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      Health Behaviour in Children and Adolescents with Type 1 Diabetes Compared to a Representative Reference Population

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          Abstract

          Objective

          We provide a population-based overview of health behaviours of children and adolescents with type 1 diabetes in comparison to the general population, and analyse their relevance for glycaemic control and self-rated health status.

          Methods

          Data from questionnaires of 11- to 17-year-old children and adolescents with diabetes (n = 629) were compared to a representative sample (n = 6,813).

          Results

          Children and adolescents with type 1 diabetes had a significantly increased odds of infrequent physical activity (adjusted OR 1.56), short overall duration of physical activity per week (OR 1.55, difference -1.3 hours/week), and high daily computer use (OR 2.51). They had a lower odds of active and passive smoking (OR 0.31 and OR 0.29), and high daily television time (OR 0.68). The odds of an at least good and excellent self-rated health status was increased with intense physical activity, and decreased with active smoking and prolonged daily use of computer and television. Active smoking and prolonged daily use of computer were associated with higher HbA1c.

          Conclusions

          Children and adolescents with type 1 diabetes showed a different profile of health behaviour. Their overall health may improve if their education stresses specifically frequent physical activity with longer overall duration and less frequent television or computer use.

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          Most cited references29

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          Barriers to Physical Activity Among Patients With Type 1 Diabetes

          OBJECTIVE—To determine, in an adult population with type 1 diabetes, barriers to regular physical activity using a diabetes-specific barriers measure (the Barriers to Physical Activity in Diabetes [type 1] [BAPAD1] scale) and factors associated with these barriers. RESEARCH DESIGN AND METHODS—One hundred adults with type 1 diabetes answered a questionnaire assessing perceived barriers to physical activity and related factors. A1C was obtained from the medical chart of each individual. RESULTS—Fear of hypoglycemia was identified as being the strongest barrier to physical activity. Greater knowledge about insulin pharmacokinetics and using appropriate approaches to minimize exercise-induced hypoglycemia were factors associated with fewer perceived barriers. Greater barriers were positively correlated with A1C levels (r = 0.203; P = 0.042) and negatively with well-being (r = −0.45; P < 0.001). CONCLUSIONS—Fear of hypoglycemia is the strongest barrier to regular physical activity in adults with type 1 diabetes, who should therefore be informed and supported in hypoglycemia management.
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            A descriptive epidemiology of screen-based media use in youth: a review and critique.

            The purpose of this systematic review was to (i) estimate the prevalence and dose of television (TV) viewing, video game playing and computer use, and (ii) assess age-related and (iii) secular trends in TV viewing among youth (< or = 18 yr). Ninety studies published in English language journals between 1949 and 2004 were included, presenting data from 539 independent samples (the unit of analysis). Results suggest contemporary youth watch on average 1.8-2.8 h of TV per day, depending on age and gender. Most (66%) are "low users" (< 2 h day(-1)) of TV but 28% watch more than 4 h day(-1). Boys and girls with access to video games spend approximately 60 and 23 min day(-1), respectively, using this technology. Computer use accounts for an additional 30 min day(-1). Age-specific data suggest TV viewing decreases during adolescence, but those considered "high users" at young ages are likely to remain high users when older. For children with access to a television set, the number of hours spent viewing does not appear to have increased over the past 50 years.
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              Health effects of media on children and adolescents.

              Youth spend an average of >7 hours/day using media, and the vast majority of them have access to a bedroom television, computer, the Internet, a video-game console, and a cell phone. In this article we review the most recent research on the effects of media on the health and well-being of children and adolescents. Studies have shown that media can provide information about safe health practices and can foster social connectedness. However, recent evidence raises concerns about media's effects on aggression, sexual behavior, substance use, disordered eating, and academic difficulties. We provide recommendations for parents, practitioners, the media, and policy makers, among others, for ways to increase the benefits and reduce the harm that media can have for the developing child and for adolescents.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                10 November 2014
                : 9
                : 11
                : e112083
                Affiliations
                [1 ]Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Duesseldorf, Germany
                [2 ]Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University, Duesseldorf, Germany
                [3 ]Institute of Movement and Neurosciences, German Sport University, Cologne, Germany
                [4 ]Department of Paediatrics, Cambridge University, Addenbrooke's Hospital, Cambridge, United Kingdom
                [5 ]Institute for Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
                TNO, Netherlands
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: SK ASP KC CB CG KS GG RWH TM JR. Analyzed the data: SK ASP KC CB CG KS BS EM GG RWH TM JR. Wrote the paper: SK ASP KC CB CG KS BS EM GG RWH TM JR.

                ¶ These authors are shared first and senior authors on this work.

                Article
                PONE-D-14-20593
                10.1371/journal.pone.0112083
                4226508
                25384048
                019732d4-6bea-43f7-bd70-44704263b4c7
                Copyright @ 2014

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 8 May 2014
                : 13 October 2014
                Page count
                Pages: 11
                Funding
                The study was supported by the Competence Network for Diabetes Mellitus funded by the Federal Ministry of Education and Research (support code 01GI0802, 01GI1109A, 01GI1106). The German Diabetes Center is institutionally funded by the German Ministry of Health and the Ministry of Innovation, Sciences and Research of the Federal State of North Rhine-Westphalia. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Endocrinology
                Diabetic Endocrinology
                Pediatric Endocrinology
                Epidemiology
                Pediatric Epidemiology
                Social Epidemiology
                Pediatrics
                Adolescent Medicine
                Custom metadata
                The authors confirm that, for approved reasons, some access restrictions apply to the data underlying the findings. Data may not be made available in the paper, supplemental file or public repository due to ethical restrictions. However, data can be made available upon request. Readers may contact Joachim Rosenbauer ( joachim.rosenbauer@ 123456ddz.uni-duesseldorf.de ) or Anna Stahl-Pehe ( anna-stahl@ 123456ddz.uni-dueseldorf.de ) to request the data.

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