Improving weight status in childhood: results from the eat well be active community programs

Objectives

The eat well be active Community Programs (ewba) aimed to prevent obesity among children aged 0–18 years in two Australian communities from 2006 to 2010.

Methods

ewba was a multi-strategy intervention in children’s settings. The evaluation was quasi-experimental, including a before and after survey with intervention (INT) and non-randomised comparison (COMP) communities. Outcome measures included BMI-z score (zBMI) and overweight/obesity prevalence in children aged 4–5 years; and zBMI, waist circumference (WC) z-score and overweight/obesity prevalence in children aged10–12 years.

Results

After 3 years, among the 4–5 years old, mean zBMI was significantly lower in both INT (?0.20, p < 0.05) and COMP (?0.15, p < 0.05), however, changes were not significantly different between INT and COMP. There was a larger reduction in overweight/obesity prevalence in INT (?6.3 %) compared to COMP (?3.7 %) (p < 0.05, χ ² test). In the 10–12 years old, mean zBMI did not change significantly in INT or COMP. There was a significant reduction in WC z-score in INT (?0.17, p < 0.05) but not in COMP (?0.10, p = NS), although not significantly different between INT and COMP (p = 0.092).

Conclusions

These findings suggest that the ewba community intervention had a moderate impact, showing modest improvements in weight status at 3-year follow-up.     

Prevalence of obesity,overweight and thinness in Australian children and adolescents by socioeconomic status and ethnic/cultural group in 2006 and 2012

Objectives

To study the prevalence of obesity, overweight and thinness, by sex, SES and ethnic background in 2006 and 2012.

Methods

Large national surveys of school students were conducted. Height/weight was measured. The outcomes were height, weight, BMI, thinness, overweight and obesity (IOTF), SES and ethnicity.

Results

Obesity in 2006 and 2012 in boys and girls was 7.5 and 7.1 %, and 5.8 and 5.6 %; being overweight was 17.7 and 18.5 %, and 18.9 and 18.7 %; thinness was 3.8 and 4.6 %, and 5.0 and 6.0 %. Independent predictors of obesity in 2006 and 2012 were being Pacific Islander (OR 5.03, 5.66), Middle Eastern (OR 3.64, 1.50), aboriginal (OR 2.43 in 2012 only), African (OR 1.99 2012 only), Southern European (OR 1.75, 1.72), low SES (OR 2.22, 2.20), middle SES (OR 1.52, 1.60), female (OR 0.77, 0.82) and adolescent (OR 1.08, 2012 only). Predictors of thinness in 2006 and 2012 were ethnicity: Indian (OR 5.29, 1.96), African (OR 2.71, 2006 only), Asian (OR 1.69, 1.57) and female (OR 1.30, 1.27).

Conclusions

The predictors of obesity and thinness were ethnically based, suggesting culturally appropriate interventions in socially and economically disadvantaged communities.     

Overweight and obesity prevalence and determinants in Italy: an update to 2010

Purpose

To provide updated information on trends and determinants of underweight, overweight, and obesity in Italian adults.

Methods

We considered data from 5 surveys conducted annually between 2006 and 2010, on a total of 14,135 subjects aged 18 years or more (6,834 men and 7,301 women), representative of the Italian adult population, including self-reported information on height and weight.

Results

Overall, 3.1 % of the Italian adult population was underweight (body mass index, BMI, <18.5 kg/m²; 0.8 % men, 5.3 % women), 31.8 % overweight (25≤ BMI <30 kg/m²; 39.8 % men, 24.4 % women), and 8.9 % obese (BMI ≥30 kg/m²; 8.5 % men, 9.4 % women). We observed no specific pattern of overweight/obesity across calendar years in men (multivariate prevalence ratios, PR, for 2010 vs 2006: 0.95; p for trend: 0.980) and a non-significant decreased trend in women (PR: 0.92; p for trend: 0.051). Prevalence of overweight/obesity significantly increased with age (PRs for ≥65 vs 18–24 years: 2.01 in men, 2.65 in women), decreased with education (PRs for high vs low education: 0.79 in men, 0.54 in women), and was less frequent in single than in married adults (PRs: 0.85 in men, 0.78 in women). Overweight/obesity was significantly more frequent in adults from southern versus northern Italy (PRs: 1.13 in men, 1.32 in women) and in former versus never smokers (PRs: 1.23 in men, 1.19 in women).

Conclusions

In Italy, we did not find unfavorable trends in overweight and obesity prevalence across calendar years. However, there are specific subgroups of the population with elevated prevalence of overweight and obesity, mainly adults from southern Italy and less educated ones.     

Breast milk fatty acid composition differs between overweight and normal weight women: the STEPS Study

Objective

We studied differences in breast milk fatty acid (FA) composition between overweight and normal weight women and the effect of FA composition on children’s cholesterol concentrations at 13 months and growth from birth to 13 months.

Methods

Samples were collected from lactating women (n = 100) participating in STEPS study at infant’s age of 3 months, and FA composition was analyzed with gas chromatography. Diet of mother was studied with Index of Diet Quality at third trimester of pregnancy and with food frequency questionnaire on sampling day. The children’s weights and heights were collected from hospital records at birth and during study visits at 13 months.

Results

Overweight women’s breast milk compared to normal weight women’s breast milk contained higher amount of saturated FAs (46.3 vs. 43.6 %, P = 0.012), lower amount of n-3FAs (2.2 vs. 2.7 %, P = 0.010), lower ratio of unsaturated to saturated FAs (1.1 vs. 1.3, P = 0.008), and higher ratio of n-6 to n-3 FAs (5.7 vs. 4.9, P = 0.031) than those of normal weight women even after adjusting for maternal diet (P < 0.05 for all). Normal weight women adhered more to dietary recommendations during pregnancy, whereas no differences were found in diet at sampling 3 months postpartum. The children’s weight gains correlated with saturated FAs (R = 0.22, P = 0.04) and the ratio of unsaturated to saturated FAs (R = ?0.23, P = 0.038) in milk; however, effects diminished after adjusting for total duration of breastfeeding. Milk FA composition was not associated with children’s cholesterol concentrations at 13 months.

Conclusions

Breast milk FA composition differed between overweight and normal weight women.     

Retinol-binding protein 4 and insulin resistance are related to body fat in primary and secondary schoolchildren: the Ouro Preto study

Purpose

Evidence suggests that plasma retinol-binding protein 4 (RBP4) and insulin resistance are related to body fat (BF). We aimed to assess the relationship between RBP4 and insulin resistance with obesity in a mixed (skin color) cohort of the Brazilian population.

Methods

A nested case–control study was conducted in 227 schoolchildren aged 7–14 years. Schoolchildren with a high BF percentage (% BF, ≥ 30 for girls and ≥ 25 for boys) were identified as the obese group (n = 137), and those with lower values were identified as the non-obese group (n = 90). Percentage of body fat (% BF) was determined by tetrapolar bioimpedance (Quantum II, RJL System), RBP4 by enzyme-linked immunosorbent assay (Immunology Consultants Laboratory), plasma fasting insulin by chemiluminescent immunoassay (Access^® Immunoassay System) and insulin resistance by the homeostasis model insulin resistance (IR_HOMA) index. Serum lipid profile and arterial blood pressure were evaluated.

Results

The significant independent risk factors associated with obesity were as follows: male sex, increased serum LDL-C, RBP4 and IR_HOMA. Among children with higher RBP4, the association with obesity increased significantly (from 3.1 to 8.5) in the presence of insulin resistance, when compared to higher RBP4 and non-insulin resistance.

Conclusion

IR_HOMA and RBP4 showed significant associations with obesity and traditional CVD risk factors. They might therefore be used as a marker for CVD risk and have clinical implications in the development of comorbidities associated with obesity.     

The relationship between body mass index and health-related quality of life in urban disadvantaged children

Introduction

The study’s aim was to establish, for children living in urban disadvantage, the nature and extent of the relationship between body mass index (BMI) and health-related quality of life (HRQoL), including the role of individual and family factors in influencing this relationship.

Methods

Within the context of a longitudinal design, 255 children aged 7–12 years (50 % male) self-reported their HRQoL (Kidscreen-27) and had their height and weight measured at year one and two. One parent/guardian for each child was also assessed at year one with the OSLO Social Support Scale and Hospital Anxiety and Depression Scale. Regression analysis was also conducted.

Results

BMI was weakly inversely associated with ‘total HRQoL’ (r = ?.15, p < .05), ‘physical well-being’ and ‘autonomy and parent relations’. Significant differences were found between normal weight and obese children on all but the latter dimension. Neither weight group, however, fell below the average European HRQoL range. BMI predicted physical well-being a year later and vice versa, whilst autonomy and parent relations also predicted BMI a year later. In terms of ‘overweight’ children (38 %), those approaching adolescence had poorer physical and school well-being than younger children, and those whose parents had moderate-to-severe levels of depression fared worse on school well-being than children whose parents were not depressed.

Conclusion

The findings suggest that obesity programmes could aim to prevent/reduce obesity and optimise HRQoL in urban disadvantaged preadolescent children whilst also targeting parental mental health difficulties. Future research should examine mediators of the effect of BMI on HRQoL.     

Demographic and Placement Variables Associated with Overweight and Obesity in Children in Long-Term Foster Care

Overweight and obesity is a growing problem for children in foster care. This study describes the prevalence of overweight and obesity in an urban, ethnic minority population of children ages 2–19 in long-term foster care (N = 312) in Los Angeles, California. It also investigates whether demographics or placement settings are related to high body mass index. The estimates of prevalence of overweight/obesity (≥85th percentile) and obesity (≥95th percentile) were presented for gender, age, ethnicity, and placement type. Multiple logistic regression was used to examine potential associations between demographic and placement variables and weight status. The prevalence of overweight/obesity was almost 40 % and obesity was 23 % for the study population. Children placed in a group home had the highest prevalence of overweight/obesity (60 %) and obesity (43 %) compared to other types of placement. Within this study, older children (ages 12–19) were more likely to be overweight/obese than normal weight compared to children between 2 and 5 years old when controlling for gender, ethnicity and placement (OR = 2.10, CI = 1.14–3.87). These findings suggest that older age and long-term foster care in general may be risk factors for obesity. Child welfare agencies and health care providers need to work together to train caregivers with children in long-term foster care in obesity treatment interventions and obesity prevention strategies.     

Quality of life and psychological functioning in pediatric obesity: the role of body image dissatisfaction between girls and boys of different ages

Purpose

This study aims to explore the associations between weight status, body image dissatisfaction (BID), and psychosocial adjustment [quality of life (QOL), internalizing and externalizing problems] of normal-weight and obese youth. It aims to explore whether the associations between weight status and psychosocial adjustment are mediated by BID as well as the moderating role of youth’s age and gender on these associations.

Methods

The sample comprised 260 children and adolescents aged 8–18 years with normal weight (n = 128) and obesity (n = 132). All of the participants completed self-report instruments, including the KIDSCREEN-10, Strengths and Difficulties Questionnaire, and Collins Body Image scale.

Results

Obese youth, regardless of gender, reported poorer QOL, more internalizing/externalizing problems, and higher rates of BID compared with their normal-weight counterparts. BID mediated the relationship between weight status and QOL, but only for youth above 12-year old. The relationship between weight status and internalizing/externalizing problems was direct and independent of youth’s age and gender.

Conclusions

Pediatric obesity is associated with poorer psychosocial outcomes, which underlines the need for preventive and early interventions. An important target in psychological interventions seems to be BID, which proved to be an important mechanism linking obesity and decreased QOL among adolescents.     

Sex-stratified socio-economic gradients in physical inactivity, obesity, and diabetes: evidence of short-term changes in Argentina

Objectives

To evaluate how socio-economic gradients in NCDs and NCD-related risk factors change over time.

Methods

Secondary analysis of cross-sectional data from the 2005 and 2009 Argentine National Risk Factor Surveys (N = 41,392 and N = 34,732) was conducted. We analyzed inequalities in three risk factors (low physical activity, obesity, and diabetes) according to income and educational attainment. The analysis was based on sex-stratified and age-adjusted logistic regression.

Results

The overall prevalence of low physical activity, obesity, and diabetes increased from 2005 to 2009. Increases occurred in most of the income and education groups, but females with the lowest socio-economic status generally showed the highest increases. In 2005, differences in physical inactivity among women with different levels of education were not statistically significant. By 2009, women with low education (OR = 1.57, 95 % CI = 1.34–1.84) and medium education (OR = 1.18, 95 % CI = 1.06–1.32) were more likely than women with high education to be physically inactive.

Conclusion

Inequalities in physical inactivity, obesity, and diabetes have grown in Argentina over a short period of time.     

Children Treated for Nocturnal Enuresis: Characteristics and Trends Over a 15-Year Period

Background

Nocturnal Enuresis (NE) is one of the most prevalent childhood disorders and has significant negative psychosocial impact on the child and family.

Objective

To assess the characteristics of children with NE and trends over a 15-year period.

Methods

The study included 18,677 children [11,205 (60 %) boys and 7,472 (40 %) girls] referred to a network of clinics specializing in treatment of voiding problems (Age range: 4–12 years; Mean age = 7.06) between the years 1995–2009. We analyzed socio-demographic characteristics and trends over time using a standard questionnaire administered in the clinics.

Results

Over the course of the 15-year period, children were referred to treatment at a younger age (Mean age 1st period = 7.52, Mean age 2nd period = 7.12, Mean age 3rd period = 6.71) and the likelihood of referrals of younger children (4–5 years) increased (1st period = 24.5 %; 2nd period = 33.6 %; and 3rd period = 41.9 %). More children were referred during winter than summer or transition seasons. The higher prevalence of boys was maintained across this period. In addition, girls had 34 % higher chance to suffer from primary NE compared to boys and had 12 % higher chance to suffer from NE only compared to boys. Birth order and children’s age predicted NE type (primary/secondary) and in addition to family size also predicted enuresis pattern (NE only/combined NE and Diurnal Enuresis).

Conclusions

The findings of this largest study on children referred for NE treatment provides a wider understanding of important associated factors to this phenomenon.     

A composite score combining waist circumference and body mass index more accurately predicts body fat percentage in 6- to 13-year-old children

Purpose

Body mass index (BMI) and waist circumference (WC) are widely used to predict % body fat (BF) and classify degrees of pediatric adiposity. However, both measures have limitations. The aim of this study was to evaluate whether a combination of WC and BMI would more accurately predict %BF than either alone.

Methods

In a nationally representative sample of 2,303 6- to 13-year-old Swiss children, weight, height, and WC were measured, and %BF was determined from multiple skinfold thicknesses. Regression and receiver operating characteristic (ROC) curves were used to evaluate the combination of WC and BMI in predicting %BF against WC or BMI alone. An optimized composite score (CS) was generated.

Results

A quadratic polynomial combination of WC and BMI led to a better prediction of %BF (r ² = 0.68) compared with the two measures alone (r ² = 0.58–0.62). The areas under the ROC curve for the CS [0.6 * WC-SDS + 0.4 * BMI-SDS] ranged from 0.962 ± 0.0053 (overweight girls) to 0.982 ± 0.0046 (obese boys) and were somewhat greater than the AUCs for either BMI or WC alone. At a given specificity, the sensitivity of the prediction of overweight and obesity based on the CS was higher than that based on either WC or BMI alone, although the improvement was small.

Conclusion

Both BMI and WC are good predictors of %BF in primary school children. However, a composite score incorporating both measures increased sensitivity at a constant specificity as compared to the individual measures. It may therefore be a useful tool for clinical and epidemiological studies of pediatric adiposity.     

Impact of toilet hygiene training program: results from 11- to 16-year-old secondary school Turkish children

Objectives

The purpose of the study is to evaluate the effectiveness of toilet hygiene education in secondary school students.

Methods

The study was quasi-experimental with a pre-test–post-test design and includes a control group. The study was conducted at a secondary school in Istanbul, Turkey with 100 students (50 students for experiment and 50 students for control). The experiment and control groups were in the same school population. Data were collected with the student information form and toilet hygiene evaluation form (THEF), which were developed by the researchers.

Results

When we examined the toilet hygiene techniques used by the students, they indicated 58 % (n = 58) wiped perinea from front to back, 25 % (n = 25) back to front and 17 % (n = 17) randomly. It was found that 69 % (n = 69) of the students changed their underwear every 2–3 days; 80 % (n = 80) were trained by parents on toilet hygiene. Total THEF scores, which were obtained pre and post (shortly after) education, showed significant differences in the experiment group (p = 0.000). Total THEF scores obtained post education (shortly after and 1 month later) showed significant differences in the experiment group (p = 0.009).

Conclusions

The toilet hygiene education program is found to be successful in secondary school students.     

Health-related quality of life in rural children living in four European countries: the GABRIEL study

Objective

Measuring children’s health-related quality of life (HRQOL) is of growing importance given increasing chronic diseases. By integrating HRQOL questions into the European GABRIEL study, we assessed differences in HRQOL between rural farm and non-farm children from Germany, Austria, Switzerland and Poland to relate it to common childhood health problems and to compare it to a representative, mostly urban German population sample (KIGGS).

Methods

The parents of 10,400 school-aged children answered comprehensive questionnaires including health-related questions and the KINDL-R questions assessing HRQOL.

Results

Austrian children reported highest KINDL-R scores (mean: 80.9; 95 % CI [80.4, 81.4]) and Polish children the lowest (74.5; [73.9, 75.0]). Farm children reported higher KINDL-R scores than non-farm children (p = 0.002). Significantly lower scores were observed in children with allergic diseases (p < 0.001), with sleeping difficulties (p < 0.001) and in overweight children (p = 0.04). The German GABRIEL sample reported higher mean scores (age 7–10 years: 80.1, [79.9, 80.4]; age 11–13 years: 77.1, [74.9, 79.2]) compared to the urban KIGGS study (age 7–10 years: 79.0, [78.7–79.3]; age 11–13 years: 75.1 [74.6–75.6]). Socio-demographic or health-related factors could not explain differences in HRQOL between countries.

Conclusions

Future increases in chronic diseases may negatively impact children’s HRQOL.     

The impact of bystanding to workplace bullying on symptoms of depression among women and men in industry in Sweden: an empirical and theoretical longitudinal study

Background

Prospective studies on bystanding to workplace bullying and the health outcomes are scarce.

Aim

To investigate the work environmental risk factors of depressive symptoms among bystanders to bullying in both women and men in four large industrial organizations in Sweden.

Method

The number of respondents at four large industrial enterprises with more than one year at the workplace at T1: n = 2,563 (Women: n = 342; Men: n = 2,227). Bystanders to bullying at T1: n = 305 (Women: n = 30; Men: n = 275). The total number of those with symptoms of depression at T2: Women: n = 30; Men: n = 161. Two thousand one hundred and seventy-seven employees answered the questionnaire on T1 and T2 with an 18-month interval. “To have depressive symptoms” was defined as not having depressive symptoms at T1 but having depressive symptoms at T2.

Results

The number of men who were bystanders to bullying was larger compared to women. However, the proportion of women who were bystanders to bullying and developed depressive symptoms 18 months later was higher in comparison with men (33.3 and 16.4 %, respectively). Further, “Being a bystander to bullying” 1.69 (1.13–2.53), “Rumors of changes in the workplace” 1.53 (1.10–2.14), “Reduced role clarity” 2.30 (1.21–4.32), “Lack of appreciation of being in the group” 1.76 (1.22–2.53) increased the risk of future symptoms of depression. “Job Strain” was not an adjusted risk factor for depression.

Conclusion

Our results support previous findings that bystanding to workplace bullying is related to future depressive symptoms.     

Cost-effectiveness analysis, prevention of atopic dermatitis by oral application of bacterial lysate in newborns/small children

Objectives

The aim of this analysis was to determine the cost-effectiveness compared to placebo of prophylactic treatment with sterile bacterial lysate (Escherichia coli and Enterococcus faecalis) (verum) of newborns/small children with heredity for atopy [atopic dermatitis (AD)]. Infants were followed from the age of 5 weeks until 3 years of age. During this time, the number of children with AD who were treated with verum or placebo was observed at eight visits. Cost-effectiveness analyses were performed at different time points.

Methods

A randomized, double-blind placebo-controlled clinical trial performed in Germany included 606 newborns. After randomization, n = 303 patients were classified in the placebo group and n = 303 in the verum group. A total of 119 participants left the study, so data from n = 250 patients of the placebo group and n = 237 patients of the verum group were available for analysis. At the beginning of the study, newborns were treated prophylactically with bacterial lysate or placebo for 26 weeks. After this, children were observed until the age of 3 years. A systematic literature research was done to evaluate treatment costs of atopic eczema in newborn/small children. Finally, 17 publications were included and checked for searched treatment costs of AD. A study was then initiated to evaluate the direct costs to statutory health insurance. Based on the described clinical trial, a decision tree model was developed. Using the evaluated direct costs and prevalence according to the clinical trial, the developed model can be used in cost-effectiveness analyses.

Results

The focus of the analyses was on the subgroup “single heredity for atopy” in clinical trials. Cost-effectiveness analysis showed an advantage for bacterial lysate after 3 years. To further support this result a model extension was executed; the model was expanded from 3 to 6 years. Cost-effectiveness of bacterial lysate was also proven after 6 years.

Conclusion

Prophylactic treatment with bacterial lysate of infants with single heredity for atopy for 26 weeks in the 1st year of life is cost-effective at the age of 3 and 6 years, i.e. prophylactic use of bacterial lysate generated lower costs by leading to lower prevalence compared to placebo.     

Gezielte individuelle Förderung von 3- bis 6-Jährigen

Background:

School entry examinations in Mecklenburg-Western Pomerania (MWP), Germany, show prevalence rates of motor, linguistic or social developmental delays in up to 17.6 % of children. These delays act unfavourably on a successful start in school (http://www.regierung-mv.de).The early detection of developmental risks in 3–6-year-olds is regulated by an amendment of the law on preschools (KiföG M-V) since 2010. As regulated in this law, preschools receive additional financial resources to implement measures of targeted individualized promotion of 3- to 6-year-old children with developmental risks.

Objectives:

In the following study the specific use and suitability of these additional financial resources was analysed.

Methods:

108 preschools received a semi-standardised questionnaire. Data collection was focused on additional measures of targeted individualized promotion and the volume and respective use of additional financial resources spent for these.

Results:

104 preschools responded to the questionnaire (response rate: 96.3 %). In 2012 these preschools received on average 36,643 € for the targeted individualized promotion. 79.8 % (n = 83) of the preschools used the money for additional personnel. Predominantly (89.2 %) state-certified educators without specific qualifications were hired. Between 12 and 15 preschools (11.5 to 14.4 %) perform structured programs for promoting motor skills, language, social skills and health, respectively.

Conclusions:

Despite additional financial resources measures of targeted individualized promotion seem to be unspecific and do not differ from already implemented activities in the preschools. Additional funds were mostly used to relieve the pedagogical staff. Educator’s access to evidence based programs seems to be limited.     

Adult immunization policies in advanced economies: vaccination recommendations, financing, and vaccination coverage

Objectives

While many countries have robust child immunization programs and high child vaccination coverage, vaccination of adults has received less attention. The objective of this study was to describe the adult vaccination policies in developed countries.

Methods

From 2010 to 2011, we conducted a survey of 33 advanced economies as defined by the International Monetary Fund. The survey asked about national recommendations for adults for 16 vaccines or vaccine components, funding mechanisms for recommended adult vaccines, and the availability of adult vaccination coverage estimates.

Results

Thirty-one of 33 (93.9 %) advanced economies responded to the survey. Twelve of 31 (38.7 %) reported having a comprehensive adult immunization schedule. The total number of vaccines or vaccine components recommended for adults ranged from one to 15 with a median of 10. Seasonal influenza (n = 30), tetanus (n = 28), pneumococcal polysaccharide (n = 27), and hepatitis B (n = 27) were the most frequently recommended vaccines or components.

Conclusions

Approximately two-thirds of survey respondents do not have a comprehensive adult vaccine schedule, and most do not measure vaccination coverage. We found that a funding mechanism is available for most recommended adult vaccines.     

Development of a short form of the Brazilian Parental-Caregiver Perceptions Questionnaire using exploratory and confirmatory factor analysis

Purpose

This study presents the Brazilian short form of the P-CPQ.

Methods

Data from a representative sample of 702 parents/caregivers of children were randomly divided in two subsamples. A development sample (n = 502) was used for exploratory factor analysis (EFA), and a validation sample (n = 200) was used for confirmatory factor analysis (CFA). The EFA was used to determine the hypothetical factor structure and internal consistency. The CFA was applied to test the factor structure of the original P-CPQ, alternative models and the validity and reliability of the Brazilian short form of the P-CPQ.

Results

A 3-factor model (alternative model 2) had a factor structure with high factor loadings, acceptable fit indices (χ²/df = 2.38; GFI = 0.90; CFI = 0.90; TLI = 0.87; AGFI = 0.85; SRMR = 0.07) and both convergent and discriminant validity (Pearson bivariate zero order correlations among factors <0.85).

Conclusions

The Brazilian P-CPQ with three subscales and 13 items appears to be a valid short version to be used in further studies to evaluate parents/caregivers’ perceptions of children’s oral health-related quality of life.     

The Active Ageing–concept translated to the residential long-term care

Purpose

Active Ageing (AA), as described by the WHO (Active Ageing: a policy framework. World Health Organisation, Geneva 5), is an important concept in gerontology. Since the AA-concept has not been examined in the context of residential long-term care facilities, our study addresses this gap by describing the determinants of AA within this setting.

Methods

A qualitative study with semi-structured focus groups, followed by a thematic analysis, was conducted. Through purposive sampling, four focus groups of either residents of long-term care facilities (n = 8), children of residents (n = 8), community-dwelling older people (n = 8) and gerontologists (n = 6) were formed.

Results

The thematic analysis yielded nine determinants of AA. Seven correspond to those identified by the WHO: Culture, Behaviour, Psychological Factors, Physical Environment, Social Environment, Economic Characteristics and Health and Social Care. Two new determinants were identified: Meaningful Leisure and Participation. The determinant Participation is seen as crucial to AA in residential care.

Conclusion

This study points to a more extensive set of determinants of AA than those identified by the WHO (Active Ageing: a policy framework. World Health Organisation, Geneva 5). Staff of long-term care facilities can make use of these determinants to promote AA in their residents.     

Impaired parent-reported health-related quality of life of underweight and obese children at elementary school entry

Purpose

Examine the health-related quality of life of 5–6-year-old underweight, overweight and obese children.

Methods

Our cross-sectional study included 3,227 parent–child dyads from the “Be active, eat right” study. Parents completed questionnaires regarding child and parental characteristics. Health-related quality of life of the child was measured using the Child Health Questionnaire Parent Form 28. Children were classified normal weight, overweight, obese, severely obese, and underweight according to the international age and gender BMI cutoff points. Bootstrap analyses were performed for general linear models corrected for potential confounding variables.

Results

Severely obese children (β, ?2.60; 95 % CI, ?4.80 to ?0.57, p < 0.01) and underweight children (β, ?1.11; 95 % CI, ?1.85 to ?0.39, p < 0.01) had lower parent-reported scores on the physical summary scale. On the physical functioning profile scale parents of overweight and severely obese children also reported statistically significant lower scores (p < 0.05 and p < 0.01, respectively).There were no significant differences regarding the psychosocial summary scale scores between the different weight categories.

Conclusion

Underweight and overweight children experience impaired health-related quality of life on the physical functioning domain. Physicians, teachers and parents should be aware of the possible negative impact on health-related quality of life in underweight and overweight 5–6-year-old children.