In this sample and setting, fundamental movement skills were significantly associated with habitual physical activity, but the association between the two variables was weak. The present study questions whether the widely assumed relationships between motor skills and habitual physical activity actually exist in young children.

Objective To assess whether a physical activity intervention reduces body mass index in young children. Design Cluster randomised controlled single blinded trial over 12 months. Setting Thirty six nurseries in Glasgow, Scotland. Participants 545 children in their preschool year, mean age 4.2 years (SD 0.2) at baseline. Intervention Enhanced physical activity programme in nursery (three 30 minute sessions a week over 24 weeks) plus home based health education aimed at increasing physical activity through play and reducing sedentary behaviour. Main outcome measure Body mass index, expressed as a standard deviation score relative to UK 1990 reference data. Secondary measures were objectively measured physical activity and sedentary behaviour; fundamental movement skills; and evaluation of the process. Results Group allocation had no significant effect on the primary outcome measure at six and 12 months or on measures of physical activity and sedentary behaviour by accelerometry. Children in the intervention group had significantly higher performance in movement skills tests than control children at six month follow-up (P = 0.0027; 95% confidence interval 0.3 to 1.3) after adjustment for sex and baseline performance. Conclusions Physical activity can significantly improve motor skills but did not reduce body mass index in young children in this trial. Trial registration Current Controlled Trials ISRCTN36363490.

SummaryBackgroundAddressing the causes of low engagement in health care is a prerequisite for reducing health inequalities. People who miss multiple appointments are an under-researched group who might have substantial unmet health needs. Individual-level patterns of missed general practice appointments might thus provide a risk marker for vulnerability and poor health outcomes. We sought to ascertain the contributions of patient and practice factors to the likelihood of missing general practice appointments.MethodsFor this national retrospective cohort analysis, we extracted UK National Health Service general practice data that were routinely collected across Scotland between Sept 5, 2013, and Sept 5, 2016. We calculated the per-patient number of missed appointments from individual appointments and investigated the risk of missing a general practice appointment using a negative binomial model offset by number of appointments made. We then analysed the effect of patient-level factors (including age, sex, and socioeconomic status) and practice-level factors (including appointment availability and geographical location) on the risk of missing appointments.FindingsThe full dataset included information from 909 073 patients, of whom 550 083 were included in the analysis after processing. We observed that 104 461 (19·0%) patients missed more than two appointments in the 3 year study period. After controlling for the number of appointments made, patterns of non-attendance could be differentiated, with patients who were aged 16–30 years (relative risk ratio [RRR] 1·21, 95% CI 1·19–1·23) or older than 90 years (2·20, 2·09–2·29), and of low socioeconomic status (Scottish Index of Multiple Deprivation decile 1: RRR 2·27, 2·22–2·31) significantly more likely to miss multiple appointments. Men missed fewer appointments overall than women, but were somewhat more likely to miss appointments in the adjusted model (1·05, 1·04–1·06). Practice factors also substantially affected attendance patterns, with urban practices in affluent areas that typically have appointment waiting times of 2–3 days the most likely to have patients who serially miss appointments. The combination of both patient and practice factors to predict appointments missed gave a higher pseudo R2 value (0·66) than models using either group of factors separately (patients only R2=0·54; practice only R2=0·63).InterpretationThe findings that both patient and practice characteristics contribute to non-attendance of general practice appointments raise important questions for both the management of patients who miss multiple appointments and the effectiveness of existing strategies that aim to increase attendance. Addressing these issues should lead to improvements in provision of services and public health.FundingScottish Government Chief Scientist Office and Data Sharing and Linkage Service of the Scottish Government.