Objectively assessed recess physical activity in girls and boys from high and low socioeconomic backgrounds

BackgroundThe school environment influences children&rsquo;s opportunities for physical activity participation. The aim of the present study was to assess objectively measured school recess physical activity in children from high and low socioeconomic backgrounds.MethodsFour hundred and seven children (6&ndash;11 years old) from 4 primary schools located in high socioeconomic status (high-SES) and low socioeconomic status (low-SES) areas participated in the study. Children&rsquo;s physical activity was measured using accelerometry during morning and afternoon recess during a 4-day school week. The percentage of time spent in light, moderate, vigorous, very high and in moderate- to very high-intensity physical activity were calculated using age-dependent cut-points. Sedentary time was defined as 100 counts per minute.ResultsBoys were significantly (p&thinsp;&lt;&thinsp;0.001) more active than girls. No difference in sedentary time between socioeconomic backgrounds was observed. The low-SES group spent significantly more time in light (p&thinsp;&lt;&thinsp;0.001) and very high (p&thinsp;&lt;&thinsp;0.05) intensity physical activity compared to the high-SES group. High-SES boys and girls spent significantly more time in moderate (p&thinsp;&lt;&thinsp;0.001 and p&thinsp;&lt;&thinsp;0.05, respectively) and vigorous (p&thinsp;&lt;&thinsp;0.001) physical activity than low-SES boys.ConclusionsDifferences were observed in recess physical activity levels according to socioeconomic background and sex. These results indicate that recess interventions should target children in low-SES schools.<br /

Influence of Physical Activity on Bone Strength in Children and Adolescents: A Systematic Review and Narrative Synthesis

A preponderance of evidence from systematic reviews supports the effectiveness of weight‐bearing exercises on bone mass accrual, especially during the growing years. However, only one systematic review (limited to randomized controlled trials) examined the role of physical activity (PA) on bone strength. Thus, our systematic review extended the scope of the previous review by including all PA intervention and observational studies, including organized sports participation studies, with child or adolescent bone strength as the main outcome. We also sought to discern the skeletal elements (eg, mass, structure, density) that accompanied significant bone strength changes. Our electronic‐database, forward, and reference searches yielded 14 intervention and 23 observational studies that met our inclusion criteria. We used the Effective Public Health Practice Project (EPHPP) tool to assess the quality of studies. Due to heterogeneity across studies, we adopted a narrative synthesis for our analysis and found that bone strength adaptations to PA were related to maturity level, sex, and study quality. Three (of five) weight‐bearing PA intervention studies with a strong rating reported significantly greater gains in bone strength for the intervention group (3% to 4%) compared with only three significant (of nine) moderate intervention studies. Changes in bone structure (eg, bone cross‐sectional area, cortical thickness, alone or in combination) rather than bone mass most often accompanied significant bone strength outcomes. Prepuberty and peripuberty may be the most opportune time for boys and girls to enhance bone strength through PA, although this finding is tempered by the few available studies in more mature groups. Despite the central role that muscle plays in bones’ response to loading, few studies discerned the specific contribution of muscle function (or surrogates) to bone strength. Although not the focus of the current review, this seems an important consideration for future studies. © 2014 American Society for Bone and Mineral Research

Information Asymmetry in Hospitals: Evidence of the Lack of Cost Awareness in Clinicians

BACKGROUND: Information asymmetries and the agency relationship are two defining features of the healthcare system. These market failures are often used as a rationale for government intervention. Many countries have government financing and provision of healthcare in order to correct for this, while health technology agencies also exist to improve efficiency. However, informational asymmetries and the resulting principal-agent problem still persist, and one example is the lack of cost awareness amongst clinicians. This study explores the cost awareness of clinicians across different settings. METHODS: We targeted four clinical cohorts: medical students, Senior House Officers/Interns, Mid-grade Senior Registrar/Residents, and Consultant/Attending Physicians, in six hospitals in the United Kingdom, the United States, Australia, New Zealand and Spain. The survey asked respondents to report the cost (as they recalled) of different types of scans, visits, medications and tests. Our analysis focused on the differential between the perceived/recalled cost and the actual cost. We explored variation across speciality, country and other potential confounders. Cost-awareness levels were estimated based on the cost estimates within 25% of the actual cost. RESULTS: We received 705 complete responses from six sites across five countries. Our analysis found that respondents often overestimated the cost of common tests while underestimating high-cost tests. The mean cost-awareness levels varied between 4 and 23% for different items. Respondents acknowledged that they did not feel they had received adequate training in cost awareness. DISCUSSION: The current financial climate means that cost awareness and the appropriate use of scarce healthcare resources is more paramount than perhaps ever before. Much of the focus of health economics research is on high-cost innovative technologies, yet there is considerable waste in the system with respect to overtreatment and overdiagnosis. Common reasons put forward for this include defensive medicine, poor education, clinical uncertainty and the institution of protocols. CONCLUSION: Given the role of clinicians in the healthcare system, as agents both for patients and for providers, more needs to be done to remove informational asymmetries and improve clinician cost awareness