Assessing the acceptability and feasibility of the MEND Programme in a small group of obese 7–11-year-old children

BACKGROUND AND AIMS: An uncontrolled, pilot study to evaluate feasibility and acceptability of a new community based childhood obesity treatment programme. METHODS: The mind, exercise, nutrition and diet (MEND) programme was held at a sports centre, twice-weekly, for 3 months. The programme consists of behaviour modification, physical activity and nutrition education. The primary outcome measure was waist circumference. Secondary outcomes were body mass index (BMI), cardiovascular fitness (heart rate, blood pressure and number of steps in 2 min), self-esteem and body composition. BMI of parents was also measured. See http://www.mendprogramme.org. RESULTS: Eleven obese children (7-11 years) and their families were recruited. Mean attendance was 78% (range 63-88%) with one drop out. Waist circumference, cardiovascular fitness and self-esteem were all significantly improved at 3 months and continued to improve at 6 months. BMI was significantly improved at 3 months but lost significance by 6 months. Deuterium studies showed a beneficial trend but were not significant. Of the 17 parents measured, seven were obese (BMI >/= 30) and eight overweight (BMI >/= 25). CONCLUSIONS: Although limited by the small number of participants and no control group, the MEND programme was acceptable to families and produced significant improvements in a range of risk factors associated with obesity that persisted over 3 months.     

A longitudinal study of night waking in the first year

A longitudinal study of the development of sleep patterns addressed the issue of continuity and change in night waking in the course of the first year. Mothers of 118 infants, who took part in a follow-up study of normal babies, completed a sleep questionnaire at 3, 6, 9 and 12 months. Regular night waking was a common characteristic throughout the first year (46% at 3 months, 39%, 58% and 55% respectively at 6, 9 and 12 months). The number of awakenings per night was a function of age. Following a decline in the number of interruptions from 3 to 6 months, an increase in night waking at age 9 months was recorded. Although the methodology does not lend itself to an objective validation of the changes in sleep-wake states, nor is it suitable for causal explanations, it is, nevertheless, important to note this profile. The increase in night waking towards the end of the first year coincides with significant socio-emotional advances which characterize this developmental stage.     

"Our class does not smoke"; the Czech version of the "smoke-free class competition" programme

The "Smoke-Free Class Competition" programme stems from a theory of the consequences of cultural and social miming in the onset of smoking addiction: it initiates non-smokers' active encouragement in supporting a non-smoking environment in class groups of teenagers. The first experience with the programme (Our Class Does Not Smoke) in the Czech Republic was obtained from a set of 13 classes from 6 primary schools with 261 14-year-olds who had been acquainted with the programme rules and voluntarily agreed to abide by them. METHODS: Methodological instruction for teachers, school psychologists, pupils and parents providing motivation to various activities (discussion, craft projects, group therapy with smokers, demonstrations of ascertaining exposure and health consequences of smoking) were compiled to support the programme. The one-year programme schedule had a number of control points for assessing its immediate and long-term effect on the prevalence of smoking: (1) prior to programme onset, (2) after a half-year of intensive intervention, (3) after a further 3 months, (4) in the 12th month from programme onset. RESULTS: A complete abstaining condition in the four-months of the competition period was observed by all pupils in 31% of the classes; the number of smokers dropped in other 23% classes, remained unchanged in the same number of classes and increased in the same number of classes. In the second half of the programme, 38.5% of classes dropped out of the competition; the prevalence of smoking children was identical in 15.5% and higher in 46%, in the 12th month compared to the programme onset. However, the final prevalence of regular smokers in the competition set is only at the level of one third (10.3% versus 29.7%) compared to the same age group of the Czech population. CONCLUSION: The programme successfully swayed the smoking habits of children.     

Preventing obesity at weaning: parental views about the EMPOWER programme

Background Infant growth and lifestyle are now recognized as being critical determinants of later obesity. EMPOWER (Empowering Parents to Prevent Obesity at Weaning: Exploratory Research) was developed as an intervention for parents whose babies are at high risk. Delivered by specially trained health visitors, it is underpinned by the Family Partnership Model and uses a strengths‐based, solution‐focused way of working with families. Methods Mothers of babies participating in the pilot of EMPOWER in Leeds were recruited to take part in a study to examine perceptions about the programme's acceptability and usefulness. Interviews were taped and transcribed, and thematic analysis undertaken. Results Families talked positively about the approach of the EMPOWER health visitor with her emphasis on listening, partnership working and shared problem‐solving. Parents particularly valued the use of a non‐judgemental approach, which they felt had helped them to discuss openly, sensitive issues such as weight and diet. They identified a number of important benefits ranging from increased knowledge about the most appropriate types and amount of food to feed their toddler, to more far‐reaching changes within the family as a whole, including modifications to their own diet and lifestyle. Programmes of this nature were perceived as more valuable than the standard help that is currently available. Conclusion The EMPOWER programme appears to be both acceptable and valued by targeted parents and a potentially effective means of supporting high‐risk families to prevent their children from developing obesity. An exploratory randomized controlled trial is now underway to ascertain the feasibility of conducting a definitive phase 3 trial.     

Evaluation of perinatal and intrafamilial hepatitis B prevention programmes in a well child clinic: 9-year follow-up study in Turkey

Evaluating the performance of well child clinics on adherence to recommended perinatal hepatitis B prevention programmes as well as assessing the outcome of infants living with hepatitis B surface antigen (HBsAg)-positive parents is important. A retrospective study was performed of 336 babies who had at least one HBsAg-positive parent and were followed-up in the well child clinic of Gazi University Hospital (Ankara, Turkey) between 2001 and 2009. Rates of passive immunisation in 109 babies with HBsAg-positive mothers and initiation of hepatitis B vaccination of all 336 babies with HBsAg-positive parents were 98.8% and 100% respectively. Ninety-two babies (27.4%) were lost to follow-up before completing primary immunisation. The recommended perinatal hepatitis B prevention programme was performed successfully in 194 of the 306 infants who were old enough for post-vaccination serotesting (63.4%). One baby became HBsAg-positive, and 88.1% of babies were seroprotected. Hepatitis B surface antibody (anti-HBs) levels were found to be increased if the HBsAg-positive parent was the father. There was a negative correlation between serotesting time and anti-HBs titres. The study infants had a total of 187 siblings and 123 (65.8%) were serotested after completing primary immunisation with 108 found to be seropositive. Although the vaccination rate in the perinatal hepatitis B prevention programme is satisfactory, post-vaccination serotesting and evaluation of infants and their siblings are still deficient.     

Evaluation of a sensory-motor education programme for 'parents-to-be'

Summary A controlled clinical trial was conducted to evaluate a sensory-motor education programme presented to expectant parents in prenatal classes. Short information sessions on sensory-motor development were provided to experimental parents by an occupational therapist. Statistically significant differences between experimental and control groups were noted in the home environments at 3 months of age, with the experimental families exhibiting more favourable environments. No statistically significant differences in development at 8 months of age between the two groups were observed.     

Increased Parent Limits on Teen Driving: Positive Effects from a Brief Intervention Administered at the Motor Vehicle Administration

The purpose of this study was to determine whether exposure to a brief intervention administered at the Motor Vehicle Administration (MVA) increases parental limits on teen driving. A total of 658 parents and their 16-year-old adolescents were recruited from a local MVA site as adolescents successfully tested for provisional licenses. At the MVA, participating parents completed written surveys about expected teen driving during the 1st month of provisional licensure. One month later, 579 parent-teen dyads completed follow-up telephone interviews about teen driving within the past month. On weeks assigned as intervention, parents were exposed to a video and given the video and a driving agreement to take home. In multivariate linear regression analyses, the results indicated that when controlling for selected demographic and baseline psychosocial variables, intervention parents reported more driving rules, restricted driving, limits for high-speed roads, weekend night restrictions, and overall driving limits than did parents in the control group. When compared to control teens, intervention teens reported more limits on passengers, high-speed roads, and night driving, and on overall driving limits, but there were no differences for overall driving or driving under high-risk conditions. In addition, intervention parents were about 3 times, and intervention teens were about 5 times, more likely than controls to report using a parent-teen driving agreement. These results indicate that brief exposure to intervention at an MVA office may help increase parental limits on teen driving.     

An online positive parenting skills programme for paediatric traumatic brain injury: feasibility and parental satisfaction

We examined the feasibility of and parental satisfaction with a training programme for parents with children who had suffered traumatic brain injury (TBI). Families who did not have a home computer and/or webcam were loaned the necessary equipment. Skype was used for videoconferencing. After the initial treatment session in the family's home, the remaining nine sessions were conducted online. Each session had two parts: (1) a self-guided web session with information about a particular skill; (2) a videoconference session with the therapist. Three of the 20 families (15%) dropped out prior to the final 6-month follow-up visit. Of the remaining 17 families, 13 (65% of those enrolled) completed 9-14 sessions. Almost all of the caregivers (87%) said that the Skype sessions were helpful compared to a conventional office visit. Almost all parents were satisfied with the programme and the technology that was used. Parental satisfaction with the programme was not influenced by prior computer ownership or comfort with technology. The programme appears to be feasible for a wide range of parents of children with TBI and provides an alternative to conventional office-based sessions that may not be accessible to all families.     

Acceptability of the Checkpoints Parent-Teen Driving Agreement: pilot test.

BACKGROUND: Parent-teen driving agreements are potentially important tools to facilitate parental management of teen driving and reduce adolescent driving risk. The Checkpoints Parent-Teen Driving Agreement (Checkpoints P-TDA) was designed so that parents could initially impose strict limitations on teen driving in high-risk driving conditions (e.g., at night and with teen passengers) and gradually increase driving privileges over time as teens demonstrate responsible driving behavior. METHODS: To assess the acceptability of the format and content of the Checkpoints P-TDA, it was pilot tested with a convenience sample of 47 families recruited as their teens tested for a driver's license at five private driving schools in Connecticut. Family members were interviewed at the driving schools about potential limits on teen driving, asked to use the driving agreement, and re-interviewed within 3 months about acceptability of the driving agreement and initial driving limits placed on teens. RESULTS: Most families (38 of 47) used and liked the agreement. In addition, most parents placed the recommended strict initial limits on teen driving related to driving unsupervised at night, with teen passengers, and on high-speed roads. Moreover, parents reported placing more strict limits on their teens' driving than they originally intended. CONCLUSIONS: The results showed promise for the acceptability of the Checkpoints P-TDA, which will be tested statewide.     

Follow-up examinations: are multidrug-resistant tuberculosis patients in Uttar Pradesh,India, on track?

Setting: All multidrug-resistant tuberculosis (MDR-TB) patients who had completed 6 months of treatment under the Revised National Tuberculosis Control Programme (RNTCP) in Uttar Pradesh, the largest state in northern India.Objective: To determine the proportion of MDR-TB patients with regular follow-up examinations, and underlying provider and patient perspectives of follow-up services.Methods: A retrospective cohort study was undertaken involving record reviews of 64 eligible MDR-TB patients registered during April–June 2013 in 11 districts of the state. Patients and programme personnel from the selected districts were interviewed using a semi-structured questionnaire.Results: A total of 34 (53.1%) patients underwent follow-up sputum culture at month 3, 43 (67.2%) at month 4, 36 (56.3%) at month 5 and 37 (57.8%) at month 6. Themes associated with irregular follow-up that emerged from the interviews were multiple visits, long travel distances, shortages of equipment at the facility and lack of knowledge among patients regarding the follow-up schedule.Conclusion: The majority of the MDR-TB patients had irregular follow-up visits. Provider-related factors outweigh patient-related factors on the poor follow-up examinations. The programme should focus on the decentralisation of follow-up services and ensure logistics and patient-centred counselling to improve the regularisation of follow up.     

Vertical transmission of HGV and outcome of the infected babies

To assess the risk of HGV mother-to-infant transmission and the clinical outcome of infected babies, we investigated 103 mother-infant couples and followed-up the infected children for 4-72 months. Twenty (19.4%) mothers were HGV-RNA positive and transmission occurred in ten (50%) babies; only one child acquired HGV and HCV infection. Maternal factors, such as history of intravenous drug use, HCV-RNA positivity, HIV coinfection, type of delivery and type of feeding were not related to HGV transmission. One HGV infected baby showed a mild hepatitis when he was also infected by Cytomegalovirus. Two babies cleared HGV within the first year of life. The HGV transmission rate is elevated but HGV infection seems to be benign, at least in a short-term follow-up.     

Childhood obesity treatment: targeting parents exclusively v. parents and children

There is a consensus that interventions to prevent and treat childhood obesity should involve the family; however, the extent of the child's involvement has received little attention. The goal of the present study was to evaluate the relative efficacy of treating childhood obesity via a family-based health-centred intervention, targeting parents alone v. parents and obese children together. Thirty-two families with obese children of 6-11 years of age were randomised into groups, in which participants were provided for 6 months a comprehensive educational and behavioural programme for a healthy lifestyle. These groups differed in their main agent of change: parents-only v. the parents and the obese child. In both groups, parents were encouraged to foster authoritative parenting styles (parents are both firm and supportive; assume a leadership role in the environmental change with appropriate granting of child's autonomy). Only the intervention aimed at parents-only resulted in a significant reduction in the percentage overweight at the end of the programme (P=0.02) as well as at the 1-year follow-up meeting. The differences between groups at both times were significant (P<0.05). A greater reduction in food stimuli in the home (P<0.05) was noted in the parents-only group. In both groups, the parents' weight status did not change. Regression analysis shows that the level of attendance in sessions explained 28 % of the variability in the children's weight status change, the treatment group explained another 10 %, and the improvement in the obesogenic load explained 11 % of the variability. These results suggest that omitting the obese child from active participation in the health-centred programme may be beneficial for weight loss and for the promotion of a healthy lifestyle among obese children.     

Prevalence of hepatitis B surface antigen in pregnant mothers and its perinatal transmission

1000 pairs of maternal and cord blood samples were collected simultaneously at the time of delivery. 23 (2.3%) of the maternal samples were positive for HBsAg by enzyme-linked immunosorbent assay. HBeAg was detected in 11 (47%) of the 23 HBsAg positive mothers and anti-HBeAg was detected in another 5 samples. HBsAg and HBeAg were detected in 7 (30%) of the 23 cord blood samples from HBsAg-positive mothers, and anti-HBeAg was detected in one of these samples. At follow-up (6-18 months), antigenaemia had persisted in 17 (85%) of the 20 HBsAg-positive mothers and in 9 (45%) of 20 babies born to HBsAg-positive mothers. Seven of the 10 babies (70%) born to mothers positive for both HBsAg and HBeAg had persistent HBsAg in their blood, in contrast to 2 of the 10 babies (20%) born to mothers positive for HBsAg only. However, none of these mothers or their babies were found to have anti-HBeAg at follow-up. We conclude that the presence of HBeAg in mothers' blood enhances vertical transmission of hepatitis B virus infection to their babies.     

Implementation research on kangaroo mother care,Bangladesh

ObjectiveTo describe the implementation, coverage and performance of the national kangaroo mother care programme in Bangladesh.MethodsKangaroo mother care services for clinically stable babies with birth weight under 2000 g were set up in government-run health-care facilities in rural and urban areas of Bangladesh. Each facility provided counselling on kangaroo mother care, ensured adequate nutrition, and followed up mothers and babies. We studied implementation of the programme from January 2016 to March 2020 using data from the national database. We tracked the number of eligible babies enrolled and their outcomes, mortality and post-discharge follow-up.FindingsThe numbers of kangaroo mother care facilities increased from 16 in 2016 to 108 in 2020. Over the 4-year period 64 426 babies weighing under 2000 g were born in these facilities,  6410 of whom received kangaroo mother care. The quarterly percentage of eligible babies receiving kangaroo mother care increased from 4.7% (37/792) during the first quarter to 21.7% (917/4226) during the last five quarters of the programme. Deaths of babies receiving kangaroo mother care showed a downward trend over the study period. The overall mortality was 1.2% (77/6410), with large quarterly fluctuations in mortality. Post-discharge follow-up was low and only 15–20% of babies received four follow-up visits.ConclusionImplementation of kangaroo mother care interventions is feasible in low-resource settings. Such care has the potential to reduce mortality among low-birth-weight and premature babies. Challenges include low coverage, expanding the programme to the community and strengthening the monitoring system.     

Satisfaction with telemedicine for teaching listening and spoken language to children with hearing loss

Auditory-Verbal Therapy (AVT) is an effective early intervention for children with hearing loss. The Hear and Say Centre in Brisbane offers AVT sessions to families soon after diagnosis, and about 20% of the families in Queensland participate via PC-based videoconferencing (Skype). Parent and therapist satisfaction with the telemedicine sessions was examined by questionnaire. All families had been enrolled in the telemedicine AVT programme for at least six months. Their average distance from the Hear and Say Centre was 600 km. Questionnaires were completed by 13 of the 17 parents and all five therapists. Parents and therapists generally expressed high satisfaction in the majority of the sections of the questionnaire, e.g. most rated the audio and video quality as good or excellent. All parents felt comfortable or as comfortable as face-to-face when discussing matters with the therapist online, and were satisfied or as satisfied as face-to-face with their level and their child's level of interaction/rapport with the therapist. All therapists were satisfied or very satisfied with the telemedicine AVT programme. The results demonstrate the potential of telemedicine service delivery for teaching listening and spoken language to children with hearing loss in rural and remote areas of Australia.     

The prevalence of HCV infection in a cohort of pregnant women, the related risk factors and the possibility of vertical transmission

The prevalence of antibodies for one or more HCV antigens was 2.3% of 1,347 mothers at childbirth. Compared with the principal factors studied, the presence of antibodies was more frequent in women who were carriers of HIV infection (3/3), in those who had suffered liver diseases (5/37) or who had had transfusion (3/25). This was as opposed to women who did not have any risk factor (p < 0.001). The prevalence of HCV-RNA was 1.3%; in relation to the antibody state, such a condition was more frequent in subjects with antibodies for 3 or 4 antigens (about 80%) compared with those who were positive for 1 or 2 antigens. HCV-RNA of the same genotype as the mother (type 1; 1a) was also found in the funicular blood of 2 of the 18 babies born to mothers who were positive for HCV-RNA. In the course of the follow-up (from the 3rd to the 18th month) the viral RNA was not found in any of the babies, nor was it found in the 2 who were positive at birth. Even the antibodies gradually disappeared, although slowly. At the 10th month, 91% of the babies resulted as having no antibodies and at the 18th month none of the babies resulted as having antibodies. Breast-feeding also appeared to have no influence on the transmission of the infection; out of 18 viremic mothers indeed 12 (67%) breast-fed their babies.     

Empowering low-income parents with skills to reduce excess pediatric emergency room and clinic visits through a tailored low literacy training intervention

In this article, we evaluate the impact of a health literacy intervention to decrease emergency room and doctor's office visits for common childhood illness symptoms. Our education model trained low-income parents of young children (9,240 families) at 55 Head Start sites on the use of a low-literacy health book to respond to common childhood illnesses. The overall strategic framework required each Head Start site to create a Health Improvement Project to plan, successfully train, monitor, and keep the momentum through a strong follow-up with families regarding their health care decisions. The study was conducted from 2003 to 2006. Each family was tracked for 3 months prior to the training using self-report, and for 6 months afterward. The average number of emergency room and doctor visits among parents decreased 58% and 41% respectively (p < .001). Further, work days missed by the primary caretaker per year decreased 42%, and school days missed per year decreased 29% (p < .001). During the health literacy intervention, emergency room and doctor visits reported among parents decreased, as well as the number of work days and school days missed per year. Significant cost savings for the health care system can be anticipated through thoughtful broad dissemination of this training model.     

Testing an empowerment intervention to help parents make homes smoke-free: a randomized controlled trial

The objective of this randomized controlled trial was to test if parents’ participation in an intervention based on an empowerment ideology and participatory experiences decreased the number of cigarettes smoked in homes. Sixty families were randomized to the intervention (n = 30) or control (n = 30) group. The intervention included three weekly group sessions followed by three weekly follow-up telephone calls over six consecutive weeks. During group sessions, parents shared experiences about environmental tobacco smoke, identified personal strengths and resources, and developed action plans. Data were collected in interviewer-administered questionnaires at baseline and 6 months follow-up. Ninety-three percent of the sample consisted of mothers, 77% of whom smoked during pregnancy. Forty-two percent of the total sample reported a household income of <$15,000. The median number of cigarettes smoked in the home daily decreased from 18 to 4 in the total sample however no statistically significant difference was detected between groups at 6 months follow-up. Participation in the study, independent of group, may have resulted in parents decreasing the number of cigarettes smoked in the home. Valuable lessons were learned about recruiting and working with this group of parents, all of whom faced the challenges of tobacco and almost half of whom lived in poverty.     

Influence of parental mental health on early termination of breast-feeding: a case-control study

BACKGROUND: The WHO recommends exclusive breast-feeding for babies up to 6 months of age. The association between maternal mental health and breast-feeding duration is contradictory. This is a case-control study to investigate this association. METHODS: 153 families with 4-month-old babies from an urban area in southern Brazil were investigated: in 51 families, breast-feeding had being discontinued (cases); in 102, babies were being breast-fed (controls). Two researchers evaluated maternal and paternal mental health during home visits using semistructured interviews and scales. RESULTS: Disorders were found in 59% of case mothers versus 48% of control mothers. Depression was the most prevalent disorder affecting both mothers and fathers. We did not identify a statistically significant association between maternal mental disorder at 4 months after delivery and early termination of breast-feeding. When the mother had mental problems during the first month after delivery, however, she was twice as likely to interrupt breast-feeding. Among the mothers with mental disorders during puerperium, 76% still had the problem 4 months postpartum. An association was observed between maternal and paternal mental health. CONCLUSIONS: Parental mental health does not seem to be associated with breast-feeding at 4 months in this culture setting where most mothers have good family and social support for breast-feeding. Maternal mental disorders during puerperium, however, may negatively affect the duration of breast-feeding.     

发育迟缓儿童早期综合干预的重要性

目的 探讨发育迟缓儿童早期综合干预的重要性。 方法 到本中心体检发育迟缓的3月龄婴儿,根据家长自愿原则分为两组,干预组:共71例,其中早产婴儿36例为干预Ⅰ组,足月产35例为干预Ⅱ组,早期综合应用视、听刺激,婴儿操、抚触、游泳、运动干预训练、喂养指导,分别在干预前、干预后1个月、3个月、5个月运用Gesell量表进行评估。未接受干预训练仅常规保健的作为对照组:共62例,其中早产婴儿30例为对照Ⅰ组,足月产32例为对照Ⅱ组。结果 在干预后1、3、5个月评估时,干预Ⅰ组与对照Ⅰ组相比,身高分别增长0.6、0.9和1.3 cm(P<0.05);体重分别增长0.62、0.70、0.76 kg(P<0.05),DQ平均增长5、9和12(P<0.05)。干预Ⅱ组与对照Ⅱ组相比,身高分别增长0.5、0.9、1.5 cm(P<0.05),体重分别增长0.59、0.74、0.80 kg(P<0.05);DQ平均增长4、7、10(P<0.05)。 结论早期综合干预可促进发育迟缓儿童体格、运动、行为心理发展。