The relationship between childcare and adiposity, body mass and obesity-related risk factors: protocol for a systematic review of longitudinal studies

BACKGROUND: The rising prevalence of obesity, particularly in childhood, is a global public health emergency. There is some evidence that exposure to non-parental childcare before age 6 years is associated with subsequent development of obesity and obesity-related behaviours such as physical activity, sedentary behaviour, sleep, diet and stress, although these findings are inconsistent. It is possible that the relationship between early childcare and later obesity and obesity-related behaviours depends on characteristics of childcare exposure such as type (i.e. informal versus formal care), duration (i.e. number of years spent in childcare), intensity (e.g. number of hours per week) and timing (i.e. age of onset of childcare) of care received. The relationship may also be moderated by socio-demographic characteristics of children and their families. We will conduct a systematic review exploring longitudinal associations between childcare (type, duration, intensity and timing) and measures of adiposity and body mass, physical activity, sedentary behaviour, sleep, diet and stress. We will also assess whether these relationships vary by socio-demographic factors. METHODS: We will include studies that explore longitudinal associations between childcare attendance in children aged <6 years not in primary school at first assessment and body weight, adiposity, physical activity, diet, sleep and stress. We will limit studies to those involving middle- and high-income countries. Two independent reviewers will screen search results in two stages: (1) title and abstract and (2) and full text. One reviewer will extract relevant data and a second will verify this information. We will assess risk of bias of included studies using an adaption of the United States Department of Agriculture National Evidence Library Bias Assessment Tool. We will tabulate and summarise results narratively. We may conduct meta-analysis if at least five studies report comparable data. DISCUSSION: To our knowledge, this will be the first systematic review to summarise the existing evidence on longitudinal associations between childcare and adiposity, body mass and obesity-related risk factors. The results will be of relevance to other researchers, childcare practitioners and policy makers. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015027233.British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, National Institute for Health Research, Wellcome Trus

Associations of childcare type, age at start, and intensity with body mass index trajectories from 10 to 42 years of age in the 1970 British Cohort Study

Background: Attending childcare is related to greater childhood obesity risk, but there are few long-term follow-up studies. We aimed to examine the associations of childcare type, age at start, and intensity with body mass index body mass index (BMI) trajectories from ages 10 to 42 years. Methods: The sample comprised 8234 individuals in the 1970 British Cohort Study, who had data on childcare attendance (no, yes), type (formal, informal), age at start (4-5, 3-3.99, 0-2.99 years old), and intensity (1, 2, 3, 4-5 days/week) reported at age 5 years and 32 563 BMI observations. Multilevel linear spline models were used to estimate the association of each exposure with the sample-average BMI trajectory, with covariate adjustment. A combined age at start and intensity exposure was also examined. Results: Attending vs not attending and the type of childcare (none vs formal/informal) were not strongly related to BMI trajectories. Among participants who attended childcare 1 to 2 days a week, those who started when 3 to 3.99 years old had a 0.197 (−0.004, 0.399) kg/m2 higher BMI at age 10 years than those who started when 4 to 5 years old, and those who started when 0 to 2.99 years old had a 0.289 (0.049, 0.529) kg/m2 higher BMI. A similar dose-response pattern for intensity was observed when holding age at start constant. By age 42 years, individuals who started childcare at age 0 to 2.99 years and attended 3 to 5 days/week had a 1.356 kg/m2 (0.637, 2.075) higher BMI than individuals who started at age 4 to 5 years and attended 1 to 2 days/week. Conclusions: Children who start childcare earlier and/or attend more frequently may have greater long-term obesity risk

Contribution of anadromous fish to the diet of European catfish in a large river system

Many anadromous fish species, when migrating from the sea to spawn in fresh waters, can potentially be a valuable prey for larger predatory fish, thereby efficiently linking these two ecosystems. Here, we assess the contribution of anadromous fish to the diet of European catfish (Silurus glanis) in a large river system (Garonne, southwestern France) using stable isotope analysis and allis shad (Alosa alosa) as an example of anadromous fish. Allis shad caught in the Garonne had a very distinct marine delta(13)C value, over 8 per thousand higher after lipid extraction compared to the mean delta(13)C value of all other potential freshwater prey fish. The delta(13)C values of European catfish varied considerably between these two extremes and some individuals were clearly specializing on freshwater prey, whereas others specialized on anadromous fish. The mean contribution of anadromous fish to the entire European catfish population was estimated to be between 53% and 65%, depending on the fractionation factor used for delta(13)C

Modelling-based evaluation of the costs, benefits and cost-effectiveness of multipathogen point-of-care tests for sexually transmitted infections in symptomatic genitourinary medicine clinic attendees

Objectives To quantify the costs, benefits and cost-effectiveness of three multipathogen point-of-care (POC) testing strategies for detecting common sexually transmitted infections (STIs) compared with standard laboratory testing. Design Modelling study. Setting Genitourinary medicine (GUM) services in England. Population A hypothetical cohort of 965 988 people, representing the annual number attending GUM services symptomatic of lower genitourinary tract infection. Interventions The decision tree model considered costs and reimbursement to GUM services associated with diagnosing and managing STIs. Three strategies using hypothetical point-of-care tests (POCTs) were compared with standard care (SC) using laboratory-based testing. The strategies were: A) dual POCT for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG); B) triplex POCT for CT-NG and Mycoplasma genitalium (MG); C) quadruplex POCT for CT-NG-MG and Trichomonas vaginalis (TV). Data came from published literature and unpublished estimates. Primary and secondary outcome measures Primary outcomes were total costs and benefits (quality-adjusted life years (QALYs)) for each strategy (2016 GB, £) and associated incremental cost-effectiveness ratios (ICERs) between each of the POC strategies and SC. Secondary outcomes were inappropriate treatment of STIs, onward STI transmission, pelvic inflammatory disease in women, time to cure and total attendances. Results In the base-case analysis, POC strategy C, a quadruplex POCT, was the most cost-effective relative to the other strategies, with an ICER of £36 585 per QALY gained compared with SC when using microcosting, and cost-savings of £26 451 382 when using tariff costing. POC strategy C also generated the most benefits, with 240 467 fewer clinic attendances, 808 fewer onward STI transmissions and 235 135 averted inappropriate treatments compared with SC. Conclusions Many benefits can be achieved by using multipathogen POCTs to improve STI diagnosis and management. Further evidence is needed on the underlying prevalence of STIs and SC delivery in the UK to reduce uncertainty in economic analyses

Disruption of a Proto-Planetary Disk by the Black Hole at the Milky Way Centre

Recently, an ionized cloud of gas was discovered plunging toward the supermassive black hole, SgrA*, at the centre of the Milky Way. The cloud is being tidally disrupted along its path to closest approach at ~3100 Schwarzschild radii from the black hole. Here, we show that the observed properties of this cloud of gas can naturally be produced by a proto-planetary disk surrounding a low-mass star, which was scattered from the observed ring of young stars orbiting SgrA*. As the young star approaches the black hole, its disk experiences both photo-evaporation and tidal disruption, producing a cloud. Our model implies that planets form in the Galactic centre, and that tidal debris from proto-planetary disks can flag low mass stars which are otherwise too faint to be detected.Comment: Accepted to Nature Communications; new Figure 4b provides predicted Br-gamma emission as a function of tim

Multi-setting Bell inequality for qudits

We propose a generalized Bell inequality for two three-dimensional systems with three settings in each local measurement. It is shown that this inequality is maximally violated if local measurements are configured to be mutually unbiased and a composite state is maximally entangled. This feature is similar to Clauser-Horne-Shimony-Holt inequality for two qubits but is in contrast with the two types of inequalities, Collins-Gisin-Linden-Massar-Popescu and Son-Lee-Kim, for high-dimensional systems. The generalization to aribitrary prime-dimensional systems is discussed.Comment: Accepted for publication in Phys. Rev.

Childcare in infancy and later obesity: A narrative review of longitudinal studies

Purpose of Review The purpose of this review was to summarize the current literature on the longitudinal relationship between non-parental childcare during infancy and later obesity. Recent Findings Eleven studies met the inclusion criteria, comprising 74 associations relevant to the review. Studies were highly heterogeneous in terms of defining childcare, categorizing different types of childcare, assessing obesity, and age at measurement of outcome and exposure. Most of the associations were either non-significant (42 associations, 57%) or showed a significant association between increased exposure to childcare and greater obesity (30 associations, 41%). There were very few examples of associations indicating that childcare was associated with lower obesity. Summary There is limited research on the longitudinal relationship between childcare in infancy and later obesity. Existing studies showed mixed results, similar to recent reviews reporting on cross-sectional studies and older ages. The different definitions of childcare and wide variety of measures of exposure make comparisons between studies challenging.Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged