School-based obesity prevention programs in rural communities: a scoping review

OBJECTIVE

The objective of this review was to examine existing literature and conceptually map the evidence for school-based obesity prevention programs implemented in rural communities, as well as identify current gaps in the literature.

INTRODUCTION

Pediatric obesity is a significant public health condition worldwide. Rural residency places children at increased risk of obesity. Schools have been identified as an avenue for obesity prevention in rural communities.

INCLUSION CRITERIA

We considered citations focused on children (5 to 18 years of age) enrolled in a rural educational setting. We included obesity prevention programs delivered in rural schools that focused on nutrition or dietary changes, physical activity or exercise, decreasing screen time, or combined nutrition and physical activity that aimed to prevent childhood obesity. We included all quantitative, qualitative, and mixed methods research designs, as well as text and opinion data.

METHODS

A search was conducted of published and unpublished studies in English from 1990 through April 2020 using PubMed, CINAHL Complete, ERIC, Embase, Scopus, Academic Search Premier, Cochrane Register of Controlled Trials, and ClinicalTrials.gov. Gray literature was also searched. After title and abstract review, potentially relevant citations were retrieved in full text. The full texts were assessed in detail against the inclusion criteria by 2 independent reviewers. Included citations were reviewed and data extracted by 2 independent reviewers and captured on a spreadsheet targeting the review objectives.

RESULTS

Of the 105 studies selected for full-text review, 72 (68.6%) were included in the final study. Most of the studies (n = 50) were published between 2010 and 2019 and were conducted in the United States (n = 57). Most studies included children in rural elementary or middle schools (n = 57) and targeted obesity prevention (n = 67). Teachers implemented the programs in half of the studies (n = 36). Most studies included a combination of physical activity and nutrition components (n = 43). Other studies focused solely on nutrition (n = 9) or physical activity (n = 9), targeted obesity prevention policies (n = 9), or other components (n = 8). Programs ranged in length from weeks to years. Overall, weight-related, physical activity-specific, and nutrition-specific outcomes were most commonly examined in the included citations.

CONCLUSIONS

Obesity prevention programs that focused on a combination of physical activity and nutrition were the most common. Multiple outcomes were examined, but most programs included weight-specific and health behavior-specific outcomes. The length and intensity of rural school-based obesity prevention programs varied. More research examining scientific rigor and specific outcomes of rural school-based obesity prevention programs is needed.

Barriers and facilitators to cancer clinical trial enrollment and participation among rural populations: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to identify barriers and facilitators related to cancer clinical trial enrollment and participation among rural populations.

INTRODUCTION

Advancing the effectiveness of cancer treatment and increasing early detection of cancer relies on enrollment and participation of individuals in cancer clinical trials. Lack of enrollment and participation in trials is a concern, and there is evidence that individuals living in rural areas are unlikely to participate in such trials. Information on barriers to, and facilitators of, enrollment and participation in cancer clinical trials is needed for the development of evidence-based interventions to increase the enrollment and participation of rural populations.

INCLUSION CRITERIA

The review will consider studies on adults aged 18 years or older living in rural areas. Studies that report on barriers and facilitators to enrollment and participation in cancer clinical trials, including both cancer therapeutic and cancer early detection trials, will be included in the review. The review will consider quantitative, qualitative, and text and opinion papers for inclusion.

METHODS

The search strategy will aim to locate published primary studies, reviews, and opinion papers, the latter including those by professional oncology organizations. The databases to be searched include MEDLINE, CINAHL, Embase, Web of Science, and Cochrane Library. Gray literature databases will also be searched. Two independent reviewers will retrieve full-text studies and extract data. The results will be presented in diagrammatic format with a narrative summary.

Improvements for the Prior Authorization Process for Elective Surgical Procedures at an Academic Medical Center

Prior authorization is an approval process to ensure that services provided by healthcare organizations will be reimbursed by insurance carriers. Prior authorization denials can result in revenue loss. Due to multiple prior authorization issues, over $21 million in charges was denied, and $291,217.63 was ultimately written off as uncollectible in a one-year period at the Department of Surgery at Hospital X. This paper aimed to design an improved process to reduce, or eliminate, the issues causing charges to be written off. Three divisions with the most prior authorization denials within the department were identified. A comprehensive review of the current prior authorization process was conducted. Each division was found to have a unique prior authorization issue that was causing charges to be written off. Barriers were identified, educational training was provided accordingly, and process changes were implemented thereafter. When comparing the results pre- and post-interventions, these interventions resulted in these charges no longer being denied or written off. The processes utilized here can be easily replicated for organizations with similar barriers.

Prevalence and subgroup comparisons of obesity and severe obesity among Mississippi public school students

This study examined the prevalence of obesity and severe obesity among Mississippi K-12 public school students and the obesity rate differences within subgroups categorized by sex, race, and grade level. Anthropometric data from a weighted, representative sample of Mississippi public school students were collected through the biennial Child and Youth Prevalence of Obesity Survey (CAYPOS). Overall prevalence rates and those of the subgroups were calculated and compared. The 2017 data indicated that overall 23.7% of Mississippi public schools students met the criterion of class I obesity, 9.1% met the criterion of class II obesity, and 3.2% met the criterion of class III obesity. Among those with severe obesity, the prevalence was significantly higher among black students (10.9%) when compared to their white counterparts (7.3%) (p < 0.001), and among high school students (12.0%) when compared to elementary (6.5%) and middle school students (9.6%) (p < 0.001). As to racial differences by sex, black females had the highest severe obesity rates (11.9%), followed by black males (9.9%). White females had the lowest severe obesity rate (5.8%). At lower grade levels, black students had higher prevalence rates than whites but at 12th grade level the gap between the two races are almost closed. These findings were compared to other current studies in order to better evaluate the current health profiles of Mississippi public school students.

Prostate Cancer Screening Recommendations for General and Specific Populations in the Western Nations

There is a chaotic scenario that exists in the field of prostate cancer (PCa) screening. To balance goals, such as decreasing mortality, avoiding unnecessary procedures, and decreasing the cost of medical care, the pendulum seems to have swung to the side of more restricted screening. The decrease in PCa screening has led to a slowly creeping decline in the favourable outcomes that existed among patients with PCa. If a potential patient or a family member is trying to get clear guidance about PCa screening by searching the internet, they will end up confused by several recommendations from many organisations. It is even more challenging to obtain any clarity about PCa screening for special populations, such as those with a family history of PCa, those of African descent/African Americans, and the elderly. The advent of genomic medicine and precision medicine is an opportunity to identify those at a very high risk of developing aggressive PCa, so that PCa screening can be more actively undertaken among them. In this paper, the authors review the current recommendations by different entities and summarise emerging molecular markers that may help bring clarity to PCa screening. The authors predict that concrete, consensual guidelines will emerge in less than one decade. Meanwhile, this article suggests intermediary steps that will help save lives from PCa mortality, especially for under-represented populations. This paper is a catalyst to stimulate further discussion and serves as a guide to noncancer-specialists for the near future as precision medicine progresses to better understand risk–benefit and cost–benefit ratios in PCa screening.

Lack of Racial Survival Differences in Metastatic Prostate Cancer in National Cancer Data Base (NCDB): A Different Finding Compared to Non-metastatic Disease

Background: Inconsistent findings have been reported in the literature regarding racial differences in survival outcomes between African American and white patients with metastatic prostate cancer (mPCa). The current study utilized a national database to determine whether racial differences exist among the target population to address this inconsistency.

Methods: This study retrospectively reviewed prostate cancer (PCa) patient data (N = 1,319,225) from the National Cancer Database (NCDB). The data were divided into three groupings based on the metastatic status: (1) no metastasis (N = 318,291), (2) bone metastasis (N = 29,639), and (3) metastases to locations other than bone, such as brain, liver, or lung (N = 952). Survival probabilities of African American and white PCa patients with bone metastasis were examined through parametric proportional hazards Weibull models and Bayesian survival analysis. These results were compared to patients with no metastasis or other types of metastases.

Results: No statistically supported racial disparities were observed for African American and white men with bone metastasis (p = 0.885). Similarly, there were no racial disparities in survival for those men suffering from other metastases (liver, lung, or brain). However, racial disparities in survival were observed among the two racial groups with non-metastatic PCa (p < 0.001) or when metastasis status was not taken into account (p < 0.001). The Bayesian analysis corroborates the finding.

Conclusion: This research supports our previous findings and shows that there are no racial differences in survival outcomes between African American and white patients with mPCa. In contrast, racial disparities in the survival outcome continue to exist among non-metastatic PCa patients. Further research is warranted to explain this difference.

Breastfeeding History, Preschool Children's Sleep, and Obesity

Breastfeeding and sleep are both considered medically and physiologically protective factors for child health. Most existing research studied their impact on child health outcomes, respectively. Few studies examined the two factors collectively to explore any potential associations among a history of breastfeeding and quantity of sleep in children and child health. This study sought to uncover the association among breastfeeding history, the amount of sleep, and obesity in preschool-aged children to provide additional insights into their protective physical and psychological effects on health outcomes. As part of a larger study examining obesity in preschool children, the current investigation explored the association among obesity, a history of breastfeeding, and the total number of hours of preschool children's sleep, as reported by parents. Actual heights and weights were collected on a total of 1,693 children 3-5 years of age enrolled in licensed child care facilities in Mississippi. Descriptive analyses of the demographic and parent survey variables were conducted to explore the status related to breastfeeding in Mississippi. To understand the relationships between breastfeeding and covariates, bivariate analyses such as chi-square independent tests, Cochran-Mantel-Haenszel chi-square tests, and Fisher's exact tests were performed. Obesity was negatively correlated to breastfeeding, and Caucasian mothers were significantly more likely to breastfeed than African American mothers. Obesity was also negatively correlated to the amount of sleep, and African American children reportedly slept significantly less than Caucasian children. The average amount of time of sleep reported for children with a history of being breastfed was significantly higher than for those who were not breastfed, suggesting that breastfeeding could have a significant positive association with preschool children's sleep, serving as an additional protective factor obesity. The interaction between breastfeeding and subsequent sleep as children mature is an important area for future research to fully explore their foundational impact in family health practices that combat obesity in children and promote other subsequent health outcomes.