human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine the television- , DVD- , and video-viewing habits of children younger than 2 years . DESIGN A telephone survey of 1009 parents of children aged 2 to 24 months . SETTING Parents in Minnesota and Washington state were surveyed . PARTICIPANTS A r and om sample of parents of children born in the previous 2 years was drawn from birth certificate records . Households in which English was not spoken were excluded , as were children with major disabilities . MAIN OUTCOME MEASURE The amount of regular television and DVD/video viewing by content , reasons for viewing , and frequency of parent-child coviewing . RESULTS By 3 months of age , about 40 % of children regularly watched  television , DVDs , or videos .  By 24 months , this proportion rose to 90 % . The median age at which regular media exposure was introduced was 9 months . Among those who watched , the average viewing time per day rose from 1 hour per day for children younger than 12 months to more than 1.5 hours per day by 24 months . Parents watched with their children more than half of the time . Parents gave education , entertainment , and babysitting as major reasons for media exposure in their children younger than 2 years . CONCLUSIONS Parents should be urged to make educated choices about their children 's media exposure . Parental hopes for the educational potential of television can be supported by encouraging those parents who are already allowing screen time to watch with their children OBJECTIVE To test the hypothesis that audible television is associated with decreased parent and child interactions .  DESIGN Prospect i ve , population -based observational study . SETTING Community . PARTICIPANTS Three hundred twenty-nine 2- to 48-month-old children . MAIN EXPOSURES Audible television .  Children wore a digital recorder on r and om days for up to 24 months . A software program incorporating automatic speech- identification technology processed the recorded file to analyze the sounds the children were exposed to and the sounds they made . Conditional linear regression was used to determine the association between audible television and the outcomes of interest . OUTCOME MEASURES Adult word counts , child vocalizations , and child conversational turns . RESULTS Each hour of audible television was associated with significant reductions in age-adjusted z scores for child vocalizations ( linear regression coefficient , -0.26 ; 95 % confidence interval [ CI ] , -0.29 to -0.22 ) , vocalization duration ( linear regression coefficient , -0.24 ; 95 % CI , -0.27 to -0.20 ) , and conversational turns ( linear regression coefficient , -0.22 ; 95 % CI , -0.25 to -0.19 ) . There were also significant reductions in adult female ( linear regression coefficient , -636 ; 95 % CI , -812 to -460 ) and adult male ( linear regression coefficient , -134 ; 95 % CI , -263 to -5 ) word count . CONCLUSIONS Audible television is associated with decreased exposure to discernible human adult speech and decreased child vocalizations . These results may explain the association between infant television exposure and delayed language development Background Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results Objective : To examine risk factors for rapid weight gain  between 3 and 5 years of age . Design : Nationally representative prospect i ve cohort study . Participants : A total of 11 653 preschool children participating in the UK Millennium Cohort Study , with anthropometry at 3 and 5 years . Measurements : Weight gain z-scores were calculated from 3 to 5 years . Children in the top quarter of this distribution were classified as gaining weight rapidly . A total of 26 biological and early life , social , psychological , behavioural and environmental risk factors were examined . Results : Among the participants , 13 % of normal weight , 63 % of overweight and 88 % of obese 5-year olds had experienced rapid weight gain since 3 years of age . Six biological and early life factors and two social factors were found to be significantly associated with this growth pattern . In a mutually adjusted model , children were more likely to gain weight rapidly if they had a higher body mass index at age 3 ( adjusted odds ratio : 1.27 , 95 % confidence interval : 1.23–1.32 ) , if they were of Bangladeshi ( adjusted odds ratio : 1.88 , 95 % confidence interval : 1.27–2.79 ) or black ( adjusted odds ratio : 1.47 , 95 % confidence interval : 1.07–2.02 ) ethnicity , if their mother was overweight ( adjusted odds ratio : 1.32 , 95 % confidence interval : 1.15–1.51 ) or had been overweight before pregnancy ( adjusted odds ratio : 1.56 , 95 % confidence interval : 1.36–1.79 ) , if their father was overweight ( adjusted odds ratio : 1.56 , 95 % confidence interval : 1.34–1.81 ) or if their mother smoked during pregnancy ( adjusted odds ratio:1.23 , 95 % confidence interval : 1.09–1.38 ) . Children were also more likely to gain weight rapidly if others smoked in the same room ( adjusted odds ratio : 1.31 , 95 % confidence interval : 1.16–1.49 ) or if they were a lone child in the household ( adjusted odds ratio : 1.14 , 95 % confidence interval : 1.01–1.30 ) . Conclusions : Factors operating during pregnancy and early life increase the risk of rapid weight gain in young children ; thus , signalling the importance of obesity prevention programmes before and during pregnancy and for children at an early age . In particular , these programmes should address parental weight status and smoking habits , both modifiable risk factors IMPORTANCE Identifying associations between preschool-aged children 's electronic media use and their later well-being is essential to supporting positive long-term outcomes . OBJECTIVE To investigate possible dose-response associations of young children 's electronic media use with their later well-being . DESIGN , SETTING , AND PARTICIPANTS The IDEFICS ( Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants ) study is a prospect i ve cohort study with an intervention component . Data were collected at baseline from September 1 , 2007 , through June 30 , 2008 , and at follow-up from September 1 , 2009 , through May 31 , 2010 , in 8 European countries participating in the IDEFICS study . This investigation is based on 3604 children aged 2 to 6 years who participated in the longitudinal component of the IDEFICS study only and not in the intervention .  EXPOSURE Early childhood electronic media use . MAIN OUTCOMES AND MEASURES The following 6 indicators of well-being from 2 vali date d instruments were used as outcomes at follow-up : Peer problems and Emotional problems subscales from the Strengths and Difficulties Question naire and Emotional well-being , Self-esteem , Family functioning , and Social networks subscales from the KINDLR ( Question naire for Measuring Health-Related Quality of Life in Children and Adolescents-Revised Version ) . Each scale was dichotomized to identify those children at risk for poorer outcomes . Indicators of electronic media use ( weekday and weekend television and electronic game [e-game]/computer use ) from baseline were used as predictors . RESULTS Associations varied between boys and girls ; however , associations suggested that increased levels of electronic media use predicted poorer well-being outcomes . Television viewing on weekdays or weekends was more consistently associated with poorer outcomes than e-game/computer use . Across associations , the likelihood of adverse outcomes in children ranged from a 1.2- to 2.0-fold increase for emotional problems and poorer family functioning for each additional hour of television viewing or e-game/computer use depending on the outcome examined . CONCLUSIONS AND RELEVANCE Higher levels of early childhood electronic media use are associated with children being at risk for poorer outcomes with some indicators of well-being . Further research is required to identify potential mechanisms Background / Objectives : This longitudinal study describes the relationship between young children ’s screen time , dietary habits  and anthropometric measures . The hypothesis was that television viewing and other screen activities at baseline result in increased consumption of sugar-sweetened beverages ( SSB ) and increased BMI , BMI z-score and waist to height ratio ( WHtR ) two years later . A second hypothesis was that SSB consumption mediates the association between the screen activities and changes in the anthropometric measures .Subjects/ Methods : The study is a part of the prospect i ve cohort study IDEFICS ( “ Identification and prevention of dietary and lifestyle-induced health effects in children and infants ” ) , investigating diet , lifestyle and social determinants of obesity in 2 to 9-year-olds in eight European countries ( baseline n=16 225 , two-year follow-up ; n=11 038 ) .  Anthropometry was objective ly measured , and behaviours were parent-reported . Results : The main hypothesis was supported , but the second hypothesis was not confirmed . The odds ratio of being in the highest quintile of % change in WHtR was 1.26 ( 95 % CI : 1.17–1.36 ) and in BMI 1.22 ( 95 % CI : 1.13–1.31 ) , for each hour per day watching television . The odds ratio of having  increased SSB consumption was 1.19 ( 95 % CI : 1.09–1.29 ) for each hour per day watching TV . The associations for total screen time were slightly weaker . Conclusions : The results indicate substantial effects of TV viewing and other screen activities for young children , both on their consumption of sugary drinks and on an increase in BMI and central obesity . Our findings suggest that television viewing seems to have a stronger effect on food habits and anthropometry than other screen activities in this age group Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Abstract Objective To identify risk factors in early life ( up to 3 years of age ) for obesity in children in the United Kingdom . Design Prospect i ve cohort study . Setting Avon longitudinal study of parents and children , United Kingdom . Participants 8234 children in cohort aged 7 years and a sub sample of 909 children ( children in focus ) with data on additional early growth related risk factors for obesity . Main outcome measures Obesity at age 7 years , defined as a body mass index 3 95th centile relative to reference data for the UK population in 1990 . Results Eight of 25 putative risk factors were associated with a risk of obesity in the final models : parental obesity ( both parents : adjusted odds ratio , 10.44 , 95 % confidence interval 5.11 to 21.32 ) , very early ( by 43 months ) body mass index or adiposity rebound ( 15.00 , 5.32 to 42.30 ) , more than eight hours spent watching television per week at age 3 years ( 1.55 , 1.13 to 2.12 ) , catch-up growth ( 2.60 , 1.09 to 6.16 ) , st and ard deviation score for weight at age 8 months ( 3.13 , 1.43 to 6.85 ) and 18 months ( 2.65 , 1.25 to 5.59 ) ; weight gain in first year ( 1.06 , 1.02 to 1.10 per 100 g increase ) ; birth weight , per 100 g ( 1.05 , 1.03 to 1.07 ) ; and short ( < 10.5 hours ) 
    Output:
    
agent
Associations between objective ly measured total sedentary time and indicators of adiposity and motor development were predominantly null .
Associations between screen time and indicators of adiposity , motor or cognitive development , and psychosocial health were primarily unfavourable or null .
Associations between time spent seated ( e.g. , in car seats or strollers ) or in the supine position , and indicators of adiposity and motor development , were primarily unfavourable or null .
Conclusions These findings continue to support the importance of minimizing screen time for disease prevention and health promotion in the early years , but also highlight the potential cognitive benefits of interactive non-screen-based sedentary behaviours such as reading and storytelling .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine the television- , DVD- , and video-viewing habits of children younger than 2 years . DESIGN A telephone survey of 1009 parents of children aged 2 to 24 months . SETTING Parents in Minnesota and Washington state were surveyed . PARTICIPANTS A r and om sample of parents of children born in the previous 2 years was drawn from birth certificate records . Households in which English was not spoken were excluded , as were children with major disabilities . MAIN OUTCOME MEASURE The amount of regular television and DVD/video viewing by content , reasons for viewing , and frequency of parent-child coviewing . RESULTS By 3 months of age , about 40 % of children regularly watched  television , DVDs , or videos .  By 24 months , this proportion rose to 90 % . The median age at which regular media exposure was introduced was 9 months . Among those who watched , the average viewing time per day rose from 1 hour per day for children younger than 12 months to more than 1.5 hours per day by 24 months . Parents watched with their children more than half of the time . Parents gave education , entertainment , and babysitting as major reasons for media exposure in their children younger than 2 years . CONCLUSIONS Parents should be urged to make educated choices about their children 's media exposure . Parental hopes for the educational potential of television can be supported by encouraging those parents who are already allowing screen time to watch with their children OBJECTIVE To test the hypothesis that audible television is associated with decreased parent and child interactions .  DESIGN Prospect i ve , population -based observational study . SETTING Community . PARTICIPANTS Three hundred twenty-nine 2- to 48-month-old children . MAIN EXPOSURES Audible television .  Children wore a digital recorder on r and om days for up to 24 months . A software program incorporating automatic speech- identification technology processed the recorded file to analyze the sounds the children were exposed to and the sounds they made . Conditional linear regression was used to determine the association between audible television and the outcomes of interest . OUTCOME MEASURES Adult word counts , child vocalizations , and child conversational turns . RESULTS Each hour of audible television was associated with significant reductions in age-adjusted z scores for child vocalizations ( linear regression coefficient , -0.26 ; 95 % confidence interval [ CI ] , -0.29 to -0.22 ) , vocalization duration ( linear regression coefficient , -0.24 ; 95 % CI , -0.27 to -0.20 ) , and conversational turns ( linear regression coefficient , -0.22 ; 95 % CI , -0.25 to -0.19 ) . There were also significant reductions in adult female ( linear regression coefficient , -636 ; 95 % CI , -812 to -460 ) and adult male ( linear regression coefficient , -134 ; 95 % CI , -263 to -5 ) word count . CONCLUSIONS Audible television is associated with decreased exposure to discernible human adult speech and decreased child vocalizations . These results may explain the association between infant television exposure and delayed language development Background Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results Objective : To examine risk factors for rapid weight gain  between 3 and 5 years of age . Design : Nationally representative prospect i ve cohort study . Participants : A total of 11 653 preschool children participating in the UK Millennium Cohort Study , with anthropometry at 3 and 5 years . Measurements : Weight gain z-scores were calculated from 3 to 5 years . Children in the top quarter of this distribution were classified as gaining weight rapidly . A total of 26 biological and early life , social , psychological , behavioural and environmental risk factors were examined . Results : Among the participants , 13 % of normal weight , 63 % of overweight and 88 % of obese 5-year olds had experienced rapid weight gain since 3 years of age . Six biological and early life factors and two social factors were found to be significantly associated with this growth pattern . In a mutually adjusted model , children were more likely to gain weight rapidly if they had a higher body mass index at age 3 ( adjusted odds ratio : 1.27 , 95 % confidence interval : 1.23–1.32 ) , if they were of Bangladeshi ( adjusted odds ratio : 1.88 , 95 % confidence interval : 1.27–2.79 ) or black ( adjusted odds ratio : 1.47 , 95 % confidence interval : 1.07–2.02 ) ethnicity , if their mother was overweight ( adjusted odds ratio : 1.32 , 95 % confidence interval : 1.15–1.51 ) or had been overweight before pregnancy ( adjusted odds ratio : 1.56 , 95 % confidence interval : 1.36–1.79 ) , if their father was overweight ( adjusted odds ratio : 1.56 , 95 % confidence interval : 1.34–1.81 ) or if their mother smoked during pregnancy ( adjusted odds ratio:1.23 , 95 % confidence interval : 1.09–1.38 ) . Children were also more likely to gain weight rapidly if others smoked in the same room ( adjusted odds ratio : 1.31 , 95 % confidence interval : 1.16–1.49 ) or if they were a lone child in the household ( adjusted odds ratio : 1.14 , 95 % confidence interval : 1.01–1.30 ) . Conclusions : Factors operating during pregnancy and early life increase the risk of rapid weight gain in young children ; thus , signalling the importance of obesity prevention programmes before and during pregnancy and for children at an early age . In particular , these programmes should address parental weight status and smoking habits , both modifiable risk factors IMPORTANCE Identifying associations between preschool-aged children 's electronic media use and their later well-being is essential to supporting positive long-term outcomes . OBJECTIVE To investigate possible dose-response associations of young children 's electronic media use with their later well-being . DESIGN , SETTING , AND PARTICIPANTS The IDEFICS ( Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants ) study is a prospect i ve cohort study with an intervention component . Data were collected at baseline from September 1 , 2007 , through June 30 , 2008 , and at follow-up from September 1 , 2009 , through May 31 , 2010 , in 8 European countries participating in the IDEFICS study . This investigation is based on 3604 children aged 2 to 6 years who participated in the longitudinal component of the IDEFICS study only and not in the intervention .  EXPOSURE Early childhood electronic media use . MAIN OUTCOMES AND MEASURES The following 6 indicators of well-being from 2 vali date d instruments were used as outcomes at follow-up : Peer problems and Emotional problems subscales from the Strengths and Difficulties Question naire and Emotional well-being , Self-esteem , Family functioning , and Social networks subscales from the KINDLR ( Question naire for Measuring Health-Related Quality of Life in Children and Adolescents-Revised Version ) . Each scale was dichotomized to identify those children at risk for poorer outcomes . Indicators of electronic media use ( weekday and weekend television and electronic game [e-game]/computer use ) from baseline were used as predictors . RESULTS Associations varied between boys and girls ; however , associations suggested that increased levels of electronic media use predicted poorer well-being outcomes . Television viewing on weekdays or weekends was more consistently associated with poorer outcomes than e-game/computer use . Across associations , the likelihood of adverse outcomes in children ranged from a 1.2- to 2.0-fold increase for emotional problems and poorer family functioning for each additional hour of television viewing or e-game/computer use depending on the outcome examined . CONCLUSIONS AND RELEVANCE Higher levels of early childhood electronic media use are associated with children being at risk for poorer outcomes with some indicators of well-being . Further research is required to identify potential mechanisms Background / Objectives : This longitudinal study describes the relationship between young children ’s screen time , dietary habits  and anthropometric measures . The hypothesis was that television viewing and other screen activities at baseline result in increased consumption of sugar-sweetened beverages ( SSB ) and increased BMI , BMI z-score and waist to height ratio ( WHtR ) two years later . A second hypothesis was that SSB consumption mediates the association between the screen activities and changes in the anthropometric measures .Subjects/ Methods : The study is a part of the prospect i ve cohort study IDEFICS ( “ Identification and prevention of dietary and lifestyle-induced health effects in children and infants ” ) , investigating diet , lifestyle and social determinants of obesity in 2 to 9-year-olds in eight European countries ( baseline n=16 225 , two-year follow-up ; n=11 038 ) .  Anthropometry was objective ly measured , and behaviours were parent-reported . Results : The main hypothesis was supported , but the second hypothesis was not confirmed . The odds ratio of being in the highest quintile of % change in WHtR was 1.26 ( 95 % CI : 1.17–1.36 ) and in BMI 1.22 ( 95 % CI : 1.13–1.31 ) , for each hour per day watching television . The odds ratio of having  increased SSB consumption was 1.19 ( 95 % CI : 1.09–1.29 ) for each hour per day watching TV . The associations for total screen time were slightly weaker . Conclusions : The results indicate substantial effects of TV viewing and other screen activities for young children , both on their consumption of sugary drinks and on an increase in BMI and central obesity . Our findings suggest that television viewing seems to have a stronger effect on food habits and anthropometry than other screen activities in this age group Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Abstract Objective To identify risk factors in early life ( up to 3 years of age ) for obesity in children in the United Kingdom . Design Prospect i ve cohort study . Setting Avon longitudinal study of parents and children , United Kingdom . Participants 8234 children in cohort aged 7 years and a sub sample of 909 children ( children in focus ) with data on additional early growth related risk factors for obesity . Main outcome measures Obesity at age 7 years , defined as a body mass index 3 95th centile relative to reference data for the UK population in 1990 . Results Eight of 25 putative risk factors were associated with a risk of obesity in the final models : parental obesity ( both parents : adjusted odds ratio , 10.44 , 95 % confidence interval 5.11 to 21.32 ) , very early ( by 43 months ) body mass index or adiposity rebound ( 15.00 , 5.32 to 42.30 ) , more than eight hours spent watching television per week at age 3 years ( 1.55 , 1.13 to 2.12 ) , catch-up growth ( 2.60 , 1.09 to 6.16 ) , st and ard deviation score for weight at age 8 months ( 3.13 , 1.43 to 6.85 ) and 18 months ( 2.65 , 1.25 to 5.59 ) ; weight gain in first year ( 1.06 , 1.02 to 1.10 per 100 g increase ) ; birth weight , per 100 g ( 1.05 , 1.03 to 1.07 ) ; and short ( < 10.5 hours ) 
    Output:
    