives. CONCLUSION: COVID-19 has disproportionately impacted ethnic minority groups. Vaccination is an effective strategy for mitigating risk. We have demonstrated factors contributing to vaccine reluctance, hesitancy and refusal and highlighted levers for change.

Game of snakes and ladders: barriers and enablers for aspiring women leaders in healthcare.

BACKGROUND: Women comprise over three-quarters of the National Health Service workforce, yet remain underrepresented in senior medical grades, on managerial boards and in senior leadership roles. This is attributed to a wide range of internalised, interpersonal and structural factors. OBJECTIVE: To explore the experiences of aspiring clinical leaders working with senior female leader colleagues and the perceived impact of these interactions on professional development and future aspirations. METHODS: Healthcare professionals, self-identifying as female aspiring clinical leaders, were recruited via email and social media to participate in a focus group or semistructured interview. Interviews were recorded and reviewed and the key enablers, barriers and actions to facilitate opportunities for female clinical leaders in the workplace identified. RESULTS: Participants (n=11) had varied experiences of working with senior female colleagues. Reported barriers from existing leaders included 'Queen Bee' phenomenon and reticence to talk about barriers faced. Enablers included 'nudging' towards opportunities and women leaders sharing challenges they had faced and overcome. CONCLUSION: Supporting women to achieve their leadership potential requires individualised support, role modelling and mentorship, and organisational change to tackle workplace biases and microaggressions. These are crucial to ensuring gender balance across leadership in health and social care.

Policy and pregnancy: the impact on working families in the NHS.

The NHS is the largest employer in the UK, with 77% of its workforce made up by women. The UK Health and Safety Executive clearly states that 'risks to a pregnant woman and her baby must be minimised by employers'. Recent studies demonstrate that shift work, uncontrolled working hours and night shifts increase risks to the developing fetus; however, this evidence has not been taken up by the NHS. Our analysis explores women's experience of conception and pregnancy in the NHS. The thematic analysis from the survey results identified several key areas: feeling unable to speak up to their trainers and programme directors; unable to control their work patterns; conflicting and inconsistent guidance; and being caught between occupational health and the trust or deaneries. This subsequently leads to greater stress, longer unnecessary exposure to occupational hazards, and complications in pregnancy and career outcomes.

Gender balance in an unprecedented time.

As the NHS responds to the ongoing COVID-19 pandemic, the strain is being felt across the entire workforce. Both direct effects of COVID-19 and the response to the crisis are unearthing a number of societal inequalities, not least, those relating to gender. The fact that women play a disproportionate role in frontline health and social care roles and perform the majority of caregiving responsibilities is more exposed than ever before. Concurrently, the underrepresentation of women in senior clinical and leadership roles is being brought into stark relief. Redressing gender imbalance across health and social care is vital if we are to translate experience and learnings from our frontline workforce into our national preparedness and response effort. It is also important as we continue to promote wider gender and health equity goals within society. While we focus on responding to the current situation, an opportunity arises for greater value to be assigned to frontline health and caregiver roles. We must raise the profile of women leaders who are taking a stand during this crisis and use this opportunity to ensure that our future health and social care leadership reflects the wider workforce and the population.

Women speakers in healthcare: speaking up for balanced gender representation.

Women comprise the majority of the UK's health and social care workforce, yet remain underrepresented in senior leadership positions. This is reflected in the balance of speakers, chairs and panels convened for healthcare conferences, with disproportionate gender balance. Accumulating evidence suggests that greater diversity across multiple characteristics, including gender, improves staff experience, organisational performance and patient outcomes. Conferences provide opportunities for inclusivity and new ideas only when attendees feel empowered to speak up. If we are to increase diversity of our current leadership, aspiring leaders need to see relatable role models. This article explores the issue of 'manels' and male-dominated speaker lineups, offering practical suggestions for conference organisers, women speakers and male allies to address the issue. We also outline the background to 'Women Speakers in Healthcare': a grassroots initiative founded by a team of aspiring leaders, which aims to achieve balanced gender representation at all healthcare conferences and events.

Interventions for preventing obesity in children.

BACKGROUND: Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review. OBJECTIVES: To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers. SELECTION CRITERIA: Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI. MAIN RESULTS: We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update. AUTHORS' CONCLUSIONS: Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.

Sugar and artificially sweetened beverage consumption and adiposity changes: National longitudinal study.

BACKGROUND: In response to increasing policy action and public concern about the negative health effects of sugar-sweetened beverages (SSBs), there is increased promotion of artificially sweetened beverages (ASBs). These have been linked with obesity and diabetes in recent experimental work. This study examined associations between SSB and ASB consumption and changes in adiposity in a nationally representative sample of UK children. METHODS: We conducted a longitudinal study of 13,170 children aged 7-11 years in the UK Millennium Cohort Study, collected in 2008 and 2012. Logistic regression was used to assess socio-demographic and behavioural correlates of weekly SSB and ASB consumption at 11 years. Linear regression examined associations between SSB/ASB consumption and changes in adiposity measures between 7 and 11 years. RESULTS: Boys were more likely to consume SSBs weekly (62.3% v 59.1%) than girls at age 11 years. South Asian children were more likely to consume SSBs weekly (78.8% v 58.4%) but less likely to consume ASBsweekly (51.7% v 66.3%) than White children. Daily SSB consumption was associated with increases in percentage body fat between ages 7 and 11 (+0.57%, 95% confidence intervals 0.30;0.83). Daily ASB consumption was associated with increased percentage body fat at age 11 (+1.18 kg/m(2), 0.81;1.54) and greater increases between ages 7 and 11 (+0.35 kg/m(2), 0.09;0.61). CONCLUSION: Consumption of SSBs and ASBs was associated with BMI and percentage body fat increases in UK children. Obesity prevention strategies which encourage the substitution of SSBs with ASBs may not yield the adiposity benefits originally intended and this area should be a focus for further research.

"Chase CRP", "Review patient": Improving the Quality of Weekend Medical Handover at a London Teaching Hospital.

Clinical handover has been identified as a "major preventable cause of harm" by the Royal College of Physicians (RCP). Whilst working at a London teaching hospital from August 2013, we noted substandard weekend handover of medical patients. The existing pro forma was filled incompletely by day doctors so it was difficult for weekend colleagues to identify unwell patients, with inherent safety implications. Furthermore, on-call medical staff noted that poor accessibility of vital information in patients' files was affecting acute clinical management. We audited the pro formas over a six week period (n=83) and the Friday ward round (WR) entries for medical inpatients over two weekends (n=84) against the RCP's handover guidance. The results showed poor documentation of several important details on the pro formas, for example, ceiling of care (4%) and past medical history (PMH) (23%). Problem lists were specified on 62% of the WR entries. We designed new handover pro formas and 'Friday WR sheets' to provide prompts for this information and used Medical Meetings and emails to explain the project's aims. Re-audit demonstrated significant improvement in all parameters; for instance, PMH increased to 52% on the pro formas. Only 10% of Friday WR entries used our sheet. However, when used, outcomes were much better, for example, problem list documentation increased to 100%. In conclusion, our interventions improved the provision of crucial information needed to prioritise and manage patients over the weekend. Future work should further highlight the importance of safe handover to all doctors to induce a shift in culture and optimise patient care.

Exploring the spectrum of 3-M syndrome, a primordial short stature disorder of disrupted ubiquitination.

3-M syndrome is an autosomal recessive primordial growth disorder characterized by small birth size and post-natal growth restriction associated with a spectrum of minor anomalies (including a triangular-shaped face, flat cheeks, full lips, short chest and prominent fleshy heels). Unlike many other primordial short stature syndromes, intelligence is normal and there is no other major system involvement, indicating that 3-M is predominantly a growth-related condition. From an endocrine perspective, serum GH levels are usually normal and IGF-I normal or low, while growth response to rhGH therapy is variable but typically poor. All these features suggest a degree of resistance in the GH-IGF axis. To date, mutations in three genes CUL7, OBSL1 and CCDC8 have been shown to cause 3-M. CUL7 acts an ubiquitin ligase and is known to interact with p53, cyclin D-1 and the growth factor signalling molecule IRS-1, the link with the latter may contribute to the GH-IGF resistance. OBSL1 is a putative cytoskeletal adaptor that interacts with and stabilizes CUL7. CCDC8 is the newest member of the pathway and interacts with OBSL1 and, like CUL7, associates with p53, acting as a co-factor in p53-medicated apoptosis. 3-M patients without a mutation have also been identified, indicating the involvement of additional genes in the pathway. Potentially damaging sequence variants in CUL7 and OBSL1 have been identified in idiopathic short stature (ISS), including those born small with failure of catch-up growth, signifying that the 3-M pathway could play a wider role in disordered growth.