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Inadequate Access to Potable Water Impacts Early Childhood Development in Low-Income Areas in Cape Town, South Africa.
Wright, CY, Kapwata, T, Cook, C, Howard, SJ, Makaula, H, Merkley, R, Mshudulu, M, Tshetu, N, Naidoo, N, Scerif, G, et al
Annals of global health. 2023;(1):82
Abstract
BACKGROUND Water and sanitation are vital to human health and well-being. While these factors have been studied in relation to health, very little has been done to consider such environmental risk factors with child development. Here, we investigated possible relations between household water access/storage and early childhood development in four low-income settlements in the City of Cape Town, Western Cape province of South Africa. Our objectives were 1) to determine water access/storage practices in dwellings of children; 2) to assess early childhood development; and 3) and to understand the relationship between water access/storage practices in relation to early childhood development. METHODS We used a questionnaire to assess household water risk factors and the International Development and Early Learning Assessment (IDELA) tool to assess child early learning / cognitive, socio-emotional and motor development. RESULTS Mean age of the children (N = 192) was 4 years and 55% were female. The mean IDELA score was 48% (range: 36-54%) where the higher the score, the better the child's development. Around 70% of households had a tap inside their dwelling and half said that they stored water with the largest percentage of storage containers (21%) being plastic/no lid. Child IDELA scores were lower for children living in households that did not have an indoor tap and for households who stored water. CONCLUSIONS Given the risks associated with climate change and the already poor conditions many children face regarding water and sanitation, research is needed to further investigate these relations to provide evidence to support appropriate interventions and ensure healthy child development.
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2.
Effect of Omega-3 Supplementation on Self-Regulation in Typically Developing Preschool-Aged Children: Results of the Omega Kid Pilot Study-A Randomised, Double-Blind, Placebo-Controlled Trial.
Roach, LA, Byrne, MK, Howard, SJ, Johnstone, SJ, Batterham, M, Wright, IMR, Okely, AD, de Groot, RHM, van der Wurff, ISM, Jones, AL, et al
Nutrients. 2021;(10)
Abstract
Supplementation of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) may enhance self-regulation (SR) and executive functioning (EF) in children of preschool age. The aim of the Omega Kid Study was to investigate the effect of n-3 LCPUFA supplementation on SR and EF in typically developing preschool-aged children. A double-blind placebo-controlled pilot trial was undertaken, the intervention was 12 weeks and consisted of 1.6 g of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) per day compared to placebo. The HS-Omega-3 Index® was assessed by capillary blood samples at baseline and post-intervention. Seventy-eight children were enrolled and randomised to either the n-3 LCPUFA treatment (n = 39) or placebo (n = 39) group. Post intervention, there was a significant three-fold increase in the HS-Omega-3 Index® in the n-3 LCPUFA group (p < 0.001). There were no improvements in SR or EF outcome variables for the n-3 LCPUFA group post intervention compared to the placebo group determined by linear mixed models. At baseline, there were significant modest positive Spearman correlations found between the HS-Omega-3 index® and both behavioural self-regulation and cognitive self-regulation (r = 0.287, p = 0.015 and r = 0.242, p = 0.015 respectively). Although no treatment effects were found in typically developing children, further research is required to target children with sub-optimal self-regulation who may benefit most from n-3 LCPUFA supplementation.
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3.
'Jump start' childcare-based intervention to promote physical activity in pre-schoolers: six-month findings from a cluster randomised trial.
Okely, AD, Stanley, RM, Jones, RA, Cliff, DP, Trost, SG, Berthelsen, D, Salmon, J, Batterham, M, Eckermann, S, Reilly, JJ, et al
The international journal of behavioral nutrition and physical activity. 2020;17(1):6
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Plain language summary
Australian national guidelines recommend children have at least 180 minutes of physical activity per day. But many do not reach this, especially those in low socio-economic areas. There is a lack of evidence on effective interventions to increase movement in children. This 6-month randomised control trial aimed to assess the promotion of physical activity in 658 children from disadvantaged areas. The results showed that daily physical activity was not increased in children who participated in a structured exercise programme. When further analysis was performed it was shown that overweight and obese children did marginally increase their daily physical activity whilst on a structured exercise programme. It was concluded that six-month intervention of a structured exercise programme did not increase a child’s overall daily physical activity.; six months may not be an adequate amount of time to embed this type of regime. Healthcare professionals could use this study to understand that although a structured exercise programme may not be the answer for children with low activity levels, participating in movement and exercise is important from a young age.
Abstract
BACKGROUND Participation in adequate levels of physical activity during the early years is important for health and development. We report the 6-month effects of an 18-month multicomponent intervention on physical activity in early childhood education and care (ECEC) settings in low-income communities. METHODS A cluster randomised controlled trial was conducted in 43 ECEC settings in disadvantaged areas of New South Wales, Australia. Three-year-old children were recruited and assessed in the first half of 2015 with follow-up 6 months later. The intervention was guided by Social Cognitive Theory and included five components. The primary outcome was minutes per hour in total physical activity during ECEC hours measured using Actigraph accelerometers. Intention-to-treat analysis of the primary outcome was conducted using a generalized linear mixed model. RESULTS A total of 658 children were assessed at baseline. Of these, 558 (85%) had valid accelerometer data (mean age 3.38y, 52% boys) and 508 (77%) had valid accelerometry data at 6-month follow-up. Implementation of the intervention components ranged from 38 to 72%. There were no significant intervention effects on mins/hr. spent in physical activity (adjusted difference = - 0.17 mins/hr., 95% CI (- 1.30 to 0.97), p = 0.78). A priori sub-group analyses showed a greater effect among overweight/obese children in the control group compared with the intervention group for mins/hr. of physical activity (2.35mins/hr., [0.28 to 4.43], p = 0.036). CONCLUSIONS After six-months the Jump Start intervention had no effect on physical activity levels during ECEC. This was largely due to low levels of implementation. Increasing fidelity may result in higher levels of physical activity when outcomes are assessed at 18-months. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12614000597695.
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Compliance with the 24-Hour movement guidelines for the early years: Cross-sectional and longitudinal associations with executive function and psychosocial health in preschool children.
McNeill, J, Howard, SJ, Vella, SA, Cliff, DP
Journal of science and medicine in sport. 2020;(9):846-853
Abstract
OBJECTIVE To examine whether meeting the Australian 24-Hour Movement Guidelines was associated with cognitive and psychosocial health in preschoolers. DESIGN Prospective observational study. METHODS Cross-sectional (n=247) and 12-month longitudinal (n=185) data from the PATH-ABC study were examined. Physical activity was assessed by accelerometry. Parents reported children's screen time and sleep. Children were categorised at baseline as meeting: i) none/one guideline, ii) two guidelines, or iii) 24-Hour Movement Guidelines. Associations with executive functions and psychosocial health were examined using linear regression, adjusting for covariates and preschool clustering. Longitudinal associations were additionally adjusted for baseline levels of development. RESULTS High proportions of children met the physical activity (94.3%) and sleep (89.9%) guidelines, 17.8% and 17.4% met screen time and 24-Hour Movement Guidelines, respectively. Cross-sectionally, children meeting both sleep and physical activity guidelines displayed better phonological working memory (p=0.026) and shifting (p= 0.034) scores compared to children who did not. Meeting two (p=0.037) and three (p=0.017) guidelines were associated with better phonological working memory and shifting scores, respectively (vs. meeting 0/1 guideline). Longitudinally, children meeting the physical activity guideline at baseline displayed better shifting performance 12-months later compared to those who did not (p<0.002). No associations with remaining cognitive outcomes, and no associations with psychosocial outcomes were evident. CONCLUSIONS Null associations suggest that meeting the recommendations may not be adequate for broad cognitive and psychosocial health outcomes in preschoolers. However, supporting preschool children to meet the physical activity and sleep guidelines, may be beneficial for aspects of cognitive health.
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The Acute Effects of a "Reduced Sitting Preschool Day" on Executive Function and Musculoskeletal Health in Preschoolers: A Randomized Cross-Over Study.
Ellis, YG, Cliff, DP, Howard, SJ, Okely, AD
Pediatric exercise science. 2019;(4):505-513
Abstract
PURPOSE To examine the acute effects of a reduced sitting day on executive function (EF) and musculoskeletal health in preschoolers. METHODS A sample of 29 children (54% boys; 4-5 y) participated in a randomized cross-over trial. Each child completed 2 protocols, which simulate a day at childcare in random order for 2.5 hours; a typical preschool day (50% sitting) and a reduced preschool day (25% sitting) where most sitting activities were replaced with standing activities. Sitting, standing, and stepping time were objectively assessed using an activPAL accelerometer. EF was evaluated using tablet-based EF assessments (inhibition, working memory, and task shifting). Musculoskeletal health was assessed using a handheld dynamometer and goniometer. RESULTS Compared with the typical preschool day, the reduced sitting day showed no significant differences for EF scores. Effect sizes for inhibition (d = 0.04), working memory (d = 0.02), and shifting (d = 0.11) were all small. For musculoskeletal health, no significant differences were reported after the reduced preschool day. The effect sizes for the hip extension force, hamstring flexibility, gastrocnemius length, and balancing on 1 leg were all small (d = 0.21, d = 0.25, d = 0.28, and d = 0.28). CONCLUSIONS This study suggests that reducing sitting time is unlikely to result in acute changes in EF and musculoskeletal health among preschoolers.
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Evaluation of an intervention to reduce adolescent sitting time during the school day: The 'Stand Up for Health' randomised controlled trial.
Parrish, AM, Trost, SG, Howard, SJ, Batterham, M, Cliff, D, Salmon, J, Okely, AD
Journal of science and medicine in sport. 2018;(12):1244-1249
Abstract
OBJECTIVES Adolescents spend large proportions of the school day sitting; potentially increasing their health risks. This study aimed to evaluate the feasibility, acceptability and potential efficacy of a school-based intervention to reduce adolescent sitting time during the school day. DESIGN Two-arm parallel-group randomised controlled trial. METHODS Adolescents (13-16 years) were recruited from four private high schools in New South Wales, Australia. Schools were pair-matched and randomised to treatment or control. Research assistants were blinded to intervention aims and treatment allocation. Intervention initiatives included classroom and outdoor environmental measures to break up and reduce the proportion of adolescent school time spent sitting. Teacher and students surveys assessed intervention feasibility, acceptability and potential efficacy. Proportional sitting time was the primary outcome, measured by activPAL monitors, worn for one week during the school day. Secondary outcomes included body mass index, body fatness, working memory and non-verbal reasoning. Data were analysed using a general linear model for continuous variables and adjusted for clustering. RESULTS While teachers and students supported the program, process evaluation results indicate aspects of the intervention were not implemented with fidelity. Eighty-eight adolescents (Mage=14.7±0.7, 50% male) participated in the trial. Eighty-six had valid data for all variables (43 controls, 43 intervention). There was no significant intervention effect on the primary outcome. There was a significant effect on working memory (adjusted difference ±SD=-0.42±1.37; p=0.048 (Cohen's d)=0.31). CONCLUSIONS These findings contribute to limited research in this area, providing guidance for future interventions in the high school environment. TRIAL REGISTRATION The study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN 12614001001684).
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"GET-UP" study rationale and protocol: a cluster randomised controlled trial to evaluate the effects of reduced sitting on toddlers' cognitive development.
Santos, R, Cliff, DP, Howard, SJ, Veldman, SL, Wright, IM, Sousa-Sá, E, Pereira, JR, Okely, AD
BMC pediatrics. 2016;(1):182
Abstract
BACKGROUND The educational and cognitive differences associated with low socioeconomic status begin early in life and tend to persist throughout life. Coupled with the finding that levels of sedentary time are negatively associated with cognitive development, and time spent active tends to be lower in disadvantaged circumstances, this highlights the need for interventions that reduce the amount of time children spend sitting and sedentary during childcare. The proposed study aims to assess the effects of reducing sitting time during Early Childhood Education and Care (ECEC) services on cognitive development in toddlers from low socio-economic families. METHODS/DESIGN We will implement a 12-months 2-arm parallel group cluster randomised controlled trial (RCT) with Australian toddlers, aged 12 to 26 months at baseline. Educators from the ECEC services allocated to the intervention group will receive professional development on how to reduce sitting time while children attend ECEC. Participants' cognitive development will be assessed as a primary outcome, at baseline and post-intervention, using the cognitive sub-test from the Bayley Scales of Infant and Toddler Development. DISCUSSION This trial has the potential to inform programs and policies designed to optimize developmental and health outcomes in toddlers, specifically in those from disadvantaged backgrounds. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12616000471482 , 11/04/2016, retrospectively registered.
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Increasing physical activity among young children from disadvantaged communities: study protocol of a group randomised controlled effectiveness trial.
Stanley, RM, Jones, RA, Cliff, DP, Trost, SG, Berthelsen, D, Salmon, J, Batterham, M, Eckermann, S, Reilly, JJ, Brown, N, et al
BMC public health. 2016;(1):1095
Abstract
BACKGROUND Participation in regular physical activity (PA) during the early years helps children achieve healthy body weight and can substantially improve motor development, bone health, psychosocial health and cognitive development. Despite common assumptions that young children are naturally active, evidence shows that they are insufficiently active for health and developmental benefits. Exploring strategies to increase physical activity in young children is a public health and research priority. METHODS Jump Start is a multi-component, multi-setting PA and gross motor skill intervention for young children aged 3-5 years in disadvantaged areas of New South Wales, Australia. The intervention will be evaluated using a two-arm, parallel group, randomised cluster trial. The Jump Start protocol was based on Social Cognitive Theory and includes five components: a structured gross motor skill lesson (Jump In); unstructured outdoor PA and gross motor skill time (Jump Out); energy breaks (Jump Up); activities connecting movement to learning experiences (Jump Through); and a home-based family component to promote PA and gross motor skill (Jump Home). Early childhood education and care centres will be demographically matched and randomised to Jump Start (intervention) or usual practice (comparison) group. The intervention group receive Jump Start professional development, program resources, monthly newsletters and ongoing intervention support. Outcomes include change in total PA (accelerometers) within centre hours, gross motor skill development (Test of Gross Motor Development-2), weight status (body mass index), bone strength (Sunlight MiniOmni Ultrasound Bone Sonometer), self-regulation (Heads-Toes-Knees-Shoulders, executive function tasks, and proxy-report Temperament and Approaches to learning scales), and educator and parent self-efficacy. Extensive quantitative and qualitative process evaluation and a cost-effectiveness evaluation will be conducted. DISCUSSION The Jump Start intervention is a unique program to address low levels of PA and gross motor skill proficiency, and support healthy lifestyle behaviours among young children in disadvantaged communities. If shown to be efficacious, the Jump Start approach can be expected to have implications for early childhood education and care policies and practices, and ultimately a positive effect on the health and development across the life course. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry No: ACTRN12614000597695 , first received: June 5, 2014.
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The (Possibly Negative) Effects of Physical Activity on Executive Functions: Implications of the Changing Metabolic Costs of Brain Development.
Howard, SJ, Cook, CJ, Said-Mohamed, R, Norris, SA, Draper, CE
Journal of physical activity & health. 2016;(9):1017-22
Abstract
BACKGROUND An area of growth in physical activity research has involved investigating effects of physical activity on children's executive functions. Many of these efforts seek to increase the energy expenditure of young children as a healthy and low-cost way to affect physical, health, and cognitive outcomes. METHODS We review theory and research from neuroscience and evolutionary biology, which suggest that interventions seeking to increase the energy expenditure of young children must also consider the energetic trade-offs that occur to accommodate changing metabolic costs of brain development. RESULTS According to Life History Theory, and supported by recent evidence, the high relative energy-cost of early brain development requires that other energy-demanding functions of development (ie, physical growth, activity) be curtailed. This is important for interventions seeking to dramatically increase the energy expenditure of young children who have little excess energy available, with potentially negative cognitive consequences. Less energy-demanding physical activities, in contrast, may yield psychosocial and cognitive benefits while not overburdening an underweight child's already scarce energy supply. CONCLUSIONS While further research is required to establish the extent to which increases in energy-demanding physical activities may compromise or displace energy available for brain development, we argue that action cannot await these findings.
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Acquired antifungal drug resistance in Aspergillus fumigatus: epidemiology and detection.
Howard, SJ, Arendrup, MC
Medical mycology. 2011;:S90-5
Abstract
Voriconazole is the recommended agent for invasive aspergillosis, with lipid amphotericin B or caspofungin as second line treatment choices. Being the only agents available in oral formulation, azoles are used in chronic infections and often over longer time periods. In addition to being used in clinical medicine, azoles are employed extensively in agriculture. Azole-resistant Aspergillus has been isolated in azole naïve patients, in azole exposed patients and in the environment. The primary underlying mechanism of resistance is as a result of alterations in the cyp51A target gene, with a variety of mutations found in clinical isolates but just one identified in a environmental strain (a point mutation at codon 98 accompanied by a tandem repeat in the promoter region). Much less is currently known about echinocandin resistance in Aspergillus, in part because susceptibility testing is not routinely performed and because the methods suffer from technical difficulties and suboptimal reproducibility. Clinical breakthrough cases have been reported however, and resistance has been confirmed in vivo. In this paper we review the current knowledge on epidemiology, susceptibility testing and underlying mechanisms involved in azole and echinocandin resistance in Aspergillus.