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Summary Objective Studies examining associations between movement behaviours (i.e. physical activity, sedentary behaviour and sleep duration) and obesity focus on average values of these movement behaviours, despite important within‐country and between‐country variability. A better understanding of movement behaviour inequalities is important for developing public health policies and behaviour‐change interventions. The objective of this ecologic analysis at the country level was to determine if inequality in movement behaviours is a better correlate of obesity than average movement behaviour volume in children from all inhabited continents of the world. Methods This multinational, cross‐sectional study included 6,128 children 9–11 years of age. Moderate‐to‐vigorous physical activity (MVPA), total sedentary time (SED) and sleep period time were monitored over 7 consecutive days using waist‐worn accelerometry. Screen time was self‐reported. Inequality in movement behaviours was determined using Gini coefficients (ranging from 0 [complete equality] to 1 [complete inequality]). Results The largest inequality in movement behaviours was observed for screen time (Gini of 0.32; medium inequality), followed by MVPA (Gini of 0.21; low inequality), SED (Gini of 0.07; low inequality) and sleep period time (Gini of 0.05; low inequality). Average MVPA (h d−1) was a better correlate of obesity than MVPA inequality (r = −0.77 vs. r = 0.00, p = 0.03). Average SED (h d−1) was also a better correlate of obesity than SED inequality (r = 0.52 vs. r = −0.32, p = 0.05). Differences in associations for screen time and sleep period time were not statistically significant. MVPA in girls was found to be disproportionally lower in countries with more MVPA inequality. Conclusions Findings from this study show that average MVPA and SED should continue to be used in population health studies of children as they are better correlates of obesity than inequality in these behaviours. Moreover, the findings suggest that MVPA inequality could be greatly reduced through increases in girls' MVPA alone.

BACKGROUND: It is unknown whether moderate-to-vigorous physical activity (MVPA) thresholds for obesity should be adapted depending on level of sedentary behaviour in children.OBJECTIVE: The objective of the study is to determine the MVPA thresholds that best discriminate between obese and non-obese children, by level of screen time and total sedentary time in 12 countries.METHODS: This multinational, cross-sectional study included 6522 children 9-11 years of age. MVPA and sedentary time were assessed using waist-worn accelerometry, while screen time was self-reported. Obesity was defined according to the World Health Organization reference data.RESULTS: Receiver operating characteristic curve analyses showed that the best thresholds of MVPA to predict obesity ranged from 53.8 to 73.9 min d-1in boys and from 41.7 to 58.7 min d-1in girls, depending on the level of screen time. The MVPA cut-offs to predict obesity ranged from 37.9 to 75.9 min d-1in boys and from 32.5 to 62.7 min d-1in girls, depending on the level of sedentary behaviour. The areas under the curve ranged from 0.57 to 0.73 ('fail' to 'fair' accuracy), and most sensitivity and specificity values were below 85%, similar to MVPA alone. Country-specific analyses provided similar findings.CONCLUSIONS: The addition of sedentary behaviour levels to MVPA did not result in a better predictive ability to classify children as obese/non-obese compared with MVPA alone.

Background: Globally, the high prevalence of overweight and low levels of physical activity among children has serious implications for morbidity and premature mortality in adulthood. Various parental factors are associated with childhood overweight and physical activity. The objective of this paper was to investigate relationships between parental education or overweight, and (i) child overweight, (ii) child physical activity, and (iii) explore household coexistence of overweight, in a large international sample. Methods: Data were collected from 4752 children (9–11 years) as part of the International Study of Childhood Obesity, Lifestyle and the Environment in 12 countries around the world. Physical activity of participating children was assessed by accelerometry, and body weight directly measured. Questionnaires were used to collect parents' education level, weight, and height. Results: Maternal and paternal overweight were positively associated with child overweight. Higher household coexistence of parent-child overweight was observed among overweight children compared to the total sample. There was a positive relationship between maternal education and child overweight in Colombia 1.90 (1.23–2.94) [odds ratio (confidence interval)] and Kenya 4.80 (2.21–10.43), and a negative relationship between paternal education and child overweight in Brazil 0.55 (0.33–0.92) and the USA 0.54 (0.33–0.88). Maternal education was negatively associated with children meeting physical activity guidelines in Colombia 0.53 (0.33–0.85), Kenya 0.35 (0.19–0.63), and Portugal 0.54 (0.31–0.96). Conclusions: Results are aligned with previous studies showing positive associations between parental and child overweight in all countries, and positive relationships between parental education and child overweight or negative associations between parental education and child physical activity in lower economic status countries. Relationships between maternal and paternal education and child weight status and physical activity appear to be related to the developmental stage of different countries. Given these varied relationships, it is crucial to further explore familial factors when investigating child overweight and physical activity. Refereed/Peer-reviewed

Particle-related pollution (PM10, PM2.5 and soot) was measured in both indoor and outdoor microenvironments at four public elementary schools in Bogota, Colombia. Three of these schools were located alongside major urban roads in which different types of public transit systems are used (bus rapid transit system and conventional transit buses). The fourth school was located on a non-congested road (background school). Pollutant levels at schools situated on major-roads were higher than those found at the low-congestion-road school. Outdoor black carbon daily mean concentrations at the schools located near major roads were up to six times higher than those recorded at the background school. Mean particulate matter concentrations at schools near major roads were above international standards, suggesting that school-age children in Bogota are exposed to pollution levels that are considered to be harmful by environmental and public health authorities. Elevated indoor and outdoor pollutant concentrations documented in this study suggested that traffic has a direct impact on air quality regarding the schools' characterised microenvironments. Se caracterizaron los niveles de material particulado respirable (PM10), material particulado fino (PM2.5) y carbono elemental (BC) en microambientes intramurales y exteriores de cuatro colegios distritales en Bogotá. Tres de estos colegios estaban ubicados en inmediaciones de vías principales consideradas de alto tráfico vehicular, por las que circulan distintos tipos de transporte público (colectivo convencional y transporte público masivo). El colegio restante (utilizado como sitio control) se encontraba ubicado sobre una vía secundaria, no congestionada. En general, los niveles de contaminación encontrados en los microambientes de los colegios ubicados en vías con alto tráfico vehicular fueron significativamente mayores que aquellos reportados en el colegio control. Por ejemplo, las concentraciones de BC documentadas en microambientes exteriores de los colegios ubicados sobre vías principales fueron hasta seis veces mayores que aquellas encontradas en el colegio control. Las concentraciones promedio reportadas sugieren que los menores en edad escolar en Bogotá se encuentran expuestos a niveles de contaminación considerados como nocivos para la salud por las autoridades internacionales. Adicionalmente, la evidencia recolectada propone que en los colegios evaluados, el tráfico vehicular tiene un impacto importante en la calidad del aire al interior de los mismos.

We conducted a meta-analysis to assess the performance of PCR for the diagnosis of smear-negative pulmonary tuberculosis (SPT) and to identify factors that account for differences in the diagnostic accuracy of different studies. Studies published before February 2002 were included if sensitivity and specificity of PCR in smear-negative respiratory or gastric-aspirate specimens could be calculated. Analysis was conducted by using summary receiver operating characteristics models. Sensitivity and specificity ranged from 9 to 100% and from 25 to 100%, respectively. Fewer than 40% of the 50 studies reported results by number of patients, reported clinical characteristics of patients, or used as a reference standard combined culture and clinical criteria. Studies that included bronchial specimens showed higher accuracy than studies that evaluated only sputum specimens or included gastric aspirates. Studies that did not report that tests were applied blindly showed higher accuracy than those reporting blind testing. Increased sensitivity due to the use of DNA purification methods was associated with decreased specificity. Studies published after 1995, using Amplicor or dUTP-UNG, were associated with an increase in specificity at the expense of lower sensitivity. We concluded that PCR is not consistently accurate enough to be routinely recommended for the diagnosis of SPT. However, PCR of bronchial specimens could be useful in highly suspicious SPT cases. Studies not reporting blind testing are likely to overestimate accuracy of PCR. Future evaluation of PCR accuracy should be conducted by patient and type of respiratory specimen, blindly, by using a reference standard that combines culture and clinical criteria and addresses the issue of how patient characteristics affect PCR accuracy.

Background We compared 24-hour waist-worn accelerometer wear time characteristics of 9–11 year old children in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) to similarly aged U.S. children providing waking-hours waist-worn accelerometer data in the 2003–2006 National Health and Nutrition Examination Survey (NHANES). Methods Valid cases were defined as having ≥4 days with ≥10 hours of waking wear time in a 24-hour period, including one weekend day. Previously published algorithms for extracting total sleep episode time from 24-hour accelerometer data and for identifying wear time (in both the 24-hour and waking-hours protocols) were applied. The number of valid days obtained and a ratio (percent) of valid cases to the number of participants originally wearing an accelerometer were computed for both ISCOLE and NHANES. Given the two surveys’ discrepant sampling designs, wear time (minutes/day, hours/day) from U.S. ISCOLE was compared to NHANES using a meta-analytic approach. Wear time for the 11 additional countries participating in ISCOLE were graphically compared with NHANES. Results 491 U.S. ISCOLE children (9.92±0.03 years of age [M±SE]) and 586 NHANES children (10.43 ± 0.04 years of age) were deemed valid cases. The ratio of valid cases to the number of participants originally wearing an accelerometer was 76.7% in U.S. ISCOLE and 62.6% in NHANES. Wear time averaged 1357.0 ± 4.2 minutes per 24-hour day in ISCOLE. Waking wear time was 884.4 ± 2.2 minutes/day for U.S. ISCOLE children and 822.6 ± 4.3 minutes/day in NHANES children (difference = 61.8 minutes/day, p

Background: It is unknown whether moderate-to-vigorous physical activity (MVPA) thresholds for obesity should be adapted depending on level of sedentary behaviour in children. Objective: The objective of the study is to determine the MVPA thresholds that best discriminate between obese and non-obese children, by level of screen time and total sedentary time in 12 countries. Methods: This multinational, cross-sectional study included 6522 children 9-11 years of age. MVPA and sedentary time were assessed using waist-worn accelerometry, while screen time was self-reported. Obesity was defined according to the World Health Organization reference data. Results: Receiver operating characteristic curve analyses showed that the best thresholds of MVPA to predict obesity ranged from 53.8 to 73.9 min d -1 in boys and from 41.7 to 58.7 min d -1 in girls, depending on the level of screen time. The MVPA cut-offs to predict obesity ranged from 37.9 to 75.9 min d -1 in boys and from 32.5 to 62.7 min d -1 in girls, depending on the level of sedentary behaviour. The areas under the curve ranged from 0.57 to 0.73 ('fail' to 'fair' accuracy), and most sensitivity and specificity values were below 85%, similar to MVPA alone. Country-specific analyses provided similar findings. Conclusions: The addition of sedentary behaviour levels to MVPA did not result in a better predictive ability to classify children as obese/non-obese compared with MVPA alone. Refereed/Peer-reviewed

OBJECTIVES: Childhood obesity is now recognized as a global public health issue. Social patterning of obesity, consistent with the theory of epidemiologic transition, has not been well described in children, and the limited research has focused on developed settings. The aim of this study was to describe the relationship between childhood obesity and household income using objective measures of adiposity and to explore how this relationship differs across levels of country human development.METHODS: The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was a multi-national cross-sectional study conducted in 12 urban/suburban study sites that represented all inhabited continents and wide ranges of development. ISCOLE collected objectively measured height, body mass and percentage body fat in 7341 10-year-old children. Multi-level random-effects models were used to examine income gradients in several obesity measures.RESULTS: The mean age of the children was 10.4 years, and 12.6% were obese, ranging from 5.4% (Finland) to 23.8% (China). For both boys and girls, obesity prevalence, body fat percentage and body mass index (BMI) z-score increased linearly with higher income at lower levels of development (all P for trend less than or equal to0.0012), but decreased linearly with higher income at higher levels of development (all P for trend less than or equal to0.0003). Country human development explained 75% of the variation in the country-specific income–obesity relationships (r=−0.87, P=0.0003).CONCLUSIONS: Results are consistent with the theory of epidemiologic transition. Global efforts to control obesity must account for socioeconomic factors within a country’s context. Future research should seek to understand global socioeconomic patterns in obesity-related lifestyle behaviors.