title: Television and DVD/video viewing in children younger than 2 years. Utilization of the PICO framework to improve searching PubMed for clinical questions GRADE guidelines: 3. Rating the quality of evidence. Development of the AGREE II, part 2: assessment of validity of items and tools to support application
abstract: 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 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 This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence Background : We established a program of research to improve the development , reporting and evaluation of practice guidelines . We assessed the construct validity of the items and user ’s manual in the β version of the AGREE II . Methods : We design ed guideline excerpts reflecting high- and low- quality guideline content for 21 of the 23 items in the tool . We design ed two study packages so that one low- quality and one high- quality version of each item were r and omly assigned to each package . We r and omly assigned 30 participants to one of the two packages . Participants review ed and rated the guideline content according to the instructions of the user ’s manual and completed a survey assessing the manual . Results : In all cases , content design ed to be of high quality was rated higher than low- quality content ; in 18 of 21 cases , the differences were significant ( p < 0.05 ) . The manual was rated by participants as appropriate , easy to use , and helpful in differentiating guidelines of varying quality , with all scores above the mid-point of the seven-point scale . Considerable feedback was offered on how the items and manual of the β-AGREE II could be improved . Interpretation : The validity of the items was established and the user ’s manual was rated as highly useful by users . We used these results and those of our study presented in part 1 to modify the items and user ’s manual . We recommend AGREE II ( available at www.agreetrust.org ) as the revised st and ard for guideline development , reporting and evaluation
target: Conclusions These guidelines represent a sensible evolution of public health guidelines whereby optimal health is framed within the balance of movement behaviours across the whole day , while respecting preferences of end-users .
background: Background The Canadian Society for Exercise Physiology convened representatives of national organizations , research experts , method ologists , stakeholders , and end-users who followed rigorous and transparent guideline development procedures to create the Canadian 24-Hour Movement Guidelines for the Early Years ( 0–4 years ) : An Integration of Physical Activity , Sedentary Behaviour , and Sleep .
  These novel guidelines for children of the early years embrace the natural and intuitive integration of movement behaviours across the whole day ( 24-h period ) .