Mild Depressive Symptoms Among Americans in Relation to Physical Activity,Current Overweight/Obesity,and Self-Reported History of Overweight/Obesity

Purpose

Overweight/obese individuals are at an increased risk for depression with some evidence of a bidirectional association. The preventative effects of physical activity among overweight/obese individuals have been well documented; however, less is known on how the duration of overweight/obesity alters the association with negative health outcomes. Therefore, the purpose of this investigation was to determine how the classification, and more specifically duration, of overweight/obesity alters the association between physical activity and depressive symptoms.

Methods

The 2005–2006 National Health and Nutrition Examination Survey (NHANES) data were used (n?=?764), and individuals were divided into six mutually exclusive groups based on physical activity status, weight classification (measured BMI), and duration of weight classification (assessed via recall). Multivariable linear and logistic regression analyses were computed to examine odds of depressive symptoms (patient health questionnaire (PHQ)-9) among groups.

Results

After adjusting for covariates, only individuals who were inactive and overweight/obese at the examination and 10 years prior were at an increased odds of depressive symptoms in comparison to those who were active and normal weight (odds ratio (OR)?=?2.40; 95 % confidence interval (CI) 1.03, 5.61; p?=?0.04).

Conclusion

Physical activity appeared to ameliorate the association with depressive symptoms independent of overweight/obesity classification or duration. The cyclic nature of overweight/obesity and depression (i.e., bidirectional association) appears to increase the odds of depression as the length of overweight/obesity is increased. These results provide support for clinicians to assess not only their clients’ current BMI but also the duration in which they have been at a certain weight classification and to further promote physical activity as a preventative measure against depressive symptoms.

     

北京市顺义区中小学生饮食行为与超重肥胖的相关性分析

目的 了解顺义区中小学生饮食行为与超重肥胖之间的相关关系,有效引导中小学生合理饮食行为,为保障其健康成长提供依据。方法 采用多层整群随机抽样方法,于2017年7月对顺义区1212名中小学生进行问卷调查,对相关因素进行Logistic 多元回归分析。结果 学生超重肥胖检出率为35.53%,其中男生为42.66%,女生为28.87%,差异有统计学意义(?字2=24.852,P＜0.01);多因素分析显示,男性是学生超重肥胖的危险因素（OR=1.863,95%CI=1.455~2.384）;而吃早餐是学生超重肥胖的保护因素,包括天天吃早餐（OR=0.164,95%CI=0.058~0.464）,有时吃早餐（OR=0.166,95%CI=0.058~0.478）。结论 顺义区中小学生超重肥胖率较高,健康饮食行为与超重肥胖之间存在相关关系,各部门应加强营养和健康知识教育,保障学生健康成长。     

Emergence and Persistence of Overweight and Obesity in 7- to 11-Year-Old Children

AimAfter dramatic rises in paediatric obesity, the critical period for obesity onset may now be pre-adolescence.MethodsWe monitored adiposity over 4 years in 400 children aged 7-9 years recruited from schools in London. Weight, height, waist circumference (WC) and fat mass were measured annually. Weight status was defined using International Obesity Task Force (IOTF) criteria, and standardised scores and percentiles used British 1990 reference data.ResultsBMI, WC and fat mass index all tracked strongly over time (average correlation for BMI = 0.95). Emergence of obesity was relatively uncommon: only 2% of the total sample increased from overweight to obese over the 4-year period, and this was nearly matched by the 1.3% that reduced from obese to overweight. However, more children (6%) moved from healthy weight to overweight than the reverse direction (2%). There were greater absolute gains in adiposity in children with higher baseline weight status, but this was disguised in analyses using standardised scores. Obesity was not an emergent trait in middle childhood, but rates were already high and, in absolute terms, adiposity increased more in overweight and obese than healthy weight children.ConclusionThese results highlight the need for active management of obesity in middle childhood.Key Words: Obesity, Adiposity, Growth, Child development, Longitudinal     

Bringing Psychotherapy to Primary Care: Innovations and Challenges

[Clin Psychol Sci Prac 17: 191–214, 2010] The segregation of mental health treatment and primary medical care in our health care system is increasingly recognized as anachronistic, as a majority of patients with psychosocial problems are turning to primary care providers. Accordingly, the development and dissemination of evidence‐based psychotherapeutic interventions compatible with the constraints of primary care is becoming increasingly urgent. This article discusses the importance of finding feasible ways to bring psychotherapy to primary care, examines interventions either specifically adapted for primary care or consistent with its constraints, assesses the compatibility of these interventions with the primary care environment, considers barriers inhibiting the widespread integration of such interventions into primary care, and discusses future directions.     

Prevalence of Obesity and Overweight in an Indigenous Population in Central Brazil: A Population-Based Cross-Sectional Study

ObjectiveTo estimate the prevalence of obesity and overweight and associated factors in indigenous people of the Jaguapiru village in Central Brazil.MethodsWe conducted a population-based cross-sectional study between January 2009 and July 2011 in the adult native population of the Jaguapiru village, Central Brazil. Sociodemographic and lifestyle data were obtained; anthropometric measures, arterial blood pressure, and blood glucose were measured. The independent variables were tested by Poisson regression, and the interactions between them were analyzed.Results1,608 indigenous people (982 females, mean age 37.7 ± 15.1 years) were included. The prevalence of obesity was 23.2% (95% CI 20.9-25.1%). Obesity was more prevalent among 40- to 49-year-old and overweight among 50- to 59-year-old persons. Obesity was positively associated with female sex, higher income, and hypertension. Among indigenous people, interactions were found with hypertension and sedentary lifestyle - hypertension in males and sedentary lifestyle in females.ConclusionsThe prevalence of obesity and overweight in indigenous people of the Jaguapiru village is high. Males as well as hypertensive and higher family income individuals have higher rates. Sedentary lifestyle and hypertension leverage the rates of obesity. Prevention and adequate public health policies can be critical for the control of excess weight and its comorbidities among Brazilian indigenous people.Key Words: Obesity, Overweight, Prevalence, South American Indians, Brazil     

Prevalence of Thinness,Overweight, Obesity,and Central Obesity in Finnish School-Aged Children: A Comparison of National and International Reference Values

IntroductionThe global epidemic of obesity concerns children, and monitoring the prevalence is of highest priority. Body mass index (BMI) with age- and sex-specific cutoff values determines weight status in children, although multiple reference systems exist. Our aim was to compare the prevalence for thinness, normal weight, overweight, and obesity in Finnish school-aged children according to national and international reference values, as well as to determine which cutoff values for overweight agree with the criteria for central obesity.MethodsThis study includes 10,646 children aged 9–12 years from the Finnish Health in Teens cohort. Height, weight, and waist circumference were measured in 2011–2014. BMI (weight [kg]/height [m]²) and the waist-to-height ratio (WHtR; waist [cm]/height [cm]) were calculated. The WHtR cutoff of >0.5 indicated central obesity. We compared the sex-specific prevalence of thinness, overweight, and obesity using the International Obesity Task Force (IOTF), World Health Organization (WHO) and Finnish (FIN) BMI-for-age reference values, as well as these three against central obesity based on the WHtR.ResultsThe prevalence of thinness, overweight, and obesity were 11.0%, 12.7%, and 2.6%, respectively, using IOTF; 2.6%, 15.9%, and 5.2% using WHO; and 5.1%, 11.4%, and 2.2% using FIN. Overweight and obesity were more common in boys than girls using WHO and FIN, while thinness was more common in girls using IOTF and FIN. IOTF versus WHO exhibited moderate agreement (κ = 0.59), which improved for IOTF versus FIN (κ = 0.74). Of those classified as overweight by WHO, 37% and 47% were regarded as normal weight according to IOTF and FIN, respectively. The prevalence of central obesity was 8.7%, and it was more common in boys than girls. WHO provided the highest sensitivity: 95% of individuals with central obesity were classified with overweight or obesity. Using FIN provided the highest specificity (93%).ConclusionOur findings show that WHO overestimates the prevalence of overweight and obesity, while IOTF overrates thinness. Thus, comparing prevalence rates between studies requires caution. The novelty of this study is the comparison of the cutoff values for overweight with central obesity. The choice of reference system affects the generalizability of the research results.     

Adolescent Overweight,Obesity and Chronic Disease-Related Health Practices: Mediation by Body Image

Background/Aims

To examine whether body image mediates the association between overweight/obesity and chronic disease-related health practices (CDRHP), including lack of physical activity (PA), infrequent breakfast consumption (IBC), screen-based media use (SBM), and smoking.

Methods

The 2006 Health Behaviors in School-Age Children survey was administered to a nationally representative sample of US students (n = 8,028) in grades 6-10 (mean age = 14.3 years). Outcome variables included self-reported measures of PA, SBM, IBC, and smoking. Body image was assessed with 5 items from the Body Investment Scale (α = 0.87) asking for agreement/disagreement with statements about one''s body. Stratifying on gender, an initial regression model estimated the association between overweight/obesity and CDRHP. Mediation models that included body image were then compared to the initial model to determine the role of body image in the relationship between overweight/obesity and CDRHP.

Results

Among boys, body image mediated the relationships of overweight/obesity with SBM, and of obesity with IBC. Among girls, it mediated the relationships of obesity with PA, IBC, and smoking, and of overweight with SBM.

Conclusion

As the prevalence of overweight/obesity among adolescent boys and girls remains high, efforts to improve their body image could result in less frequent engagement in CDRHP.Key Words: Chronic disease-related health practices, Adolescents, Obesity, Body image     

Child Overweight and Obesity in Shanghai,China: Contextualizing Chinese Socioeconomic and Gender Differences

Purpose

Childhood overweight and obesity is on the rise in China and in Chinese cities in particular. The aim of this study is to explore the extent of income differences in childhood overweight in Shanghai, China, and examine demographic, social, and behavioral explanations for these differences.

Methods

Using the 2014 Child Well-Being Study of Shanghai, China—a survey that included extensive contextual information on children and their families in China’s most populous city, prevalence rates and adjusted odds ratios of child overweight and obesity at age 7 were calculated by income tercile controlling for a wide variety of sociodemographic variables.

Results

District aggregate income increases the odds of child overweight/obesity, but only for boys. In contrast, rural hukou status was associated with lower odds of overweight/obesity for girls.

Conclusions

Boys at age 7 are more likely to be overweight and obese than girls. District income further increases this likelihood for boys, while rural hukou status decreases this likelihood for girls, suggesting that preferences for boys and thinness ideals for girls may play a role in the income patterning of childhood overweight and obesity.

     

Mixed Methods Study of Patient and Primary Care Provider Perceptions of Chronic Pain Treatment

ObjectiveA mixed-method study involving patient focus groups and survey of primary care providers (PCPs) sought to compare perspectives about chronic pain (CP) and its treatment. Our goal was to identify needs and barriers for facilitating patient-centered care.MethodsTwo focus groups of CP patients from a single academic medical center explored interactions with PCPs and their understandings, experiences, and expectations of CP treatment. They were also asked their opinions about self-assessment/communication tools. We compared themes with survey data from two PCP research networks.ResultsCP patients understand opioid risks and fear PCP judgement and condescension, while sensing PCP fear and avoidance of opioid prescribing. PCPs are dissatisfied with their ability to provide optimal CP care, despite feeling that patients are generally satisfied with their clinic visits. Evaluation tools, especially assessment of functional activities, are favorably viewed by all, but deemed time prohibitive.ConclusionPatients’ understanding of opioid risks, desire for attention on functional goals and behavioral treatment may be greater than PCPs perceive. Such gaps in understanding and attitudes, if recognized, could support high-quality communication and interventional strategies.Practice ImplicationsThese findings guide patient-PCP communication toward alignment of treatment goals and enhanced coordination of care.     

An Electronic Clinical Decision Support Tool to Assist Primary Care Providers in Cardiovascular Disease Risk Management: Development and Mixed Methods Evaluation

Background

Challenges remain in translating the well-established evidence for management of cardiovascular disease (CVD) risk into clinical practice. Although electronic clinical decision support (CDS) systems are known to improve practitioner performance, their development in Australian primary health care settings is limited.

Objectives

Study aims were to (1) develop a valid CDS tool that assists Australian general practitioners (GPs) in global CVD risk management, and (2) preliminarily evaluate its acceptability to GPs as a point-of-care resource for both general and underserved populations.

Methods

CVD risk estimation (based on Framingham algorithms) and risk-based management advice (using recommendations from six Australian guidelines) were programmed into a software package. Tool validation: Data from 137 patients attending a physician’s clinic were analyzed to compare the tool’s risk scores with those obtained from an independently programmed algorithm in a separate statistics package. The tool’s management advice was compared with a physician’s recommendations based on a manual review of the guidelines. Field test: The tool was then tested with 21 GPs from eight general practices and three Aboriginal Medical Services. Customized CDS-based recommendations were generated for 200 routinely attending patients (33% Aboriginal) using information extracted from the health record by a research assistant. GPs reviewed these recommendations during each consultation. Changes in CVD risk factor measurement and management were recorded. In-depth interviews with GPs were conducted.

Results

Validation testing: The tool’s risk assessment algorithm correlated very highly with the independently programmed version in the separate statistics package (intraclass correlation coefficient 0.999). For management advice, there were only two cases of disagreement between the tool and the physician. Field test: GPs found 77% (153/200) of patient outputs easy to understand and agreed with screening and prescribing recommendations in 72% and 64% of outputs, respectively; 26% of patients had their CVD risk factor history updated; 73% had at least one CVD risk factor measured or tests ordered. For people assessed at high CVD risk (n = 82), 10% and 9%, respectively, had lipid-lowering and BP-lowering medications commenced or dose adjustments made, while 7% newly commenced anti-platelet medications. Three key qualitative findings emerged: (1) GPs found the tool enabled a systematic approach to care; (2) the tool greatly influenced CVD risk communication; (3) successful implementation into routine care would require integration with practice software, minimal data entry, regular revision with updated guidelines, and a self-auditing feature. There were no substantive differences in study findings for Aboriginal Medical Services GPs, and the tool was generally considered appropriate for use with Aboriginal patients.

Conclusion

A fully-integrated, self-populating, and potentially Internet-based CDS tool could contribute to improved global CVD risk management in Australian primary health care. The findings from this study will inform a large-scale trial intervention.     

It's LiFe! Mobile and Web-Based Monitoring and Feedback Tool Embedded in Primary Care Increases Physical Activity: A Cluster Randomized Controlled Trial

BackgroundPhysical inactivity is a major public health problem. The It’s LiFe! monitoring and feedback tool embedded in the Self-Management Support Program (SSP) is an attempt to stimulate physical activity in people with chronic obstructive pulmonary disease or type 2 diabetes treated in primary care.ObjectiveOur aim was to evaluate whether the SSP combined with the use of the monitoring and feedback tool leads to more physical activity compared to usual care and to evaluate the additional effect of using this tool on top of the SSP.MethodsThis was a three-armed cluster randomised controlled trial. Twenty four family practices were randomly assigned to one of three groups in which participants received the tool + SSP (group 1), the SSP (group 2), or care as usual (group 3). The primary outcome measure was minutes of physical activity per day. The secondary outcomes were general and exercise self-efficacy and quality of life. Outcomes were measured at baseline after the intervention (4-6 months), and 3 months thereafter.ResultsThe group that received the entire intervention (tool + SSP) showed more physical activity directly after the intervention than Group 3 (mean difference 11.73, 95% CI 6.21-17.25; P<.001), and Group 2 (mean difference 7.86, 95% CI 2.18-13.54; P=.003). Three months after the intervention, this effect was still present and significant (compared to Group 3: mean difference 10.59, 95% CI 4.94-16.25; P<.001; compared to Group 2: mean difference 9.41, 95% CI 3.70-15.11; P<.001). There was no significant difference in effect between Groups 2 and 3 on both time points. There was no interaction effect for disease type.ConclusionsThe combination of counseling with the tool proved an effective way to stimulate physical activity. Counseling without the tool was not effective. Future research about the cost-effectiveness and application under more tailored conditions and in other target groups is recommended.

Trial Registration

ClinicalTrials.gov: {"type":"clinical-trial","attrs":{"text":"NCT01867970","term_id":"NCT01867970"}}NCT01867970, https://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT01867970","term_id":"NCT01867970"}}NCT01867970 (archived by WebCite at http://www.webcitation.org/6a2qR5BSr).     

Associations Between Sleep Duration Patterns and Overweight/Obesity at Age 6

Objective:

To investigate whether longitudinal sleep duration patterns during early childhood is a risk factor of overweight or obesity at school entry while controlling for a variety of obesogenic environmental factors.

Design, Setting, and Participants:

This is a prospective cohort study (March–December 1998 to December 2004) of a representative sample of infants born in 1997–1998 in the Canadian province of Quebec. Body mass index (BMI) was measured at ages 2.5 and 6 years. Sleep duration was reported yearly from 2.5 to 6 years of age by their mothers. Prenatal, postnatal (5 and 29 months), and lifestyle (6 y) potentially confounding factors for excess weight were assessed by interviews, questionnaires and hospital records. A group-based semiparametric mixture model was used to estimate developmental patterns of sleep duration. The relationship between sleep duration patterns and BMI was tested using multivariate logistic regression models to control for potentially confounding factors on 1138 children.

Results:

Four sleep duration patterns were identified: short persistent (5.2%), short increasing (4.7%), 10-hour persistent (50.7%), and 11-hour persistent (39.4%). After controlling for potentially confounding factors, the risk for overweight or obesity was almost 4.2 times higher for short persistent sleepers (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.6 to 11.1; P = 0.003) than for 11-hour persistent sleepers.

Conclusions:

Persistently short sleep duration (<10 h) during early childhood significantly increases the risk of excess weight or obesity in childhood, and appears to be independent of other obesogenic factors.

Citation:

Touchette E; Petit D; Tremblay RE; Boivin M; Falissard B; Genolini C; Montplaisir JY. Associations between sleep duration patterns and overweight/obesity at age 6. SLEEP 2008;31(11):1507–1514.     

The Impact of Electronic Patient Portals on Patient Care: A Systematic Review of Controlled Trials

Background

Modern information technology is changing and provides new challenges to health care. The emergence of the Internet and the electronic health record (EHR) has brought new opportunities for patients to play a more active role in his/her care. Although in many countries patients have the right to access their clinical information, access to clinical records electronically is not common. Patient portals consist of provider-tethered applications that allow patients to electronically access health information that are documented and managed by a health care institution. Although patient portals are already being implemented, it is still unclear in which ways these technologies can influence patient care.

Objective

To systematically review the available evidence on the impact of electronic patient portals on patient care.

Methods

A systematic search was conducted using PubMed and other sources to identify controlled experimental or quasi-experimental studies on the impact of patient portals that were published between 1990 and 2011. A total of 1,306 references from all the publication hits were screened, and 13 papers were retrieved for full text analysis.

Results

We identified 5 papers presenting 4 distinct studies. There were no statistically significant changes between intervention and control group in the 2 randomized controlled trials investigating the effect of patient portals on health outcomes. Significant changes in the patient portal group, compared to a control group, could be observed for the following parameters: quicker decrease in office visit rates and slower increase in telephone contacts; increase in number of messages sent; changes of the medication regimen; and better adherence to treatment.

Conclusions

The number of available controlled studies with regard to patient portals is low. Even when patient portals are often discussed as a way to empower patients and improve quality of care, there is insufficient evidence to support this assumption.     

Issues in Patient Adherence to Health Care Regimens

Abstract

This paper examines an important area of personal health behavior in which the possible link between stress and health status is not primarily a biological one but a behavioral one. The review of empirical literature is organized around four topics: 1) the limited payoff from the search for stable sociodemographic and personality correlates of adherence; 2) the inadequacy of our current theoretical formulations; 3) the role of the doctor; and 4) the doctor-patient interaction, which emphasizes mutual expectations rather than a one-way transfer of information. The concluding remarks address themselves to the need for a firmer linkage with the conceptual and empirical literature on stress and coping.     

Socio-Behavioral Factors Associated with Overweight and Central Obesity in Tehranian Adults: a Structural Equation Model

Purpose

This study aimed to test a conceptual model of associations between socio-demographic and behavioral factors and obesity in the Tehran Lipid and Glucose Study (TLGS).

Methods

Data from 2747 TLGS adult participants (58.3 % female) were analyzed. Socio-demographic and behavioral factors in the conceptual model were tested for their direct and indirect associations with overweight and central obesity, using structural equation modeling (SEM), conducted by IBM SPSS AMOS software.

Results

Overweight and central obesity were found in 61.6 and 48.1 % of respondents, respectively. Fit indices were acceptable for the conceptual model. Daily energy intake had a direct association with overweight and central obesity in both genders; however, poor dietary pattern had direct associations with overweight and central obesity only in men. In women, age, marital status, and level of education had direct associations with overweight and central obesity. In men, only age and marital status had direct associations with overweight and central obesity.

Conclusions

Age and marital status in both genders and level of education only in women were among the socio-demographic factors which were directly associated with both overweight and central obesity. Among behavioral factors, daily energy intake was the most important factor that was directly associated with both overweight and central obesity in both genders. Adherence to poor diet directly was associated with overweight and central obesity only in men. The current findings provide beneficial information for designing culturally relevant and effective interventions/strategies for prevention of overweight among Tehranian adults.