Search

Background: Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear., Objectives: This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?", Search Methods: The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant websites. Non-English language papers were included and experts were contacted., Selection Criteria: The review includes data from childhood obesity prevention studies that used a controlled study design (with or without randomisation). Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomised at a cluster level, 6 clusters were required., Data Collection and Analysis: Two review authors independently extracted data and assessed the risk of bias of included studies.  Data was extracted on intervention implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical activity (PA)-related behaviours or diet-related behaviours.  Adverse outcomes were recorded. A meta-analysis was conducted using available BMI or standardised BMI (zBMI) score data with subgroup analysis by age group (0-5, 6-12, 13-18 years, corresponding to stages of developmental and childhood settings)., Main Results: This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged 6-12 years.  The meta-analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I(2)=82%).  Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of -0.15kg/m(2) (95% confidence interval (CI): -0.21 to -0.09).  Intervention effects by age subgroups were -0.26kg/m(2) (95% CI:-0.53 to 0.00) (0-5 years), -0.15kg/m(2) (95% CI -0.23 to -0.08) (6-12 years), and -0.09kg/m(2) (95% CI -0.20 to 0.03) (13-18 years). Heterogeneity was apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention.  Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased prevalence of underweight or body image sensitivities was found.  Interventions did not appear to increase health inequalities although this was examined in fewer studies., Authors' Conclusions: We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, our synthesis indicates the following to be promising policies and strategies:·         school curriculum that includes healthy eating, physical activity and body image·         increased sessions for physical activity and the development of fundamental movement skills throughout the school week·         improvements in nutritional quality of the food supply in schools·         environments and cultural practices that support children eating healthier foods and being active throughout each day·         support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities)·         parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activitiesHowever, study and evaluation designs need to be strengthened, and reporting extended to capture process and implementation factors, outcomes in relation to measures of equity, longer term outcomes, potential harms and costs.Childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded within health, education and care systems and achieve long term sustainable impacts.

Objective: In 2006, the Victorian Government adopted the School Canteens and other school Food Services (SCFS) Policy that bans the sale of sweet drinks and confectionary and recommends the proportions of menu items based on a traffic light system of food classification. This study aims to determine whether compliance with the policy improves the nutritional profile of the menus., Methods: Items from food service menus were assessed for compliance with the SCFS policy and categorised as 'everyday' ('green'), 'select carefully' ('amber') or 'occasionally' ('red') (n=106). Profile analysis assessed differences in the nutritional profile of the menus between sub-groups., Results: Overall, 37% of menus contained items banned under the policy. The largest proportion of items on the assessed menus were from the 'amber' category (mean: 51.0%), followed by 'red' (29.3%) and 'green' (20.3%). No menus met the traffic light-based recommendations and there was no relationship between policy compliance and the proportion of items in each of the three categories., Conclusions and Implications: To increase the healthiness of the school food service we recommend a greater investment in resources and infrastructure to implement existing policies, and establishing stronger monitoring and support systems., (© 2011 The Authors. ANZJPH © 2011 Public Health Association of Australia.)

We have developed a vector Doppler ultrasound imaging method to directly quantify the magnitude and direction of muscle and tendon velocities during movement. The goal of this study was to evaluate the feasibility of using vector Tissue Doppler Imaging (vTDI) for estimating the tibialis anterior tendon velocities during dorsiflexion in children with cerebral palsy who have foot drop. Our preliminary results from this study show that tendon velocities estimated using vTDI have a strong linear correlation with the joint angular velocity estimated using a conventional 3D motion capture system. We observed a peak tendon velocity of 5.66±1.45 cm/s during dorsiflexion and a peak velocity of 8.83±2.13 cm/s during the passive relaxation phase of movement. We also obtained repeatable results from the same subject 3 weeks apart. Direct measurements of muscle and tendon velocities may be used as clinical outcome measures and for studying efficiency of movement control.

This methods paper outlines the overall design of a community-based multidisciplinary longitudinal study with the intent to stimulate interest and communication from scientists and practitioners studying the role of physical activity in preventive medicine. In adults, lack of regular exercise is a major risk factor in the development of chronic degenerative diseases and is a major contributor to obesity, and now we have evidence that many of our children are not sufficiently active to prevent early symptoms of chronic disease. The lifestyle of our kids (LOOK) study investigates how early physical activity contributes to health and development, utilizing a longitudinal design and a cohort of eight hundred and thirty 7-8-year-old (grade 2) school children followed to age 11-12 years (grade 6), their average family income being very close to that of Australia. We will test two hypotheses, that (a) the quantity and quality of physical activity undertaken by primary school children will influence their psychological and physical health and development; (b) compared with existing practices in primary schools, a physical education program administered by visiting specialists will enhance health and development, and lead to a more positive perception of physical activity. To test the first hypothesis we will monitor all children longitudinally over the 4 years. To test the second we will involve an intervention group of 430 children who receive two 50min physical education classes every week from visiting specialists and a control group of 400 who continue with their usual primary school physical education with their class-room teachers. At the end of grades 2, 4, and 6 we will measure several areas of health and development including blood risk factors for chronic disease, cardiovascular structure and function, physical fitness, psychological characteristics and perceptions of physical activity, bone structure and strength, motor control, body composition, nutritional intake, influence of teachers and family, and academic performance.

This article discusses how legal rights-based discourse could inform the response of Australian State and federal governments to the increasing prevalence of childhood obesity. The authors contend that the principles in the United Nations Convention on the Rights of the Child (a treaty which has been ratified but not implemented) are capable of providing a basis for a legislative program to prevent childhood obesity. It is argued that an approach to legislation which is grounded on the basis of children's rights would require that there be restrictions on advertising food to children. The authors set out specific proposals for legislative reforms which the federal Parliament could enact to implement the Convention so as to restrict advertising to children. The scope of the discussion is then expanded to consider the implications of rights-based discourse in broader public health contexts.

Objective: To review innovative models of primary care in different countries in order to identify potential mechanisms for reforming primary care policy in Australia., Methods: We conducted a narrative review and synthesis of evidence about models of primary care from four English-speaking comparator countries (New Zealand, Canada, the United Kingdom and the United States) and one European country (The Netherlands), with a particular focus on the relevance and applicability of these models to Australia., Results: We identified four key mechanisms for bringing about reform in primary care: flexible funding, quality frameworks, regional-level primary care organisations, and primary care infrastructure. These mechanisms are interdependent., Conclusion: There are tensions and tradeoffs involved in balancing professional and bureaucratic control and in linking quality and accountability mechanisms. Enhanced linkage between researchers, policymakers and professional groups could assist in exploring options for effective primary care reform.

To examine correlates of guideline adherence in a population with access to health care and prescription drug benefits, the authors conducted a cross-sectional analysis among 5789 patients undergoing hypertension treatment with a single medication in a large New England managed care organization. Logistic regression was used to determine correlates of adherence, defined as use of diuretics or beta blocker as antihypertensive monotherapy during the 1-year study period. Women were more likely than men to receive guideline-adherent therapy (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.45-1.85). Compared with patients covered by health maintenance organization plans, Medicare coverage was positively associated with guideline adherence (OR, 1.38; 95% CI, 1.13-1.69), but fee-for-service coverage was negatively associated (OR, 0.66; 95% CI, 0.48-0.91). Patient age was not a significant correlate of adherence to guidelines (OR, 1.01; 95% CI, 0.94-1.09). Understanding these observations may lead to strategies to improve guideline adherence and reduce health care disparities.

We have hypothesized that oxygen enhanced three-dimensional microporous poly-L-lactic acid (L-PLA) bioabsorbable polymer constructs could be implanted to produce a subacute occlusion in a porcine coronary artery, forming a thrombofibrotic occlusion containing microvascular channels. Chronic total occlusion (CTO) is increasingly prevalent in patients who present for percutaneous interventions. No reproducible animal coronary model simulating human CTOs has previously been developed. Swine coronary arteries were cannulated and a microporous L-PLA polymer pledget was advanced into a preselected segment of coronary. The coronary arteries were angiographically re-imaged at day 3, day 10, and day 28, to document the presence or absence of an occlusion. Histopathology was also performed at each time point to evaluate the lesion characteristics. A novel three-dimensional L-PLA microporous polymer construct, when implanted into porcine coronary arteries, reproducibly results in the development of a CTO at day 3. The histopathology in this porcine coronary model of CTO at day 28 closely mimics human coronary CTO, including the presence of microvascular channels and dense collagen and elastic tissue in the occlusion., (Copyright (c) 2006 Wiley-Liss, Inc.)

Background: The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) recommends treatment guidelines based on cholesterol level and number of risk factors., Objective: To evaluate how the cost-effectiveness ratios of cholesterol-lowering therapies vary according to different risk factors., Design: Cost-effectiveness analysis., Data Sources: Published data., Target Population: Women and men 35 to 84 years of age with low-density lipoprotein cholesterol levels of 4.1 mmol/L or greater (> or =160 mg/dL), divided into 240 risk subgroups according to age, sex, and the presence or absence of four coronary heart disease risk factors (smoking status, blood pressure, low-density lipoprotein cholesterol level, and high-density lipoprotein cholesterol level)., Time Horizon: 30 years., Perspective: Societal., Interventions: Step I diet, statin therapy, and no preventive treatment for primary and secondary prevention., Outcome Measures: Incremental cost-effectiveness ratios., Results of Base-Case Analysis: Incremental cost-effectiveness ratios for primary prevention with step I diet ranged from $1900 per quality-adjusted life-year (QALY) gained to $500000 per QALY depending on risk subgroup characteristics. Primary prevention with a statin compared with diet therapy was $54000 per QALY to $1400000 per QALY. Secondary prevention with a statin cost less than $50000 per QALY for all risk subgroups., Results of Sensitivity Analysis: The inclusion of niacin as a primary prevention option resulted in much less favorable incremental cost-effectiveness ratios for primary prevention with a statin (>$500000 per QALY)., Conclusions: Cost-effectiveness of treatment strategies varies significantly when adjusted for age, sex, and the presence or absence of additional risk factors. Primary prevention with a step I diet seems to be cost-effective for most risk subgroups but may not be cost-effective for otherwise healthy young women. Primary prevention with a statin may not be cost-effective for younger men and women with few risk factors, given the option of secondary prevention and of primary prevention in older age ranges. Secondary prevention with a statin seems to be cost-effective for all risk subgroups and is cost-saving in some high-risk subgroups.

Managed care organizations would appear to be natural advocates for, and users of, cost-effectiveness analysis (CEA) as a tool for maximizing health outcomes for their covered populations within fixed budgets. There is, however, little evidence that CEA plays a major role in managed care decision making. The purpose of this paper is to identify barriers to both conducting and using CEA in managed care decision making. Lack of understanding about the value and applicability of CEA, and incentives that do not align with a lifetime perspective on either health outcomes or costs may be at least as important as perceived or real methodological limitations of the methodology. Research focused on ways to overcome these barriers, and thereby improve resource allocations, is recommended.

Objective: To further assess the validity and inter-rater reliability of the Elderly Mobility Scale (EMS). Also whether the scale reflects elderly people's perceptions regarding their mobility, and whether it can predict discharge destination, or likelihood of falling., Design: Questionnaire-based study completed on admission and weekly after this on all patients referred to physiotherapy for mobility problems over the course of one month., Setting: Care of the elderly wards in the Bristol General Hospital., Subjects: Sixty-six patients (ages 66-69 years, 66% female) were included in the validity study. Nineteen patients (ages 71-95 years, 47% female) were included in the inter-rater reliability study., Interventions: EMS, Barthel and patients' perceptions of mobility were tested with routine physiotherapy treatment carried out as necessary., Main Outcome Measures: Concurrent validity was assessed by correlating EMS scores with Barthel scores using Spearman's test. Inter-rater reliability was also tested using a Spearman's correlation. EMS scores of patients were also evaluated in conjunction with whether or not they fell and their destination on discharge., Results: A significant correlation between EMS and Barthel scores indicated concurrent validity. Inter-rater reliability was demonstrated on 19 patients with a significant correlation between scores. No predictive validity could be ascribed to EMS in terms of discharge destination or likelihood of falling. Results do indicate a possible predictive validity of the functional reach component of the EMS regarding the risk of future falls., Conclusions: The EMS was found to be a valid scale with good inter-rater reliability that could be readily applied during daily clinical work. However, it was found to have no predictive validity in terms of falling or discharge destination.