Increasing rates of childhood obesity in the U.S. and other Western countries are cause for serious public health concern. Neighborhood and community environments are thought to play a contributing role in the development of obesity among youth, but it is not well understood which types of physical environmental characteristics have the most potential to influence obesity outcomes. This paper reports the results of a systematic review of quantitative research examining built and biophysical environmental variables associated with obesity in children and adolescents through physical activity. Literature searches in PubMed, PsychInfo, and Geobase were conducted. Fifteen quantitative studies met the inclusion criteria for this systematic review. The majority of studies were cross-sectional and published after 2005. Overall, few consistent findings emerged. For children, associations between physical environmental variables and obesity differed by gender, age, socioeconomic status, population density, and whether reports were made by the parent or child. Access to equipment and facilities, neighborhood pattern (e.g., rural, exurban, suburban), and urban sprawl were associated with obesity outcomes in adolescents. For most environmental variables considered, strong empirical evidence is not yet available. Conceptual gaps, methodological limitations, and future research directions are discussed.

Occupational therapists believe that play is a child's main occupation and is considered essential for healthy motor, cognitive and emotional development. However, play spaces and activities in low socio-economic areas are often different to those provided in structured occupational therapy treatment environments. The main objective was to determine play opportunities, activities, equipment, toys and the play environment for 5- to 6-year-olds living in a low-socio-economic community outside a small town in South Africa, in order to understand the nature of play in this environment better. Participant observation together with an adapted photovoice method to capture the play experience was used. Data was analysed using inductive content analysis. Two global themes emerged from the results: "neighbourhood children find ways to play" and "context influences play". Children were given ample opportunity to play and participated in extensive outdoor play. Their games were highly social and involved the imaginative use of found items as toys. Play was also used to make sense of social hazards. An understanding of play in a low-income context has implications for the development of future play assessments and the provision of play therapy in these communities. Copyright © 2015 John Wiley & Sons, Ltd.

Background The indications for microsurgical toe-to-hand transfers in congenital hand surgery have not been defined as clearly as for posttraumatic reconstruction of thumb and finger amputations. The purpose of this study was to develop simple guidelines for referral of children with congenital absent digits for consideration of microsurgical reconstruction with toe-to-hand transfers, based on the morphological or radiographic anatomy of the hand anomaly, not on embryological classifications. Methods From a consecutive series of 204 children referred with congenital absence of the thumb and fingers, 100 toe-tohand transfers were performed. The indications for microsurgical reconstruction of these children were analyzed retrospectively. Results Forty-one thumbs were reconstructed in 38 children-15 children with an absent thumb distal to the metacarpal base but with four relatively normal fingers; 12 children with an absent thumb and only one or two digits remaining on the ulnar side of the hand; and 11 children with complete absence of all five digits. Twenty-nine second toes and 12 great toes were transferred to reconstruct congenital absent thumbs. Fifty-nine fingers in 52 children were reconstructed mostly with single second toe transfers-41 children with a thumb but absence of all four fingers and 11 children with absence of all five digits. Conclusions The morphological or radiographic anatomy of a child's hand with congenital absent digits is a more logical indication for microsurgical reconstruction than any embryological classification. The three most common indications for toe transfers for reconstruction of congenital absent thumbs are (1) absent thumb distal to the carpometacarpal joint with four relatively normal fingers, (2) absent thumb with only one or two fingers remaining on the ulnar border of the hand, and (3) complete absence of the thumb and all four fingers. The two indications for toe transfers for reconstruction of congenital absent fingers are (1) absence of all four fingers but with a normal thumb remaining and (2) complete absence of all five digits.

Level III-Therapeutic study.