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 assess the effect of a governmentally-led center based child care physical activity program ( Youp’là Bouge ) on child motor skills . Patients and methods We conducted a single blinded cluster r and omized controlled trial in 58 Swiss child care centers . Centers were r and omly selected and 1:1 assigned to a control or intervention group . The intervention lasted from September 2009 to June 2010 and included training of the educators , adaptation of the child care built environment , parental involvement and daily physical activity .  Motor skill was the primary outcome and body mass index ( BMI ) , physical activity and quality of life secondary outcomes . The intervention implementation was also assessed . Results At baseline , 648 children present on the motor test day were included ( age 3.3 ± 0.6 , BMI 16.3 ± 1.3 kg/m2 , 13.2 % overweight , 49 % girls ) and 313 received the intervention . Relative to children in the control group ( n = 201 ) , children in the intervention group ( n = 187 ) showed no significant increase in motor skills ( delta of mean change ( 95 % confidence interval : -0.2 ( −0.8 to 0.3 ) , p = 0.43 ) or in any of the secondary outcomes . Not all child care centers implemented all the intervention components . Within the intervention group , several predictors were positively associated with trial outcomes : 1 ) free-access to a movement space and parental information session for motor skills 2 ) highly motivated and trained educators for BMI 3 ) free-access to a movement space and purchase of mobile equipment for physical activity ( all p < 0.05 ) . Conclusion This “ real-life ” physical activity program in child care centers confirms the complexity of implementing an intervention outside a study setting and identified potentially relevant predictors that could improve future programs . Trial registration Clinical trials.gov Physical activity is beneficial for children ’s well-being . The effect of dietary supplementation on children ’s physical activity in food-insecure areas remains little studied . We examined the effects of a lipid-based nutrient supplement ( LNS ) on children ’s objective ly measured physical activity in a r and omised , controlled , outcome -assessor-blinded trial . Mothers of the children received one capsule daily of Fe-folic acid ( IFA ) , one capsule containing eighteen micronutrients ( MMN ) or one 20 g sachet of LNS ( containing twenty-two MMN , protein , carbohydrates , essential fatty acids and 494 kJ ( 118 kcal ) ) during pregnancy and for 6 months thereafter . Children in the IFA and MMN groups received no supplementation , and these groups were collapsed into a single control group ; children in the LNS group received 20 g LNS from 6 to 18 months . We measured physical activity with accelerometers over 1 week at 18 months . The main outcome was mean vector magnitude counts/15 s.  Of the 728 children at the beginning of child intervention at 6 months , 570 ( 78 % ) provided sufficient data for analysis . The mean accelerometer counts for the 190 children in the LNS group and for the 380 children in the control group were 303 ( sd 59 ) and 301 ( sd 56 ) , respectively ( P for difference=0·65 ) . LNS , given to mothers during pregnancy and 6 months postpartum and to their infants from 6 to 18 months of age , did not increase physical activity among 18-month-old children 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 : Recent studies have cl aim ed a positive effect of physical activity and body composition on vagal tone . In pediatric population s , there is a pronounced decrease in heart rate with age . While this decrease is often interpreted as an age-related increase in vagal tone , there is some evidence that it may be related to a decrease in intrinsic heart rate . This factor has not been taken into account in most previous studies . The aim of the present study was to assess the association between physical activity and /or body composition and heart rate variability ( HRV ) independently of the decline in heart rate in young children . Methods : Anthropometric measurements were taken in 309 children aged 2–6 years .  Ambulatory electrocardiograms  were collected over 14–18 h comprising a full night and accelerometry over 7 days . HRV was determined of three different night segments : ( 1 ) over 5 min during deep sleep identified automatically based on HRV characteristics ; ( 2 ) during a 20 min segment starting 15 min after sleep onset ; ( 3 ) over a 4-h segment between midnight and 4 a.m. Linear models were computed for HRV parameters with anthropometric and physical activity variables adjusted for heart rate and other confounding variables ( e.g. , age for physical activity models ) . Results : We found a decline in heart rate with increasing physical activity and decreasing skinfold thickness . HRV parameters decreased with increasing age , height , and weight in HR-adjusted regression models . These relationships were only found in segments of deep sleep detected automatically based on HRV or manually 15 min after sleep onset , but not in the 4-h segment with r and om sleep phases . Conclusions : Contrary to most previous studies , we found no increase of st and ard HRV parameters with age , however , when adjusted for heart rate , there was a significant decrease of HRV parameters with increasing age . Without knowing intrinsic heart rate correct interpretation of HRV in growing children is impossible OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity The purpose of this study was twofold : first to document the gender differences in Moderate to Vigorous Physical Activity ( MVPA ) according to two epoch systems ( 5 vs. 60 s ) in preschoolers , and , second to document the differences in physical activity ( PA ) patterns according to two different epoch choices . The sample comprised 59 preschoolers ( 31 girls ) aged 2 - 5 years old .  PA was assessed by accelerometer during school hours . The time spent in MVPA was significantly higher ( p < .001 ) when a 5-s epoch was considered compared to the 60-s epoch , regardless gender . Further , it was found a difference of ? 17 min difference between the 2 epoch systems for MVPA . Different epoch times might affect the time spent in MVPA among preschool children Adequate physical activity is associated with improved sleep in adults . Such associations , however , vary greatly across studies in pediatric population s , with no studies involving infants found in the literature . This prospect i ve observational study was design ed , therefore , to examine the association between physical activity and  sleep patterns in infants . A total of 183 healthy infants aged 6 months wore an actigraph for 7 days to measure physical activity and sleep .  Parents and caregivers completed a  sleep-activity diary  over the same period documenting the different types of infant activities . Daily mean time spent in  screen-time-or-limited physical activity , including screen-based ( e.g. , watching television or other electronic devices ) and non-screen based activity ( e.g. , quiet play or restricted infant movement when carried by caregivers or seated in high chairs , swings , or bouncer seats ) , was 6.68 hr ( SD = 1.99 ) , which represented 47.50 % of daytime waking hours ( SD = 13.73 ) . We found that 65 ( 35.5 % ) infants engaged in some screen time during the study , with 10 ( 5.5 % ) infants having an average daily screen time > 30 min . In our multivariate linear regression model , more hours of screen-time-or-limited physical activity per day were significantly associated with a decrease in total daily 24 hr sleep duration ( p < 0.01 ) . Findings from our study suggest that reducing screen-time-or-limited physical activity might be an approach for promoting adequate sleep and lengthening infant daily sleep duration 
    Output:
    
agent
Overall , toddlers tend to exceed the total PA recommendation of 180 min/day ; however , very little of this time is spent at higher movement intensities .
Even with high PA rates , toddlers still engage in substantial ST .
***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 assess the effect of a governmentally-led center based child care physical activity program ( Youp’là Bouge ) on child motor skills . Patients and methods We conducted a single blinded cluster r and omized controlled trial in 58 Swiss child care centers . Centers were r and omly selected and 1:1 assigned to a control or intervention group . The intervention lasted from September 2009 to June 2010 and included training of the educators , adaptation of the child care built environment , parental involvement and daily physical activity .  Motor skill was the primary outcome and body mass index ( BMI ) , physical activity and quality of life secondary outcomes . The intervention implementation was also assessed . Results At baseline , 648 children present on the motor test day were included ( age 3.3 ± 0.6 , BMI 16.3 ± 1.3 kg/m2 , 13.2 % overweight , 49 % girls ) and 313 received the intervention . Relative to children in the control group ( n = 201 ) , children in the intervention group ( n = 187 ) showed no significant increase in motor skills ( delta of mean change ( 95 % confidence interval : -0.2 ( −0.8 to 0.3 ) , p = 0.43 ) or in any of the secondary outcomes . Not all child care centers implemented all the intervention components . Within the intervention group , several predictors were positively associated with trial outcomes : 1 ) free-access to a movement space and parental information session for motor skills 2 ) highly motivated and trained educators for BMI 3 ) free-access to a movement space and purchase of mobile equipment for physical activity ( all p < 0.05 ) . Conclusion This “ real-life ” physical activity program in child care centers confirms the complexity of implementing an intervention outside a study setting and identified potentially relevant predictors that could improve future programs . Trial registration Clinical trials.gov Physical activity is beneficial for children ’s well-being . The effect of dietary supplementation on children ’s physical activity in food-insecure areas remains little studied . We examined the effects of a lipid-based nutrient supplement ( LNS ) on children ’s objective ly measured physical activity in a r and omised , controlled , outcome -assessor-blinded trial . Mothers of the children received one capsule daily of Fe-folic acid ( IFA ) , one capsule containing eighteen micronutrients ( MMN ) or one 20 g sachet of LNS ( containing twenty-two MMN , protein , carbohydrates , essential fatty acids and 494 kJ ( 118 kcal ) ) during pregnancy and for 6 months thereafter . Children in the IFA and MMN groups received no supplementation , and these groups were collapsed into a single control group ; children in the LNS group received 20 g LNS from 6 to 18 months . We measured physical activity with accelerometers over 1 week at 18 months . The main outcome was mean vector magnitude counts/15 s.  Of the 728 children at the beginning of child intervention at 6 months , 570 ( 78 % ) provided sufficient data for analysis . The mean accelerometer counts for the 190 children in the LNS group and for the 380 children in the control group were 303 ( sd 59 ) and 301 ( sd 56 ) , respectively ( P for difference=0·65 ) . LNS , given to mothers during pregnancy and 6 months postpartum and to their infants from 6 to 18 months of age , did not increase physical activity among 18-month-old children 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 : Recent studies have cl aim ed a positive effect of physical activity and body composition on vagal tone . In pediatric population s , there is a pronounced decrease in heart rate with age . While this decrease is often interpreted as an age-related increase in vagal tone , there is some evidence that it may be related to a decrease in intrinsic heart rate . This factor has not been taken into account in most previous studies . The aim of the present study was to assess the association between physical activity and /or body composition and heart rate variability ( HRV ) independently of the decline in heart rate in young children . Methods : Anthropometric measurements were taken in 309 children aged 2–6 years .  Ambulatory electrocardiograms  were collected over 14–18 h comprising a full night and accelerometry over 7 days . HRV was determined of three different night segments : ( 1 ) over 5 min during deep sleep identified automatically based on HRV characteristics ; ( 2 ) during a 20 min segment starting 15 min after sleep onset ; ( 3 ) over a 4-h segment between midnight and 4 a.m. Linear models were computed for HRV parameters with anthropometric and physical activity variables adjusted for heart rate and other confounding variables ( e.g. , age for physical activity models ) . Results : We found a decline in heart rate with increasing physical activity and decreasing skinfold thickness . HRV parameters decreased with increasing age , height , and weight in HR-adjusted regression models . These relationships were only found in segments of deep sleep detected automatically based on HRV or manually 15 min after sleep onset , but not in the 4-h segment with r and om sleep phases . Conclusions : Contrary to most previous studies , we found no increase of st and ard HRV parameters with age , however , when adjusted for heart rate , there was a significant decrease of HRV parameters with increasing age . Without knowing intrinsic heart rate correct interpretation of HRV in growing children is impossible OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity The purpose of this study was twofold : first to document the gender differences in Moderate to Vigorous Physical Activity ( MVPA ) according to two epoch systems ( 5 vs. 60 s ) in preschoolers , and , second to document the differences in physical activity ( PA ) patterns according to two different epoch choices . The sample comprised 59 preschoolers ( 31 girls ) aged 2 - 5 years old .  PA was assessed by accelerometer during school hours . The time spent in MVPA was significantly higher ( p < .001 ) when a 5-s epoch was considered compared to the 60-s epoch , regardless gender . Further , it was found a difference of ? 17 min difference between the 2 epoch systems for MVPA . Different epoch times might affect the time spent in MVPA among preschool children Adequate physical activity is associated with improved sleep in adults . Such associations , however , vary greatly across studies in pediatric population s , with no studies involving infants found in the literature . This prospect i ve observational study was design ed , therefore , to examine the association between physical activity and  sleep patterns in infants . A total of 183 healthy infants aged 6 months wore an actigraph for 7 days to measure physical activity and sleep .  Parents and caregivers completed a  sleep-activity diary  over the same period documenting the different types of infant activities . Daily mean time spent in  screen-time-or-limited physical activity , including screen-based ( e.g. , watching television or other electronic devices ) and non-screen based activity ( e.g. , quiet play or restricted infant movement when carried by caregivers or seated in high chairs , swings , or bouncer seats ) , was 6.68 hr ( SD = 1.99 ) , which represented 47.50 % of daytime waking hours ( SD = 13.73 ) . We found that 65 ( 35.5 % ) infants engaged in some screen time during the study , with 10 ( 5.5 % ) infants having an average daily screen time > 30 min . In our multivariate linear regression model , more hours of screen-time-or-limited physical activity per day were significantly associated with a decrease in total daily 24 hr sleep duration ( p < 0.01 ) . Findings from our study suggest that reducing screen-time-or-limited physical activity might be an approach for promoting adequate sleep and lengthening infant daily sleep duration 
    Output:
    