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Pallan M, Mason F, Parretti HM, Adab P, Abbott S, Jolly K. Supporting healthcare professionals to address child weight with parents: a qualitative study. Br J Gen Pract 2024; 74:e417-e425. [PMID: 38575182 PMCID: PMC11005922 DOI: 10.3399/bjgp.2023.0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/06/2023] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Primary care and community healthcare professionals (HCPs) are well placed to discuss child excess weight with parents and support them to make changes. However, HCPs have concerns about addressing this issue. There is a need to understand the factors that influence HCPs in initiating these conversations to inform strategies to support them. AIM To explore with HCPs, working in primary care and community settings, their experiences of having conversations about child weight with parents, and the factors that create barriers or facilitate them to have these conversations. DESIGN AND SETTING A qualitative study with GPs, primary care nurses (PNs), and school nurses (SNs) in England. METHOD GPs and PNs were recruited to participate in semi-structured interviews. SNs from a community healthcare NHS trust were recruited to participate in focus groups. Vignettes were used to stimulate discussion. Data were analysed guided by the Framework approach. RESULTS Thirteen GPs, seven PNs, and 20 SNs participated. The following three themes were identified regarding barriers to HCPs having conversations about child excess weight: structural and organisational; HCP related; and parent or family related. The themes identified for the factors that facilitate these conversations were: structural changes (for example, dedicated appointments, access to weight assessment data, joined-up working across agencies); HCP approaches (for example, providing appropriate dietary and physical activity advice); and HCP knowledge and skills (for example, enhancing HCPs' general and weight management-related skills and knowledge of child weight management services). CONCLUSION A range of barriers exist to HCPs addressing child excess weight with parents in primary care and community settings. Actions to effect structural changes and support HCPs in developing relevant knowledge and skills are required to overcome these barriers.
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Affiliation(s)
- Miranda Pallan
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham
| | - Frances Mason
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham
| | - Helen M Parretti
- Norwich Medical School, Faculty of Medicine and Health, University of East Anglia, Norwich
| | - Peymané Adab
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham
| | - Sally Abbott
- Research Centre for Healthcare and Communities, Institute for Health and Wellbeing, Coventry University, Coventry; Department of Dietetics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry
| | - Kate Jolly
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham
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Gulati R, Gulati K, Alkhouri N, Sahni H, Mhanna MJ, Kaelber DC, Durrani HM, Suri R. Missed Opportunities in Guideline-based Fatty Liver Screening among 3.5 million children. Acad Pediatr 2024:S1876-2859(24)00018-4. [PMID: 38278482 DOI: 10.1016/j.acap.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Determine screening rates and examine socio- demographic characteristics of MAFLD screening in a large population of obese children. METHODS We used Explorys (IBM) which contains aggregated population-level electronic health record data from approximately 360 hospitals and 317,000 providers across the United States to determine MAFLD screening rates. In children 10-14 years, obesity was determined based on BMI >=95%, or encounter with an ICD obesity code. We determined screening rates by calculating the percentage of children with obesity who had an alanine aminotransferase (ALT) tested, further analyzed by gender, race and insurance. RESULTS Of 3,558,420 children, 513,170 (14.4%) were obese. Of obese children, only 9.3% were screened for NAFLD. Females were more likely screened than males (odds ratio (OR) 1.09 (95% CI:1.07-1.12)); white children were more likely screened than non-white children (OR 1.21 (95% CI:1.18-1.23)), and children with Medicaid more likely screened than children with non-Medicaid insurance (OR 1.34 (95% CI:1.32- 1.37)). CONCLUSION(S) The percentage of obese children receiving screening for MAFLD was low. Female gender, white race, and Medicaid insurance were associated with increased screening rates. These findings highlight the need to increase adherence to MAFLD screening. Reporting screening as a health quality measure may reduce implementation gaps in MAFLD screening. WHAT'S NEW IN THIS STUDY?: Our study adds knowledge about screening rates and sociodemographic characteristics of MAFLD screening among children.
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Affiliation(s)
- Reema Gulati
- Department of Pediatrics, The MetroHealth System and Case Western Reserve University, Cleveland, Ohio
| | - Kabir Gulati
- Stephen M. Ross School of Business, University of Michigan, Ann Arbor, Michigan
| | | | | | - Maroun J Mhanna
- Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, LA, United States
| | - David C Kaelber
- Department of Pediatrics, The MetroHealth System and Case Western Reserve University, Cleveland, Ohio
| | - Hafiza Mehreen Durrani
- Department of Pediatrics, The MetroHealth System and Case Western Reserve University, Cleveland, Ohio
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Ling J, Wen F, Robbins LB, Pageau L. Motivational interviewing to reduce anthropometrics among children: A meta-analysis, moderation analysis and Grading of Recommendations Assessment, Development and Evaluation assessment. Pediatr Obes 2022; 17:e12896. [PMID: 35092188 DOI: 10.1111/ijpo.12896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 12/20/2021] [Accepted: 01/11/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Limited systematic reviews exist to evaluate the effects of motivational interviewing (MI) on children's anthropometric factors. OBJECTIVE This review examined the effects of MI interventions for children and/or parents on children's anthropometric factors and included moderation analyses and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we searched Cochrane Library, PubMed, CINAHL, EMBASE, PsycINFO, Sociological Abstracts, SPORTDiscus, Education Resources Information Center, and Web of Science in December 2020. A two-step double screening approach was applied: (1) screening titles and abstracts, and (2) screening full-text articles obtained in step 1. At each step, discussion occurred until reaching consensus. The Cochrane risk-of-bias tool was used to evaluate risk of bias, and GRADE system was applied to assess overall quality of evidence. We performed meta-analyses using the Comprehensive Meta-Analysis software. RESULTS A total of 2209 records were found, and 45 eligible articles were retained. MI interventions had a pooled effect of -0.15 on body mass index (BMI; 95% confidence interval [CI]: -0.24 to -0.06), -0.36 on waist circumference (WC; 95% CI: -0.71 to -0.01) and -0.22 on percent body fat (95% CI: -0.41 to -0.03). Child baseline weight status and percent low-income families were identified as significant intervention moderators. According to the GRADE assessment, the quality of evidence on BMI percentile, BMI z-score and percent body fat was moderate, while quality on BMI and WC was low. CONCLUSIONS In conclusion, culturally appropriate clinic- or home-based MI interventions with adequate duration, dose and active parental involvement are promising in reducing anthropometrics among children.
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Affiliation(s)
- Jiying Ling
- Michigan State University College of Nursing, East Lansing, Michigan, USA
| | - Fujun Wen
- Center for Family Health, Jackson, Michigan, USA
| | - Lorraine B Robbins
- Michigan State University College of Nursing, East Lansing, Michigan, USA
| | - Lauren Pageau
- Michigan State University College of Nursing, East Lansing, Michigan, USA
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Koetsier LW, van Mil MMA, Eilander MMA, van den Eynde E, Baan CA, Seidell JC, Halberstadt J. Conducting a psychosocial and lifestyle assessment as part of an integrated care approach for childhood obesity: experiences, needs and wishes of Dutch healthcare professionals. BMC Health Serv Res 2021; 21:611. [PMID: 34183008 PMCID: PMC8238479 DOI: 10.1186/s12913-021-06635-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/14/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The causes and consequences of childhood obesity are complex and multifaceted. Therefore, an integrated care approach is required to address weight-related issues and improve children's health, societal participation and quality of life. Conducting a psychosocial and lifestyle assessment is an essential part of an integrated care approach. The aim of this study was to explore the experiences, needs and wishes of healthcare professionals with respect to carrying out a psychosocial and lifestyle assessment of childhood obesity. METHODS Fourteen semi-structured interviews were conducted with Dutch healthcare professionals, who are responsible for coordinating the support and care for children with obesity (coordinating professionals, 'CPs'). The following topics were addressed in our interviews with these professionals: CPs' experiences of both using childhood obesity assessment tools and their content, and CPs' needs and wishes related to content, circumstances and required competences. The interviews comprised open-ended questions and were recorded and transcribed verbatim. The data was analysed using template analyses and complemented with open coding in MAXQDA. RESULTS Most CPs experienced both developing a trusting relationship with the children and their parents, as well as establishing the right tone when engaging in weight-related conversations as important. CPs indicated that visual materials were helpful in such conversations. All CPs used a supporting assessment tool to conduct the psychosocial and lifestyle assessment but they also indicated that a more optimal tool was desirable. They recognized the need for specific attributes that helped them to carry out these assessments, namely: sufficient knowledge about the complexity of obesity; having an affinity with obesity-related issues; their experience as a CP; using conversational techniques, such as solution-focused counselling and motivational interviewing; peer-to-peer coaching; and finally, maintaining an open-minded, non-stigmatizing stance and harmonizing their attitude with that of the child and their parents. CONCLUSIONS Alongside the need for a suitable tool for conducting a psychosocial and lifestyle assessment, CPs expressed the need for requisite knowledge, skills and attitudes. Further developing a supporting assessment tool is necessary in order to facilitate CPs and thereby improve the support and care for children with obesity and their families.
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Affiliation(s)
- L W Koetsier
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - M M A van Mil
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - M M A Eilander
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - E van den Eynde
- Erasmus MC, University Medical Center Rotterdam, Obesity Center CGG, Rotterdam, The Netherlands
| | - C A Baan
- Tilburg University, Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg, The Netherlands
| | - J C Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - J Halberstadt
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Boni Z. Slim choices: young people’s experiences of individual responsibility for childhood obesity. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2020.1851655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Zofia Boni
- Institute of Anthropology and Ethnology, Adam Mickiewicz University, Poznan, Poland
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Dresios C, Rachiotis G, Rousou X, Panagakou S, Mouchtouri V, Hadjichristodoulou C. Nationwide Study on Practices Related to Screening Among Greek Paediatricians. Eurasian J Med 2020; 52:237-342. [PMID: 33209074 DOI: 10.5152/eurasianjmed.2020.19192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of this study was to investigate pediatricians' practices toward screening in Greece. Materials and Methods The survey was conducted within a six month period in a stratified random sample of 371 pediatricians. A questionnaire with three sections was created and pilot tested. Socio-demographic characteristics associated with inappropriate screening were identified using multivariable logistic regression models and latent class analysis. Results A total of 294 participants completed the telephone survey (response rate 78.6%). The median number of wrong answers to questions related to pediatricians' practice towards screening recommendations was 7±1.57 with minimum 2 and maximum 11 wrong answers. Pediatricians, with less than 15 years of experience, age >50 years old or view more than eighty patients per week, have had significantly higher odds of responding wrong to more than seven questions, hence be less compliant to USPSTF screening guidelines. Latent class analysis has shown that female gender, age <50 years old, and work in the private sector, were associated with a poor practice towards international screening guidelines. Conclusion Our survey found gaps in screening practices among a nationwide sample of Greek pediatricians. Moreover considerable variability in reported practices of screening was noted. There is a need for the development of a national childhood screening program in Greece.
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Affiliation(s)
- Christos Dresios
- Department of Hygiene and Epidemiology, University of Thessaly School of Medicine, Larissa, Greece
| | - Georgios Rachiotis
- Department of Hygiene and Epidemiology, University of Thessaly School of Medicine, Larissa, Greece
| | - Xanthi Rousou
- Department of Hygiene and Epidemiology, University of Thessaly School of Medicine, Larissa, Greece
| | - Sotiria Panagakou
- Department of Hygiene and Epidemiology, University of Thessaly School of Medicine, Larissa, Greece
| | - Varvara Mouchtouri
- Department of Hygiene and Epidemiology, University of Thessaly School of Medicine, Larissa, Greece
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Bozbulut R, Ertaş-Öztürk Y, Döğer E, Bideci A, Köksal E. Increased Obesity Awareness and Adherence to Healthy Lifestyle-Diet Reduce Metabolic Syndrome Risk in Overweight Children. J Am Coll Nutr 2019; 39:432-437. [PMID: 31755852 DOI: 10.1080/07315724.2019.1691951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Obesity is a common epidemic issue in all over the world. In order to prevent obesity it is essential to know about obesity and its detrimental consequences. This study aimed to evaluate children's awareness about obesity and to determine the associations between level of awareness, healthy lifestyle, dietary habits and risk factors for metabolic syndrome.Methods: Two hundred and thirty-six overweight children (119 boys and 117 girls) aged 10-14 years were enrolled to the study. Anthropometric and biochemical measurements were taken and metabolic syndrome (MetS) definition were done according to the International Diabetes Federation (IDF) consensus and divided into two groups as MetS (+) and MetS (-). Obesity awareness scale (OBA) and Adapted Healthy Lifestyle-Diet Index for Turkey (HLD-TR) were performed.Results: Among children, the prevalence of having MetS was found as 26.3%. Obesity awareness and HLD-TR index sores were lower in MetS (+) group than MetS (-) group. Metabolic syndrome related biochemical parameters and anthropometric measurements were associated with obesity awareness level of the children. The binary logistic regression model shows that a one-unit increase in the OBA index score increases the odd of not having MetS for 1.12 times after adjustments for age, gender, body mass index, and HLD-TR index score.Conclusions: Increased awareness about obesity among children will help to reduce the risk of metabolic syndrome, type 2 diabetes and atherosclerotic cardiovascular diseases in the future.
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Affiliation(s)
- Rukiye Bozbulut
- Faculty of Medicine, Department of Pediatric Endocrinology, Gazi University, Ankara, Turkey
| | - Yasemin Ertaş-Öztürk
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey
| | - Esra Döğer
- Faculty of Medicine, Department of Pediatric Endocrinology, Gazi University, Ankara, Turkey
| | - Aysun Bideci
- Faculty of Medicine, Department of Pediatric Endocrinology, Gazi University, Ankara, Turkey
| | - Eda Köksal
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey
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Sjunnestrand M, Nordin K, Eli K, Nowicka P, Ek A. Planting a seed - child health care nurses' perceptions of speaking to parents about overweight and obesity: a qualitative study within the STOP project. BMC Public Health 2019; 19:1494. [PMID: 31706318 PMCID: PMC6842180 DOI: 10.1186/s12889-019-7852-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/28/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Nurses in child health care (CHC) centers in Sweden play a key role in the early detection and management of childhood overweight/obesity, through meeting families early, regularly and over many years. However, research focusing on CHC nurses' perceptions of their role in childhood overweight/obesity management is scarce. As part of the EU-funded project "Science and Technology in childhood Obesity Policy" (STOP), this study examines CHC nurses' perceptions of speaking to parents about children's overweight/obesity and of their role in referring children to treatment for overweight/obesity. METHODS All registered CHC nurses in Stockholm County (n = 442) received an email invitation letter explaining the study. Individual face-to-face visits (n = 15) in selected centers, and phone calls (n = 24) to nurses working in these centres were also conducted. In total, 17 CHC nurses (all female, average work experience 6.7 years (SD ± 4.9 years)) from 10 municipalities (including four of the top five municipalities with the highest prevalence of overweight and obesity) in Stockholm County were interviewed. The interviews were conducted by phone, transcribed and analyzed using thematic analysis. RESULTS Two main themes were developed through the analysis: 1) The relationship between the nurse and the parent and 2) Glitch in the system. Under the first theme, nurses reported that weight-related discussions were facilitated by building and maintaining trust with parents. However, nurses also said they were reluctant to address children's weights if this could compromise parents' trust. Under the second theme, nurses highlighted several organizational barriers to addressing a child's weight with parents, including insufficient cooperation with other healthcare providers and limited time for visits. Nurses also identified lack of sufficient knowledge about what to offer the family and lack of confidence in their communication skills as additional barriers. CONCLUSIONS We found that pediatric nurses perceive relational and organizational factors as barriers to address childhood obesity with parents. To improve care, it is necessary to provide nurses with continuing education about obesity and communication skills and organizational support to improve communication within the healthcare system. TRIAL REGISTRATION ClinicalTrials.gov NCT03800823; 11 Jan 2019, prospectively registered.
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Affiliation(s)
- My Sjunnestrand
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Nordin
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Eli
- Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Paulina Nowicka
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. .,Department of Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden.
| | - Anna Ek
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Czenczek-Lewandowska E, Leszczak J, Baran J, Weres A, Wyszyńska J, Lewandowski B, Dąbrowski M, Mazur A. Levels of Physical Activity in Children and Adolescents with Type 1 Diabetes in Relation to the Healthy Comparators and to the Method of Insulin Therapy Used. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183498. [PMID: 31546871 PMCID: PMC6766014 DOI: 10.3390/ijerph16183498] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/17/2019] [Accepted: 09/18/2019] [Indexed: 02/07/2023]
Abstract
Given the fact that physical exertion leads to blood glucose fluctuations, type one diabetes mellitus (T1D) may potentially constitute a barrier for obtaining a sufficient amount of exercise. The main purpose of the study was to compare the level of physical activity between children with T1D (n = 215) and healthy controls (n = 115) and to assess the physical activity of the study group in relation to the applied method of insulin therapy, i.e., the use of insulin pen vs. insulin pump. The level of physical activity was assessed with a hip-worn tri-axial accelerometer (ActiGraph GT3X+) used by the subjects for an uninterrupted period of seven days. Children with T1D had significantly lower median values of total time of moderate (213.3 vs. 272.1 min), vigorous (135.3 vs. 19.6 min) and moderate-to-vigorous (347.4 vs. 467.4 min) physical activity compared to healthy peers respectively, (p < 0.001) in all cases. In addition, the total median number of steps was significantly lower (53,631 vs. 67,542 steps), (p < 0.001). The method of insulin therapy was not associated with significant differences in physical activity level (p > 0.001). The level of physical activity in children and adolescents with T1D is lower than in their healthy peers and does not depend on the insulin therapy method.
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Affiliation(s)
- Ewelina Czenczek-Lewandowska
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland; (J.L.); (J.B.); (A.W.); (B.L.); (M.D.); (A.M.)
- Correspondence: ; Tel.: +48-17-872-1153
| | - Justyna Leszczak
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland; (J.L.); (J.B.); (A.W.); (B.L.); (M.D.); (A.M.)
| | - Joanna Baran
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland; (J.L.); (J.B.); (A.W.); (B.L.); (M.D.); (A.M.)
| | - Aneta Weres
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland; (J.L.); (J.B.); (A.W.); (B.L.); (M.D.); (A.M.)
| | - Justyna Wyszyńska
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland; (J.L.); (J.B.); (A.W.); (B.L.); (M.D.); (A.M.)
| | - Bogumił Lewandowski
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland; (J.L.); (J.B.); (A.W.); (B.L.); (M.D.); (A.M.)
| | - Mariusz Dąbrowski
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland; (J.L.); (J.B.); (A.W.); (B.L.); (M.D.); (A.M.)
| | - Artur Mazur
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland; (J.L.); (J.B.); (A.W.); (B.L.); (M.D.); (A.M.)
- Clinical Regional Hospital No. 2 in Rzeszów, Lwowska Street 60, 35-301 Rzeszów, Poland
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High prevalence of obesity among infants presenting with intussusception: Findings in an Egyptian cohort. Arab J Gastroenterol 2019; 20:69-73. [PMID: 31155426 DOI: 10.1016/j.ajg.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 01/15/2019] [Accepted: 04/13/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND STUDY AIMS Intussusception is a life-threatening illness, with incompletely understood aetiology, although some predisposing factors are known. Intussusception frequently occurs in well-nourished chubby infants. We aimed to determine whether patients presenting with intussusception have a high prevalence of obesity. PATIENTS AND METHODS This cross sectional study was conducted in 100 infants presenting with intussusception aged ≤2 years at the Paediatric Surgery Department. Anthropometric measures, history of recent upper respiratory tract infection, timing and type of intervention were recorded. A near median split divided the population into younger (aged < 8 months, N = 47) and older (8-24 months, N = 53) groups. Obesity was defined as having a body weight for length ≥ 97.7th centile on WHO growth charts. RESULTS The study comprised 58 boys and 42 girls, 31% of whom had upper respiratory infection in the preceding month. Obesity was present in 18% of patients, based on WHO growth charts. There was a trend towards higher percentage of obese infants within the younger (25%) compared to older age groups (12%, P = 0.085), but no gender difference. Obesity did not influence the rate of success of hydrostatic reduction. Based on Egypt-specific growth charts, the percentage of infants with a weight-for-age centile ≥ 85th was 42%, of whom 7% were ≥ 97.7th centile. The corresponding percentages for the weight-for-length were 29% and 15% of patients respectively. CONCLUSION There is a high prevalence of obesity in infants presenting with intussusception, particularly under 8 months of age. The mechanistic link between obesity and the pathogenesis of intussusception deserves investigation.
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Armoon B, Karimy M. Epidemiology of childhood overweight, obesity and their related factors in a sample of preschool children from Central Iran. BMC Pediatr 2019; 19:159. [PMID: 31109318 PMCID: PMC6526611 DOI: 10.1186/s12887-019-1540-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/14/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Childhood overweight and obesity are strongly associated with the psychological and physical health of those for the duration of the lifetime. The purpose of this study was to assess the epidemiology of childhood overweight and obesity and their related factors in Zarandieh city, of Iran, in 2017. METHODS In a cross-sectional study, 572 preschool-mother dyads from primary care Clinics were selected by multi-stage sampling method. BMI of the children and mothers were calculated using standard method and the demographic, children nutrition and physical activity habits; the mothers perceived threat toward obesity, and their life style data were collected by self-report questionnaires for the literate mothers and interviewing for illiterate mothers. RESULT The prevalence of overweight and obesity in mothers was 30.8 and 20.3% respectively. This rate in children was 15.5 and 9.9% respectively. The multiple logistic regression analysis showed that variables of mother's BMI, Birth weight, Mother's employment, watching TV > 2 h/day, Computer games> 2 h/day and daily breakfast eating (≥4/week), perceived threat, health responsibility, stress management, physical activity, and healthy eating were the significant predictors of the child's BMI respectively. CONCLUSIONS Our results indicated that the prevalence of overweight and obesity are high in preschool children and their mothers. It seems that necessary to have suitable intervention programs to help mothers understand the serious risk of childhood obesity and the importance of creating a healthy lifestyle by them in childhood.
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Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Tehran-Saveh freeway, Keveh Industrial Estate Company, Saveh, Postcode: 3914334911, Iran
| | - Mahmood Karimy
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Tehran-Saveh freeway, Keveh Industrial Estate Company, Saveh, Postcode: 3914334911, Iran.
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Osmundsen TC, Dahl U, Kulseng B. Enhancing knowledge and coordination in obesity treatment: a case study of an innovative educational program. BMC Health Serv Res 2019; 19:278. [PMID: 31046766 PMCID: PMC6498688 DOI: 10.1186/s12913-019-4119-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 04/24/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Currently, there is a lack of knowledge, organisation and structure in modern health care systems to counter the global trend of obesity, which has become a major risk factor for noncommunicable diseases. Obesity increases the risk of diabetes, cardiovascular diseases, musculoskeletal disorders and cancer. There is a need to strengthen integrated care between primary and secondary health care and to enhance care delivery suited for patients with complex, long-term problems such as obesity. This study aimed to explore how an educational program for General Practitioners (GPs) can contribute to increased knowledge and improved coordination between primary and secondary care in obesity treatment, and reports on these impacts as perceived by the informants. METHODS In 2010, an educational program for the specialist training of GPs was launched at three hospitals in Central Norway opting for improved care delivery for patients with obesity. In contrast to the usual programs, this educational program was tailored to the needs of GPs by offering practice and training with a large number of patients with obesity and type 2 diabetes for an extended period of time. In order to investigate the outcomes of the program, a qualitative design was applied involving interviews with 13 GPs, head physicians and staff at the hospitals and in one municipality. RESULTS Through the program, participants strengthened care delivery by building knowledge and competence. They developed relations between primary and secondary care providers and established shared understanding and practices. The program also demonstrated improvement opportunities, especially concerning the involvement of municipalities. CONCLUSIONS The educational program promoted integrated care between primary and secondary care by establishing formal and informal relations, by improving service delivery through increased competence and by fostering shared understanding and practices between care levels. The educational program illustrates the combination of advanced high-quality training with the development of integrated care.
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Affiliation(s)
| | - Unni Dahl
- Norwegian Hospital Construction Agency, Klæbuveien 118, 7031 Trondheim, Norway
| | - Bård Kulseng
- Centre for Obesity Research (ObeCe), Clinic of Surgery, St. Olavs University Hospital, 7006 Trondheim, Norway
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, N-7489 Trondheim, Norway
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Czenczek-Lewandowska E, Leszczak J, Weres A, Baran J, Wyszyńska J, Grzegorczyk J, Lewandowski B, Mazur A. Sedentary behaviors in children and adolescents with type 1 diabetes, depending on the insulin therapy used. Medicine (Baltimore) 2019; 98:e15625. [PMID: 31083260 PMCID: PMC6531069 DOI: 10.1097/md.0000000000015625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Assessment of sedentary behaviors in children and adolescents with type 1 diabetes (T1D), relative to the method of insulin therapy used, and in comparison to healthy controls.The study group consisted of 215 children with T1D, including 109 (50.7%) insulin pen and 106 (49.3%) insulqsain pump users. The control group comprised 115 healthy children. The subjects' sedentary time was measured with a tri-axial accelerometer ActiGraph GT3X+, used continuously for 7 days.The diabetes group was characterized by a significantly higher "% in sedentary time" score (P = .024) and a lower "mean daily breaks in sedentary time" result (P = .007), which means that they spent much more time on sedentary activities compared to the control group. There were no significant differences between the children using insulin pump and insulin pen in the "% in sedentary time" score (P = .294) and "mean daily breaks in sedentary time" (P = .251).The T1D is a serious encumbrance, leading to longer duration of sedentary time, in comparison to healthy controls. The type of insulin therapy did not significantly affect the percentage of the wear-day spent in sedentary time and mean daily breaks in sedentary time.
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Affiliation(s)
| | | | | | | | | | | | | | - Artur Mazur
- Faculty of Medicine, University of Rzeszów
- Clinical Provincial Hospital No. 2, Rzeszów, Poland
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Sastre LR, Matson S, Gruber KJ, Haldeman L. A qualitative study examining medical provider advice, barriers, and perceived effectiveness in addressing childhood obesity to patients and families from a low-income community health clinic. SAGE Open Med 2019; 7:2050312119834117. [PMID: 30834116 PMCID: PMC6396046 DOI: 10.1177/2050312119834117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/05/2019] [Indexed: 11/18/2022] Open
Abstract
Objective: To examine medical provider (n = 16) perceptions in addressing and managing pediatric obesity with a diverse, low-income patient population. Methods: Semi-structured audio-recorded interviews were performed at three pediatric clinics. Transcripts were reviewed using content analysis and consensus was reached among authors for themes. Themes were grouped into categories including: (1) initiation of weight discussions, (2) advice and perceived effectiveness, and (3) barriers. Results: Most providers reported being comfortable addressing weight and use a variety of methods to initiate conversations; however, many challenges were reported, which include limited time and parent misperceptions of child’s weight. A broad range of lifestyle advice was utilized, but preference to discuss physical activity over nutrition was reported. Conclusion: Results suggest that successful management of children’s weight involves addressing issues at both the parent and the provider levels. Improved nutrition resources or training for providers is suggested; however, time must also be available for individualized counseling. Incorporation of registered dietitians may also reduce the burden.
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Affiliation(s)
- Lauren R Sastre
- Department of Nutrition Science, East Carolina University, Greenville, NC, USA
| | - Stephanie Matson
- Department of Human Nutrition, Winthrop University, Rock Hill, SC, USA
| | - Kenneth J Gruber
- Center for Youth, Family and Community Partnerships, The University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Lauren Haldeman
- Department of Nutrition, The University of North Carolina at Greensboro, Greensboro, NC, USA
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15
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O’Donoghue D, Davison G, Hanna LJ, McNaughten B, Stevenson M, Thompson A. Calibration of confidence and assessed clinical skills competence in undergraduate paediatric OSCE scenarios: a mixed methods study. BMC MEDICAL EDUCATION 2018; 18:211. [PMID: 30223814 PMCID: PMC6142704 DOI: 10.1186/s12909-018-1318-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 08/29/2018] [Indexed: 05/05/2023]
Abstract
BACKGROUND The relationship between confidence and competence in clinical skills development is complex but important. This study aims to determine undergraduate paediatric student confidence in performing three common paediatric clinical skills framed as Objective Structured Clinical Examination (OSCE) scenarios and to compare this with subsequent assessed performance. The study also aims to explore possible barriers to successful paediatric skills completion. METHODS A mixed-methods study was conducted on medical students. Cross-sectional questionnaire data relating to confidence in performing a number of paediatric skills were compared with assessed paediatric skills competency. Focus groups were carried out to identify themes in paediatric skills completion to triangulate this data. RESULTS Eighty-five medical students participated in the study. Students had high levels of pre-test confidence in their ability to perform paediatrics skills. However agreement between pre-test confidence and subsequent task performance was poor and students had significantly greater belief in their skills ability than was subsequently demonstrated. Focus groups identified paediatric skills complexity, conflicting teaching and having limited supervised skills opportunities and as being possible contributory factors to this discrepancy. CONCLUSIONS Student paediatric skills confidence is not matched by performance. The reasons for this are diverse but mostly modifiable. A major factor is the lack of supervised skills experience with appropriate feedback to support students in learning to calibrate their confidence against their competence. A number of recommendations are made including the introduction of formative assessment opportunities.
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Affiliation(s)
- Dara O’Donoghue
- Royal Belfast Hospital for Sick Children, 180-184 Falls Road, Belfast, BT12 6BE UK
- Centre for Medical Education, Queen’s University, Whitla Medical Building, 97 Lisburn Road, Belfast, BT97AE UK
| | - Gail Davison
- Royal Belfast Hospital for Sick Children, 180-184 Falls Road, Belfast, BT12 6BE UK
| | - Laura-Jo Hanna
- Royal Belfast Hospital for Sick Children, 180-184 Falls Road, Belfast, BT12 6BE UK
| | - Ben McNaughten
- Royal Belfast Hospital for Sick Children, 180-184 Falls Road, Belfast, BT12 6BE UK
| | - Michael Stevenson
- Centre for Medical Education, Queen’s University, Whitla Medical Building, 97 Lisburn Road, Belfast, BT97AE UK
| | - Andrew Thompson
- Royal Belfast Hospital for Sick Children, 180-184 Falls Road, Belfast, BT12 6BE UK
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16
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Mâsse LC, Carbert NS, Scarr J, O'Donnell M. Constraints to implementing guidelines for the identification, assessment, and management of childhood obesity in the clinical care setting: Prevention and treatment framework. Prev Med Rep 2018; 12:87-93. [PMID: 30202722 PMCID: PMC6129691 DOI: 10.1016/j.pmedr.2018.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/02/2018] [Accepted: 08/26/2018] [Indexed: 11/19/2022] Open
Abstract
The "Pathway for the Identification, Assessment and Management of Overweight and Obese Children & Youth" was developed to support healthcare providers in identifying and treating childhood obesity in British Columbia (Canada). Purpose The study aimed to determine the feasibility and effectiveness of using the Pathway in clinical settings. Methods 13 healthcare providers (7 family physicians, 2 pediatricians, 2 registered dietitians, and 2 nurse practitioners) assessed the Pathway and participated in semi-structured interviews in 2015. A direct constant comparative analysis guided the coding of the interviews in the NVivo 9 software. Results The interviews uncovered the complexity of factors that influenced practices of healthcare providers. Three broad issues were identified as required if the "Pathway" were to be used and fully implemented in practices. First, the "Pathway" needs to be modified in terms of how it is presented and explained and be supplemented with appropriate documentation and resources for its implementation, Second, the constraints that limit implementation need to be addressed and should include a focus on both individual (i.e., the healthcare providers themselves) and environmental (i.e., factors within and outside of providers' organizations) factors. Lastly, there is a need to establish processes and/or infrastructure for adapting the "Pathway" to the local context as resources and supports vary by organizations and regions. Conclusion Healthcare providers should be involved in screening and managing childhood obesity. Addressing the challenges found in this study will enable healthcare providers to take a more active role in addressing childhood obesity in their day to day practices.
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Affiliation(s)
- Louise C. Mâsse
- School of Population and Public Health, BC Children's Hospital Research Institute, University of British Columbia, Canada
- Corresponding author at: 4480 Oak Street, RM F508, Vancouver, BC V6H 3V4, Canada.
| | - Nicole S. Carbert
- School of Population and Public Health, BC Children's Hospital Research Institute, University of British Columbia, Canada
| | | | - Maureen O'Donnell
- Child Health BC, Canada
- Pediatrics, University of British Columbia, Canada
- Family Practice, University of British Columbia, Canada
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17
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Reliability and Validity of HeartSmartKids: A Survey of Cardiovascular Risk Factors in Children. J Pediatr Health Care 2018; 32:381-386. [PMID: 29548796 DOI: 10.1016/j.pedhc.2018.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/08/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Reliable and valid instruments to measure counseling effectiveness related to eating, activity, and inactivity are lacking. HeartSmartKids (HSK; HeartSmartKids, LLC, Boulder, Colorado) is a bilingual decision-support technology that can be used to assess and counsel families on cardiovascular risk factors in children. The purpose of this study was to establish preliminary test-retest reliability and convergent validity of HSK questions relative to a previously validated questionnaire, HABITS. METHOD Data were collected from children (ages 9-14 years) during an intervention study. A multitrait/multimethod correlation matrix framework was used to examine the test-retest reliability (n = 35) and convergent validity (n = 103) of HSK relative to HABITS. RESULTS HSK had moderate/strong test-retest reliability and good convergent validity between HSK and HABITS. DISCUSSION This study provides preliminary test-retest reliability and convergent validity of a useful clinical tool that can be used to quickly assess children's nutrition (e.g., fruit/vegetable consumption, snacks, sugar-sweetened beverages, breakfast) and activity habits to guide behavior change counseling. Additional work should be done validating HSK with objective measures.
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Darling KE, Fahrenkamp AJ, Ruzicka E, Levitt M, Broerman L, Sato A. Provider perceptions of pediatric obesity management in clinical practice. CHILDRENS HEALTH CARE 2018. [DOI: 10.1080/02739615.2018.1471997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Katherine E. Darling
- Department of Psychological Sciences, Kent State University, Kent, OH, United States
| | - Amy J. Fahrenkamp
- Department of Psychological Sciences, Kent State University, Kent, OH, United States
| | - Elizabeth Ruzicka
- Department of Psychological Sciences, Kent State University, Kent, OH, United States
| | - Michelle Levitt
- Pediatrics, Akron Children’s Hospital, Akron, OH, United States
| | - Lisa Broerman
- Pediatrics, Akron Children’s Hospital, Akron, OH, United States
| | - Amy Sato
- Department of Psychological Sciences, Kent State University, Kent, OH, United States
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19
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Bucher Della Torre S, Courvoisier DS, Saldarriaga A, Martin XE, Farpour-Lambert NJ. Knowledge, attitudes, representations and declared practices of nurses and physicians about obesity in a university hospital: training is essential. Clin Obes 2018; 8:122-130. [PMID: 29327430 DOI: 10.1111/cob.12238] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/08/2017] [Accepted: 11/23/2017] [Indexed: 11/26/2022]
Abstract
In the context of a worldwide obesity epidemic, healthcare providers play a key role in obesity management. Knowledge of current guidelines and attitudes to prevent stigmatization are especially important. This study aimed to assess knowledge, attitudes, beliefs, perception of opportunity for intervention, declared practices and need for training and material of nurses and physicians about obesity in a Swiss University Hospital. A total of 834 physicians and nurses filled an online survey. The questionnaire was based on literature, exploratory interviews and expert committee review. It was pre-tested with 15 physicians and nurses. Participants declared a low level of negative attitudes towards individuals living with obesity. However, the results highlighted a lack of knowledge to diagnose obesity in adults and children, as well as confidence and training to care of patients with obesity. One-third of providers did not know how to calculate body mass index. Half of providers felt it was part of their role to take care of patients with obesity, even if 55% of them had the feeling that they did not have adequate training. Nurses and physicians working in a university hospital showed a low level of negative attitudes but a lack of knowledge and skills on obesity management. Training should be improved in this population to insure adequate and coherent messages and equal access to evidence-based treatment for patients living with obesity.
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Affiliation(s)
- S Bucher Della Torre
- Department of Nutrition and Dietetics, School of Health Sciences - Geneva, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - D S Courvoisier
- Quality of Care Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - A Saldarriaga
- Department of Public Education, Geneva Child and Youth Health Service, Geneva, Switzerland
| | - X E Martin
- Health and Movement Consultation, Unit of Pediatric Cardiology, Service of Pediatric Specialties, Department of Child and Adolescent, University Hospitals of Geneva, Switzerland
| | - N J Farpour-Lambert
- Obesity Prevention and Care Program, Service of Therapeutic Education for Chronic Diseases, Department of Community Medicine, Primary Care and Emergency, University Hospitals of Geneva, Geneva, Switzerland
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20
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Murang ZR, Tuah N, Naing L. Knowledge, attitude and practice towards eating and physical activity among primary school children in Brunei: a cross-sectional study. Int J Adolesc Med Health 2017; 32:/j/ijamh.ahead-of-print/ijamh-2017-0118/ijamh-2017-0118.xml. [PMID: 29190212 DOI: 10.1515/ijamh-2017-0118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/17/2017] [Indexed: 11/15/2022]
Abstract
Background Childhood obesity has become a global public health crisis. Many studies have been conducted to explore the knowledge, attitude and practices towards eating and physical activity amongst parents and healthcare workers. However, very little is known amongst children. It is imperative to understand these factors as they have been associated with obesity among children. Objective This study aimed to assess the knowledge, attitude and practices of Bruneian children towards eating and physical activity, in order to identify the factors that influence the development of obesity. Methods The study involved 353 children from four primary schools in Brunei. The data collection tool used was modified validated questionnaires with sections on demographic characteristic, knowledge about obesity, eating habits and physical activity. Results The majority of children (>60%) had good knowledge of obesity and intake of healthy food, but, 84.2% lacked knowledge on the required daily servings of fruits and vegetables. 68.8% purchased food and beverages from their school canteen. 93.8% were aware about the health benefits of physical activity and 70.2% spent only 1-2 h of screen time per day, however, 46.9% did not meet the recommended amount of physical activity although they reported to have performed enough. This suggested that a comprehensive education on food intake requirements and physical activity are necessary in order to better educate children. Conclusion Health educators and public health professionals may find our findings useful in order to plan and develop tailored interventions for children, as well as better promotion of a healthy lifestyle to children and their families.
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Affiliation(s)
- Zaidah Rizidah Murang
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, Negara Brunei Darussalam
| | - Naa Tuah
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, Negara Brunei Darussalam.,Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Lin Naing
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, Negara Brunei Darussalam
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Alulis S, Grabowski D. Theoretical frameworks informing family-based child and adolescent obesity interventions: A qualitative meta-synthesis. Obes Res Clin Pract 2017; 11:627-639. [PMID: 28844833 DOI: 10.1016/j.orcp.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 07/10/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Child and adolescent obesity trends are rising throughout the world, revealing treatment difficulties and a lack of consensus about treatment. The family system is broadly viewed as a potential setting for facilitation of behaviour change. Therefore, family-based interventions have come into focus. However, the use of theoretical frameworks to strengthen these interventions is rare and very uneven. OBJECTIVE AND METHOD To conduct a qualitative meta-synthesis of family-based interventions for child and adolescent obesity to identify the theoretical frameworks applied, thus understanding how theory is used in practice. A literature review was conducted between January and March 2016. A total of 35 family-based interventions were selected for analysis. RESULTS Eleven interventions explicitly stated that theory guided the development and were classified as theory-inspired. The social cognitive, self-efficacy and Family Systems Theory appeared most frequently. The remaining 24 were classified as theory-related as theoretical elements of self-monitoring; stimulus control, reinforcement and modelling were used. CONCLUSION The designs of family-based interventions reveal numerous inconsistencies and a significant void between research results and health care practice. Based on the analysis, this article proposes three themes to be used as focus points when designing future interventions and when selecting theories for the development of solid, theory-based frameworks for application. The themes are: (1) age of target group, (2) intervention objective, and (3) self-efficacy and readiness for change.
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Affiliation(s)
- Sarah Alulis
- Steno Diabetes Center Copenhagen, Health Promotion Research, Niels Steensens Vej 8, 2820 Gentofte, Denmark; Lund University, Paradisgatan 2, 221 00 Lund, Sweden.
| | - Dan Grabowski
- Steno Diabetes Center Copenhagen, Health Promotion Research, Niels Steensens Vej 8, 2820 Gentofte, Denmark.
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22
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Willson ML, Vernooij RW, Gagliardi AR, Armstrong M, Bernhardsson S, Brouwers M, Bussières A, Fleuren M, Gali K, Huckson S, Jones S, Lewis SZ, James R, Marshall C, Mazza D. Questionnaires used to assess barriers of clinical guideline use among physicians are not comprehensive, reliable, or valid: a scoping review. J Clin Epidemiol 2017; 86:25-38. [DOI: 10.1016/j.jclinepi.2016.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/27/2016] [Accepted: 12/23/2016] [Indexed: 01/26/2023]
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Gies I, AlSaleem B, Olang B, Karima B, Samy G, Husain K, Elhalik M, Miqdady M, Rawashdeh M, Salah M, Mouane N, Rohani P, Singhal A, Vandenplas Y. Early childhood obesity: a survey of knowledge and practices of physicians from the Middle East and North Africa. BMC Pediatr 2017; 17:115. [PMID: 28454516 PMCID: PMC5408831 DOI: 10.1186/s12887-017-0865-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 04/14/2017] [Indexed: 01/09/2023] Open
Abstract
Background Childhood obesity is one of the most serious public health issues of the twenty-first century affecting even low- and middle-income countries. Overweight and obese children are more likely to stay obese into adulthood. Due to the paucity of data on local practices, our study aimed to assess the knowledge and practices of physicians from the Middle East and North Africa region with respect to early-onset obesity. Methods A specific questionnaire investigating the perception and knowledge on early-onset obesity was circulated to healthcare providers (general physicians, pediatricians, pediatric gastroenterologist, neonatologists) practicing in 17 Middle East and North African countries. Results A total of 999/1051 completed forms (95% response) were evaluated. Of all respondents, 28.9% did not consistently use growth charts to monitor growth during every visit and only 25.2% and 46.6% of respondents were aware of the correct cut-off criterion for overweight and obesity, respectively. Of those surveyed, 22.3, 14.0, 36.1, 48.2, and 49.1% of respondents did not consider hypertension, type 2 diabetes, coronary heart disease, fatty liver disease, and decreased life span, respectively, to be a long-term complication of early childhood obesity. Furthermore, only 0.7% of respondents correctly answered all survey questions pertaining to knowledge of early childhood overweight and obesity. Conclusion The survey highlights the low use of growth charts in the evaluation of early childhood growth in Middle East and North Africa region, and demonstrated poor knowledge of healthcare providers on the short- and long-term complications of early-onset obesity. This suggests a need for both continued professional education and development, and implementation of guidelines for the prevention and management of early childhood overweight and obesity. Electronic supplementary material The online version of this article (doi:10.1186/s12887-017-0865-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Inge Gies
- Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bader AlSaleem
- Pediatric Gastroenterology, Hepatology and Nutrition Department, Children's Hospital, King Fahad Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Beheshteh Olang
- Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Berkouk Karima
- Hepatology and Nutrition Society Group Member, Maillot Hospital Algiers, Algeria, Gastroenterology, Algiers, Algeria
| | - Gamal Samy
- Department of Medical Childhood Studies, Institute of Postgraduate Childhood Studies, Ain Shams University, Cairo, Egypt
| | - Khaled Husain
- Pediatric Gastroenterology, Hepatology and Nutrition Unit, Department of Pediatrics, Amiri Hospital, Arabian Gulf Street, Kuwait City, Kuwait
| | - Mahmoud Elhalik
- Pediatric and Neonatology Department, Latifa Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Mohamad Miqdady
- Pediatric Gastroenterology, Hepatology and Nutrition Division, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | | | | | - Nezha Mouane
- Gastroenterology Nutrition Department, Children Hospital Ibn Sina, University Mohammed V Faculty of Medicine, Rabat, Morocco
| | - Pejman Rohani
- Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atul Singhal
- The Childhood Nutrition Research Centre, Institute of Child Health, University College London, London, UK
| | - Yvan Vandenplas
- Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
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Frankfurter C, Cunningham C, Morrison KM, Rimas H, Bailey K. Understanding academic clinicians’ intent to treat pediatric obesity. World J Clin Pediatr 2017; 6:60-68. [PMID: 28224097 PMCID: PMC5296631 DOI: 10.5409/wjcp.v6.i1.60] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 07/29/2016] [Accepted: 10/27/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To examine the extent to which the theory of planned behavior (TPB) predicts academic clinicians’ intent to treat pediatric obesity.
METHODS A multi-disciplinary panel iteratively devised a Likert scale survey based on the constructs of the TPB applied to a set of pediatric obesity themes. A cross-sectional electronic survey was then administered to academic clinicians at tertiary care centers across Canada from January to April 2012. Descriptive statistics were used to summarize demographic and item agreement data. A hierarchical linear regression analysis controlling for demographic variables was conducted to examine the extent to which the TPB subscales predicted intent to treat pediatric obesity.
RESULTS A total of 198 physicians, surgeons, and allied health professionals across Canada (British Columbia, Alberta, Manitoba, Saskatchewan, Nova Scotia, Ontario and Quebec) completed the survey. On step 1, demographic factors accounted for 7.4% of the variance in intent scores. Together in step 2, demographic variables and TPB subscales predicted 56.9% of the variance in a measure of the intent to treat pediatric obesity. Perceived behavioral control, that is, confidence in one’s ability to manage pediatric obesity, and subjective norms, congruent with one’s context of practice, were the most significant predictors of the intent to treat pediatric obesity. Attitudes and barriers did not predict the intent to treat pediatric obesity in this context.
CONCLUSION Enhancing self-confidence in the ability to treat pediatric obesity and the existence of supportive treatment environments are important to increase clinicians’ intent to treat pediatric obesity.
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Barabas G, Tengblad A, Östgren CJ. Low carbohydrate diet and obesity treatment in primary health care: dietary advice after the new Swedish report. BMC Nutr 2016. [DOI: 10.1186/s40795-015-0042-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Uesugi KH, Dattilo AM, Black MM, Saavedra JM. Design of a Digital-Based, Multicomponent Nutrition Guidance System for Prevention of Early Childhood Obesity. J Obes 2016; 2016:5067421. [PMID: 27635257 PMCID: PMC5007363 DOI: 10.1155/2016/5067421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/21/2016] [Accepted: 07/17/2016] [Indexed: 12/02/2022] Open
Abstract
Interventions targeting parenting focused modifiable factors to prevent obesity and promote healthy growth in the first 1000 days of life are needed. Scale-up of interventions to global populations is necessary to reverse trends in weight status among infants and toddlers, and large scale dissemination will require understanding of effective strategies. Utilizing nutrition education theories, this paper describes the design of a digital-based nutrition guidance system targeted to first-time mothers to prevent obesity during the first two years. The multicomponent system consists of scientifically substantiated content, tools, and telephone-based professional support delivered in an anticipatory and sequential manner via the internet, email, and text messages, focusing on educational modules addressing the modifiable factors associated with childhood obesity. Digital delivery formats leverage consumer media trends and provide the opportunity for scale-up, unavailable to previous interventions reliant on resource heavy clinic and home-based counseling. Designed initially for use in the United States, this system's core features are applicable to all contexts and constitute an approach fostering healthy growth, not just obesity prevention. The multicomponent features, combined with a global concern for optimal growth and positive trends in mobile internet use, represent this system's future potential to affect change in nutrition practice in developing countries.
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Affiliation(s)
| | - Anne M. Dattilo
- Nestlé Nutrition, 12 Vreeland Road, Florham Park, NJ 07932, USA
| | - Maureen M. Black
- Department of Pediatrics, University of Maryland School of Medicine, 737 W Lombard Street No. 161, Baltimore, MD 21201, USA
- RTI International, East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709-2194, USA
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Health care providers' perceived barriers to and need for the implementation of a national integrated health care standard on childhood obesity in the Netherlands - a mixed methods approach. BMC Health Serv Res 2016; 16:83. [PMID: 26955883 PMCID: PMC4784354 DOI: 10.1186/s12913-016-1324-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2010, a national integrated health care standard for (childhood) obesity was published and disseminated in the Netherlands. The aim of this study is to gain insight into the needs of health care providers and the barriers they face in terms of implementing this integrated health care standard. METHODS A mixed-methods approach was applied using focus groups, semi-structured, face-to-face interviews and an e-mail-based internet survey. The study's participants included: general practitioners (GPs) (focus groups); health care providers in different professions (face-to-face interviews) and health care providers, including GPs; youth health care workers; pediatricians; dieticians; psychologists and physiotherapists (survey). First, the transcripts from the focus groups were analyzed thematically. The themes identified in this process were then used to analyze the interviews. The results of the analysis of the qualitative data were used to construct the statements used in the e-mail-based internet survey. Responses to items were measured on a 5-point Likert scale and were categorized into three outcomes: 'agree' or 'important' (response categories 1 and 2), 'disagree' or 'not important'. RESULTS Twenty-seven of the GPs that were invited (51 %) participated in four focus groups. Seven of the nine health care professionals that were invited (78 %) participated in the interviews and 222 questionnaires (17 %) were returned and included in the analysis. The following key barriers were identified with regard to the implementation of the integrated health care standard: reluctance to raise the subject; perceived lack of motivation and knowledge on the part of the parents; previous negative experiences with lifestyle programs; financial constraints and the lack of a structured multidisciplinary approach. The main needs identified were: increased knowledge and awareness on the part of both health care providers and parents/children; a social map of effective intervention; structural funding; task rearrangements; a central care coordinator and structural information feedback from the health care providers involved. CONCLUSIONS The integrated health care standard stipulate that the care of overweight or obese children be provided using an integrated approach. The barriers and needs identified in this study can be used to define strategies to improve the implementation of the integrated health care standard pertaining to overweight and obese children in the Netherlands.
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Bailey K, Cunningham C, Pemberton J, Rimas H, Morrison KM. Understanding Academic Clinicians' Decision Making for the Treatment of Childhood Obesity. Child Obes 2015; 11:696-706. [PMID: 26580274 DOI: 10.1089/chi.2015.0031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although most clinicians agree that obesity is a major problem, treatment rates remain low. We conducted this discrete choice experiment (DCE) to understand academic clinicians' decisions in treating childhood obesity. METHODS A total of 198 academic pediatric surgeons, pediatricians, family physicians, and allied health professionals were recruited from 15 teaching hospitals across Canada to participate in this DCE. Participants completed 15 tasks choosing between three obesity treatment scenarios to identify the scenario in which they would most likely treat pediatric obesity. RESULTS Latent class analysis revealed two classes with early intervention and late intervention preferences. Participants in the early intervention group (30%) were sensitive to variations in patient and family support. They would likely intervene if patients were obese, with normal lipid levels, were prediabetic, had high blood pressure, and when obesity was lifestyle associated. Late intervention clinicians (70%) were more likely to intervene if patients were morbidly obese, had abnormal lipid levels, required insulin for diabetes, had very high blood pressure, or when obesity impacted the patient's mental health. Simulations predicted that increasing colleague support for intervention, providing expert consultation, and mobilizing multidisciplinary support would increase the likelihood of treating pediatric obesity earlier from 16.1% to 81.5%. CONCLUSIONS This DCE was implemented to understand the factors clinicians use in making decisions. Most academic clinicians choose to intervene late in the clinical course when more-severe obesity-related morbidities are present. Increased support from colleagues, expert consultation, and multidisciplinary support are likely to lead to earlier treatment of obesity among academic clinicians caring for children.
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Affiliation(s)
- Karen Bailey
- 1 Division of Pediatric Surgery, Department of Surgery, McMaster Children's Hospital , Hamilton, Ontario, Canada .,2 McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University , Hamilton, Ontario, Canada
| | - Charles Cunningham
- 3 Department of Psychiatry & Behavioral Neurosciences, McMaster University , Hamilton, Ontario, Canada
| | - Julia Pemberton
- 2 McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University , Hamilton, Ontario, Canada
| | - Heather Rimas
- 3 Department of Psychiatry & Behavioral Neurosciences, McMaster University , Hamilton, Ontario, Canada
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Kuhle S, Doucette R, Piccinini-Vallis H, Kirk SFL. Successful childhood obesity management in primary care in Canada: what are the odds? PeerJ 2015; 3:e1327. [PMID: 26623175 PMCID: PMC4662587 DOI: 10.7717/peerj.1327] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 09/24/2015] [Indexed: 12/11/2022] Open
Abstract
Background. The management of a child presenting with obesity in a primary care setting can be viewed as a multi-step behavioral process with many perceived and actual barriers for families and primary care providers. In order to achieve the goal of behavior change and, ultimately, clinically meaningful weight management outcomes in a child who is considered obese, all steps in this process should ideally be completed. We sought to review the evidence for completing each step, and to estimate the population effect of secondary prevention of childhood obesity in Canada. Methods. Data from the 2009/2010 Canadian Community Health Survey and from a review of the literature were used to estimate the probabilities for completion of each step. A flow chart based on these probabilities was used to determine the proportion of children with obesity that would undergo and achieve clinically meaningful weight management outcomes each year in Canada. Results. We estimated that the probability of a child in Canada who presents with obesity achieving clinically meaningful weight management outcomes through secondary prevention in primary care is around 0.6% per year, with a range from 0.01% to 7.2% per year. The lack of accessible and effective weight management programs appeared to be the most important bottleneck in the process. Conclusions. In order to make progress towards supporting effective pediatric obesity management, efforts should focus on population-based primary prevention and a systems approach to change our obesogenic society, alongside the allocation of resources toward weight management approaches that are comprehensively offered, equitably distributed and robustly evaluated.
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Affiliation(s)
- Stefan Kuhle
- Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynaecology and Pediatrics, Dalhousie University , Halifax, Nova Scotia , Canada
| | - Rachel Doucette
- Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynaecology and Pediatrics, Dalhousie University , Halifax, Nova Scotia , Canada ; Department of Family Medicine, Dalhousie University , Halifax, Nova Scotia , Canada
| | | | - Sara F L Kirk
- School of Health and Human Performance, Dalhousie University and the IWK Health Centre , Halifax, Nova Scotia , Canada
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Gance-Cleveland B, Aldrich H, Dandreaux D, Oetzel KB, Schmiege S. A Virtual Childhood Obesity Collaborative: Satisfaction With Online Continuing Education. J Pediatr Health Care 2015; 29:413-23. [PMID: 25777493 DOI: 10.1016/j.pedhc.2015.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION This descriptive study evaluated school-based health center (SBHC) providers' satisfaction with Web-based continuing education as part of a virtual childhood obesity intervention. METHOD Thirty-six participants from 24 SBHCs in six states participated in the training modules. Modules were divided into four learning sessions, with a total of 17 training modules. Participants completed satisfaction surveys after each module, as well as an overall survey at the end of the training. Questions were rated on a 4-point Likert scale (4 = strongly agree, 3 = agree, 2 = disagree, 1 = strongly disagree). RESULTS Participation in the first two learning sessions was higher than the last two. Provider satisfaction of training modules by question type and content area was quite high (μ = 3.66-3.33). Overall satisfaction means ranged from 3.76 to 3.24. Many providers also reported plans to make changes in their practice after completing the training. DISCUSSION This study demonstrated that a virtual childhood obesity collaborative is an acceptable delivery method for continuing education.
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Seburg EM, Olson-Bullis BA, Bredeson DM, Hayes MG, Sherwood NE. A Review of Primary Care-Based Childhood Obesity Prevention and Treatment Interventions. Curr Obes Rep 2015; 4. [PMID: 26213643 PMCID: PMC4512668 DOI: 10.1007/s13679-015-0160-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Effective obesity prevention and treatment interventions targeting children and their families are needed to help curb the obesity epidemic. Pediatric primary care is a promising setting for these interventions, and a growing number of studies are set in this context. This review aims to identify randomized controlled trials of pediatric primary care-based obesity interventions. A literature search of 3 databases retrieved 2947 publications, of which 2899 publications were excluded after abstract (n=2722) and full-text review (n=177). Forty-eight publications, representing 31 studies, were included in the review. Eight studies demonstrated a significant intervention effect on child weight outcomes (e.g., BMI z-score, weight-for-length percentile). Effective interventions were mainly treatment interventions, and tended to focus on multiple behaviors, contain weight management components, and include monitoring of weight-related behaviors (e.g., dietary intake, physical activity, or sedentary behaviors). Overall, results demonstrate modest support for the efficacy of obesity treatment interventions set in primary care.
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Affiliation(s)
- Elisabeth M. Seburg
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
| | - Barbara A. Olson-Bullis
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
| | - Dani M. Bredeson
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
| | - Marcia G. Hayes
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
| | - Nancy E. Sherwood
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
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Njelekela MA, Muhihi A, Mpembeni RNM, Anaeli A, Chillo O, Kubhoja S, Lujani B, Ngarashi D, Maghembe M. Knowledge and attitudes towards obesity among primary school children in Dar es Salaam, Tanzania. Niger Med J 2015; 56:103-8. [PMID: 25838624 PMCID: PMC4382598 DOI: 10.4103/0300-1652.150692] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Childhood obesity has increased over the past two decades. Child obesity is likely to persist through adulthood and increases the risk of non-communicable diseases (NCDs) later in life. This study assessed knowledge and attitudes towards obesity among primary school children in Dar es Salaam, Tanzania. MATERIALS AND METHODS A cross-sectional study was conducted in randomly selected primary schools in Dar es Salaam. A structured questionnaire was used to assess the knowledge and attitudes. Anthropometric and blood pressure measurements were taken using standard procedures. RESULTS A total of 446 children were included in the analysis. The mean age of the participants was 11.1 ± 2.0 years. The mean body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 16.6 ± 4.0 kg/m(2), 103.9 ± 10.3 mmHg and 65.6 ± 8.2 mmHg, respectively. Prevalence of obesity (defined as BMI >95(th) percentile for age and sex) was 5.2%. Half of the children (51.1%) had heard about obesity from teachers at school (20%), radio (19.4%) and books/newspaper (17.3%). Less than half (45.4%) had knowledge about the risk factors for childhood obesity and correctly defined obesity (44.6%). However, a good number of the children (72.1%) were aware that they can be affected by obesity. Majority of them had negative attitude towards obesity and various factors leading to or resulting from childhood obesity. CONCLUSIONS Knowledge about childhood obesity among primary school children is moderate and have negative attitude towards obesity. Integrating educational programs early in primary schools may be an effective strategy to impact knowledge about obesity and other non-communicable diseases early in childhood.
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Affiliation(s)
- Marina A Njelekela
- Executive Director, Muhimbili National Hospital, Dar es Salaam, Tanzania
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Alfa Muhihi
- Clinical Trial Unit, Africa Academy for Public Health, Dar es Salaam, Tanzania
- Interventions Thematic Group, Ifakara Health Institute, Ifakara, Morogoro, Tanzania
| | - Rose N. M. Mpembeni
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Amani Anaeli
- Department of Developmental Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Omary Chillo
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sulende Kubhoja
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Benjamin Lujani
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Davis Ngarashi
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mwanamkuu Maghembe
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Aldrich H, Gance-Cleveland B, Schmiege S, Dandreaux D. School-based health center providers' treatment of overweight children. J Pediatr Nurs 2014; 29:521-7. [PMID: 24947663 DOI: 10.1016/j.pedn.2014.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/15/2014] [Accepted: 05/16/2014] [Indexed: 11/18/2022]
Abstract
This descriptive study was to determine self-reported treatment practices of school-based health center (SBHC) providers when caring for overweight/obese children. Providers (N=33) from SBHCs in 6 states (AZ, CO, NM, MI, NY, and NC) completed a baseline survey before being trained on obesity recommendations. SBHC providers reported patient/parent barriers to be more significant to treatment than clinician/setting barriers (p<0.0001). Most providers (97%) indicated childhood overweight needs treatment, yet only 36% said they initiate treatment in children who do not want to control their weight. SBHC providers also did not commonly refer overweight/obese children to specialists.
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Affiliation(s)
- Heather Aldrich
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | | | - Sarah Schmiege
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Danielle Dandreaux
- Center for Improving Health Outcomes in Children, Teens, and Families, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ.
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Aldrich H, Gance-Cleveland B, Schmiege S, Dandreaux D. Identification and assessment of childhood obesity by school-based health center providers. J Pediatr Health Care 2014; 28:526-33. [PMID: 24974347 DOI: 10.1016/j.pedhc.2014.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/28/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION School-based health centers (SBHCs) serve many overweight/obese children, yet little is known about provider adherence to obesity guidelines. The purpose of this descriptive study was to evaluate obesity care assessment practices of SBHC providers prior to completing training on obesity guidelines. METHOD Providers (n = 33) from SBHCs in six states (AZ, CO, NM, MI, NY, and NC) completed The International Life Science Institute Research Foundation Assessment of Overweight in Children and Adolescents Survey. RESULTS Most providers reported using body mass index percentile (93.9%) to assess weight. In caring for overweight/obese children, providers reported screening for hypertension 100% of the time and cardiovascular disease 93.9% of the time, and approximately two thirds reported requesting total cholesterol and lipid profile laboratory assessments. Some assessment guidelines were not routinely followed. DISCUSSION SBHCs serve a high-risk population, and providers in this study may benefit from additional training on assessment guidelines and quality improvement processes to improve adherence to current guidelines.
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Estrada E, Eneli I, Hampl S, Mietus-Snyder M, Mirza N, Rhodes E, Sweeney B, Tinajero-Deck L, Woolford SJ, Pont SJ. Children's Hospital Association consensus statements for comorbidities of childhood obesity. Child Obes 2014; 10:304-17. [PMID: 25019404 PMCID: PMC4120655 DOI: 10.1089/chi.2013.0120] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Childhood obesity and overweight affect approximately 30% of US children. Many of these children have obesity-related comorbidities, such as hypertension, dyslipidemia, fatty liver disease, diabetes, polycystic ovary syndrome (PCOS), sleep apnea, psychosocial problems, and others. These children need routine screening and, in many cases, treatment for these conditions. However, because primary care pediatric providers (PCPs) often are underequipped to deal with these comorbidities, they frequently refer these patients to subspecialists. However, as a result of the US pediatric subspecialist shortage and considering that 12.5 million children are obese, access to care by subspecialists is limited. The aim of this article is to provide accessible, user-friendly clinical consensus statements to facilitate the screening, interpretation of results, and early treatment for some of the most common childhood obesity comorbidities. METHODS Members of the Children's Hospital Association (formerly NACHRI) FOCUS on a Fitter Future II (FFFII), a collaboration of 25 US pediatric obesity centers, used a combination of the best available evidence and collective clinical experience to develop consensus statements for pediatric obesity-related comorbidities. FFFII also surveyed the participating pediatric obesity centers regarding their current practices. RESULTS The work group developed consensus statements for use in the evaluation and treatment of lipids, liver enzymes, and blood pressure abnormalities and PCOS in the child with overweight and obesity. The results of the FFFII survey illustrated the variability in the approach for initial evaluation and treatment as well as pattern of referrals to subspecialists among programs. CONCLUSIONS The consensus statements presented in this article can be a useful tool for PCPs in the management and overall care of children with overweight and obesity.
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Affiliation(s)
- Elizabeth Estrada
- Division of Endocrinology, Connecticut Children's Medical Center, University of Connecticut, Hartford, CT
| | - Ihuoma Eneli
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Sarah Hampl
- Weight Management, Children's Mercy Hospital, University of Missouri–Kansas City, Kansas City, MO
| | - Michele Mietus-Snyder
- Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington, DC
| | - Nazrat Mirza
- Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington, DC
| | - Erinn Rhodes
- Division of Endocrinology, Boston Children's Hospital, Boston, MA
| | - Brooke Sweeney
- Department of Pediatrics, Kosair Children's Hospital, University of Louisville, Louisville, KY
| | | | - Susan J. Woolford
- Department of Pediatrics, C.S. Mott Children's Hospital and Von Voigtlander Women's Hospital, University of Michigan, Ann Arbor, MI
| | - Stephen J. Pont
- Dell Children's Medical Center, University of Texas Southwestern, Austin, TX
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Walker DM, Robbins JM, Brown D, Berhane Z. Improving processes of care for overweight and obese children: evidence from the 215-GO! program in Philadelphia health centers. Public Health Rep 2014; 129:303-10. [PMID: 24791028 DOI: 10.1177/003335491412900314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Daniel M Walker
- Daniel Walker is a Doctoral Candidate with the Tulane School of Public Health and Tropical Medicine in New Orleans, Louisiana. Jessica Robbins is an Epidemiologist with the PDPH and an Adjunct Assistant Professor at the Drexel School of Public Health, both in Philadelphia, Pennsylvania. Darryl Brown and Zekarias Berhane are Assistant Professors with the Drexel School of Public Health
| | - Jessica M Robbins
- Daniel Walker is a Doctoral Candidate with the Tulane School of Public Health and Tropical Medicine in New Orleans, Louisiana. Jessica Robbins is an Epidemiologist with the PDPH and an Adjunct Assistant Professor at the Drexel School of Public Health, both in Philadelphia, Pennsylvania. Darryl Brown and Zekarias Berhane are Assistant Professors with the Drexel School of Public Health
| | - Darryl Brown
- Daniel Walker is a Doctoral Candidate with the Tulane School of Public Health and Tropical Medicine in New Orleans, Louisiana. Jessica Robbins is an Epidemiologist with the PDPH and an Adjunct Assistant Professor at the Drexel School of Public Health, both in Philadelphia, Pennsylvania. Darryl Brown and Zekarias Berhane are Assistant Professors with the Drexel School of Public Health
| | - Zekarias Berhane
- Daniel Walker is a Doctoral Candidate with the Tulane School of Public Health and Tropical Medicine in New Orleans, Louisiana. Jessica Robbins is an Epidemiologist with the PDPH and an Adjunct Assistant Professor at the Drexel School of Public Health, both in Philadelphia, Pennsylvania. Darryl Brown and Zekarias Berhane are Assistant Professors with the Drexel School of Public Health
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Davoli AM, Broccoli S, Bonvicini L, Fabbri A, Ferrari E, D'Angelo S, Di Buono A, Montagna G, Panza C, Pinotti M, Romani G, Storani S, Tamelli M, Candela S, Giorgi Rossi P. Pediatrician-led motivational interviewing to treat overweight children: an RCT. Pediatrics 2013; 132:e1236-46. [PMID: 24144717 DOI: 10.1542/peds.2013-1738] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of family pediatrician-led motivational interviews (MIs) on BMI of overweight (85th ≥ BMI percentile ≥ 95 th) children aged 4 to 7 years. METHODS All the family pediatricians working in Reggio Emilia Province (Italy) were invited to participate in the study; 95% accepted. Specific training was provided. Parents were asked to participate in the trial if they recognized their child as overweight. Children were individually randomly assigned to MIs or usual care. All children were invited for a baseline and a 12-month visit to assess BMI and lifestyle behaviors. The usual care group received an information leaflet, and the intervention group received 5 MI family meetings. The primary outcome was the individual variation of BMI, assessed by pediatricians unblinded to treatment groups. RESULTS Of 419 eligible families, 372 (89%) participated; 187 children were randomized to MIs and 185 to the usual care group. Ninety-five percent of the children attended the 12-month visit. The average BMI increased by 0.49 and 0.79 during the intervention in the MI and control groups, respectively (difference: -0.30; P = .007). MI had no effect in boys or in children whose mothers had a low educational level. Positive changes in parent-reported lifestyle behaviors occurred more frequently in the MI group than in the control group. CONCLUSIONS The pediatrician-led MI was overall effective in controlling BMI in these overweight children aged 4 to 7 years, even though no effect was observed in male children or when the mother's education level was low.
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Affiliation(s)
- Anna Maria Davoli
- Epidemiology Unit, Local Health Authority of Reggio Emilia, via Amendola 2, Reggio Emilia, Italy.
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