Physical activity and sedentary time among preschoolers in centre-based childcare: a systematic review.

BACKGROUND: Many preschoolers spend a substantial portion of their day enrolled in centre-based childcare; the amounts of physical activity and sedentary time accumulated in this environment are critical to preschoolers' ability to meet movement guidelines. The purpose of this systematic review was to provide a comprehensive overview of the objectively assessed physical activity and sedentary time of preschoolers in centre-based childcare (registration no. CRD42016033502). METHODS: Eight online databases were searched using terms related to physical activity, sedentary time, preschoolers and centre-based childcare. Published, peer-reviewed primary studies written in English that objectively assessed (via accelerometry) the physical activity and sedentary time of preschoolers (2-5 years) in centre-based childcare were included. RESULTS: Fifty-five studies (published 2004-2017) from 11 countries, representing 13,956 participants were included. Studies reported light physical activity (n=38) ranging from 2.94 to 29.96 mins/hr, moderate-to-vigorous physical activity (n=46) which ranged from 1.29 to 22.66 mins/hr, and total physical activity (n=42) ranging from 4.23 to 47.17 mins/hr. Sedentary time (n=47) ranged from 12.38 to 55.77 mins/hr. CONCLUSION: Physical activity and sedentary time were highly varied and inconsistent between studies; therefore, it is difficult to determine preschoolers' true amount of physical activity and sedentary time during childcare hours. Despite this variability, preschoolers were noted to participate in high rates of sedentary time in this setting. The lack of homogeneity is an important finding in and of itself as it highlights the lack of consistency in measuring, processing, and reporting paediatric physical activity data.

Physical activity and sedentary time during childcare outdoor play sessions: A systematic review and meta-analysis.

Outdoor playtime has been highly correlated with moderate-to vigorous-intensity physical activity (MVPA), while also being associated with decreased sedentary time. This systematic review and meta-analysis sought to examine the physical activity levels and sedentary time of young children (2-5years) during outdoor play periods at centre-based childcare. Eight online databases were searched for peer-reviewed, English-language, original research. Two reviewers independently extracted data (study design, participants, method of measurement, and physical activity and/or sedentary time of participants). Time spent in outdoor activity intensities were converted to percentage of time, and averaged across the two measurement types: accelerometry and observational. Of the 26 included articles, 11 used accelerometry, 13 employed direct observation, and 2 adopted a combination of both measurement methods. Average percentage of time engaged in MVPA and sedentary pursuits ranged from 6.7% to 43% and 23.2% to 63.5% by accelerometry, and 2% to 53.9% and 46.1% to 80.2% by observation, respectively. Total physical activity (only measured by accelerometry) ranged from 23.2% to 63.5% of outdoor playtime. Meta-analysis of 11 accelerometer studies found that children spent a mean (95% CI) of: 13.99% (10.35-17.63) of outdoor playtime in MVPA, 43.77% (32.95-54.58) in TPA, and 52.81% (44.1-61.51) in sedentary time. Overall, young children have the potential to be highly active during outdoor play sessions at centre-based childcare; however, many children still engage in substantial amounts of sedentary time. Future research should explore the frequency and/or duration of outdoor time which best support young children's physical activity and limits sedentary time in childcare.

Medical students' perceived comfort and competence performing physical examinations on patients with obesity: A mixed-methods needs assessment.

Physicians are unsatisfied with their training in the care of patients with obesity. Physical examination is a key component of care, and modifications to techniques are often necessary for patients with obesity. To determine learning needs, we examined medical students' perceived comfort and competency in conducting physical examinations on patients with obesity. This mixed-methods study of Canadian medical students used a questionnaire and semi-structured focus groups to assess medical students' perceived comfort and competence in examining patients with obesity. Participants included 175 Canadian medical students. A minority of medical students felt comfortable (42%) or competent (14%) examining patients with obesity. Physical exam challenges included modifying exam manoeuvres, interpreting findings and communicating sensitively around weight. Lack of early exposure to patients with obesity, minimal instruction by preceptors and a lack of curricular focus on obesity were felt to be barriers to improving these skills. Students perceived their lack of confidence as negatively impacting their ability to manage patients with obesity and more training in this area was desired to prevent disparities in care. Medical students feel that adequate training on how to perform an obesity-specific physical examination is lacking. Developing curricula and including formal teaching around these key competencies within medical education is essential.

Can HbA1c detect undiagnosed diabetes in acute medical hospital admissions?

OBJECTIVE: To study hyperglycaemia in acute medical admissions to Irish regional hospital. RESEARCH DESIGN AND METHODS: From 2005 to 2007, 2061 white Caucasians, aged >18 years, were admitted by 1/7 physicians. Those with diabetes symptoms/complications but no previous record of hyperglycaemia (n=390), underwent OGTT with concurrent HbA1c in representative subgroup (n=148). Comparable data were obtained for 108 primary care patients at risk of diabetes. RESULTS: Diabetes was diagnosed immediately by routine practice in 1% (22/2061) [aged 36 (26-61) years (median IQ range)/55% (12/22) male] with pre-existing diabetes/dysglycaemia present in 19% (390/2061) [69 (58-80) years/60% (235/390) male]. Possible diabetes symptoms/complications were identified in 19% [70 (59-79) years/57% (223/390) male] with their HbA1c similar to primary care patients [54 (46-61) years], 5.7 (5.3-6.0)%/39 (34-42)mmol/mol (n=148) vs 5.7 (5.4-6.1)%/39 (36-43)mmol/mol, p=0.35, but lower than those diagnosed on admission, 10.2 (7.4-13.3)%/88 (57-122)mmol/mol, p<0.001. Their fasting plasma glucose (FPG) was similar to primary care patients, 5.2 (4.8-5.7) vs 5.2 (4.8-5.9) mmol/L, p=0.65, but 2hPG higher, 9.0 (7.3-11.4) vs 5.5 (4.4-7.5), p<0.001. HbA1c identified diabetes in 10% (15/148) with 14 confirmed on OGTT but overall 32% (48/148) were in diabetic range on OGTT. The specificity of HbA1c in 2061 admissions was similar to primary care, 99% vs 96%, p=0.20, but sensitivity lower, 38% vs 93%, p<0.001 (63% on FPG/23% on 2hPG, p=0.037, in those with possible symptoms/complications). CONCLUSION: HbA1c can play a diagnostic role in acute medicine as it diagnosed another 2% of admissions with diabetes but the discrepancy in sensitivity shows that it does not reflect transient/acute hyperglycaemia resulting from the acute medical event.