Child eating behavior predicts body mass index after 1 year: results from the Swiss Preschooler's Health Study (SPLASHY).

Child obesity is a growing global issue. Preventing early development of overweight and obesity requires identifying reliable risk factors for high body mass index (BMI) in children. Child eating behavior might be an important and malleable risk factor that can be reliably assessed with the parent-report Child Eating Behavior Questionnaire (CEBQ). Using a hierarchical dataset (children nested within child care centers) from a representative cohort of Swiss preschool children, we tested whether eating behavior, assessed with a 7-factor solution of the CEBQ, and BMI at baseline predicted the outcome BMI after 1 year, controlling for socioeconomic status (n = 555; 47% female; mean age = 3.9 years, range: 2.2-6.6; mean BMI = 16 kg/m2, range: 11.2-23; mean age- and sex-corrected z-transformed BMI, zBMI = 0.4, range -4 to +4.7). The statistical model explained 65.2% of zBMI at follow-up. Baseline zBMI was a strong positive predictor, uniquely explaining 48.8% of outcome variance. A linear combination of all CEBQ scales, taken together, explained 10.7% of outcome variance. Due to their intercorrelations, uniquely explained variance by any individual scale was of negligible clinical relevance. Only food responsiveness was a significant predictor, when accounting for all other predictors and covariates in the model, and uniquely explained only 0.4% of outcome variance. Altogether, our results confirm, extend, and refine previous research on eating behavior and zBMI in preschool children, by adjusting for covariates, accounting for intercorrelations between predictors, partitioning explained outcome variance, and providing standardized beta estimates. Our findings show the importance of carefully examining the contribution of predictors in multiple regression models for clinically relevant outcomes.

Trend in loneliness among Swiss university students during the first year of the COVID-19 pandemic.

BACKGROUND: The need to maintain physical and social distance between people and the stay-at-home recommendation/order to contain the spread of COVID-19 have raised concerns about the possible increase in loneliness. However, few studies have analyzed trends or changes in loneliness in samples of young adults. The present study aimed to explore the prevalence of loneliness and its change during the COVID-19 pandemic. PARTICIPANTS AND PROCEDURE: This is a repeated cross-sectional study analyzing data collected through six online surveys between April 2020 and March 2021 from 5,669 university students in Switzerland. Logistic regression models were used to examine trends in loneliness and associations between loneliness, well-being, life at home, COVID-19 symptoms and tests. RESULTS: Loneliness decreased between April 2020 and May-June 2020. In contrast, loneliness was higher in December 2020, January and March 2021 compared to April 2020. Loneliness was associated with younger age, studying architecture, design and civil engineering or engineering, enjoying time spent with family/partner, experiencing tensions and conflicts at home, boredom, feeling locked up and subjective well-being and current health. CONCLUSIONS: Our findings highlight an increase in loneliness during the second wave of the COVID-19 pandemic, although a seasonality effect cannot be excluded. Public health systems and educational institutions need to monitor the effects of social distancing measures and reduced social contact on students' loneliness and well-being.

Eating behaviour in Swiss preschool children-Validation of a German and a French version of the Children's Eating Behaviour Questionnaire (CEBQ).

Young children's eating behavior is crucial for any further development of healthy eating. Early eating behavior are often assessed through parental report. The Children's Eating Behaviour Questionnaire (CEBQ) is a widely used parental questionnaire that has been validated in families of different gender, age and cultural background. Research has shown that the 8-factor structure has some inconsistencies and sample characteristics such as age, gender, and culture can influence the results. To which extent such sample characteristics might influence results within a multi-lingual culture has not been investigated so far. Therefore, the aim of the study was to evaluate the factor structure of the CEBQ among 511 preschool children of the French and German parts of Switzerland, aged 2 to 6 years (Mean 3.85 years; SD 0.69). Confirmatory Factor Analysis showed a modified structure of the original questionnaire, with a 7-factor structure providing a reasonable fit to the data (TLI = 0.954, CFI = 0.952, RMSEA = 0.063 and SRMR = 0.067). The subscale 'Desire to drink' was removed, and a few items moved to other subscales as they loaded higher on a different subscale compared to the original model. Reliabilities based on the coefficient omega were acceptable to satisfying across the seven factors, ranging from 0.66 to 0.90. There were no significant gender or age differences, but French speaking children showed higher levels of 'Satiety responsiveness' and lower 'Enjoyment of food' than German speaking children. Yet, these effects were small. The German and French CEBQ are valid and reliable versions of the original CEBQ and can be used in a multicultural context.

Seeking Health in a Digital World: Exploring Immigrant Parents' Quest for Child Health Information-A Scoping Review.

During pregnancy and early parenthood, parents' strong interest in pediatric health information presents a valuable opportunity to positively impact long-term health-seeking behavior and overall child health. In line with the increasing prevalence of digital transformation, a scoping review was conducted to explore two key aspects: (1) information seeking and use of digital health information among immigrant parents, and (2) associated reasons and factors. The literature search covered the period until July 2022, using Web of Science, MEDLINE, and CINAHL Complete databases. Out of 625 articles, 12 were included, comprising six qualitative, five quantitative studies, and one review. The majority of studies focused on immigrants in North America, primarily from Latin America and Asia. The studies varied in topics and methodologies, making it challenging to draw general conclusions. Nevertheless, while most immigrant parents rely on digital information on child health, they often prefer human sources such as family, friends, or healthcare providers. Trustworthiness and accessibility emerged as critical criteria for health resources. Two focus group discussions, derived from the results of the review, confirmed these findings for migrant mothers in Switzerland.

Changes in socioeconomic resources and mental health after the second COVID-19 wave (2020-2021): a longitudinal study in Switzerland.

BACKGROUND: During the 2020/2021 winter, the labour market was under the impact of the COVID-19 pandemic. Changes in socioeconomic resources during this period could have influenced individual mental health. This association may have been mitigated or exacerbated by subjective risk perceptions, such as perceived risk of getting infected with SARS-CoV-2 or perception of the national economic situation. Therefore, we aimed to determine if changes in financial resources and employment situation during and after the second COVID-19 wave were prospectively associated with depression, anxiety and stress, and whether perceptions of the national economic situation and of the risk of getting infected modified this association. METHODS: One thousand seven hundred fifty nine participants from a nation-wide population-based eCohort in Switzerland were followed between November 2020 and September 2021. Financial resources and employment status were assessed twice (Nov2020-Mar2021, May-Jul 2021). Mental health was assessed after the second measurement of financial resources and employment status, using the Depression, Anxiety and Stress Scale (DASS-21). We modelled DASS-21 scores with linear regression, adjusting for demographics, health status, social relationships and changes in workload, and tested interactions with subjective risk perceptions. RESULTS: We observed scores above thresholds for normal levels for 16% (95%CI = 15-18) of participants for depression, 8% (95%CI = 7-10) for anxiety, and 10% (95%CI = 9-12) for stress. Compared to continuously comfortable or sufficient financial resources, continuously precarious or insufficient resources were associated with worse scores for all outcomes. Increased financial resources were associated with higher anxiety. In the working-age group, shifting from full to part-time employment was associated with higher stress and anxiety. Perceiving the Swiss economic situation as worrisome was associated with higher anxiety in participants who lost financial resources or had continuously precarious or insufficient resources. CONCLUSION: This study confirms the association of economic stressors and mental health during the COVID-19 pandemic and highlights the exacerbating role of subjective risk perception on this association.

The relationship of parenting style and eating behavior in preschool children.

BACKGROUND: Eating behavior represents individual appetitive traits which are related to the individual's regulation of food intake. Eating behavior develops at an early age. There is some evidence that parenting styles might impact on the child's eating behavior. The aim of this study was to investigate the relationship of different dimensions of positive and negative parenting styles with the child's eating behavior at a critical age period of the child's early development. METHODS: Parents of 511 preschool children (aged 2-6 years) completed the Children Eating Behavior Questionnaire and the Alabama Parenting Questionnaire. RESULTS: Analyses revealed that different dimensions of negative parenting styles were associated with eating behavior of the child. In details, inconsistent parenting showed a consistent association with eating behavior of a child (i.e. higher emotional eating, higher food responsiveness, higher food fussiness, higher satiety responsiveness and more enjoyment of food), whereas corporal punishment was associated with more emotional overeating and more food responsiveness but less satiety responsiveness. Further, powerful implementation was related to higher food responsiveness and less enjoyment of food and low monitoring was associated with higher emotional overeating and more slowness in eating. There was no such consistent association of positive parenting and eating behavior. CONCLUSIONS: More negative parenting styles were associated with eating behavior which is more often related to potential weight problems in a long term, whereas positive parenting did not show such a consistent relationship with eating behavior. Negative parenting should be in the focus of prevention and treatment of eating behavior problems in young children. TRIAL REGISTRATION: ISRCTN41045021 (06/05/2014).

Change in Alcohol Consumption and Binge Drinking in University Students During the Early COVID-19 Pandemic.

Objectives: Young adults have been overly affected by the containment measures against COVID-19 and, consequently, worsening in mental health and change in health behavior have been reported. Because the life phase of emerging adulthood is crucial for developing health behaviors, this study aims to examine increase in alcohol consumption, single and multiple binge drinking, and associated factors in students during lockdown and post-lockdown periods. Methods: A prospective open cohort study design with nine survey time points between April 2020 and June 2021 was conducted. The present study uses pooled data from the first survey T0 (3 April to 14 April) and follow-ups at T1 (30 April to 11 May 2020) and T2 (28 May to 8 June 2020). Students from all faculties of the Zurich University of Applied Sciences (ZHAW) (N = 12'431) were invited. Of the 1,300 students who participated at baseline and in at least one follow-up, 1,278 (98.3%) completed the questionnaires, final net sample size was 947. Generalized Estimating Equations (GEE) models were used to investigate the factors associated with increases in alcohol consumption based on number of occasions/last 30 days; drinks/week, and binge drinking at T0, and respective changes at T1 and T2 (increases, decreases, no change). Results: Overall, 20% of Swiss university students reported an increased alcohol consumption and 26% engaged in binge drinking. Number of drinks at baseline was associated with a higher probability of increased alcohol consumption, as well as engaging in single and multiple binge drinking events. Higher anxiety scores were associated with a higher probability to increase the alcohol consumption and engaging at least once in binge drinking. Additional factors associated with any binge drinking were male gender, younger age and not living with parents. Higher perceived social support was only associated with engaging in heavy binge drinking. Conclusions: A substantial number of students developed a more risky health behavior regarding alcohol consumption. It is important to identify at risk students and design target prevention including factors such as age, gender and social norms. Further, health behavior and determinants of health behaviors of students should be carefully monitored during the further course of the pandemic.

How effective is fine motor training in children with ADHD? A scoping review.

BACKGROUND: Motor deficiencies are observed in a large number of children with ADHD. Especially fine motor impairments can lead to academic underachievement, low self-esteem and frustration in affected children. Despite these far-reaching consequences, fine motor deficiencies have remained widely undertreated in the ADHD population. The aim of this review was to systematically map the evidence on existing training programs for remediating fine motor impairments in children with ADHD and to assess their effectiveness. METHODS: The scoping review followed the PRISMA-ScR guidelines. In March 2020, PsycINFO, MEDLINE (PubMed), Web of Science, Google Scholar and The Cochrane Database of Systematic Reviews were searched for evidence. The eligibility criteria and the data charting process followed the PICO framework, complemented by study design. The investigated population included children with a formal ADHD diagnosis (either subtype) or elevated ADHD symptoms aged between 4 and 12 years, both on and off medication. All training interventions aiming at improving fine motor skills, having a fine motor component or fine motor improvements as a secondary outcome were assessed for eligibility; no comparators were specified. RESULTS: Twelve articles were included in the final report, comprising observational and experimental studies as well as a review. Both offline and online or virtual training interventions were reported, often accompanied by physical activity and supplemented by training sessions at home. The training programs varied in length and intensity, but generally comprised several weeks and single or multiple training sessions per week. All interventions including more than one session were effective in the treatment of fine motor deficiencies in children with ADHD and had a wide range of additional positive outcomes. The effects could be maintained at follow-up. CONCLUSIONS: Fine motor training in children with ADHD can be very effective and multiple approaches including specific fine motor and cognitive training components, some kind of physical activity, feedback mechanisms, or multimodal treatments can be successful. Training programs need to be tailored to the specific characteristics of the ADHD population. A mHealth approach using serious games could be promising in this context due to its strong motivational components.

Generalized Anxiety among Swiss Health Professions and Non-Health Professions Students: An Open Cohort Study over 14 Months in the COVID-19 Pandemic.

To date, little is known about the long-term trajectory of generalized anxiety disorder (GAD) symptoms in health professions (HP) students over the course of the pandemic. Like health professionals in general, HP students may have a significantly greater susceptibility to GAD symptoms due to their involvement in the health care system and the associated specific stressors and risks during the COVID-19 pandemic. The HEalth in Students during the Corona pandemic study (HES-C) provided the opportunity to investigate the long-term course of GAD symptoms with eight measurement points over 14 months in 9380 HP and non-HP students in Switzerland between March 2020 and June 2021. We employed logistic regression models with clustered sandwich standard errors to estimate unadjusted and adjusted prevalence of GAD symptoms. In the full model, we adjusted for age, gender, nationality, social status, social support, self-efficacy, and COVID-19 symptoms in the past 4 weeks. At baseline, the estimated adjusted GAD symptom prevalence was 17.6% (95% CI = 14.4-20.7) in HP students and 24.4% (95% CI = 22.3-26.5) in their peers. With the peak of the second SARS-CoV-2 infection wave in October/November 2020, GAD symptom prevalence substantially increased and then remained stable over time, despite changes in the epidemiological situation and its associated containment measures. At the last follow-up in June 2021, GAD symptom prevalence in HP and non-HP students was 22.9% (95% CI = 16.3-29.5) and 36.9% (95% CI = 32.9-40.9), respectively. Absolute differences in GAD symptom prevalence between student groups over all eight measurement points ranged from 6.2% to 14.9% (all p < 0.05). Non-HP students are identified as a specifically vulnerable group. Accordingly, target group-specific public health campaigns and interventions should be developed with the aim to strengthen their resources, reducing GAD symptoms, and preventing chronification.

To Vaccinate or Not to Vaccinate-This Is the Question among Swiss University Students.

The speed and innovation of the COVID-19 vaccine development has been accompanied by insecurity and skepticism. Young adults' attitude to vaccination remains under investigation, although herd immunity cannot be reached without them. The HEalth in Students during the Corona pandemic study (HES-C) provided the opportunity to investigate vaccination intention in 1478 students in the sixth survey wave (January 2021), including vaccination intention, psychological antecedents of vaccine hesitancy, trust in government's vaccination strategy, and vaccination history. Associations with vaccination intention were analyzed with multivariate ordinal regression and predicted margins were calculated adjusting for gender, age, anxiety, health profession, and subjective health status. A third was decided (yes 25.1%, no 7.6%), and 68% were unsure about getting the COVID-19 vaccine when available. Next to demographic characteristics, vaccination history (influenza vaccination OR = 1.39; 95% CI: 1.06-1.83, travel vaccination OR = 1.29; 95% CI: 1.04-1.60), trust in vaccination strategy (OR = 2.40; 95% CI: 1.89-3.05), and 5C dimensions were associated with vaccination intention: confidence (OR = 2.52; 95% CI: 2.09-3.03), complacency (OR = 0.79; 95% CI: 0.66-0.96), calculation (OR = 0.79; 95% CI: 0.70-0.89), constraints (OR = 1.18; 95% CI: 0.99-1.41), and collective responsibility (OR = 4.47; 95% CI: 3.69-5.40). Addressing psychological antecedents and strengthening trust in official strategies through targeted campaigns and interventions may increase decisiveness and result in higher vaccination rates.

Walking onset: a poor predictor for motor and cognitive skills in healthy preschool children.

BACKGROUND: The onset of walking is thought to be an indicator of early development. However, evidence is mixed and clear data on this relationship at preschool age is missing. The study aimed at investigating if walking onset and motor and cognitive development in preschool children are related. METHODS: A total of 555 children (mean age 3.86 years) of the Swiss Preschoolers' Health Study SPLASHY were tested twice at their childcare center (at baseline and one year later). Motor skills and cognitive skills were assessed by standardized testing procedures and parents were asked to provide information on walking onset of their child. RESULTS: Late onset of walking was related to poorer motor skills (fine motor skills, static and dynamic balance (all p < 0.003)) and poorer cognitive skills (selective attention and visual perception (p = 0.02; p = 0.001) in late preschool age. CONCLUSIONS: For children with late walking onset a close monitoring of their development in the regular pediatric child health visits may be reasonable. TRIAL REGISTRATION: ISRCTN41045021 .

A Longitudinal Study on Generalized Anxiety Among University Students During the First Wave of the COVID-19 Pandemic in Switzerland.

OBJECTIVE: The COVID-19 pandemic and government measures implemented to counter the spread of the infection may be a major stressor affecting the psychological health of university students. This study aimed to explore how anxiety symptoms changed during the pandemic. METHODS: 676 students (76% females) at Zurich University of Applied Sciences participated in the first (T0) and second (T1) survey waves. Anxiety symptoms were assessed using the Generalized Anxiety Disorder-Scale-7 (GAD-7). Risk and protective factors (e.g., COVID-19-related variables) were examined. RESULTS: GAD-7 scores decreased significantly from T0 to T1 (mean change: -0.446, SE = 0.132, 95% CI: -0.706, -0.186, t = -3.371, df = 659, p = 0.001). Participants with moderate-to-severe anxiety score were 20.2 and 15.6% at T0 and T1, respectively. The following positively predicted anxiety: older age, female gender, non-Swiss nationality, loneliness, participants' concern about their own health, and interaction between time and participants' concern about their own health. Resilience and social support negatively predicted anxiety. CONCLUSIONS: Our findings provide information for public health measures and psychological interventions supporting the mental health of university students during the COVID-19 emergency.

Students' experience and adherence to containment measures during COVID-19 in Switzerland.

BACKGROUND: Young adults are not considered a risk group, but the public health response to COVID-19 impacts all citizens. We investigated the impact on young adults' and their adherence to containment measures addressing potential gender differences. METHODS: In April 2020 12 341 students of the Zurich University of Applied Sciences were invited to a longitudinal health survey. Survey topics spanned socio-demographic data, students' health status and behavior, COVID-19 specific impact, concerns, information sources, adherence to containment measures, and trust in government bodies. Group comparisons by gender and multivariate ordinal regression models assessing adherence to restrictions of mobility and social contacts were conducted (n = 2373). RESULTS: Mean age was 26.4 (SD = 5.6), 70% were female. 43.5% reported some concern about their own health, 2.7% stated major worries. Women experienced more conflicts (p < 0.000) and, enjoyed time with the family more (p < 0.000). Men felt less locked up (p = 0.001). The most frequented COVID-19 information source was public media (48%) and confidence in government bodies was high (82%) for both genders. Men yielded lower adjusted odds (OR; 95%-CI) of adherence regarding the following measures: social distancing (0.68; 0.53-0.87), non-utilization of public transport (0.74; 0.56-0.97), 5-person limit for social gatherings (0.47; 0.35-0.64) and the stay at home rule (0.64; 0.51-0.82). CONCLUSION: Early in the pandemic a high degree of adherence was observed in this young academic population. Containment measures restricting movement and social contact yielded considerable differences by gender, information source and perceived susceptibility to the virus. More targeted communication may increase adherence regarding mobility restrictions.

Depressive Symptoms in Swiss University Students during the COVID-19 Pandemic and Its Correlates.

BACKGROUND: COVID-19 containment measures and the uncertainties associated with the pandemic may have contributed to changes in mental health risks and mental health problems in university students. Due to the high burden of the disease, depression is of particular concern. However, knowledge about the prevalence of depressive symptoms in Swiss university students during the pandemic is limited. We therefore assessed the prevalence of depressive symptoms and their change during the COVID-19 pandemic in a large sample of Swiss university students. METHODS: We assessed depressive symptoms in two cross-sectional cohorts of university students (n = 3571) in spring and autumn 2020 during the COVID-19 pandemic and compared them with a matched sample of the Swiss national population (n = 2328). Binary logistic regression models estimated prevalence with corresponding 95% confidence intervals (95% CI). RESULTS: Adjusted prevalence of depressive symptoms in female (30.8% (95% CI: 28.6-33.0)) and male students (24.8% (95% CI: 21.7-28.1)) was substantially higher than in the matching female (10.9% (95% CI: 8.9-13.2)) and male (8.5% (6.6-11.0)) pre-pandemic national population. Depressive symptoms in the two consecutive student cohorts did not significantly differ. CONCLUSIONS: More than a quarter of Swiss university students reported depressive symptoms during the COVID-19 pandemic, which was substantially higher as compared to the matched general population. Universities should introduce measures to support students in such times of crisis and gain an understanding of the factors impacting mental health positively or negatively and related to university structures and procedures.

Swiss University Students' Risk Perception and General Anxiety during the COVID-19 Pandemic.

University students were confronted with abrupt changes to their daily lives by the COVID-19 lock-down. We investigated Generalized Anxiety Disorder Scale-7 (GAD-7) and anxiety levels, and the association between perceived impact on well-being, studies, and daily lives and anxiety levels, adjusted for gender, age, social class and affiliation. Early in the lock-down all students of the Zurich University of Applied Sciences (N = 12,429) were invited to a voluntary longitudinal health survey. Participation rate was 20% (n = 2437): 70% females, median age 25 yrs. (IQR 23-28). A total of 10% reported a deterioration of well-being compared to pre-Corona. LCA yielded three classes varying in perceived COVID-19 impact: 1 (low, n = 675), 2 (moderate, n = 1098), and 3 (strong, n = 656). Adjusted proportion of moderate to severe anxiety by class were 45% (95% CI: 28.0-62.0), 15.5% (95% CI: 13.1-17.9), and 5.1% (95% CI: 4.7-5.6), respectively. Multivariate regression analyses yielded an OR for moderate to severe anxiety of 3.88 (95% CI: 2.5-6.0, class 2) and 22.43 (95% CI: 14.5-34.6, class 3) compared to class-1. The investigated association implies that containment measures have a selective effect on anxiety in students. The diversity of students' perception and associated anxiety should be monitored and considered in future response to pandemics.

Cardiac vagal tone in preschool children: Interrelations and the role of stress exposure.

INTRODUCTION: Cardiac vagal tone has been understood as the biological correlate of emotion regulation and can be divided into emotion regulation (tonic cardiac vagal tone (TCVT)) and the flexibility to adapt to changing conditions (phasic cardiac vagal tone (PCVT)). There is evidence that TCVT influences PCVT dynamics in adults and that stress exposure impacts on cardiac vagal tone in adults and older children. The aim of the study was to investigate the impact of TCVT on PCVT dynamics in preschoolers and to identify the influence of stress exposures on cardiac vagal tone. METHOD: Measures of heart rate variability including baseline (TCVT), during an age-adapted stress task (PCVT stress reactivity) and during recovery (PCVT recovery) were assessed in 222 children aged 2-6 years of the SPLASHY study. Further, parents were asked to complete questionnaires on early stress exposure (including pregnancy, birth and early life) and current stress exposure (including family stress and parenting). RESULTS: Preschool children with high TCVT showed less PCVT reactivity (p < 0.001) and more increase of vagal tone (PCVT) during early recovery (p = 0.016). Further only child's low birth weight was a relevant stress exposure impacting on early and late PCVT recovery (p = 0.03/p = 0.005). None of the other early or late stress exposure conditions, nor the accumulation of stress exposures influenced TCVT or PCVT dynamics in these healthy preschoolers. DISCUSSION: TCVT impacts on PCVT dynamics in a lab-based stress task in healthy preschool children and only low birth weight is related to more change during early and to less late PCVT recovery.

Motor Competence and Physical Activity in Early Childhood: Stability and Relationship.

Background: Normal motor development and adequate levels of physical activity engagement during the early years of life form the foundation of long-term psychological and physiological health. This is one of the very few studies that investigate the stability and relationships of motor competence and physical activity in preschool children. Methods: Baseline and 12 month follow-up data of physical activity and motor competence of 550 preschool children aged 2-6 years from the Swiss Preschoolers' Health Study were used for this work. Physical activity data, expressed in counts per minute for total physical activity and minutes per day for time spent moderately-to-vigorously physically active, were collected over 1 week using accelerometers. Motor competence was assessed with the Zurich Neuromotor Assessment. Both motor competence and physical activity were age- and sex-adjusted. To examine the individual stability of physical activity and motor competence and reciprocal cross-sectional and longitudinal effects between these two domains, a latent variable cross-lagged panel model where motor competence was represented through a latent construct was examined using structural equation modeling. Results: A weak cross-sectional correlation of motor competence with total physical activity (r = 0.24) and moderate-to-vigorous physical activity (r = 0.23) was found. Motor competence exhibited high stability (ß = 0.82) in the preschool years and physical activity was moderately stable with estimates ranging from ß = 0.37 for total physical activity to ß = 0.48 for moderate-to-vigorous physical activity. In contrast to the autoregressive coefficients denoting individual stability, both cross-lagged effects were negligible indicating that physical activity was not a determinant of motor competence or vice versa. Conclusions: Motor competence and physical activity developed independently of each other in early childhood. Although measures of quantity and intensity of physical activity were not related to motor development, specific movement experiences and practice-which are not reflected by accelerometry-may be needed for skill development. Future research should focus on examining what type of physical activity is important for motor development and how to assess it, and also whether the relationship between physical activity and motor competence evolves over time. Clinical Trial Registration: Current Controlled Trials ISRCTN41045021 (date of registration: 21.03.14).

Association of physical activity with adiposity in preschoolers using different clinical adiposity measures: a cross-sectional study.

BACKGROUND: More research is needed about the association between physical activity (PA), sedentary behaviour (SB), and adiposity in preschoolers, particularly using more direct clinical measures of adiposity. Therefore, the main objective of this study was to investigate the association between objectively measured PA and different clinical adiposity measures in a large sample of preschoolers. METHODS: Four hundred sixty-three predominantly normal-weight (77%) 2-6-year-old preschool children participated in the Swiss Preschoolers' Health Study (SPLASHY). Physical activity was measured using accelerometers and was analyzed using 15-s (uni-axial) epoch length using validated cut-offs. Adiposity measures included body mass index (BMI), the sum of four skinfolds, and waist circumference (WC). Multilevel linear regression modeling, adjusted for age, sex and wear time, was used to assess the association between PA and SB with BMI, WC, and skinfold thickness. RESULTS: Total PA and different PA intensities were positively and SB was inversely associated with BMI in the total sample and in the normal-weight children (p < 0.05). Total PA was inversely associated with skinfold thickness in overweight and obese children (p < 0.05), while there was only a weak association for vigorous PA (p > 0.05). Moderate and moderate-to-vigorous PA were positively, and SB was negatively associated with WC in the total sample and in the normal-weight children (p < 0.05). Additional adjustment for potential sociocultural and biological confounding variables attenuated some of the results. CONCLUSIONS: In this very young and predominantly normal-weight population, PA is positively related to BMI and WC, but this relationship is not observed in overweight and obese children. In this latter population, PA is inversely, and SB is positively related to skinfold thickness. Skinfold thickness could represent a useful and simple clinical measure of body fat in preschoolers. The role of vigorous PA in the prevention of early childhood obesity should be further investigated in future studies. TRIAL REGISTRATION: ISRCTN ISRCTN41045021 . Retrospectively registered 06 May 2014.

Accelerometer-derived physical activity estimation in preschoolers - comparison of cut-point sets incorporating the vector magnitude vs the vertical axis.

BACKGROUND: ActiGraph accelerometers are a widely used tool to objectively measure physical activity (PA) behavior in young children and several validated cut-point sets exist to estimate time spent in different PA intensities (sedentary time, light PA, moderate-to-vigorous PA). Applying different cut-point sets leads to large and meaningful differences in results. So far, only cut-point sets validated for the vertical axis have been compared and only the influence on time spent in moderate-to-vigorous PA has been analyzed. METHODS: A range of validated cut-point sets with their respective epoch length was applied to analyze cross-sectional data of the Swiss Preschoolers' Health Study (SPLASHY): 1) Vertical axis in combination with an epoch length of 15 s (VA-15), 2) Vertical axis in combination with an epoch length of 60 s (VA-60) and 3) Vector magnitude in combination with an epoch length of 60 s (VM-60). PA was measured for eight consecutive days using ActiGraph accelerometers (wGT3X-BT). Three days were required to be included in the analysis (minimum two weekdays and one weekend-day with at least ten hours recording per day). RESULTS: Four hundred forty-five preschoolers (mean age 3.9 ± 0.5 years; 46% girls) had valid accelerometer measurements. A longer epoch (VA-60 vs VA-15) resulted in 2% less sedentary time (ST), 18% more light PA (LPA) and 51% less moderate-to-vigorous PA (MVPA); using the vector magnitude compared to the vertical axis (VM-60 vs VA-60) resulted in 34% less ST, 27% more LPA and 63% more MVPA (all p ≤ 0.001). Comparing all three sets of cut-points, ST ranged from 4.0 to 6.2 h, LPA from 5.1 to 7.6 h and MVPA from 0.8 to 1.6 h. CONCLUSIONS: Estimated time spent in different PA intensities was strongly influenced by the choice of cut-point sets. Both, axis selection and epoch length need to be considered when comparing different studies especially when they relate PA behavior to health. The differences in the prevalence of children fulfilling PA guidelines highlight the relevance of these findings. TRIAL REGISTRATION: Current Controlled Trials ISRCTN41045021 (date of registration: 21.03.2014).

Age-Adapted Stress Task in Preschoolers Does not Lead to Uniform Stress Responses.

Acute stress response measures serve as an indicator of physiological functioning, but have previously led to contradictory results in young children due to age-related cortisol hypo-responsivity and methodological inconsistencies in assessment. The aim of this study was to investigate stress responses during a validated age-adapted socio-evaluative stress task in children aged 2-6 years in a child care environment and to detect socio-demographic, task- and child-related characteristics of stress responses. Stress responses were assessed in 323 children for salivary cortisol and salivary alpha amylase (sAA), and in 328 children for changes in heart rate variability (HRV). These data were then associated with socio-demographic (e.g. SES), task-related (e.g. task length) and child-related characteristics (e.g. self-regulation) of stress responses using multilevel models. Analyses revealed elevated sympathetic reactivity (sAA: Coeff=0.053, p=0.004) and reduced HRV (Coeff=-0.465, p<0.001), but no hypothalamic-pituitary-adrenal (HPA) response (Coeff=0.017, p=0.08) during the stress task. Child's age (Coeff=-5.82, p<0.001) and movement during the task (Coeff=-0.17, p=0.015) were associated with acute cortisol release, while diurnal sAA was associated with acute sAA release (Coeff=0.24, p<0.001). Age (Coeff=-0.15, p=0.006) and duration of the task (Coeff=0.13, p=0.015) were further associated with change of HRV under acute stress condition. Children showed inconsistent stress responses which contradicts the assumption of a parallel activation of both stress systems in a valid stress task for young children and might be explained by a pre-arousal to the task of young children in a child care setting. Further results confirm that child- and task-related conditions need to be considered when assessing stress responses in these young children.