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Assessment of correlates of physical activity occurring at different times of the day, locations and contexts, is imperative to understanding children’s physical activity behaviour. The purpose of this review was to identify the correlates of children’s physical activity (aged 8–14 years) occurring during the school break time and after-school periods. A review was conducted of the peer-reviewed literature, published between 1990 and January 2011. A total of 22 studies (12 school break time studies, 10 after-school studies) were included in the review. Across the 22 studies, 17 studies were cross-sectional and five studies were interventions. In the school break time studies, 39 potential correlates were identified, of which gender and age were consistently associated with school break time physical activity in two or more studies, and family affluence, access to a gym, access to four or more physical activity programs and the condition of a playing field were all associated with school break time physical activity in only one study. Access to loose and fixed equipment, playground markings, size of and access to play space and the length of school break time were all positively associated with changes in school break time physical activity in intervention studies. Thirty-six potential correlates of after-school physical activity were identified. Gender (with boys more active), younger age, lower body mass index (for females), lower TV viewing/playing video games, and greater access to facilities were associated with higher levels of after-school physical activity in two or more studies. Parent supervision was negatively associated with females’ after-school physical activity in one study. This review has revealed a relatively small number of studies investigating the school break time and after-school periods in the specified age range and only a few correlates have demonstrated a consistent association with physical activity. This highlights the infancy of this area and a need for further investigation into time-specific physical activity behaviour so that interventions designed for these specific periods can target the important correlates.

Background Accelerometers have been used to determine the amount of time that children spend sedentary. However, as time spent sitting may be detrimental to health, research is needed to examine whether accelerometer sedentary cut-points reflect the amount of time children spend sitting. The aim of this study was to: a) examine agreement between ActiGraph (AG) cut-points for sedentary time and objectively-assessed periods of free-living sitting and sitting plus standing time using the activPAL (aP); and b) identify cut-points to determine time spent sitting and sitting plus standing. Methods Forty-eight children (54% boys) aged 8-12 years wore a waist-mounted AG and thigh-mounted aP for two consecutive school days (9-3:30 pm). AG data were analyzed using 17 cut-points between 50-850 counts·min -1 in 50 counts·min -1 increments to determine sedentary time during class-time, break time and school hours. Sitting and sitting plus standing time were obtained from the aP for these periods. Limits of agreement were computed to evaluate bias between AG50 to AG850 sedentary time and sitting and sitting plus standing time. Receiver Operator Characteristic (ROC) analyses identified AG cut-points that maximized sensitivity and specificity for sitting and sitting plus standing time. Results The smallest mean bias between aP sitting time and AG sedentary time was AG150 for class time (3.8 minutes), AG50 for break time (-0.8 minutes), and AG100 for school hours (-5.2 minutes). For sitting plus standing time, the smallest bias was observed for AG850. ROC analyses revealed an optimal cut-point of 96 counts·min -1 (AUC = 0.75) for sitting time, which had acceptable sensitivity (71.7%) and specificity (67.8%). No optimal cut-point was obtained for sitting plus standing (AUC = 0.51). Conclusions Estimates of free-living sitting time in children during school hours can be obtained using an AG cut-point of 100 counts·min -1 . Higher sedentary cut-points may capture both sitting and standing time.

ObjectivesThe UK Health Security Agency (UKHSA) highlighted an epidemic of cases of Mycoplasma pneumoniae in children during the winter season of 2023 to 2024. Mycoplasma epidemics have been described to occur every 4 to 7 years, however this epidemic was felt to have shown a three-fold increase in case numbers in comparison to the previous epidemic in 2019–2020 (Todkill et. Al, 2024). The aim of this review was to describe the number of cases and clinical course in children with M. pneumoniae isolated in our tertiary centre over the winter of 2023/2024.MethodsAll paediatric cases with a positive isolation of M. Pneumoniae either in serology (IgM positive) or pcr testing between October 2023 and March 2024 were identified by microbiology and virology laboratory records across Newcastle Upon Tyne Hospitals (Great North Children’s Hospital and Freeman Hospital). Retrospective data was collected from patient electronic records.Results25 patients were included. 64% male, 36% female with mean age 8.9 years. Positive isolates were obtained from bronchoalveolar lavage (40%), endo-tracheal secretions (20%) and blood IgM serology (20%). Co-infection was seen in 48% with Rhinovirus being the most common secondary pathogen (58%).The mean length of hospital stay was 8.8 days. 64% of patients received intravenous antibiotics (average duration 5.3 days). 72% received oral antibiotics either as their primary treatment or as step-down from intravenous (average duration was 6.1 days). 2 patients did not receive antibiotics.48% of patients (n=12) did not require respiratory support. 16% (n=4) required low flow oxygen. 36% (n=9) were admitted to the paediatric intensive care unit (PICU); average length of stay on PICU was 10.2 days. Of those, 7 patients required intubation and ventilation (28% of whole cohort); mean time of intubation 7.7 days. 1 patient required non-invasive ventilation and 1 high flow nasal cannula oxygen. 1 patient required chest drain insertion for empyema.ConclusionsWe describe a variation in severity of M. Pneumoniae associated illness. Our cohort is limited by only capturing children who had microbiology samples processed however it is evident M. pneumoniae can be a pathogen leading to serious illness in children. It is important that seasonal epidemics are communicated promptly to frontline healthcare professionals so appropriate antibiotic treatment can be initiated early.ReferenceTodkill D, Lamagni T, Pebody R, Ramsay M, Woolham D, Demirijan A, Salzmann A, Chand M, Hughes H, Bennett C, Hope R, Watson C, Brown C, Elliot A. Persistent elevation in incidence of pneumonia in children in England, 2023/24. Euro Surveill. 2024;29(32). doi.10.2807/1560-7917

To describe time adolescents spend using electronic media (television, computer, video games, and telephone); and to examine associations between self-reported health/well-being and daily time spent using electronic media overall and each type of electronic media. Design–Cross-sectional data from the third (2005) wave of the Health of Young Victorians Study, an Australian school-based population study. Outcome Measures–Global health, health-related quality of life (HRQoL; KIDSCREEN), health status (Pediatric Quality of Life Inventory 4.0; PedsQL), depression/anxiety (Kessler-10), and behavior problems (Strengths and Difficulties Questionnaire). Exposure Measures–Duration of electronic media use averaged over 1 to 4 days recalled with the Multimedia Activity Recall for Children and Adolescents (MARCA) computerized time-use diary. Analysis–Linear and logistic regression; adjusted for demographic variables and body mass index z score. A total of 925 adolescents (mean ± standard deviation age, 16.1 ± 1.2 years) spent, on average, 3 hours 16 minutes per day using electronic media (television, 128 minutes per day; video games, 35; computers, 19; telephone, 13). High overall electronic media use was associated with poorer behavior, health status, and HRQoL. Associations with duration of specific media exposures were mixed; there was a favorable association between computer use (typing/Internet) and psychological distress, whereas high video game use was associated with poorer health status, HRQoL, global health, and depression/anxiety. Television and telephone durations were not associated with any outcome measure. Despite television's associations with obesity, time spent in other forms of media use appear more strongly related to adolescent health and well-being. This study supports efforts to reduce high video game use and further exploration of the role of computers in health enhancement.

Background Much attention has been paid to adolescents' screen time, however very few studies have examined non-screen sedentary time (NSST). This study aimed to (1) describe the magnitude and composition of screen sedentary time (SST) and NSST in Australian adolescents, (2) describe the socio-demographic correlates of SST and NSST, and (3) determine whether screen time is an adequate surrogate for total sedentary behaviour in this population. Methods 2200 9-16 year old Australians provided detailed use of time data for four days. Non-screen sedentary time (NSST) included time spent participating in activities expected to elicit <3 METs whilst seated or lying down (other than sleeping), excluding screen-based activities (television, playing videogames or using computers). Total sedentary time was the sum of screen time and NSST. Results Adolescents spent a mean (SD) of 345 (105) minutes/day in NSST, which constituted 60% of total sedentary time. School activities contributed 42% of NSST, socialising 19%, self-care (mainly eating) 16%, and passive transport 15%. Screen time and NSST showed opposite patterns in relation to key socio-demographic characteristics, including sex, age, weight status, household income, parental education and day type. Because screen time was negatively correlated with NSST (r = -0.58), and exhibited a moderate correlation (r = 0.53) with total sedentary time, screen time was only a moderately effective surrogate for total sedentary time. Conclusions To capture a complete picture of young people's sedentary time, studies should endeavour to measure both screen time and NSST.

The lunchtime and after-school contexts are critical windows in a school day for children to be physically active. While numerous studies have investigated correlates of children's habitual physical activity, few have explored correlates of physical activity occurring at lunchtime and after-school from a social-ecological perspective. Exploring correlates that influence physical activity occurring in specific contexts can potentially improve the prediction and understanding of physical activity. Using a context-specific approach, this study investigated correlates of children's lunchtime and after-school physical activity. Cross-sectional data were collected from 423 South Australian children aged 10.0-13.9 years (200 boys; 223 girls) attending 10 different schools. Lunchtime and after-school physical activity was assessed using accelerometers. Correlates were assessed using purposely developed context-specific questionnaires. Correlated Component Regression analysis was conducted to derive correlates of context-specific physical activity and determine the variance explained by prediction equations. The model of boys' lunchtime physical activity contained 6 correlates and explained 25% of the variance. For girls, the model explained 17% variance from 9 correlates. Enjoyment of walking during lunchtime was the strongest correlate for both boys and girls. Boys' and girls' after-school physical activity models explained 20% variance from 14 correlates and 7% variance from the single item correlate, \"I do an organised sport or activity after-school because it gets you fit\", respectively. Increasing specificity of correlate research has enabled the identification of unique features of, and a more in-depth interpretation of, lunchtime and after-school physical activity behaviour and is a potential strategy for advancing the physical activity correlate research field. The findings of this study could be used to inform and tailor gender-specific public health messages and interventions for promoting lunchtime and after-school physical activity in children.

Background Sedentary behaviour has been linked with adverse health outcomes in young people; however, the nature and context of being sedentary is poorly understood. Accurate quantification and description of sedentary behaviour using population-level data is required. The aim of this research was to describe sedentary behaviour among New Zealand (NZ) youth and examine whether sedentary behaviour differs by Body Mass Index (BMI) status in this population. Methods A national representative cross-sectional survey of young people aged 5-24 years (n = 2,503) was conducted in 2008-2009. Data from this survey, which included subjectively (recall diary; n = 1,309) and objectively (accelerometry; n = 960) measured sedentary behaviour for participants aged 10-18 years were analysed using survey weighted methods. Results Participants self-reported spending on average 521 minutes per day (standard error [SE] 5.29) in total sedentary behaviour, 181 minutes per day (SE 3.91) in screen-based sedentary activities (e.g., television and video games), and 340 minutes per day (SE 5.22) in other non-screen sedentary behaviours (e.g., school, passive transport and self-care). Accelerometer-measured total sedentary behaviour was on average 420 minutes per day (SE 4.26), or 53% (SE 0.42%) of monitored time. There were no statistically significant differences in time spent in sedentary behaviour among overweight, obese and healthy/underweight young people. Conclusions Both subjective and objective methods indicate that NZ youth spend much of their waking time being sedentary. No relationships were found between sedentary behaviour and BMI status. These findings extend previous research by describing engagement in specific sedentary activities, as well as quantifying the behaviour using an objective method. Differences in what aspects of sedentary behaviour the two methods are capturing are discussed. This research highlights the potential for future interventions to target specific sedentary behaviours or demographic groups.

Few studies have investigated physical activity changes over the transition from primary to secondary school. This study assessed change in physical activity and the psychosocial correlates across 12 months in two cohorts of adolescent girls, who were either in primary school in year 1, moving to secondary school in year 2 (Transition cohort) or an older cohort (Secondary cohort) who remained in early secondary school. Female adolescents (n = 191; 38% response rate) in South Australia self-reported physical activity and psychosocial correlates of physical activity. Changes between baseline and 12-month follow-up were assessed using paired t-tests. Multiple regression modelling identified psychosocial predictors of physical activity change. Physical activity declined in the transition but not the secondary cohort. The decline was most pronounced during school break times. Independent predictors of physical activity change were: change in enjoyment in the transition cohort; and changes in enjoyment, perceived outcomes, and friend encouragement in the secondary cohort. Transitioning from primary to secondary school is a critical period during which physical activity typically declines, particularly among females. Effective physical activity promotion in this vulnerable group will depend on a deeper understanding of the sociocultural, curricular and environmental influences on physical activity that are unique to each school context.

ObjectivesEmpyema is the most common complication of community-acquired pneumonia in children. Obtaining positive culture results to guide management can be challenging in empyema as commonly antibiotics have been given before cultures taken. We set out to investigate the outcomes of children with empyema managed at our tertiary paediatric respiratory service to examine potential areas for improvements in management and to understand the current microbiology picture in our region.MethodsA retrospective review of electronic patient records was performed on paediatric cases coded as ‘empyema’ between January 2022 and February 2024. Researchers collected quantitative data on patients’ diagnostics, management and clinical outcomes including length of stay and follow up.Results43 records were reviewed. 67% were male (n=29), mean age was 4.4 years.The most common pathogen was Group A streptococcus (GAS) (47%, n=20), followed by Strep. pneumoniae (33%, n=14) (figure 1). Viral co-infection was seen in 25% (n=11). 16s RT-PCR testing was performed in 40% (n=17). A respiratory pathogen was identified in 84% of cases using a combination of standard culture and molecular based testing. In four children with negative pleural fluid cultures, 16s RT-PCR detected a pathogen (GAS [n=2], Fusobacterium [n=1], Strep. pneumoniae [n=1]).12% of patients (n=5) were managed conservatively with antibiotics. Primary management with chest drains occurred in 56% (n=24) with intrapleural fibrinolytics used in only 12.5% of these (n=3/24). Primary decortication occurred in 21% of cases (n=9). Secondary decortication was required in 37.5% (n=9/24). Median length of stay was shortest in children who received primary decortication (10 days) and longest in those who required further surgical intervention after initial chest drain insertion (17 days).Abstract 7824 Figure 1Microbiological trends in empyema patients January 2022 to February 2024[Image Omitted. See PDF.]ConclusionsGAS was the most common pathogen isolated, reflective of the changing microbiological landscape post COVID-19 pandemic. Co-infection with viruses was common. Understanding this could help guide clinicians on initial antibiotic choice while cultures are pending or if they are sterile. This series also demonstrates the utility of combining both traditional culture and molecular testing in empyema allowing for timely microbiological diagnosis. Further work to investigate earlier intravenous to oral antibiotics switch and use of narrower spectrum agents is suggested.

Background Evidence suggests that differences exist in physical activity (PA) participation among Culturally and Linguistically Diverse (CALD) children and adolescents. It is possible that these differences could be influenced by variations in measurement technique and instrument reliability. However, culturally sensitive instruments for examining PA behaviour among CALD populations are lacking. This study tested the reliability of the Child and Adolescent Physical Activity and Nutrition Survey (CAPANS-PA) recall questionnaire among a sample of Chinese-Australian youth. Methods The psychometric property of the CAPANS-PA questionnaire was examined among a sample of 77 Chinese-Australian youth (aged 11 - 14 y) who completed the questionnaire twice within 7 days. Test-retest reliability of individual items and scales within the CAPANS-PA questionnaire was determined using Kappa statistics for categorical variables and intraclass correlation coefficients (ICC) for continuous variables. Results The CAPANS-PA questionnaire demonstrated acceptable test-retest reliability for frequency and duration of time spent in weekly Moderate to Vigorous Physical Activity (MVPA) (ICC ≥ 0.70) for all participants. Test-retest reliability for time spent in weekly sedentary activities was acceptable for females (ICC = 0.82) and males (ICC = 0.72). Conclusions The results suggest the CAPANS-PA questionnaire provides reliable estimates for type, frequency and duration of MVPA participation among Chinese-Australian youth. Further investigation into the reliability of the sedentary items within the CAPANS-PA is required before these items can be used with confidence. This study is novel in that the reliability of instruments among CALD groups nationally and internationally remains sparse and this study contributes to the wider body of available psychometrically tested instruments. In addition, this study is the first to our knowledge to successfully engage and investigate the basic health enhancing behaviours of Chinese-Australian adolescents.