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Importance: The digital phenomenon termed technoference refers to interruptions in routine social interactions due to technology use. Technoference may negatively affect parents' attention to cues necessary for supporting children's mental health., Objective: To explore whether there are directional prospective associations between perceived parental technoference and emerging adolescents' mental health symptoms (anxiety, depression, inattention, and hyperactivity)., Design, Setting, and Participants: This cohort study assessed a general population of mothers and emerging adolescents in Calgary, Alberta, Canada. Women were recruited during pregnancy between May 3, 2008, and December 13, 2010, with convenience sampling and repeated follow-up; eligible women were 18 years or older, spoke English, had a gestational age of at least 24 weeks, and received local prenatal care. Data collection for the present study took place when emerging adolescents were aged 9 (May 20 to July 15, 2020), 10 (March 4 to April 30, 2021), and 11 (November 22, 2021, to January 17, 2022) years. Mothers provided consent for their child to participate, and emerging adolescents provided assent. Data were analyzed from December 1 to 31, 2023, using random-intercept cross-lagged panel models., Exposure: Perceived parental technoference., Main Outcomes and Measures: Emerging adolescents completed questionnaires about their perception of parental technoference and their mental health symptoms (depression, anxiety, hyperactivity, and inattention) at the 3 study times. This study did not rely on statistical significance, but instead on the magnitude of effect sizes to determine meaningful effects., Results: Participants included 1303 emerging adolescents (mean [SD] age, 9.7 [0.8] years at time 1; of the 1028 reporting information, 529 [51.5%] were girls). Cross-sectional associations indicated correlations between perceptions of parental technoference and emerging adolescents' mental health (r range, 0.17-0.19). Higher levels of anxiety at 9 and 10 years of age were prospectively associated with higher parental technoference scores at 10 (β = 0.11 [95% CI, -0.05 to 0.26]) and 11 (β = 0.12 [95% CI, 0.001-0.24]) years of age, with small magnitudes of effect size. Higher parental technoference scores at 9 and 10 years of age were prospectively associated with higher hyperactivity at 10 (β = 0.07 [95% CI, -0.07 to 0.22]) and 11 (β = 0.11 [95% CI, -0.02 to 0.24]) years of age and inattention at 11 years of age (β = 0.12 [95% CI, 0.001-0.24]), with small magnitudes of effect size. No gender differences were identified., Conclusions and Relevance: In this 3-wave longitudinal birth cohort study, perceived parental technoference was associated with emerging adolescents' mental health. The findings speak to the need to discuss digital technology use and mental health with parents and emerging adolescents as a part of routine care.

Objective: To conduct a meta-analysis documenting healthcare service utilization rates for pediatric (age <19 years) eating disorders during compared to before the COVID-19 pandemic., Method: PsycINFO, MEDLINE, Embase, and Web of Science Core Collection were searched for studies published up to May 19, 2023. Studies with pediatric visits to primary care, inpatient, outpatient, and emergency department for eating disorders before and during the pandemic were included. This preregistered review (PROSPERO CRD42023413392) was reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were analyzed with random-effects meta-analyses., Results: A total of 52 studies reporting >148,000 child and adolescent eating disorder-related visits to >300 health settings across 15 countries were included (mean age, 12.7 years; SD = 4.1 years; 87% girls). There was strong evidence of an increase in healthcare use for eating disorders during the pandemic (rate ratio [RR] = 1.54, 95% CI = 1.38-1.71). Moderator analysis revealed larger rate increases among girls (RR = 1.48, 95% CI = 1.28-1.71) compared to boys (RR = 1.24, 95% CI = 1.06-1.45) and for adolescents (age ≥12 to 19 years) (RR = 1.53, 95% CI = 1.29-1.81) compared to children (RR = 0.87, 95% CI = 0.53-1.43). Moderator analysis demonstrated strong evidence of increased use of emergency department (RR = 1.70, 95% CI = 1.48-1.97), inpatient (RR = 1.56, 95% CI = 1.33-1.84), and outpatient (RR = 1.62, 95% CI = 1.35-1.95) services, as well as strong evidence of increased rates of anorexia nervosa (RR = 1.48, 95% CI = 1.24-1.75)., Conclusion: Healthcare use for pediatric eating disorders increased substantially during the COVID-19 pandemic, particularly among girls and adolescents. It is important to continue to monitor whether changes in healthcare use associated with acute pediatric mental distress are sustained beyond the COVID-19 pandemic., Study Preregistration Information: Risk factors for eating disorders for youth during the COVID-19 pandemic; https://www.crd.york.ac.uk/; CRD42023413392., Diversity & Inclusion Statement: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science., (Copyright © 2024 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Although 24-hour movement behaviors are known to be interconnected, limited knowledge exists about whether change in one behavior during the COVID-19 pandemic (eg, increased screen time) was associated with change in another (eg, reduced physical activity or sleep). This review estimates mediational associations between changes in children's physical activity, screen time, and sleep during the COVID-19 pandemic., Methods: We included studies published between January 1, 2020 and June 27, 2022, in the PubMed/MEDLINE, Embase, PsycINFO, SPORTDiscus, and Web of Science databases. Summary data were extracted from included studies and analyzed with random-effects meta-regression., Results: This review included 26 studies representing 18,959 children across 18 mid-high-income countries (53% male; mean age, 11.5 [2.9] y). There was very good evidence of decreased total daily physical activity (factor change, 0.62; 90% CI, 0.47-0.81) and strong evidence of increased screen time (1.56; 90% CI, 1.38-1.77). There was very good evidence of decreased moderate to vigorous physical activity (0.75; 90% CI, 0.62-0.90) and weak evidence of increased sleep (1.02; 90% CI, 1.00-1.04). Mediational analysis revealed strong evidence that most of the reduction in total daily physical activity from before, to during, the pandemic was associated with increased screen time (0.53; 90% CI, 0.42-0.67). We observed no further mediational associations., Conclusion: Increased reliance on and use of screen-based devices during the COVID-19 pandemic can be linked with reduced child and adolescent physical activity. This finding links COVID-related restrictions to potential displacement effects within child and adolescent 24-hour movement behavior.

Exposure to adverse childhood experiences (ACEs), including maltreatment and family dysfunction, is a major contributor to the global burden of disease and disability. With a large body of international literature on ACEs having emerged over the past 25 years, it is timely to now synthetize the available evidence to estimate the global prevalence of ACEs and, through a series of moderator analyses, determine which populations are at higher risk. We searched studies published between January 1, 1998 and August 5, 2021 in Medline, PsycINFO and Embase. Study inclusion criteria were using the 8- or 10-item ACE Questionnaire (±2 items), reporting the prevalence of ACEs in population samples of adults, and being published in English. The review protocol was registered with PROSPERO (CRD42022348429). In total, 206 studies (208 sample estimates) from 22 countries, with 546,458 adult participants, were included. The pooled prevalence of the five levels of ACEs was: 39.9% (95% CI: 29.8-49.2) for no ACE; 22.4% (95% CI: 14.1-30.6) for one ACE; 13.0% (95% CI: 6.5-19.8) for two ACEs; 8.7% (95% CI: 3.4-14.5) for three ACEs, and 16.1% (95% CI: 8.9-23.5) for four or more ACEs. In subsequent moderation analyses, there was strong evidence that the prevalence of 4+ ACEs was higher in populations with a history of a mental health condition (47.5%; 95% CI: 34.4-60.7) and with substance abuse or addiction (55.2%; 95% CI: 45.5-64.8), as well as in individuals from low-income households (40.5%; 95% CI: 32.9-48.4) and unhoused individuals (59.7%; 95% CI: 56.8-62.4). There was also good evidence that the prevalence of 4+ ACEs was larger in minoritized racial/ethnic groups, particularly when comparing study estimates in populations identifying as Indigenous/Native American (40.8%; 95% CI: 23.1-59.8) to those identifying as White (12.1%; 95% CI: 10.2-14.2) and Asian (5.6%; 95% CI: 2.4-10.2). Thus, ACEs are common in the general population, but there are disparities in their prevalence. They are among the principal antecedent threats to individual well-being and, as such, constitute a pressing social issue globally. Both prevention strategies and downstream interventions are needed to reduce the prevalence and mitigate the severity of the effects of ACEs and thereby reduce their deleterious health consequences on future generations., (© 2023 World Psychiatric Association.)

Importance: There is a growing body of high-quality cohort-based research that has examined changes in child and adolescent mental health during the COVID-19 pandemic vs before the pandemic. Some studies have found that child and adolescent depression and anxiety symptoms have increased, while others have found these symptoms to have remained stable or decreased., Objective: To synthesize the available longitudinal cohort-based research evidence to estimate the direction and magnitude of changes in depression and anxiety symptoms in children and adolescents assessed before and during the pandemic., Data Sources: Medline, Embase, and PsycInfo were searched for studies published between January 1, 2020, and May 17, 2022., Study Selection: Included studies reported on depression and/or anxiety symptoms, had cohort data comparing prepandemic to pandemic estimates, included a sample of children and/or adolescents younger than 19 years, and were published in English in a peer-reviewed journal., Data Extraction and Synthesis: In total, 53 longitudinal cohort studies from 12 countries with 87 study estimates representing 40 807 children and adolescents were included., Main Outcomes and Measures: Standardized mean changes (SMC) in depression and anxiety symptoms from before to during the pandemic., Results: The analysis included 40 807 children and adolescents represented in pre-COVID-19 studies and 33 682 represented in during-COVID-19 studies. There was good evidence of an increase in depression symptoms (SMC, 0.26; 95% CI, 0.19 to 0.33). Changes in depression symptoms were most conclusive for study estimates among female individuals (SMC, 0.32; 95% CI, 0.21 to 0.42), study estimates with mid to high income (SMC, 0.35; 95% CI, 0.07 to 0.63), and study estimates sourced from North America (SMC, 0.25; 95% CI, 0.15 to 0.36) and Europe (SMC, 0.35; 95% CI, 0.17 to 0.53). There was strong evidence that anxiety symptoms increased slightly during the pandemic (SMC, 0.10; 95% CI, 0.04 to 0.16), and there was some evidence of an increase in study estimates with mid to high income., Conclusions: This systematic review and meta-analysis of longitudinal studies including children and adolescents found an increase in depression symptoms during the COVID-19 pandemic, particularly among female individuals and those from relatively higher-income backgrounds.

Background: There is a lack of consensus about the effect of the COVID-19 pandemic on the mental health of children and adolescents. We aimed to compare rates of paediatric emergency department visits for attempted suicide, self-harm, and suicidal ideation during the pandemic with those before the pandemic., Methods: For this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO for studies published between Jan 1, 2020, and Dec 19, 2022. Studies published in English with data on paediatric (ie, those aged <19 years) emergency department visits before and during the COVID-19 pandemic were included. Case studies and qualitative analyses were excluded. Changes in attempted suicide, self-harm, suicidal ideation, and other mental-illness indicators (eg, anxiety, depression, and psychosis) were expressed as ratios of the rates of emergency department visits during the pandemic compared with those before the pandemic, and we analysed these with a random-effects meta-analysis. This study was registered with PROSPERO, CRD42022341897., Findings: 10 360 non-duplicate records were retrieved, which yielded 42 relevant studies (with 130 sample-estimates) representing 11·1 million emergency department visits for all indications of children and adolescents across 18 countries. The mean age of the samples of children and adolescents across studies was 11·7 years (SD 3·1, range 5·5-16·3), and there were on average 57·6% girls and 43·4% boys as a proportion of emergency department visits for any health reasons (ie, physical and mental). Only one study had data related to race or ethnicity. There was good evidence of an increase in emergency department visits for attempted suicide during the pandemic (rate ratio 1·22, 90% CI 1·08-1·37), modest evidence of an increase in emergency department visits for suicidal ideation (1·08, 0·93-1·25), and good evidence for only a slight change in self-harm (0·96, 0·89-1·04). Rates of emergency department visits for other mental-illness indications showed very good evidence of a decline (0·81, 0·74-0·89), and paediatric visits for all health indications showed strong evidence of a reduction (0·68, 0·62-0·75). When rates for attempted suicide and suicidal ideation were combined as a single measure, there was good evidence of an increase in emergency department visits among girls (1·39, 1·04-1·88) and only modest evidence of an increase among boys (1·06, 0·92-1·24). Self-harm among older children (mean age 16·3 years, range 13·0-16·3) showed good evidence of an increase (1·18, 1·00-1·39), but among younger children (mean age 9·0 years, range 5·5-12·0) there was modest evidence of a decrease (0·85, 0·70-1·05)., Interpretation: The integration of mental health support within community health and the education system-including promotion, prevention, early intervention, and treatment-is urgently needed to increase the reach of mental health support that can mitigate child and adolescent mental distress. In future pandemics, increased resourcing in some emergency department settings would help to address their expected increase in visits for acute mental distress among children and adolescents., Funding: None., Competing Interests: Declaration of interests TV has received honoraria for presentations related to youth suicide during the pandemic and is also the Chair of the COVID-19 Task Force and the Children and Schools working group for the Royal Society of Canada and is the President of the International Society for Research on Aggression. DJK has received grant funding related to research on youth suicide from the Canadian Institutes of Health Research, Sobey's Foundation, and SickKids Foundation in the past 36 months. All other authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Importance: To limit the spread of COVID-19, numerous restrictions were imposed on youths, including school closures, isolation requirements, social distancing, and cancelation of extracurricular activities, which independently or collectively may have shifted screen time patterns., Objective: To estimate changes in the duration, content, and context of screen time of children and adolescents by comparing estimates taken before the pandemic with those taken during the pandemic and to determine when and for whom screen time has increased the most., Data Sources: Electronic databases were searched between January 1, 2020, and March 5, 2022, including MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials. A total of 2474 nonduplicate records were retrieved., Study Selection: Study inclusion criteria were reported changes in the duration (minutes per day) of screen time before and during the pandemic; children, adolescents, and young adults (≤18 years); longitudinal or retrospective estimates; peer reviewed; and published in English., Data Extraction and Synthesis: A total of 136 articles underwent full-text review. Data were analyzed from April 6, 2022, to May 5, 2022, with a random-effects meta-analysis., Main Outcomes and Measures: Change in daily screen time comparing estimates taken before vs during the COVID-19 pandemic., Results: The meta-analysis included 46 studies (146 effect sizes; 29 017 children; 57% male; and mean [SD] age, 9 [4.1] years) revealed that, from a baseline prepandemic value of 162 min/d (2.7 h/d), during the pandemic there was an increase in screen time of 84 min/d (1.4 h/d), representing a 52% increase. Increases were particularly marked for individuals aged 12 to 18 years (k [number of sample estimates] = 26; 110 min/d) and for device type (handheld devices [k = 20; 44 min/d] and personal computers [k = 13; 46 min/d]). Moderator analyses showed that increases were possibly larger in retrospective (k = 36; 116 min/d) vs longitudinal (k = 51; 65 min/d) studies. Mean increases were observed in samples examining both recreational screen time alone (k = 54; 84 min/d) and total daily screen time combining recreational and educational use (k = 33; 68 min/d)., Conclusions and Relevance: The COVID-19 pandemic has led to considerable disruptions in the lives and routines of children, adolescents, and families, which is likely associated with increased levels of screen time. Findings suggest that when interacting with children and caregivers, practitioners should place a critical focus on promoting healthy device habits, which can include moderating daily use; choosing age-appropriate programs; promoting device-free time, sleep, and physical activity; and encouraging children to use screens as a creative outlet or a means to meaningfully connect with others.

Importance: Numerous physical distancing measures were implemented to mitigate the spread of the COVID-19 virus, which could have negatively affected child and adolescent physical activity levels., Objectives: To conduct a systematic review and meta-analysis of the literature that used validated measures to document changes in child and adolescent physical activity during the COVID-19 pandemic and to estimate whether changes in physical activity differed between participant-level, contextual, and methodological moderators., Data Sources: PubMed, PsycInfo, SPORTDiscus, Web of Science, Scopus, CINAHL, and MEDLINE were searched (from January 1, 2020, to January 1, 2022). A total of 1085 nonduplicate records were retrieved., Study Selection: Studies were included if they reported (1) changes in the duration of physical activity at any intensity for children or adolescents (age ≤18 years) comparing before and during the COVID-19 pandemic using validated physical activity measurement tools and were (2) from general population samples, (3) peer-reviewed, and (4) published in English., Data Extraction and Synthesis: A total of 126 articles underwent full-text review. Data were analyzed using a random-effects meta-analysis, which was conducted in January 2022., Main Outcomes and Measures: Change in the duration of engagement in physical activity at any intensity comparing before and during COVID-19., Results: Twenty-two studies including 46 independent samples and 79 effect sizes from 14 216 participants (median age, 10.5 years; range, 3-18 years) were included. The percentage change in the duration of engagement in total daily physical activity from before to during COVID-19 was -20% (90% CI, -34% to -4%). Moderation analyses revealed that changes were larger for higher-intensity activities (-32%; 90% CI, -44% to -16%), corresponding to a 17-minute reduction in children's daily moderate-to-vigorous physical activity levels. The reduction in physical activity was also larger for samples located at higher latitudes (37%; 90% CI, -1% to 89%) and for studies with a longer duration between physical activity assessments (25%; 90% CI, -0.5% to 58%)., Conclusions and Relevance: Children and adolescents have experienced measurable reductions in physical activity during the COVID-19 pandemic. Findings underscore the need to provide bolstered access to support and resources related to physical activity to ensure good health and social functioning among children and adolescents during pandemic recovery efforts.

Objectives: The purpose of this study was to estimate between and within-athlete variabilities, to form threshold values for interpreting changes in locomotor activity in a female junior international hockey team., Design: Thirty-three female international hockey players (age: 20 ± 0.9 year; height: 166.1 ± 4.4 cm; body mass: 62.5 ± 6.2 kg) competed in thirty-four junior international hockey games.., Methods: Data were monitored through global positioning system technology. Locomotor activity was quantified as relative distances covered by players for each quarter at three speed zones (<16 km/h, 16-19.9 km/h, >20 km/h). Data were analysed using linear mixed models, accounting for the fixed effects of position (defenders, n = 13; midfielders, n = 8; forwards, n = 12), game result, type, location, and opposition rank. Variabilities are summarised as coefficients of variation (%CV)., Results: Variabilities in athletes' game-to-game and quarter-to-quarter locomotor activity differed substantially between lower (<16 km/h) and higher (16-19.9 km/h and >20 km/h) speed zones. Game-to-game variability of low-speed movement (<16 km/h) was 5%; whereas, corresponding variabilities for high- (16-19.9 kmh) and very high-speed (>20 km/h) running were 22% and 34%, respectively. Within-athlete quarter-to-quarter variability increased for each speed zone, and was greatest for midfielders in low-speed movement and for defenders in high and very high-speed running., Conclusions: The game-to-game variabilities inform thresholds for estimating changes in performance over time. Caution is required when interpreting such data, and coaches should carry out estimates in their specific contexts. Additionally, quarter-to-quarter variabilities in high- and very high-speed running for junior international hockey players outline position specific differences informing training practices to better prepare players for game demands., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Parenting young children with developmental disabilities presents unique opportunities and challenges. Parents can experience meaningful priority shifts in and appreciation for their lives, but they can also be at greater risk for diminished emotional health. Physiological child factors warrant further investigation as correlates for parent risk of or protection from depression., Aim: This study examined the relations between parental depressive symptoms and the (1) sleep quality and (2) physical activity in their children with developmental disabilities adjusting for parent- and child-level factors., Methods and Procedures: Children and parents were recruited for participation in this study from a university-based neurodevelopmental clinic. Parents completed questionnaires about themselves including measures of depressive symptoms and about their children including measures of sleep quality and physical activity. Researchers administered developmental measures to the children and physicians completed children's diagnostic evaluations. Participants were 147 children (32 ± 4 months old) mostly with autism spectrum disorder (ASD) and their parents (mostly mothers). Factors associated with parent-reported depressive symptoms were analyzed with a generalized linear model., Outcomes and Results: An R 2 deviance value of 43 % confirmed that there was a substantial, moderate-to-large sized, improvement in the proportion of variance explained by the final model when compared with a null, or intercept-only, model. Depressive symptoms were approximately two times higher for parents of children with above average sleep disturbances and one and half times higher for parents whose children engaged in above average physical activity., Conclusion and Implications: Our study demonstrates the importance of considering children's sleep and physical activity in supporting children's developmental disabilities because they may offer pathways to enhanced family resilience and well-being., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: While it has been purported that excessive screen time can lead to behavioral problems, it has also been suggested that children with behavioral dysregulation receive more access to screens to manage problematic behavior. In this study, both temporally stable and longitudinal associations between screen time and externalizing and internalizing behaviors across childhood are examined to directly address this issue of directionality., Methods: Data are from a prospective cohort of 10,172 Irish children, collected between 2010 and 2018 when children were ages 3, 5, 7, and 9. Children's screen time (hours/day) and externalizing and internalizing behaviors (Strengths and Difficulties Questionnaire) were assessed via caregiver report. Random-intercepts cross-lagged panel models were used to estimate longitudinal bidirectional associations while controlling for temporally stable (i.e., 'time-invariant' or 'trait-like') differences between children., Results: Temporally stable differences between children were observed for both screen time and behavior problems. Longitudinal trajectories for screen time lacked stability; however, and externalizing and internalizing behaviors stabilized increasingly during later childhood. Greater externalizing and internalizing behaviors at age 3 were directionally associated with increased screen time at age 5. Greater screen time at ages 3 and 5 was directionally associated with increased internalizing behaviors at ages 5 and 7, respectively. More screen time at age 7 was directionally associated with fewer internalizing behaviors at age 9. Screen time was not associated with later externalizing behaviors., Conclusions: Bidirectional associations between screen time and internalizing behaviors were observed for preschoolers. Directional associations between screen time and internalizing difficulties were observed across childhood. These findings can inform screen use guidelines and family media planning at different ages and stages of development., (© 2021 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

The objective of this study was to explore the extent to which the association between screen time and psychosocial development in preschool children differed between the sexes and according to their frequency of engagement in physical activity. Data are based on a prospective cohort of Irish children, collected between 2010 and 2013 when children were ages 3 (n=9786) and 5 years (n=9001). Children's screen time (h/day), psychosocial development (Strengths and Difficulties Questionnaire), and physical activity (bouts/week) were assessed via caregiver report. The magnitude of the association between screen time and changes in behavioural difficulties differed significantly between the sexes. For boys, the association between increased screen time and the onset of behavioural problems coincided directly with a reduction in their frequency of engagement in physical activity. The association between screen time and changes in behavioural difficulties was not moderated by girls' engagement in physical activity, however; and there was no difference in the association between screen time and prosocial behaviours at different frequencies of engagement in physical activity for either boys or girls.Conclusions: Results support recommendations to establish greater balance between physical activity and sedentary behaviours in token economy systems to minimise the negative effects of excessive screen time. What is Known: • Provision of screen time has become normalised as a behavioural reinforcer for use with young children. • Screen viewing above recommended guidelines is associated with behavioural problems that reflect poor self-regulation. What is New: • Boys' levels of engagement in physical activity moderated the relationship between screen time and changes in behavioural difficulties between the ages of 3 and 5 years. • Neither screen time nor physical activity was significantly associated with changes in prosocial behaviours between the ages of 3 and 5 years for either boys or girls.

Background and Aims: Despite the crucial role of exercise in the prevention of comorbidities and complications in type 1 diabetes mellitus (T1DM), people living with the disease are often insufficiently physically active, mainly due to the fear of hypoglycaemia. Research using continuous glucose monitoring (CGM) devices has shown that exercise affects glycaemic control in T1DM for over 24 h. The aim of this systematic review and meta-analysis is, therefore, to investigate the delayed effects of different exercise modalities on glycaemic control in adults with T1DM., Methods and Results: The literature search of experimental studies was conducted on PubMed, SPORTDiscus and EMBASE from January 2000 to September 2019. Twelve studies using CGM devices were included. Compared to endurance, intermittent exercise increased the time spent in hypoglycaemia (0.62, 0.07 to 1.18; standardised effect size, 95% CI) and reduced the mean interstitial glucose concentration (-0.88, -1.45 to -0.33). No differences emerged in the time spent in hyperglycaemia (-0.07, -0.58 to 0.45) or in the proportion of exercisers experiencing hypoglycaemic events (0.82, 0.45 to 1.49; proportion ratio, 95% CI) between conditions. The systematic review also found a reduced risk of hypoglycaemia if exercise is performed in the morning rather than in the afternoon, and with a 50% rapid-acting insulin reduction. It was not possible to determine the benefits of resistance exercise., Conclusions: For the first time, we systematically investigated the delayed effect of exercise in adults with T1DM, highlighted undetected effects, shortcomings in the existing literature, and provided suggestions to design future comparable studies., Competing Interests: Declaration of competing interest None., (Copyright © 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Objective: To explore whether the associations between developmental delays in the first year of life and psychosocial outcomes in preschool children are affected by participation in organized sport., Study Design: Data were obtained from the infant cohort of the Growing Up in Ireland project. Parents reported on child development (Ages and Stages Questionnaire) at age 1 year, psychosocial characteristics (Strengths and Difficulties Questionnaire) at ages 3 and 5 years, and engagement in organized sport at age 5 years. Data were analyzed using mixed models., Results: At age 1 year, 15% of the cohort was classified as having developmental delays. These children exhibited more behavioral difficulties (0.55, ±0.27; mean difference, ±95% confidence limits [CL]) (P < .0001) and fewer prosocial behaviors (-0.54, ±0.11) (P < .0001) at age 3 years. For boys in this group, engagement in sport was associated with a significant decrease in behavioral difficulties between ages 3 and 5 years (-0.44, ±0.39) (P = .03). Compared with those classified as lacking regular engagement (ie, never engaging, or engaging <1 hour/week), the relative effect of sport on changes in behavioral difficulties for boys with developmental delays was statistically significant (0.70, ±0.59) (P = .02). Participation in sport was not associated with significant changes in behavioral difficulties for girls, or a significant change in prosocial behaviors for boys or girls., Conclusions: Regular participation in sport by boys could attenuate some of the behavioral difficulties associated with early development. Lack of opportunities for engaging in sport could negatively affect boys' behavioral regulation in the preschool period., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Among the various psychological determinants of physical activity (PA) in early childhood, relatively little attention has been paid to the role of parent beliefs in the benefits of PA for their child. Believing that PA is beneficial may impact parent behavior, resulting in more opportunities for PA in early childhood, particularly among children with neurodevelopmental disabilities (NDs) who may face more barriers to PA. Greater opportunity for PA may promote the development of motor skills and healthy body composition. This study examined the association between parental beliefs about PA and children's weight status in a sample of 147 children (32 ± 4 months old) with NDs. The proportion of parents with below average (mean - 1SD) perceptions of the benefits of PA whose children were overweight or obese was approximately was 2.5 times (proportion ratio, 2.35; 95% CI, 1.05-5.27) larger than it was for parents with above average (mean + 1SD) perceptions (after adjusting for the confounding effects of ethnicity, marital status, and mothers' self-reported depressive symptoms). Mothers' self-reported depressive symptoms was the only other covariate that was significantly associated with the weight status of these children, though, these data also signal possible ( p = 0.07) differences in proportions between Hispanic/Latinx and White children in the sample who were classified as overweight and obese. Our study demonstrates the importance of considering parental or caregiver beliefs in the value of PA as another risk factor that may predict risk for overweight and obesity. Future studies should include parental beliefs in the benefits of PA as a potential psychological determinant of PA and associated health outcomes., (Copyright © 2020 Lakes, Neville, Abdullah and Donnelly.)

Purpose : Children with special educational needs and disabilities (SEND) are often excluded from physical education (PE). Opportunities exist to enhance the competence of trainee teachers, thus preparing them for the demands of inclusive PE (IPE). In this study, we examined the effect of IPE training workshops on trainee teachers' self-efficacy for including SEND children within PE. Method : Data was collection from 366 trainee teachers across 44 workshops (63% females; 57% primary-school trainees; age, 23 ± 5 y, mean ± standard deviation; age range 18-53 y). A pre-post design was used to assess the effect of the workshop and possible moderating factors. Data were analyzed using mixed modelling. Results : IPE training had a large beneficial effect on trainees' self-efficacy (1.61, ±0.21; standardized effect size, 99% confidence limits). Mixed modelling revealed substantial differences in the mean outcome between workshops. The standard deviation (SD) representing this variation between workshops was moderate-sized (SD = 0.30, ±0.30). We also found that trainees with an above average sense of self-efficacy at baseline (mean +1SD) were likely to benefit more. Workshop size (0.35, ±0.42) and trainees' perception of workshop quality (0.39, ±0.19) were substantial moderators of changes in self-efficacy. Other moderators with possible substantial effects were trainee specialization and completion of a school-based placement. Conclusion : This study supports the viability of embedding IPE within teacher training. Attention should be paid to trainees' starting points prior to scheduling training. The size of workshops and quality of delivery should also be considered when developing IPE competencies within trainees.

On the basis of extensive research on the relationship between physical activity, exercise and health, as well as strong support from policymakers and practitioners, the "Exercise is Medicine" initiative has become something of a linchpin in the agenda for modern healthcare reform and reflects a broader acceptance that the philosophy of health politics must shift from social engineering to performativity. However, in spite of the avowed commitment to encouraging individuals to take on a more reflexive relation to their health, it remains unclear as to whether an initiative such as this is, unambiguously, a good thing. In this paper, a number of cautionary remarks are made with respect to "Exercise is Medicine" in principle as well as in practice. Firstly, it is argued that equating exercise with medicine is to equate it with a definition of and relation to the body to which it is not entirely akin. And secondly, it is argued that any proposed alignment of the fitness and healthcare industries needs further critical examination, a realigning of interests, and a thorough reconsideration of their suitability of fit.

This article examines the concept of fitness, which, in spite of its much avowed cultural significance, has become the subject of much critical attention. In particular, it considers the now contested relation of fitness to health; the fact that, although there appears to be a clear consensus on a simple causal relation between the two, this has been deemed illusory outside the medico-scientific context of its production. In response to the problems with both of these positions, this article examines the potential for reconfiguring the relation between fitness and health on new terms. A complemental model of health and fitness is proposed; one that strives to account for the body's objective and subjective dimensions and for those intermediary varieties of experience that lie in between., (© 2012 The Authors. Sociology of Health & Illness © 2012 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.)

The ubiquitous mammalian extracellular matrix glycosaminoglycan hyaluronan (HA) plays a pivotal role in the regulation of cell phenotype in fibrosis and scarring. Transforming growth factor-beta 1 (TGF-β1) and interleukin-1 beta (IL-1β) up-regulate hyaluronan synthase (HAS) 1 and HAS2 in dermal fibroblasts and renal proximal tubular epithelial cells, and subsequent HA synthesis regulates cell phenotype. In the present study, we investigated the mechanism of HAS1 transcriptional up-regulation in response to these cytokines. We used 5'-rapid amplification of cDNA ends analysis to identify the 5' end of HAS1 transcripts, resulting in an increase of 26 nucleotides to the HAS1 exon 1 sequence of reference sequence NM&#95;001523. Constitutive luciferase activity of upstream DNA sequences was shown in luciferase reporter assays, but our reporter vector signals were refractory to the addition of TGF-β1 and IL-1β. Using siRNAs to knockdown transcription factor mRNAs, we showed that TGF-β1 up-regulation of HAS1 transcription was mediated via Smad3 but not Smad2, while HAS1 induction by IL-1β was Sp3, not Sp1, dependent., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Aberrant expression of the human hyaluronan synthase 2 (HAS2) gene has been implicated in the pathology of malignancy, pulmonary arterial hypertension, osteoarthritis, asthma, thyroid dysfunction, and large organ fibrosis. Renal fibrosis is associated with increased cortical synthesis of hyaluronan (HA), an extracellular matrix glycosaminoglycan, and we have shown that HA is a correlate of interstitial fibrosis in vivo. Our previous in vitro data have suggested that both HAS2 transcriptional induction and subsequent HAS2-driven HA synthesis may contribute to kidney fibrosis via phenotypic modulation of the renal proximal tubular epithelial cell (PTC). Post-transcriptional regulation of HAS2 mRNA synthesis by the natural antisense RNA HAS2-AS1 has recently been described in osteosarcoma cells, but the antisense transcript was not detected in kidney. In this study, PTC stimulation with IL-1β or TGF-β1 induced coordinated temporal profiles of HAS2-AS1 and HAS2 transcription. Constitutive activity of the putative HAS2-AS1 promoter was demonstrated, and transcription factor-binding sequence motifs were identified. Knockdown of Sp1/Sp3 expression by siRNA blunted IL-1β induction of both HAS2-AS1 and HAS2, and Smad2/Smad3 knockdown similarly attenuated TGF-β1 stimulation. Inhibition of IL-1β-stimulated HAS2-AS1 RNA induction using HAS2-AS1-specific siRNAs also suppressed up-regulation of HAS2 mRNA transcription. The thermodynamic feasibility of HAS2-AS1/HAS2 heterodimer formation was demonstrated in silico, and locus-specific cytoplasmic double-stranded RNA was detected in vitro. In summary, our data show that transcriptional induction of HAS2-AS1 and HAS2 occurs simultaneously in PTCs and suggest that transcription of the antisense RNA stabilizes or augments HAS2 mRNA expression in these cells via RNA/mRNA heteroduplex formation.