Parents' and caregivers' concerns about obesity in young children: a qualitative study

To address the childhood obesity epidemic, it is necessary to understand parents' and caregivers' concerns and beliefs regarding their children's weight problems and best practices for addressing those concerns. Formative research methods were used to identify obesity-related concerns of Hispanic, Black, and White parents of young children (5-8 years old) in North Carolina. Participants identified challenges at multiple levels of influence. In all groups, participants reported that they had trouble finding enough time to help their children develop healthy lifestyles. Conflicting family priorities and needs often made it difficult to ensure that their children had healthy diets. Children's own diet and activity preferences and their parent or caregiver's inability to adequately guide their choices also contributed to obesigenic behaviors. In addition, many thought that physician and community support for their efforts to manage their children's eating habits was inadequate. Findings from these focus groups suggest that participants would be receptive to positive, multilevel prevention approaches to help their children attain and maintain healthy weights.     

'Drops for allergy' in children: often applied, but not effective

The practice of using an 'allergy service', supported by manufacturers of sublingual immunotherapy, should be discouraged for a number of reasons. There is an obvious conflict of interest when an employee from a commercial firm with an interest in allergy treatment is involved in interpreting allergy tests and discussing treatment. Most allergic diseases can be well controlled with drug therapy, without having to resort to immunotherapy. Finally, no good evidence exists to prove clinically relevant effects of sublingual immunotherapy in children with atopic disease. Until results of well-designed studies become available, sublingual immunotherapy in children should not be used.     

Child-feeding strategies are associated with maternal concern about children becoming overweight, but not children's weight status

BACKGROUND: Research suggests that parents use specific child-feeding strategies to influence their child's weight based on perceptions and concerns about their child's overweight risk, but limited data are available on ethnically diverse low-income populations. OBJECTIVE: This cross-sectional study examined associations between mothers' perception and concern about children's weight, child-feeding strategies, and child overweight in an ethnically diverse population. SUBJECTS: Mothers of preschool children (n=967) who participated in a federally funded nutrition program were asked how they fed their child, how they perceived child's weight, and whether or not they were concerned about their child becoming overweight. STATISTICAL ANALYSES PERFORMED: Logistic regression to calculate odds of maternal perception/concern given child weight, feeding strategy given maternal perception/concern, and child overweight given feeding strategy. RESULTS: Only 21% (n=23/108) of overweight preschoolers were perceived as overweight. Maternal perception of overweight was not associated with feeding strategies. About 53% (n=76/144) of Hispanic, 42% (n=23/55) of African-American, and 29% (n=223/768) of white mothers reported concern about their child becoming overweight. Mothers reporting concern were more likely to restrict child's intake of select foods (odds ratio 5.94; 95% confidence interval 1.74 to 20.28) and less likely to pressure child to eat (odds ratio 0.39; 95% confidence interval 0.15 to 0.99); however, these strategies did not predict child overweight. CONCLUSIONS: Mothers concerned about their child becoming overweight were more likely to restrict children's intake of specific foods and less likely to pressure their child to eat; however, this study did not detect an association between feeding strategies and child overweight.     

黔南地区执业医生、护士清洁洗手状况问卷调查

以不记名问卷调查方式对某地区76所医院、其他医疗机构、非医疗机构的执业医生、护士清洁洗手情况进行调查。共发放问卷2948份，回收问卷2479份（84．09％），有效问卷2150份（72．93％）。2150名被调查者中，医生占50．84％，护士占49．16％。调查结果显示，接触患者前和无菌操作前洗手率分别为40．37％与69．36％，接触患者和污染物后洗手率分别为87．49％与85．81％，进食前和工作结束后洗手率分别为85．77％和84．70％；56．28％的人洗手时间〉10s，43．72％的人洗手时间〈10s，14．28％的人洗手时间〈5s；洗手后擦手，使用专用毛巾者占60．42％，使用纸巾或自然晾干者占23．72％，使用公用毛巾者占11．40％，在工作服上擦手者占7．35％。提示应加强医护人员对手卫生的重视，加强洗手指征、洗手技术等专业知识的指导和培训，做好手卫生的监督、监测、反馈工作。     

More education in paediatric audiology needed for child welfare clinic nurses and doctors

Opinions on formal and further education in paediatric audiology were surveyed by interviewing nurses and doctors in 28 Finnish child welfare clinics. Over half of the nurses recalled that they had been taught hearing screening during their period of practical training. Regarding formal teaching in paediatric audiology, the majority of doctors referred to courses in either otolaryngology, paediatrics or both. None of the doctors and only three of the nurses had taken part in any updating courses dealing with paediatric audiology during the last three years, and it turned out that no such courses had been arranged in three of the five hospital districts. However, 17 out of the 27 doctors and 23 out of the 28 nurses expressed their interest in further education. The present amount of formal education in paediatric audiology was ascertained from all five Finnish medical faculties and the five nursing schools in the provinces of Oulu and Lapland. The university departments of otolaryngology carry the major responsibility for teaching in paediatric audiology, which includes one to two hours of lectures and none to four hours of tutorials, depending on the faculty concerned. The amount of audiometric training at nursing schools varies from none to five hours and that of lectures in otolaryngology from three to twenty hours. Better co-ordination between departments of otolaryngology, general practice and paediatrics is needed when arranging teaching in paediatric audiology for medical students. Trainee child welfare nurses seem to need more guided practice in audiometry, and there is an obvious need for increasing the amount of practice in audiological departments. Specialist clinics should plan and implement a programme for updating training in paediatric audiology, including evaluation of the programme.     

Screening by nurses and junior doctors to detect malnutrition when patients are first assessed in hospital

Four hundred and fifty four ward nurses and 319 junior doctors in 70 hospitals were interviewed about the last patient they had admitted, using a brief questionnaire. The availability of weighing scales and height measuring equipment was assessed by observers who visited the wards of 107 hospitals. Two thirds of nurses and doctors asked patients about recent food intake; half of the nurses and three quarters of the doctors asked about unintentional weight loss. Answers to the questions were recorded in the notes on 52-80 per cent of occasions. Two thirds of nurses weighed the patient, but only 11 per cent (%) measured height; approximately 80% of results were recorded. Most nurses and doctors who asked no questions about nutrition and made no measurements failed to do so because they regarded them as unimportant. Weighing scales were adequately provided, but height measuring equipment was available in only 17% of wards.     

Adverse childhood experiences and complex health concerns among child welfare-involved children

Adverse childhood experiences (ACEs) contribute to public health concerns, as they have been linked to chronic diseases in adulthood. From the seminal ACEs study in the mid-1990s (Felitti et al., 1998) to today, the Centers for Disease Control (2016) reports well over 50 studies that link ACEs to adult health conditions such as cancer, heart disease, lung disease, and mental illness. This preponderance of evidence has prompted widespread attention to the possibility that preventing and successfully treating ACE-associated traumatic stress would greatly reduce our country’s incidence of chronic disease and the associated public health burden and cost (Danese et al., 2009). To illustrate, one study suggests that child abuse and neglect alone costs the United States $124 billion annually, with individual lifetime costs that are higher than or equal to the economic burden of diabetes and stroke (Fang, Brown, Florence, & Mercy, 2012). That child maltreatment is just one category of 10 total ACEs suggests that the total financial impact of ACEs in the United States is likely much greater and that some populations, such as children involved in child welfare, may be disproportionately affected by the negative effects of adverse childhood experiences.     

Parents' reports of home and out-of-home injuries among children attending child care centers

Parents of 371 children up to 30 months of age in full time care in 24 child care centers were telephoned to ascertain the number and severity of child injuries occurring both at home and in child care. In addition injury incident reports were collected from six centers. Almost equal numbers of injuries were reported to have occurred at home and in child care. The rate of parent-reported child care injuries was 52 per 100,000 child hours. Only 25 of the 149 separate child care injury events resulted in a medical visit, a rate of 8.8 per 100,000 child hours. Careful matching of center-reported events with those reported by parents revealed very little overlap. The discrepancy was only partly explained by parental notification of child care injuries by centers. More deliberate attention to the communication of information about injury events occurring in child care is indicated if child care injuries are to be prevented.     

Longitudinal measures of circulating leptin and ghrelin concentrations are associated with the growth of young Peruvian children but are not affected by zinc supplementation

BACKGROUND: Leptin, ghrelin, and insulin are hormonal regulators of energy balance and, therefore, may be related to growth during infancy. Zinc is essential for growth, and its growth effects may be mediated through these hormones. OBJECTIVE: We examined the effects of supplemental zinc on plasma leptin, ghrelin, and insulin concentrations among young children at risk of zinc deficiency and examined the relations between these hormones and physical growth. DESIGN: Children (n = 142) aged 6-8 mo were randomly assigned to receive 3 mg Zn/d as a supplement, in a fortified food, or as a placebo for 6 mo. Relations between hormones and anthropometric z scores, body composition, and growth rates were examined at baseline and 3 and 6 mo after the start of the intervention. RESULTS: No treatment group-related differences were found in plasma leptin, ghrelin, or glucose concentrations or in anthropometric z scores at 3 or 6 mo after the start of the zinc intervention. Neither plasma leptin nor ghrelin concentrations at baseline or 3 mo were predictive of subsequent changes in growth. However, changes in weight-for-age z scores over the two 3-mo time intervals were positively associated with subsequent leptin concentrations and inversely associated with subsequent plasma ghrelin concentrations. CONCLUSIONS: Supplemental zinc did not affect the children's growth, anthropometric indexes, or plasma hormone concentrations in this study population. Our results suggest that plasma leptin and ghrelin concentrations in later infancy are a consequence of previous weight changes rather than predictors of short-term growth.     

Low plasma vitamin B-12 in Kenyan school children is highly prevalent and improved by supplemental animal source foods

The high prevalence of vitamin B-12 deficiency in many regions of the world is becoming recognized as a widespread public health problem, but it is not known to what extent this deficiency results from a low intake of the vitamin or from its malabsorption from food. In rural Kenya, where a previous study identified a high prevalence of inadequate vitamin B-12 intakes, this study examined whether plasma vitamin B-12 concentrations were associated with dietary sources of the vitamin at baseline and could be increased by supplementation with animal source foods (ASF). The 4 experimental groups in 503 school children were: 1) control (no food provided); 2) githeri (a maize and bean staple with added oil); 3) githeri + meat (githeri + minced beef); or 4) githeri + milk (githeri + milk). Feedings were isocaloric. Dietary data were collected at baseline, and biochemical data at baseline and after 1 and 2 y of feeding. Baseline plasma vitamin B-12 concentration was 193.6 +/- 105.3 pmol/L and correlated with % energy from ASF (r = 0.308, P < 0.001). The odds ratio for low plasma vitamin B-12 (<148 pmol/L), which occurred in 40% of children, was 6.28 [95% CI: 3.07-12.82] for the lowest vs. highest ASF intake tertile (P < 0.001). Feeding ASF (meat or milk) greatly reduced the prevalence of low plasma vitamin B-12 (P < 0.001). The high prevalence of low plasma vitamin B-12 concentrations in these children is predicted by a low intake of ASF, and supplemental ASF improves vitamin B-12 status.     

Prioritization attitudes among doctors and nurses examined by a scenario method

OBJECTIVES: To investigate doctors' and nurses' attitudes toward 14 potential prioritization criteria. METHODS: This study was performed by using the random paired scenario method. The respondents received a questionnaire with 12 pairs of scenarios, imaginary patient cases, each of which contained two to three different prioritization criteria (e.g., child, old patient, poor patient). Respondents were asked which one of each scenario pair they would choose if only one patient could be treated. The scenarios were randomly put into 30 different questionnaire sets. There was a random selection of 241 doctors and 151 nurses in Finland, with response rates of 60.3% and 50.3%, respectively. RESULTS: Doctors prioritized young patients, severe disease, expensive treatments and posteriorized (negatively prioritized) demented or institutionalized patients, and patients having a self-caused disease. Children were strongly prioritized, even over serious diseases. Expensive treatments appeared to be favored by doctors, and this result cannot be explained by severity of disease. Nurses' attitudes were similar to those of doctors. CONCLUSIONS: Children were strongly prioritized. Elderly persons were posteriorized if they had dementia or were living in institutions. Patients having a self-caused disease are posteriorized, more often by nurses than by doctors.     

Parents' causal attributions about attention deficit/hyperactivity disorder: the effect of child and parent sex

BACKGROUND: Boys with attention deficit/hyperactivity disorder (AD/HD) demonstrate disruptive behaviour at significantly higher rates compared to girls. Disruptive behaviour often develops as a result of negative interaction patterns within the caregiving relationship. Given the importance of parental cognitions as mediators of parental behaviour, the consideration of parent and child sex in the investigation of causal attributions regarding AD/HD may, at least partially, explain sex differences in the prevalence of disruptive behaviour among children with AD/HD. AIM: To examine the effect of parent and child sex on parental causal attributions and reactions about AD/HD and to investigate the interrelationships between these variables. SAMPLE: Three hundred and seventeen mothers and 317 fathers of boys and girls aged 4-6 years and enrolled in kindergartens in Athens. METHOD: A Greek version of the Parental Account of the Causes of Childhood Problems Questionnaire was used, which followed a vignette about a hypothetical child displaying symptoms of AD/HD. Half of the participants received a male and another half received a female version of the vignette. RESULTS: The child's sex greatly influenced parents' causal attributions about AD/HD. Higher ratings of intentionality were conferred to boys with AD/HD than girls and these attributions were related to stricter responses towards boys. In contrast, parents who considered biological dysfunction as underlying AD/HD, they mostly did so in the case of girls. Minimal effect of parent sex on causal attributions was found. CONCLUSIONS: Because causal attributions of intentionality relate to the response of more strictness and such attributions are more prevalent for boys than girls, then these perceptions about the aetiology of AD/HD in boys may be at the basis of negative interaction patterns. The increase of such interaction patterns may place boys at a more vulnerable position towards the development of secondary behaviour problems.     

The understanding of common health terms by doctors, nurses and patients

A survey by multiple choice questionnaire of 40 doctors, 60 health support staff and 120 patients investigated the understanding of common medical and psychological terms. Significant differences in levels of understanding were found between these groups, and level of medical education predicted the level of correct understanding. The widest gap in doctor-patient understanding was shown for common psychological terms. These terms constitute a major part of doctor-patient interactions and such differences could cause difficulty in effective doctor-patient communication.     

医护人员引导式教育联合融合教育在孤独症谱系障碍儿童视频脑电图监测前的应用

目的探讨医护人员进行的引导式教育联合融合教育,对孤独症谱系障碍(ASD)儿童视频脑电图(v-EEG)监测完成效果的影响。 方法选择2018年2至5月,于成都市第三人民医院接受v-EEG监测的61例ASD患儿为研究对象。按照接受v-EEG监测的时间,将其分为观察组(n＝31,2018年4至5月接受v-EEG监测)与对照组(n＝30,2018年2至3月接受v-EEG监测)。对观察组受试儿,在接受v-EEG监测前30～40 min,采用医护人员进行的引导式教育联合融合教育进行干预;对对照组受试儿,在接受v-EEG监测前7 d,采用社会培训中心进行的引导式教育联合融合教育进行干预。采用χ²检验,对2组患儿头皮损伤率及v-EEG完成率进行统计学比较。本研究经成都市第三人民医院伦理委员会批准(审批文号：[2018]S-28),与所有患儿监护人签署知情同意书。 结果观察组ASD患儿头皮损伤率为22.6%,显著低于对照组ASD患儿的53.3%;观察组ASD患儿v-EEG完成率为80.6%,显著高于对照组ASD患儿的56.7%,并且差异均有统计学意义(χ²＝4.011、P＝0.013,χ²＝1.893、P＝0.043)。 结论ASD患儿在接受v-EEG监测前,采用医护人员进行的引导式教育联合融合教育,有助于患儿配合完成v-EEG监测。     

Methodologic discussions for using and interpreting composite endpoints are limited, but still identify major concerns

OBJECTIVE: To investigate the rationale, potential problems and solutions of using composite endpoints (CEPs) for the assessment of intervention effects. STUDY DESIGN AND SETTING: This study is a systematic review. We searched MEDLINE, EMBASE, and the Science Citation Index, for publications appearing between 1980 and September 2005, and reviewed potentially informative textbooks. Eligible articles provided a commentary, analysis, or discussion of CEPs for any of the following areas: (1) rationale, (2) interpretation or meaning, (3) advantages, (4) limitations or conceptual problems, and (5) recommendations for use. RESULTS: Seventeen articles and one textbook proved eligible. Decreases in sample size requirements and ability to assess the net effect of an intervention were the most commonly cited advantages. Authors noted the risk of misinterpretation when heterogeneity among components with respect to either patient importance or magnitude of treatment effects as the most salient disadvantage. There were discrepancies between authors concerning the usefulness of CEPs to avoid bias from competing risks and when the direction of the effect of therapy differs across components. CONCLUSION: Methodologists have given limited attention to CEPs and their views are sometimes contradictory. Further work is needed to establish the role of CEPs in research and in guiding clinical practice.     

Attitudes, practices, and concerns about child feeding and child weight status among socioeconomically diverse white, Hispanic, and African-American mothers

Parents play an important role in the development of their children's eating behaviors. We conducted 12 focus groups (three white, three African-American, and three Hispanic-American low-income groups; three white middle-income groups) of mothers (N=101) of 2- to less than 5-year-old children to explore maternal attitudes, concerns, and practices related to child feeding and perceptions about child weight. We identified the following major themes from responses to our standardized focus group guide: 12 groups wanted to provide good nutrition, and most wanted children to avoid eating too many sweets and processed foods; 12 groups prepared foods their children liked, accommodated specific requests, and used bribes and rewards to accomplish their feeding goals (sweets were commonly used as bribes, rewards, or pacifiers); and 11 of 12 groups believed their children were prevaricating when they said they were full and mothers encouraged them to eat more. The common use of strategies that may not promote healthful weight suggests work is needed to develop culturally and socioeconomically effective overweight prevention programs. Further study is needed to verify racial/ethnic or income differences in attitudes, practices, and concerns about child feeding and perceptions of child weight.     

Plasma nitrate and nitrite are increased by a high-nitrate supplement but not by high-nitrate foods in older adults

Little is known about the effect of dietary nitrate on the nitrate/nitrite/nitric oxide cycle in older adults. We examined the effect of a 3-day control diet vs high-nitrate diet, with and without a high-nitrate supplement (beetroot juice), on plasma nitrate and nitrite kinetics and blood pressure using a randomized 4-period crossover controlled design. We hypothesized that the high-nitrate diet would show higher levels of plasma nitrate/nitrite and lower blood pressure compared with the control diet, which would be potentiated by the supplement. Participants were 8 normotensive older men and women (5 female, 3 male, 72.5 ± 4.7 years old) with no overt disease or medications that affect nitric oxide metabolism. Plasma nitrate and nitrite levels and blood pressure were measured before and hourly for 3 hours after each meal. The mean daily changes in plasma nitrate and nitrite were significantly different from baseline for both control diet + supplement (P < .001 and P = .017 for nitrate and nitrite, respectively) and high-nitrate diet + supplement (P = .001 and P = .002), but not for control diet (P = .713 and P = .741) or high-nitrate diet (P = .852 and P = .500). Blood pressure decreased from the morning baseline measure to the three 2-hour postmeal follow-up time points for all treatments, but there was no main effect for treatment. In healthy older adults, a high-nitrate supplement consumed at breakfast elevated plasma nitrate and nitrite levels throughout the day. This observation may have practical utility for the timing of intake of a nitrate supplement with physical activity for older adults with vascular dysfunction.