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Biomedical subjects

E Waters

Publications and source records attributed to E Waters.

At least 19 recordsLinked to original sources
PubMed2006

Outcome data from the LEAP (Live, Eat and Play) trial: a randomized controlled trial of a primary care intervention for childhood overweight/mild obesity.

OBJECTIVES: To reduce gain in body mass index (BMI) in overweight/mildly obese children in the primary care setting. DESIGN: Randomized controlled trial (RCT) nested within a baseline cross-sectional BMI survey. SETTING: Twenty nine general practices, Melbourne, Australia. PARTICIPANTS: (1) BMI survey: 2112 children visiting their general practitioner (GP) April-December 2002; (2) RCT: individually randomized overweight/mildly obese (BMI z-score <3.0) children aged 5 years 0 months-9 years 11 months (82 intervention, 81 control). INTERVENTION: Four standard GP consultations over 12 weeks, targeting change in nutrition, physical activity and sedentary behaviour, supported by purpose-designed family materials. MAIN OUTCOME MEASURES: Primary: BMI at 9 and 15 months post-randomization. Secondary: Parent-reported child nutrition, physical activity and health status; child-reported health status, body satisfaction and appearance/self-worth. RESULTS: Attrition was 10%. The adjusted mean difference (intervention-control) in BMI was -0.2 kg/m(2) (95% CI: -0.6 to 0.1; P=0.25) at 9 months and -0.0 kg/m(2) (95% CI: -0.5 to 0.5; P=1.00) at 15 months. There was a relative improvement in nutrition scores in the intervention arm at both 9 and 15 months. There was weak evidence of an increase in daily physical activity in the intervention arm. Health status and body image were similar in the trial arms. CONCLUSIONS: This intervention did not result in a sustained BMI reduction, despite the improvement in parent-reported nutrition. Brief individualized solution-focused approaches may not be an effective approach to childhood overweight. Alternatively, this intervention may not have been intensive enough or the GP training may have been insufficient; however, increasing either would have significant cost and resource implications at a population level.

Body Image↗
PubMed2006

Immunogenicity of the rF1+rV vaccine for plague with identification of potential immune correlates.

The rF1+rV candidate sub-unit vaccine for plague, formulated by adsorption to alhydrogel, has been demonstrated to be immunogenic in the cynomolgus macaque in a clinically relevant dose-range (5-40 microg of each sub-unit) and regimen. Following two doses of vaccine, a specific IgG titre developed in a dose-related manner with predominance of the IgG1/IgG2 isotypes. Groups of macaques receiving only a single dose of vaccine at the 40 microg dose-level had a significantly reduced peak IgG response and faster decline to baseline. Serum collected at week 5 from 19 immunised animals competed with and displaced murine Mab7.3 from binding to the V antigen in vitro. By week 53 of the schedule, although absolute IgG titres had declined, 17/19 macaque sera tested contained competing antibody, indicating the durability of a functional immune response to rF1+rV in this species. Thirteen of these week 53 sera were passively transferred into groups of naive mice, and all conferred full or partial protection against subsequent challenge of the mice with plague. Generally, those sera which were most competitive with Mab 7.3 for binding to V antigen were fully protective by passive transfer, although one week-53 serum sample was fully protective by passive transfer but not active by competitive ELISA. The early development of protective immunity in macaques was also indicated from the protection conferred on naive mice by the passive transfer of immune macaque serum collected at 2-10 weeks of the immunisation schedule. Serum samples from representative macaques within this time period also inhibited the Yersinia-mediated cytotoxicity of J774 macrophages in a qualitative in vitro assay of type three secretion.

Animals↗
PubMed2006

A qualitative study exploring barriers to a model of shared care for pre-school children's oral health.

OBJECTIVE: To explore the oral health beliefs and practices of primary health care professionals which may act as barriers to the development of a model of shared care for the oral health of pre-school children. DESIGN: Qualitative focus group discussions and semi-structured interviews. SETTING: Four rural local government areas in Victoria, Australia, 2003. SUBJECTS AND METHODS SUBJECTS: maternal and child health nurses, general medical practitioners, dental professionals and paediatricians working in the four local government areas. DATA COLLECTION: discipline specific focus groups and semi-structured interviews. DATA ANALYSIS: transcription, coding, clustering and thematic analysis. RESULTS: Several strong themes emerged from the data. All participants agreed that dental caries is a significant health issue for young children and their families. Beliefs about the aetiology of dental caries and its prevention were variable and often simplistic focusing predominantly on diet. Dental professionals did not believe that they had a primary role in the oral health of pre-school aged children but that others particularly maternal and child health nurses did. However other health care professionals were not confident in assuming this role. CONCLUSIONS: This study has identified important barriers and possible strategies for the development of an integrated and shared approach to preventing dental caries in pre-school aged children. Clear and consistent oral health information and agreed roles and responsibilities need to be developed.

Attitude of Health Personnel↗
PubMed2006

Evidence-based clinical policy: case report of a reproducible process to encourage understanding and evaluation of evidence.

We report within a case study a reproducible process to facilitate the explicit incorporation of evidence by a multidisciplinary group into clinical policy development. To support the decision-making of a multidisciplinary Intersectoral Advisory Group (IAG) convened by the Royal Australasian College of Physicians Health Policy Unit, a systematic review of randomized controlled trials about environmental tobacco smoke and smoking cessation interventions in paediatric settings was first undertaken. As reported in detail here, IAG members were then formally engaged in a transparent and replicable process to understand and interpret the synthesized evidence and to proffer their independent reactions regarding policy, practice and research. Our intention was to ensure that all IAG members were democratically engaged and made aware of the available evidence. As clinical policy must engage stakeholder representatives from diverse backgrounds, a process to equalize understanding of the evidence and 'democratize' judgment about its implications is needed. Future research must then examine the benefits of such explicit steps when guidelines, in turn, are implemented. We hypothesize that changes to future practice will be more likely if processes undertaken to develop guidelines are transparent to clinicians and other target groups.

Advisory Committees↗
PubMed2005

Criteria for the systematic review of health promotion and public health interventions.

Systematic reviews of public health interventions are fraught with challenges. Complexity is inherent; this may be due to multi-component interventions, diverse study populations, multiple outcomes measured, mixed study designs utilized and the effect of context on intervention design, implementation and effectiveness. For policy makers and practitioners to use systematic reviews to implement effective public health programmes, systematic reviews must include this information, which seeks to answer the questions posed by decision makers, including recipients of programmes. This necessitates expanding the traditional evaluation of evidence to incorporate the assessment of theory, integrity of interventions, context and sustainability of the interventions and outcomes. Unfortunately however, the critical information required for judging both the quality of a public health intervention and whether or not an intervention is worthwhile or replicable is missing from most public health intervention studies. When the raw material is not available in primary studies the systematic review process becomes even more challenging. Systematic reviews, which highlight these critical gaps, may act to encourage better reporting in primary studies. This paper provides recommendations to reviewers on the issues to address within a public health systematic review and, indirectly, provides advice to researchers on the reporting requirements of primary studies for the production of high quality systematic reviews.

Humans↗
PubMed2005

Interventions for preventing obesity in children.

BACKGROUND: Obesity prevention is an international public health priority. The prevalence of obesity and overweight is increasing in child populations throughout the world, impacting on short and long-term health. Obesity prevention strategies for children can change behaviour but efficacy in terms of preventing obesity remains poorly understood. OBJECTIVES: To assess the effectiveness of interventions designed to prevent obesity in childhood through diet, physical activity and/or lifestyle and social support. SEARCH STRATEGY: MEDLINE, PsycINFO, EMBASE, CINAHL and CENTRAL were searched from 1990 to February 2005. Non-English language papers were included and experts contacted. SELECTION CRITERIA: Randomised controlled trials and controlled clinical trials with minimum duration twelve weeks. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Twenty-two studies were included; ten long-term (at least 12 months) and twelve short-term (12 weeks to 12 months). Nineteen were school/preschool-based interventions, one was a community-based intervention targeting low-income families, and two were family-based interventions targeting non-obese children of obese or overweight parents. Six of the ten long-term studies combined dietary education and physical activity interventions; five resulted in no difference in overweight status between groups and one resulted in improvements for girls receiving the intervention, but not boys. Two studies focused on physical activity alone. Of these, a multi-media approach appeared to be effective in preventing obesity. Two studies focused on nutrition education alone, but neither were effective in preventing obesity. Four of the twelve short-term studies focused on interventions to increase physical activity levels, and two of these studies resulted in minor reductions in overweight status in favour of the intervention. The other eight studies combined advice on diet and physical activity, but none had a significant impact. The studies were heterogeneous in terms of study design, quality, target population, theoretical underpinning, and outcome measures, making it impossible to combine study findings using statistical methods. There was an absence of cost-effectiveness data. AUTHORS' CONCLUSIONS: The majority of studies were short-term. Studies that focused on combining dietary and physical activity approaches did not significantly improve BMI, but some studies that focused on dietary or physical activity approaches showed a small but positive impact on BMI status. Nearly all studies included resulted in some improvement in diet or physical activity. Appropriateness of development, design, duration and intensity of interventions to prevent obesity in childhood needs to be reconsidered alongside comprehensive reporting of the intervention scope and process.

Adolescent↗
PubMed2005

Policy interventions implemented through sporting organisations for promoting healthy behaviour change.

BACKGROUND: Sporting organisations provide an important setting for health promotion strategies that involve policies, communication of healthy messages and creation of health promoting environments. The introduction of policy interventions within sporting organisations is one strategy to target high risk behaviours such as smoking, alcohol consumption, excess sun exposure, unhealthy eating and discrimination. OBJECTIVES: To review all controlled evaluation studies of policy interventions organised through sporting settings to increase healthy behaviour (related to smoking, alcohol, healthy eating, sun protection, discrimination, safety and access). SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsyclNFO, CINAHL, SPORTDiscus, Sociological Abstracts, Dissertation Abstracts, freely available online health promotion and sports-related databases hosted by leading agencies, and the internet using sport and policy-related key words. We identified further studies in the bibliographies of articles and by contacting authors of key articles in the area. SELECTION CRITERIA: We aimed to identify research that had used study designs that incorporated an evaluated intervention and comparison. Uncontrolled studies, meeting other inclusion criteria, were to be reported in an annex to the review. Types of studies: Studies in which sporting organisations were allocated to a policy intervention or control/comparison group. No minimum follow-up required. TYPES OF PARTICIPANTS: People of all ages. Types of interventions: Any policy intervention implemented through sporting organisations to instigate and/or sustain healthy behaviour change, intention to change behaviour, or changes in attitudes, knowledge or awareness of healthy behaviour. Policies must address any of the following: smoking, alcohol, healthy eating, sun protection, access for disadvantaged groups, physical safety (not including injuries), and social and emotional health (e.g.. anti-vilification, anti-discrimination). Types of outcome measures: Behaviour change, intention to change behaviour, change in attitudes, knowledge or awareness of healthy behaviour, and policy presence. DATA COLLECTION AND ANALYSIS: We assessed whether identified citations were controlled evaluation studies and investigated the use of policy implemented in sporting settings. Abstracts were independently inspected by two reviewers and full papers were obtained where necessary. As no controlled evaluation studies were located, no data collection or analysis was undertaken. No uncontrolled studies meeting other inclusion criteria were identified and therefore no annex is presented. MAIN RESULTS: No rigorous studies were located to test the effectiveness of policy interventions organised through sporting organisations to increase healthy behaviours, attitudes, knowledge or inclusion of health oriented policies within the organisations. AUTHORS' CONCLUSIONS: We were unable to find any controlled studies to guide the use of policy interventions used in sporting settings. The search process revealed a number of case studies with anecdotal reporting of outcomes. We strongly recommend that rigorous evaluation techniques are employed more commonly in this field to illuminate the impact of health promoting policy on outcomes, and the contexts and processes which are likely to be effective in reducing harmful behaviours.

Alcohol Drinking↗
PubMed2005

Interventions implemented through sporting organisations for increasing participation in sport.

BACKGROUND: There is now compelling scientific evidence that increased levels of physical activity can bring wide-ranging health benefits. These benefits can extend beyond physical health and include other positive impacts relating to mental health and personal development. The sport and recreation sector is viewed as a priority area for increasing rates of physical activity. Participation rates have been shown to be lower in females, decline with age, and are reduced in lower socio-economic and minority groups. It is important to determine the most effective interventions that sporting organisations can use to increase participation. OBJECTIVES: To review all controlled evaluation studies of interventions organised through sporting settings to increase participation. SEARCH STRATEGY: We searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsyclNFO, CINAHL, SPORTDiscus, Sociological Abstracts, Dissertation Abstracts, and a number of freely-available online health promotion and sports-related databases. The internet was used extensively to search for studies and locate information generated by sporting bodies throughout the world. SELECTION CRITERIA: Types of studies: Controlled evaluation studies. No minimum follow-up required. Uncontrolled studies, meeting other inclusion criteria, were to be reported in an annex to the review. TYPES OF PARTICIPANTS: People of all ages. Types of interventions: Any intervention designed to increase active and/ or non-active participation in sport. These could include: mass media campaigns; information or education sessions; management or organisational change strategies; policy changes, for example to improve the socio-cultural environment to encourage people of specific age, gender or ethnicity to participate; changes to traditional or existing programs, for example club or association-initiated rule modification programs; provision of activities beyond traditional or existing programs, for example 'Come and Try' initiatives (teaser or taster programs); skill improvement programs; volunteer encouragement programs. Types of outcome measures: Change in the number of (active and non-active) participants in organised sport, change in status from non-participating to non-active or active participation, change in status from non-active to active participation. DATA COLLECTION AND ANALYSIS: We assessed whether identified citations were controlled evaluation studies which investigated the use of interventions implemented in sporting settings to increase participation. Two reviewers independently inspected abstracts. We obtained full papers where necessary. As no controlled evaluation studies were located, no data collection or analysis was undertaken. No uncontrolled studies meeting other inclusion criteria were identified and therefore no annex is presented. MAIN RESULTS: Despite a thorough review of the published and unpublished literature, we were unable to locate any rigorous studies which tested the effects of interventions organised through sporting organisations to increase participation in sport. AUTHORS' CONCLUSIONS: There is an absence of high quality evidence to support interventions designed and delivered by sporting organisations to increase participation in sport. Interventions funded and conducted in this area must be linked to a rigorous evaluation strategy in order to examine overall effectiveness, sociodemographic differentials in participation and cost-effectiveness of these strategies.

Exercise↗
PubMed2005

Healthy eating, activity and obesity prevention: a qualitative study of parent and child perceptions in Australia.

Preventative health strategies incorporating the views of target participants have improved the likelihood of success. This qualitative study aimed to elicit child and parent views regarding social and environmental barriers to healthy eating, physical activity and child obesity prevention programmes, acceptable foci, and appropriate modes of delivery. To obtain views across a range of social circumstances three demographically diverse primary schools in Victoria, Australia were selected. Children in Grades 2 (aged 7-8 years) and 5 (aged 10-11 years) participated in focus groups of three to six children. Groups were semi-structured using photo-based activities to initiate discussion. Focus groups with established parent groups were also conducted. Comments were recorded, collated, and themes extracted using grounded theory. 119 children and 17 parents participated. Nine themes emerged: information and awareness, contradiction between knowledge and behaviour, lifestyle balance, local environment, barriers to a healthy lifestyle, contradictory messages, myths, roles of the school and family, and timing and content of prevention strategies for childhood obesity. In conclusion, awareness of food 'healthiness' was high however perceptions of the 'healthiness' of some sedentary activities that are otherwise of benefit (e.g. reading) were uncertain. The contradictions in messages children receive were reported to be a barrier to a healthy lifestyle. Parent recommendations regarding the timing and content of childhood obesity prevention strategies were consistent with quantitative research. Contradictions in the explicit and implicit messages children receive around diet and physical activity need to be prevented. Consistent promotion of healthy food and activity choices across settings is core to population prevention programmes for childhood obesity.

Child↗
PubMed2005

Development of a condition-specific measure of quality of life for children with cerebral palsy: empirical thematic data reported by parents and children.

BACKGROUND: Although there is increasing recognition that quality of life (QOL) and health-related quality of life (HRQOL) are important outcome variables in clinical trials for children with cerebral palsy, there are substantial limitations in existing measures of QOL. This study identify themes of QOL for children with cerebral palsy and their parents to guide the development of a new condition-specific QOL scale. METHODS: A qualitative study of parent and child views on QOL composition was conducted, using a grounded theory framework. Families participated in semistructured interviews on QOL until thematic saturation was reached (n = 28 families). RESULTS: Overall, 13 themes emerged from the interviews: physical health, body pain and discomfort, daily living tasks, participation in regular physical and social activities, emotional well-being and self-esteem, interaction with the community, communication, family health, supportive physical environment, future QOL, provision of, and access to services, financial stability, and social well-being. CONCLUSIONS: Research with parents and children with cerebral palsy, representative of severity across the disease spectrum and socio-economic status, reinforced and expanded on the traditional themes that have underpinned QOL measurement development. This has implications not only for the development of a new QOL scale for children with cerebral palsy, but also for clinical interventions and community care management.

Activities of Daily Living↗
PubMed2005

Understanding parental motivators and barriers to uptake of child poison safety strategies: a qualitative study.

OBJECTIVES: To develop an understanding of factors acting as barriers and motivators to parental uptake of child poison safety strategies. DESIGN: A qualitative study involving semistructured interviews and focus groups. A grounded theory approach was used for the collection and analysis of data. PARTICIPANTS: Sixty five parents of children under 5 years of age, some of whom had experienced an unintentional child poisoning incident. RESULTS: A range of knowledge based, environmental, and behavioral barriers to comprehensive parental uptake of poison safety practices were identified. As a result there tended to be only partial implementation of safety initiatives in the home. Selection of safety practices was often guided by the interests and behaviors of the child. This made the child vulnerable to changes in the home environment, inadequate supervision, and/or shifts in their own behavior and developmental ability. Personal or vicarious exposure of a parent to a child poisoning incident was a significant motivator for parental review of safety practices. CONCLUSION: Environmental measures targeting child resistant containers, warning labels, and lockable poisons cupboards will support parents' efforts to maintain poison safety. Additional education campaigns using stories of actual poisoning incidents may help to increase awareness of risk and encourage increased uptake.

Accidents, Home↗
PubMed2005

Global priority setting for Cochrane systematic reviews of health promotion and public health research.

BACKGROUND: Systematic reviews of health promotion and public health interventions are increasingly being conducted to assist public policy decision making. Many intra-country initiatives have been established to conduct systematic reviews in their relevant public health areas. The Cochrane Collaboration, an international organisation established to conduct and publish systematic reviews of healthcare interventions, is committed to high quality reviews that are regularly updated, published electronically, and meeting the needs of the consumers. AIMS: To identify global priorities for Cochrane systematic reviews of public health topics. METHODS: Systematic reviews of public health interventions were identified and mapped against global health risks. Global health organisations were engaged and nominated policy-urgent titles, evidence based selection criteria were applied to set priorities. RESULTS: 26 priority systematic review titles were identified, addressing interventions such as community building activities, pre-natal and early infancy psychosocial outcomes, and improving the nutrition status of refugee and displaced populations. DISCUSSION: The 26 priority titles provide an opportunity for potential reviewers and indeed, the Cochrane Collaboration as a whole, to address the previously unmet needs of global health policy and research agencies.

Evidence-Based Medicine↗
PubMed2005

Improving hospital doctors' working lives: online questionnaire survey of all grades.

BACKGROUND: In 2001, the Department of Health produced the Improving Working Lives (IWL) for Doctors document. This is the first national survey which asks hospital doctors what changes are needed to improve their working lives. METHODS: An online questionnaire was run over a period of six weeks and was open to all doctors of all grades. Doctors were asked to choose their top five factors from a list of 35 diverse choices or to provide alternatives in free text. Demographic data were also collected. RESULTS: 1603 hospital doctors working in the UK completed the online questionnaire. Improved secretarial or managerial support was the first IWL choice for consultants, with different aspects of clinical and non-clinical support representing their top four choices. Junior hospital doctors and staff and associate specialist grades (staff grades, associate specialists, and clinical assistants) identified improved support for education and training as their first choice, while among the female specialist registrars, it was improved support for childcare. Greater opportunities to develop new skills was an important issue for doctors in the surgical specialties and improved access to mentoring was important for all junior doctors, staff and associate specialist grades, and doctors from black and ethnic minority groups. CONCLUSIONS: Hospital doctors in the UK need more support to improve their working lives. The principle needs are better secretarial and managerial support for consultants; education, training, and mentoring for junior doctors and staff and associate specialist grades; and improved opportunities to develop new skills for those in surgical specialties. Support with childcare is an important issue for female specialist registrars. The Department of Health, NHS trusts, deaneries, and Royal Colleges need to endorse policies that promote a training and working environment that will improve working lives for all hospital doctors, ensuring that appropriate and continuing support is available from the time doctors enter the new foundation programmes and proposed run-through grades, to their time spent as consultants in today's NHS.

Attitude of Health Personnel↗
PubMed2004

Body mass index and parent-reported self-esteem in elementary school children: evidence for a causal relationship.

OBJECTIVE: To clarify relationships between body mass index (BMI) and self-esteem in young children at a population level. To assess whether low self-esteem precedes or follows development of overweight/obesity in children. DESIGN: Prospective cohort study in elementary schools throughout Victoria, Australia. Child BMI and self-esteem were measured in 1997 and 2000. SUBJECTS: Random sample of 1,157 children who were in the first 4 y of elementary school (aged 5-10 y) at baseline. MEASURES: BMI was calculated from measured height and weight, then transformed to z-scores. Children were classified as nonoverweight, overweight or obese based on international cut-points. Low child self-esteem was defined as a score below the 15th percentile on the self-esteem subscale of the parent-reported Child Health Questionnaire. RESULTS: Overweight/obese children had lower median self-esteem scores than nonoverweight children at both timepoints, especially at follow-up. After accounting for baseline self-esteem, higher baseline BMI z-score predicted poorer self-esteem at follow-up (P=0.008). After accounting for baseline BMI z-score, poorer baseline self-esteem did not predict higher BMI z-score at follow-up. While nonoverweight children with low baseline self-esteem were more likely to develop overweight/obesity (OR=2.1, 95% CI=1.2, 3.6), this accounted for only a small proportion of the incidence of overweight. CONCLUSIONS: Our data show an increasingly strong association between lower self-esteem and higher body mass across the elementary school years. Overweight/obesity precedes low self-esteem in many children, suggesting a causal relationship. This indicates that prevention and management strategies for childhood overweight/obesity need to begin early to minimise the impact on self-esteem.

Body Mass Index↗
PubMed2003

Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke.

BACKGROUND: Exposure to other people's cigarette smoke (environmental tobacco smoke, or ETS) is an important child health issue. OBJECTIVES: To determine the effectiveness of interventions aiming to reduce exposure of children to ETS. SEARCH STRATEGY: The Tobacco Addiction Group register of studies was searched. MEDLINE, EMBASE and four other health and psychology databases were searched electronically, bibliographies of retrieved primary studies were checked and specialists in the area consulted. SELECTION CRITERIA: Controlled trials with or without random allocation were included in this review if they addressed participants (parents and other family members, child care workers and teachers) involved with the care and education of infants and young children (aged 0-12 years). All mechanisms for reduction of children's environmental tobacco smoke exposure, and smoking prevention, cessation, and control programmes targeting these participants are included. These include smoke free policies and legislation, health promotion, social-behavioural therapies, technology, education and clinical interventions. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed studies and extracted data. Due to heterogeneity of methodologies and outcomes, no summary measures were possible and results were synthesised using narrative summaries. MAIN RESULTS: Nineteen studies met the inclusion criteria, one of which was subsequently excluded. Three interventions were targeted at populations or community settings, seven studies were conducted in the well child health care setting and eight in the ill child health care setting. Twelve of these studies are from North America. In 12 of the 18 studies there was reduction of ETS exposure for children in both intervention and comparison groups. In only four of the 18 studies was there a statistically significant intervention effect. Three of these successful studies employed intensive counselling interventions targeted to smoking parents. There is little difference between the well infant, child respiratory illness and other child illness settings as contexts for parental smoking cessation interventions. The fourth successful intervention was in the school setting targeting the ETS exposure of children from smoking fathers. REVIEWER'S CONCLUSIONS: Brief counselling interventions, successful in the adult health setting when coming from physicians, cannot be extrapolated to adults in the setting of child health. There is limited support for more intensive counselling interventions. There is no clear evidence for differences between the respiratory, non-respiratory ill child, well child and peripartum settings as contexts for reduction of children's ETS exposure.

Age Factors↗
PubMed2003

Interventions for treating obesity in children.

BACKGROUND: The prevalence of overweight and obesity is increasing in child populations throughout the world. Obesity in children has significant short and long term health consequences. OBJECTIVES: To assess the effects of a range of lifestyle interventions designed to treat obesity in childhood. SEARCH STRATEGY: We searched CCTR, MEDLINE, EMBASE, CINAHL, PsychLIT, Science Citation Index, Social Science Citation Index. Each database was searched from 1985 to July 2001. We also contacted experts in child obesity treatment. SELECTION CRITERIA: We selected randomised controlled trials of lifestyle interventions for treating obesity in children with a minimum of six months duration. Examples of lifestyle interventions include dietary, physical activity and/or behavioural therapy interventions, with or without the support of associated family members. Interventions from any setting and delivered by any professional were considered. However, interventions that specifically dealt with the treatment of eating disorders were excluded. DATA COLLECTION AND ANALYSIS: Two of our research team independently assessed trial quality and extracted data. Authors of the included studies were contacted for additional information where this was appropriate. MAIN RESULTS: We included 18 randomised controlled trials with 975 participants. Many studies were run from a specialist obesity clinic within a hospital setting. Five studies (n=245 participants) investigated changes in physical activity and sedentary behaviour. Two studies (n=107 participants) compared problem-solving with usual care or behavioural therapy. Nine studies (n=399 participants) compared behavioural therapy at varying degrees of family involvement with no treatment or usual care or mastery criteria and contingent reinforcement. Two studies (n=224 participants) compared cognitive behavioural therapy with relaxation.Most of the studies included in this review were too small to have the power to detect the effects of the treatment. We did not conduct a meta-analysis since so few of the trials included the same comparisons and outcomes. Therefore, we synthesised the results in a narrative format. REVIEWER'S CONCLUSIONS: Although 18 research studies were found, most of these were very small studies drawn from homogenous, motivated groups in hospital settings and so generalisable evidence from them is limited. In conclusion, there is a limited amount of quality data on the components of programs to treat childhood obesity that favour one program over another. Further research that considers psychosocial determinants for behaviour change, strategies to improve clinician-family interaction, and cost-effective programs for primary and community care is required. We conclude that no direct conclusions can be drawn from this review with confidence.

Child↗
PubMed2003

Social, cultural and environmental influences on child activity and eating in Australian migrant communities.

AIM: This study set out to examine the socio-cultural, familial and environmental factors influencing health, eating habits and patterns of physical activity contributing to child and adolescent overweight and obesity. METHODS: Semi-structured, community-based interviews were conducted with contrasting key informant three-generation families; and generation by generation focus groups of grandparents, parents and children from four cultural communities in the state of Victoria, Australia. Purposive sampling occurred from Turkish, Greek, Indian and Chinese communities that have migrated to Australia within the last three generations (n = 160, eight families, 47 children aged 5-15 years, 29 parents, 42 grandparents). RESULTS: Evidence of two-way influences on eating and physical activity across three generations was evident, with children reporting the greatest cross-cultural diversity. A range of dietary restrictions was reported across all cultural groups. Efforts to foster healthy eating and lifestyle patterns within communities were evident. Parents, as a generation in particular, felt the need for more access to education and support regarding healthy limits for pre-puberty and puberty stages. CONCLUSION: There is a dynamic influence of culture on many aspects of family lifestyle across three generations. To achieve successful intervention design, childhood obesity researchers need to collaborate with diverse groups and communities. Considering the role and influence of extended family, a multigenerational, whole-of-community approach beyond that of parent and child populations ought to be considered.

Adolescent↗