Impacts of digital technologies on child and adolescent health: recommendations for safer screen use in educational settings.

The use of screen-based digital technologies (such as computers and digital devices) is increasing for children and adolescents, worldwide. Digital technologies offer benefits, including educational opportunities, social connection and access to health information. Digital fluency has been recognised as an essential skill for future prosperity. However, along with these opportunities, digital technologies also present a risk of harm to young people. This issue may be particularly important for young New Zealanders, who have among the highest rates of screen use in the world. Our recently published review examined the impacts of digital technologies on the health and wellbeing of children and adolescents. Key findings revealed some positive impacts from moderate use of digital technologies; however, frequent and extended use of screen-based digital tools were associated with negative impacts on child and adolescent health in some areas, such as eye health, noise-induced hearing loss and pain syndromes. Conversely, in areas such as mental health, wellbeing and cognition, quality of screen media content and additional factors such as age may be more important than duration of use. These challenges gave us the impetus to develop pragmatic recommendations for the use of digital technologies in schools, kura kaupapa and early childhood education. Recommendations include interventions to lower risk across different ages and stages of development. Supporting young people to mitigate risk and develop safer screen behaviours will allow them to gain essential digital skills and access opportunities that will enable them to thrive.

Where Are Czech Adolescents Active? The Patterns of Movement and Transport Behavior in Different Active Living Domains.

To understand the environmental determinants of physical activity (PA), precise spatial localization is crucial. This cross-sectional study focuses on the spatiotemporal distribution of PA among Czech adolescents (n = 171) using Global Positioning System loggers and accelerometers. The results showed that adolescents spent most of their time in sedentary behavior, with 57.2% and 58.5% of monitored time at home and school, respectively. The park and playground had the lowest proportion of sedentary behavior but also the lowest amount of moderate to vigorous PA (MVPA). However, when considering the time spent in each domain, the highest proportion of MVPA was seen in publicly accessible playgrounds (13.3% of the time). Chi-square analysis showed that the relative distribution of different PA intensities did not differ across spatial domains. Based on these results, the authors propose 2 key strategies for increasing MVPA in adolescents: Increase the time spent in activity-supportive environments, such as parks and playgrounds, and design techniques to increase MVPA at home and school settings.

A case study on variations in network structure and cross-sector alignment in two local systems serving pregnant and parenting women in recovery.

OBJECTIVE: To describe network structure and alignment across organizations in healthcare, public health, and social services sectors that serve pregnant and parenting women with substance use disorder (SUD) in an urban and a rural community. DATA SOURCES AND STUDY SETTINGS: Two community networks, one urban and one rural with each including a residential substance use treatment program, in Kentucky during 2021. STUDY DESIGN: Social network analysis measured system collaboration and cross-sector alignment between healthcare, public health, and social services organizations, applying the Framework for Aligning Sectors. To understand the alignment and structure of each network, we measured network density overall and between sectors, network centralization, and each organization's degree centrality and effective size. DATA COLLECTION/EXTRACTION METHODS: Computer-assisted telephone interviews were conducted to document alignment around shared purpose, data, financing, and governance. PRINCIPAL FINDINGS: On average, overall and cross-sector network densities in both communities were similar. However, alignment was highest for data sharing and financing in the urban community and for shared purpose and governance in the rural community. Cross-sector partnerships involving healthcare organizations were more prevalent in the rural county (44% vs. 38% for healthcare/public health, 44% vs. 29% for healthcare/social services), but more prevalent for those involving public health/social services organizations in the urban county (42% vs. 24%). A single healthcare organization had the highest degree centrality (Mdn [IQR] = 26 [26-9.5]) and effective size (Mdn [IQR] = 15.9 [20.6-8.7]) within the rural county. Social services organizations held more central positions in the urban county (degree centrality Mdn [IQR] = 13 [14.8-9.5]; effective size Mdn [IQR] = 10.4 [11.4-7.9]). CONCLUSIONS: Cross-sector alignment may strengthen local capacity for comprehensive SUD care for pregnant and parenting women. Healthcare organizations are key players in cross-sector partnerships in the rural community, where one healthcare facility holds the central brokerage role. In contrast, public health agencies are key to cross-sector collaboration with social services in the urban community.

Directed Acyclic Graph Assisted Method For Estimating Average Treatment Effect.

Observational data, such as electronic clinical records and claims data, can prove invaluable for evaluating the Average Treatment Effect (ATE) and supporting decision-making, provided they are employed correctly. The Inverse Probability of Treatment Weighting (IPTW) method, based on propensity scores, has demonstrated remarkable efficacy in estimating ATE, assuming that the assumptions of exchangeability, consistency, and positivity are met. Directed Acyclic Graphs (DAGs) offer a practical approach to assess the exchangeability assumption, which asserts that treatment assignment and potential outcomes are independent given a set of confounding variables that block all backdoor paths from treatment assignment to potential outcomes. To ensure a consistent ATE estimator, one can adjust for a minimally sufficient adjustment set of confounding variables that block all backdoor paths from treatment assignment to the outcome. To enhance the efficiency of ATE estimators, our proposal involves incorporating both the minimally sufficient adjustment set of confounding variables and predictors into the propensity score model. Extensive simulations were conducted to evaluate the performance of propensity score-based IPTW methods in estimating ATE when different sets of covariates were included in the propensity score models. The simulation results underscored the significance of including the minimally sufficient adjustment set of confounding variables along with predictors in the propensity score models to obtain a consistent and efficient ATE estimator. We applied this proposed method to investigate whether tracheostomy was causally associated with in-hospital infant mortality, utilizing the 2016 Healthcare Cost and Utilization Project Kids' Inpatient Database. The estimated ATE was found to be approximately 2.30%-2.46% with p-value >0.05.

Controversies in CPT® coding in the neonatal intensive care unit: - critical vs. intensive care.

Professional reimbursement to neonatal providers is based on the level of Current Procedural Terminology (CPT®) coding in the NICU, newborn nursery and other areas where neonatal care is provided. Four levels of evaluation and management (E&M) care-critical, intensive, routine-hospital care or normal newborn care can be provided to neonates. The work relative value units (wRVUs) associated with these four levels of care vary widely. This manuscript provides a brief review of basic features associated with each of these four levels with a specific perspective on differences between critical and intensive care codes. Coding and billing are constantly evolving fields with significant variation in interpretation and readers are encouraged to review the current publications on CPT® coding and make an informed decision on the best codes to be used for their patients.

Differences in physical activity participation among young adults in Aotearoa New Zealand.

BACKGROUND: The purpose of this study was to examine socio-demographic differences in physical activity (aerobic and muscle-strengthening) among young adults (18-24 years). METHODS: Data collected between 2017-2019 as a part of Sport New Zealand's Active NZ survey were examined using logistic regression analyses to determine the odds of participants meeting aerobic, muscle-strengthening and combined physical activity recommendations. Gender, ethnicity, employment/student status, disability status, and socio-economic deprivation were included as explanatory variables in analyses. RESULTS: The proportion of young adults meeting recommendations varied according to physical activity type (aerobic:63.2%; strength:40.1%; combined:37.2%). Young adults not employed/studying had lower odds of meeting recommendations than those full-time employed (OR = 0.43 [0.34-0.54]). Physical activity levels differ according to gender and this intersects with ethnicity, employment/student status, and social deprivation. For example, the odds of Pasifika young adults meeting combined physical activity recommendations compared to Europeans were not different (OR = 0.95 [0.76-1.19]), but when stratified by gender the odds were significantly higher for men (OR = 1.55 [1.11-2.16]) and significantly lower for women (OR = 0.64 [0.47-0.89]. Similarly, young adults in high deprivation areas had lower odds of meeting combined physical activity recommendations than those in low deprivation areas (OR = 0.81 [0.68-0.95]), but this was mainly due to the difference among women (OR = 0.68 [0.54-0.85]) as there was no difference among men (OR = 0.97 [0.76-1.25]). CONCLUSIONS: Intersections between socio-demographic characteristics should be considered when promoting physical activity among young adults in Aotearoa New Zealand, particularly young adults not employed/studying, and young women who live in deprived areas or identify as Asian or Pasifika. Tailored approaches according to activity type for each of these groups are required.

Results from Aotearoa New Zealand's 2022 Report Card on Physical Activity for Children and Youth: A call to address inequities in health-promoting activities.

Background: This article reports the methods and findings for Aotearoa New Zealand's 2022 Report Card on Physical Activity for Children and Youth indicators, and on inequities within these indicators. Methods: Grades were assigned to indicators using the Active Healthy Kids Global Alliance criteria depending on data availability, and inequities reported based on gender, ethnicity, disability status, area-level socioeconomic deprivation, urbanicity, and school year. Two additional indicators were included in this report card: Sleep, and Physical literacy. Results: Grades were assigned to indicators as follows: Overall physical activity: C+, Organised sport and physical activity: B-, Physical literacy: B, Active transportation: D, Sedentary behaviours: C-, Sleep: B+, Whanau (family) and peers: D, School: C+, Government: A. Inequities across all socio-demographic variables were observed. An 'inconclusive' grade was assigned to the Active play, Physical fitness, and Community and Environment indicators due to insufficient data. Conclusion: It is imperative that targeted, comprehensive, and population-specific approaches are implemented to support health-promoting physical activity behaviours and reduce inequities among children and youth in Aotearoa. There is a need to promote all dimensions of physical activity (overall activity, active play, recreation, organised sport, active transportation) and the reduction of screen time through policy, research, evidence-based social marketing campaigns, and urban design. Regular, nationally representative surveys that enable the consistent and regular measurement of key Report Card indicators are needed.

Sociodemographic differences in 24-hour time-use behaviours in New Zealand children.

BACKGROUND: The time that children spend in physical activity, sedentary behaviour, and sleep each day (i.e., 24-h time-use behaviours), is related to physical and mental health outcomes. Currently, there is no comprehensive evidence on New Zealand school-aged children's 24-h time-use behaviours, adherence to the New Zealand 24-h Movement Guidelines, and how these vary among different sociodemographic groups. METHODS: This study utilises data from the 8-year wave of the Growing Up in New Zealand longitudinal study. Using two Axivity AX3 accelerometers, children's 24-h time-use behaviours were described from two perspectives: activity intensity and activity type. Compositional data analysis techniques were used to explore the differences in 24-h time-use compositions across various sociodemographic groups. RESULTS: Children spent on average, 31.1%, 22.3%, 6.8%, and 39.8% of their time in sedentary, light physical activity, moderate-to-vigorous physical activity, and sleep, respectively. However, the daily distribution of time in different activity types was 33.2% sitting, 10.8% standing, 7.3% walking, 0.4% running, and 48.2% lying. Both the activity intensity and activity type compositions varied across groups of child ethnicity, gender, and household income or deprivation. The proportion of children meeting each of the guidelines was 90% for physical activity, 62.5% for sleep, 16% for screen time, and 10.6% for the combined guidelines. Both gender and residence location (i.e., urban vs. rural) were associated with meeting the physical activity guideline, whereas child ethnicity, mother's education and residence location were associated with meeting the screen time guideline. Child ethnicity and mother's education were also significantly associated with the adherence to the combined 24-h Movement Guidelines. CONCLUSIONS: This study provided comprehensive evidence on how New Zealand children engage in 24-h time-use behaviours, adherence to the New Zealand 24-h Movement Guidelines, and how these behaviours differ across key sociodemographic groups. These findings should be considered in designing future interventions for promoting healthy time-use patterns in New Zealand children.

Smart Watch Versus Classic Receivers: Static Validity of Three GPS Devices in Different Types of Built Environments.

In order to study the relationship between human physical activity and the design of the built environment, it is important to measure the location of human movement accurately. In this study, we compared an inexpensive GPS receiver (Holux RCV-3000) and a frequently used Garmin Forerunner 35 smart watch, with a device that has been validated and recommended for physical activity research (Qstarz BT-Q1000XT). These instruments were placed on six geodetic points, which represented a range of different environments (e.g., residential, open space, park). The coordinates recorded by each device were compared with the known coordinates of the geodetic points. There were no differences in accuracy among the three devices when averaged across the six sites. However, the Garmin was more accurate in the city center and the Holux was more accurate in the park and housing estate areas compared to the other devices. We consider the location accuracy of the Holux and the Garmin to be comparable to that of the Qstarz. Therefore, we consider these devices to be suitable instruments for locating physical activity. Researchers must also consider other differences among these devices (such as battery life) when determining if they are suitable for their research studies.

The protective performance of reusable cloth face masks, disposable procedure masks, KN95 masks and N95 respirators: Filtration and total inward leakage.

Face coverings are a key component of preventive health measure strategies to mitigate the spread of respiratory illnesses. In this study five groups of masks were investigated that are of particular relevance to the SARS-CoV-2 pandemic: re-usable, fabric two-layer and multi-layer masks, disposable procedure/surgical masks, KN95 and N95 filtering facepiece respirators. Experimental work focussed on the particle penetration through mask materials as a function of particle diameter, and the total inward leakage protection performance of the mask system. Geometric mean fabric protection factors varied from 1.78 to 144.5 for the fabric two-layer and KN95 materials, corresponding to overall filtration efficiencies of 43.8% and 99.3% using a flow rate of 17 L/min, equivalent to a breathing expiration rate for a person in a sedentary or standing position conversing with another individual. Geometric mean total inward leakage protection factors for the 2-layer, multi-layer and procedure masks were <2.3, while 6.2 was achieved for the KN95 masks. The highest values were measured for the N95 group at 165.7. Mask performance is dominated by face seal leakage. Despite the additional filtering layers added to cloth masks, and the higher filtration efficiency of the materials used in disposable procedure and KN95 masks, the total inward leakage protection factor was only marginally improved. N95 FFRs were the only mask group investigated that provided not only high filtration efficiency but high total inward leakage protection, and remain the best option to protect individuals from exposure to aerosol in high risk settings. The Mask Quality Factor and total inward leakage performance are very useful to determine the best options for masking. However, it is highly recommended that testing is undertaken on prospective products, or guidance is sought from impartial authorities, to confirm they meet any implied standards.

A quality improvement project improving the value of iNO utilization in preterm and term infants.

OBJECTIVE: Inhaled NO (iNO) is used in the NICU for management of hypoxemic respiratory failure. The cost of iNO is significant and does not consistently improve outcomes in infants <34 weeks. PROJECT DESIGN: Our team used The Model for Improvement to design a quality improvement project to utilize iNO for appropriate indications, ensure response to therapy and initiate timely weaning. The project was carried out at a Level IV NICU and successful interventions spread to a smaller Level III NICU. RESULTS: This project demonstrated significant improvement in all measures; total iNO hours per month, average iNO hours per patient, and the percentage of prolonged iNO courses. With an estimated cost of $115/h, the cost per patient for iNO use declined by half from $21,620 to $10,580. CONCLUSIONS: Our team improved the value of iNO utilization at our institution and spread successful interventions to another NICU in our network.

The impact of extreme reuse and extended wear conditions on protection provided by a surgical-style N95 filtering facepiece respirator.

Most respirators employed in health care settings, and often in first responder and industrial settings, are intended for single-use: the user dons the respirator, performs a work activity, and then doffs and discards the respirator. However, in the current COVID-19 pandemic, in the presence of persistent shortages of personal protective equipment, extended use and reuse of filtering facepiece respirators are routinely contemplated by many health care organizations. Further, there is considerable current effort to understand the effect of sterilization on the possibility of reuse, and some investigations of performance have been conducted. While the ability of such a respirator to continue to provide effective protection after repeated sanitization cycles is a critical component of implementing its reuse, of equal importance is an understanding of the impact that reusing the respirator multiple times in a day while performing work tasks, and even extending its wear over multiple days, has on the workplace protective performance. In this study, we subjected a stockpiled quantitatively fitted surgical style N95 filtering facepiece respirator device to extreme reuse and extended wear conditions (up to 19 uses over a duration of 5 days) and measured its protective performance at regular intervals, including simulated workplace protection factor measurements using total inward leakage. With this respirator, it was shown to be possible to maintain protection corresponding to an assigned protection factor greater than 10 under extreme usage conditions provided an individual is properly trained in the use of, and expertly fitted in, the respirator. Other factors such as hygiene and strap breakage are likely to place limits on reuse.

Effects of a Curriculum-Integrated Dance Program on Children's Physical Activity.

BACKGROUND: Curriculum-integrated dance programs are a promising but relatively under-researched strategy for increasing children's physical activity (PA). The aim of this study was to determine the impact of a curriculum-integrated dance program on children's PA. METHODS: A total of 134 primary children aged 7-9 years from 4 New Zealand schools were assigned to either a dance group (n = 78) or a control group (n = 56). The dance group participated in a 6-week curriculum-integrated dance program during school time. Although the dance program focused on curricular learning, fitness and coordination were embedded in the dance sessions. Intensity of PA varied according to the focus of each dance session. PA was measured at baseline and postintervention using a waist-mounted ActiGraph GT3X+ accelerometer for 8 consecutive days. RESULTS: There were no significant intervention effects on PA levels between the dance and control groups postintervention. CONCLUSION: Dance-embedded learning did not increase overall levels of PA in this study. Future studies may consider assessing longer term effects of a dance-based intervention, or programs that place more focus on PA promotion.

No evidence from a systematic review for the use of probiotics to prevent otitis media.

AIM: This systematic review evaluates the current evidence for the use of probiotics in the prevention of acute otitis media (AOM) in children. METHODS: This study is registered with PROSPERO prior to commencement. PubMed, MEDLINE, EMBASE and Cochrane database were searched using relating keywords. All literature was screened to determine relatability to the topic. Review articles were also screened for additional literature. RESULTS: Thirteen studies were found on probiotics and their role in preventing AOM in children. They ranged in quality from poor to moderate. Half (2/4) of the studies that used nasal probiotic formulations showed a significant difference in reducing otitis media, while only a third (3/9) of the studies using oral formulations suggest benefit in reducing AOM. None of the studies demonstrated significant adverse effects from probiotics. CONCLUSION: The evidence for any effect of probiotics on the prevention of AOM is limited, and the overall low quality of studies makes it difficult to draw definitive conclusions. No serious adverse events were noted, and there is some evidence to suggest possible benefit with nasal probiotic administration.

The business case for quality improvement.

Value in healthcare can be defined as providing the optimal outcome per health dollar spent. Improving the value of healthcare for patients and healthcare organizations requires an understanding and evaluation of the costs and benefits. Investing in quality improvement (QI) work can bring about financial results for healthcare organizations over time, have beneficial organizational effects, and improve outcomes for patients. This article continues a series of QI educational papers in the Journal of Perinatology, and reviews financial and economic measures used to create the business case for QI. Ultimately, the business case for QI is better defined as a business strategy for success.

Application of Raw Accelerometer Data and Machine-Learning Techniques to Characterize Human Movement Behavior: A Systematic Scoping Review.

BACKGROUND: Application of machine learning for classifying human behavior is increasingly common as access to raw accelerometer data improves. The aims of this scoping review are (1) to examine if machine-learning techniques can accurately identify human activity behaviors from raw accelerometer data and (2) to summarize the practical implications of these machine-learning techniques for future work. METHODS: Keyword searches were performed in Scopus, Web of Science, and EBSCO databases in 2018. Studies that applied supervised machine-learning techniques to raw accelerometer data and estimated components of physical activity were included. Information on study characteristics, machine-learning techniques, and key study findings were extracted from included studies. RESULTS: Of the 53 studies included in the review, 75% were published in the last 5 years. Most studies predicted postures and activity type, rather than intensity, and were conducted in controlled environments using 1 or 2 devices. The most common models were support vector machine, random forest, and artificial neural network. Overall, classification accuracy ranged from 62% to 99.8%, although nearly 80% of studies achieved an overall accuracy above 85%. CONCLUSIONS: Machine-learning algorithms demonstrate good accuracy when predicting physical activity components; however, their application to free-living settings is currently uncertain.