'Be active, eat right', evaluation of an overweight prevention protocol among 5-year-old children: design of a cluster randomised controlled trial

Background  

The prevalence of overweight and obesity in children has at least doubled in the past 25 years with a major impact on health. In 2005 a prevention protocol was developed applicable within Youth Health Care. This study aims to assess the effects of this protocol on prevalence of overweight and health behaviour among children.     

Éducation et prévention de l’obésité de l’enfant. bilan des études en population

The prevalences of overweight and obesity are increasing in France as well as in many countries around the world. Results of randomised controlled primary prevention studies in schools are summarized. They show the feasibility of improving school meals and energy expenditure during PE classes. However, the effect on overweight and obesity prevention are often modest. It is clear that the out-of-school life can totally compensate the effect of an intervention at school. Studies that have been able to modify the children's sedentary and active behaviours out of school have shown the most promising results. The National Nutrition and Health Plan in France comprises a set of actions targeting the whole population, from young children to the elderly, for several years. In that context, we may hope that the different actions undertaken in France including those at school will end with more favourable results.     

Peer Reviewed: An Intervention to Promote Healthy Weight: Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) Theory and Design

Health professionals are faced with the growing challenge of addressing childhood overweight. Few overweight prevention efforts have targeted young children, particularly children in child care settings. We describe the theory and development of a novel nutrition and physical activity environmental intervention. On the basis of findings from interviews and focus groups, a review of national recommendations and standards, and a review of the literature, we developed a nutrition and physical activity environmental self-assessment instrument to assess physical activity and nutrition policies and practices in child care settings. An intervention model was built around existing public health infrastructure to support use of the self-assessment instrument and encourage environmental changes at the child care level, and this intervention model became the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) program. The NAP SACC program was designed for dissemination and has potential for implementation in many settings. Broad interest in NAP SACC has been expressed by a number of states and institutions, and many groups are using NAP SACC intervention and materials. The NAP SACC program shows promise as a useful approach to promoting healthy weight behaviors in child care settings.     

An intervention to promote healthy weight: Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) theory and design

Health professionals are faced with the growing challenge of addressing childhood overweight. Few overweight prevention efforts have targeted young children, particularly children in child care settings. We describe the theory and development of a novel nutrition and physical activity environmental intervention. On the basis of findings from interviews and focus groups, a review of national recommendations and standards, and a review of the literature, we developed a nutrition and physical activity environmental self-assessment instrument to assess physical activity and nutrition policies and practices in child care settings. An intervention model was built around existing public health infrastructure to support use of the self-assessment instrument and encourage environmental changes at the child care level, and this intervention model became the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) program. The NAP SACC program was designed for dissemination and has potential for implementation in many settings. Broad interest in NAP SACC has been expressed by a number of states and institutions, and many groups are using NAP SACC intervention and materials. The NAP SACC program shows promise as a useful approach to promoting healthy weight behaviors in child care settings.     

"Childhood overweight and obesity: maternal perceptions of the time for engaging in child weight management"

ABSTRACT: BACKGROUND: There is an increasing awareness of the impact of parental risk perception on the weight course of the child and the parent's readiness to engage in preventive efforts, but only less is known about factors related to the parental perception of the right time for the implementation of preventive activities. The aim of this study was to examine parental perceptions of the appropriate time to engage in child weight management strategies, and the factors associated with different weight points at which mothers recognize the need for preventive actions. METHODS: 352 mothers with children aged 2-10 years took part in the study. We assessed mothers' perceptions of the actual and preferred weight status of their child, their ability to identify overweight and knowledge of its associated health risks, as well as perceptions of the right time for action to prevent overweight in their child. A regression analysis was conducted to examine whether demographic and weight related factors as well as the maternal general risk perception were associated with recognizing the need to implement prevention strategies. RESULTS: Although most of the parents considered a BMI in the 75th to 90th percentile a valid reason to engage in the prevention of overweight, 19% of the mothers were not willing to engage in prevention until their child reached the 97th percentile. Whereas the child's sex and the identification of an elevated BMI were significant predictors for parents' recognition of the 75th percentile as right point to engage in prevention efforts, an inability to recognize physical health risks associated with overweight silhouettes emerged as a significant factor predicting which parents would delay prevention efforts until a child's BMI reached the 97th percentile. CONCLUSION: Parental misperceptions of overweight and associated health risks constitute unfavorable conditions for preventive actions. Feedback on the health risks associated with overweight could help increase maternal readiness for change.     

Revised guideline 'prevention of cot death'

There are new insights into the pathogenesis of cot death ('sudden infant death syndrome'; SIDS). Based on these new insights, the Dutch Paediatric Association and the Dutch Child and Youth Health Care Physicians have drawn up a new guideline 'Prevention of cot death', which replaces the consensus statement of 1996. The 2 major differences from the old guideline are that co-sleeping of young infants in the same bed with the parents is now actively discouraged under the age of 4 months, and that the supine sleeping position is recommended from birth on. The recommendation that lying on one side can be used during the first 2 weeks of life has now been withdrawn.     

Testing Communities That Care: The Rationale,Design and Behavioral Baseline Equivalence of the Community Youth Development Study

Recent advances in prevention science provide evidence that adolescent health and behavior problems can be prevented by high-quality prevention services. However, many communities continue to use prevention strategies that have not been shown to be effective. Studying processes for promoting the dissemination and high-quality implementation of prevention strategies found to be effective in controlled research trials has become an important focus for prevention science. The Communities That Care prevention operating system provides manuals, tools, training, and technical assistance to activate communities to use advances in prevention science to plan and implement community prevention services to reduce adolescent substance use, delinquency, and related health and behavior problems. This paper describes the rationale, aims, intervention, and design of the Community Youth Development Study, a randomized controlled community trial of the Communities That Care system, and investigates the baseline comparability of the 12 intervention and 12 control communities in the study. Results indicate baseline similarity of the intervention and control communities in levels of adolescent drug use and antisocial behavior prior to the Communities That Care intervention. Strengths and limitations of the study's design are discussed.     

国际旅行卫生保健中心发展趋势

〔目的〕探讨在全球经济一体化导致国际间人员流动频繁及流量增加的情况下,国际旅行卫生保健中心如何加强发展,做好应对突发公共卫生事件工作。〔方法〕根据突发公共卫生事件的因素条件,查阅大量相关文献资料,结合国际旅行卫生保健中心的实际情况进行分析、归纳和总结。〔结果〕按照突发公共卫生事件的发生条件,国际旅行卫生保健中心应主要做好旅行者健康管理,加强预防接种工作,以及预防突发公共卫生事件的应急管理。〔结论〕国际旅行卫生保健中心应该从旅行者健康信息管理、信息平台构建、预防接种、旅行者信息反馈、做好口岸急救应急准备等5个方面来加强发展,为预防和应对突发公共卫生事件提供技术保障,发挥主力军作用。     

Youth Health Care Services guideline 'Early screening for hearing impairment, 0-19 years'

The Youth Health Care guideline 'Early screening for hearing impairment, ages 0-19 years' draws the attention of all parties involved to the case finding of, notably, perceptive hearing loss; it helps workers in the Youth Health Care argue their referrals and improve the next steps in the process. Referrals always aim at ruling out perceptive hearing impairment. It is essential to diagnose and subsequently treat children with perceptive hearing impairment. It is important to keep track of the process after the referral. Screening methods are the Ewing test, the 'Compacte Amsterdamse paedo-audiometrische screener' (CAPAS) test and audiograms. Each age category has groups at risk for hearing impairment. Problems in neonates are a low specificity of the Ewing/CAPAS tests, treatment of middle ear disease without ruling out perceptive hearing impairment and absence of interdisciplinary agreements regarding the steps to be taken and the necessary feedback. Children with perceptive hearing loss should be diagnosed before 18 months of age. In the near future neonatal screening may detect congenital perceptive hearing impairment, but hearing impairment may still develop after the screening. Alertness with respect to hearing impairment will remain necessary in every consultation of a child.     

Preventive activities in primary health care in Stockholm County, Sweden. Results from a survey in November 1985

A survey was conducted, during November 1985, in 110 Stockholm Public Primary Health Care Centres (PHCC) to study ongoing preventive activities. In 71% of the Health Centres there was an awareness of special risk groups in the PHCC area, such as alcohol abusers, elderly people and single parents, and in 40% of more specific risk factors like unemployment and loneliness. Individualised preventive activities were provided in 25% and group oriented activities in 50% of the health centres. There were great differences between the different regions of Stockholm County and, for example, quit-smoking groups were not distributed according to the geographical needs, i.e. to the areas with the highest prevalence of smokers. Involvement of PHC in community-based preventive activities is still rare but has started in the area of accident prevention in some PHCC. The study also underlines the need for more education as well as support to increase the element of prevention in primary health care activities.     

Guideline for nursing care in the prevention of accidental extubation

Article reports the experience of the use of a preventive guideline for the prevention of accidental extubation that occurs associated nursing care for the four moments of bigger incidence that are: bath in the stream bed, transportation, exchange of setting and change of decubitus. The content of the guide is based in the recommendations found in bibliographical survey in the MedLine and in the professional experience. The guideline is being used since September, 2005. This contribution aims at decreasing extubation incidence and to be a tool to develop a quality indicator in Intensive Care Units as well as for offering an assistance that aims patient safety.     

Nutrition guidance in The Netherlands: the role of the GP in the translation from population strategy to individual approach

An important pitfall of nutritional guidance in medical practice is how to deal with the prevention paradox: a nutritional advice that is good for the population as a whole is not necessarily proven effective for the individual patient. Evidence-based guidelines are needed to support GPs to translate these advices to the individual patient. We illustrate this with two examples: obesity and undernutrition. The Dutch Ministry of Health started a national partnership on overweight. The role of the Dutch College of GPs (NHG) in this process is to insert the GP's perspective and to 'translate' the multidisciplinary guideline into a practice guideline for GPs. A systematic review on nutritional deficiency in general practice in The Netherlands showed a prevalence ranging from 0% to 13%. The 'National Steering Committee Undernutrition' stimulates GPs to pay more attention to undernutrition, in collaboration with the Dutch College of GPs. The Cochrane Primary Health Care Field (Nijmegen) accommodates the Cochrane Diet and Nutrition Sub Field involving the inclusion of evidence from non-randomized studies, which are generally not included in Cochrane Reviews, but which form an important part of the evidence for the role of nutrition. From this international initiative, a national collaboration in The Netherlands between universities, researchers and the Dutch College was founded, which aims to support the foundation of practice-based nutrition counselling in the consulting room.     

Facilitators and Barriers for Successful Implementation of Interconception Care in Preventive Child Health Care Services in the Netherlands

Objectives Successful implementation of preconception and interconception care contributes to optimizing pregnancy outcomes. While interconception care to new mothers could potentially be provided by Preventive Child Health Care services, this care is currently not routinely available in the Netherlands. The purpose of this study was to identify facilitators and barriers for implementation of interconception care in Preventive Child Health Care services. Methods We organized four focus groups in which Preventive Child Health Care physicians and nurses, related health care professionals and policymakers participated. A semi-structured interview approach was used to guide the discussion. The transcribed discussions were analyzed. Results All four groups agreed that several facilitators are present, such as the unique position to reach women and the expertise in preventive health care. Identified barriers include unfamiliarity with interconception care among patients and health care providers, as well as lack of consensus about the concept of interconception care and how it should be organized. A broad educational campaign, local adaptation, and general agreement or a guideline for standard procedures were recognized as important for future implementation. Conclusions for practice This study identifies potentially important facilitators and barriers for the implementation of interconception care in Preventive Child Health Care services or comparable pediatric settings. These factors should be considered and strategies developed to achieve successful implementation of interconception care.     

The new CBO-guideline 'Osteoporosis' is a broadly supported standard for clinical practice

The Dutch Institute for Health Care Improvement (CBO) has published new (revised) guidelines for the screening and case-finding of osteoporosis and for its prevention and treatment. During the last few years, two other guidelines have been published by the Dutch College of General Practitioners and the Dutch Health Council, respectively. The CBO guideline would seem to reflect the current views on clinical practice the best and is supported by all the relevant medical specialist communities. Screening of the general population is discouraged, whilst case-finding is recommended with selected patients. Compared to the 1999 standard of the Dutch College of General Practitioners, this new consensus offers more possibilities for the preventive treatment of patients with possible osteoporosis and the treatment of patients with the disease. In the first years after menopause, treatment with oestrogens (combined if necessary with progestagens), tibolone and selective oestrogen receptor modulators may be considered. Treatment with bisphosphonates is advised in persons who are being or will be treated with corticosteroids, postmenopausal women with one or more osteoporotic fractures, or men and women with an increased risk and a T-score below -2.5. The CBO guideline constitutes the current standard for clinical practice with regard to osteoporosis. There would appear to be no need for a revision of the other guidelines.     

论国际旅行卫生保健中心在应对突发公共卫生事件的作用

目的探讨在全球经济一体化导致国际间人员流动频繁及流量增加的情况下,国际旅行卫生保健中心如何加强自身发展,发挥在应对突发公共卫生事件中的作用。方法根据突发公共卫生事件的因素条件,查阅大量相关杂志文献和教学资料,结合国际旅行卫生保健中心现在的实际情况进行分析、归纳和总结。结果按照突发公共卫生事件的发生条件,国际旅行卫生保健中心应主要做好对旅行者健康管理,加强预防接种工作,以及加强预防突发公共卫生事件的应急管理。结论国际旅行卫生保健中心应该从旅行者健康信息管理、信息平台构建、预防接种、旅行者信息反馈、做好口岸急救应急准备等五方面来加强自身发展,为预防突发公共卫生事件提供技术保障,发挥主力军作用。     

The impact of unstable angina guidelines in the triage of emergency department patients with possible acute coronary syndrome.

OBJECTIVE: The primary aim of this study is to determine whether implementing the Agency for Health Care Policy and Research (AHCPR) Unstable Angina Practice Guideline improves emergency physician's decision making in patients with symptoms of possible acute coronary syndrome (ACS), including those for whom the diagnosis of unstable angina is uncertain. METHODS: The authors conducted a prospective guideline implementation trial with pre-post design in the emergency departments of 1 university hospital and 1 university-affiliated community teaching hospital from January 2000 to May 2001. They enrolled 1140 adults who presented with chest pain or other symptoms of possible ACS. The intervention included the following: 1) physician training in use of the AHCPR risk groups, 2) algorithm for risk stratification, and 3) group feedback. To determine how accurately physicians interpreted the guideline algorithm, the authors compared their risk ratings with actual guideline risk groups. RESULTS: No significant difference in physician triage decisions was observed between baseline and intervention periods. Analysis of physician's risk ratings during the intervention period revealed low overall concordance with actual guideline risk groups (kappa = 0.31); however, physician's risk ratings showed superior discrimination in identifying patients with confirmed ACS (receiver operating characteristic [ROC] area .81 v. .74, P = 0.008). Strict adherence to guideline recommendations would have resulted in hospitalizing 9% more non-ACS patients without lowering the rate of missed ACS. CONCLUSION: Implementation of the AHCPR guideline did not improve triage decisions in emergency department patients with possible ACS. Assessing physician triage solely based on concordance with the AHCPR guideline may not accurately reflect the quality of patient care.     

The effect of outreach workers'' educational efforts on disadvantaged preschool children''s use of preventive services.

A special program of outreach services was implemented to assist a poverty population to appropriately use health services in the Kaiser-Permanente Medical Care Program. A study was conducted to determine the effect of outreach workers' intervention on the use of preventive services by this population. Intially, families were divided into two groups, one with and one without outreach workers. Outreach workers (neighborhood health coordinators) were trained in prevention and health education. They were then assigned to specific subgroups of the poverty population to teach the importance of preventive services and to motivate persons to use these services. This paper focuses on the effect of outreach workers' services on the use of selected preventive care services (immunizations and tine test) by preschool children from poverty families. Preschool children in families with coordinator services had higher use rates for preventive care. The sub-group for which outreach workers were specially trained to focus on preventive procedures for the pre-school group had markedly higher use rates for preventive care. The findings suggest that special intervention programs, using indigenous and nonprofessional outreach workers, can increase preventive service utilization by poverty groups.     

Anaphylaxis after vaccination of children: Review of literature and recommendations for vaccination in child and school health services in Belgium

Background

Concerns about the very small, but real risk of anaphylaxis after vaccination, has given rise to specific questions about the safe administration of vaccines to children and adolescents in the context of preventive settings (i.e. well baby clinics and school health services). As a support to preventive health professionals a guideline based on scientific evidence and supported by professional consensus was developed in Belgium.

Methods

First, a draft of guideline was written based on a review of international literature. Second, through several rounds of consultation professional consensus about the document was obtained across the Belgian communities and professional groups, and in a final version endorsed by the Belgian Superior Health Council in July 2012.

Results

In a literature overview information is given about the definition of anaphylaxis, allergens in vaccines potentially causing anaphylaxis, published incidence rates of anaphylaxis after vaccination, and strategies for first-aid management of anaphylaxis. The Belgian guideline on the prevention of anaphylaxis after vaccination includes recommendations on prevaccination risk assessment, the content of the emergency kit, measures to be taken after vaccination, differential diagnosis and first-aid management of anaphylaxis.

Conclusion

The guideline, summarized as a flowchart for the prevention and first-aid management of anaphylaxis, is considered as the actual state of the art in Belgium for vaccination of children and youngsters in preventive health services, and may inspire governmental bodies and/or professional groups in other countries to adopt similar recommendations.     

Social differences and indicators of perceived health, chronic diseases, disability and life style in the 1994. ISTAT national health interview survey

In this paper social differences in health, analysed by different dimensions (perceived health, chronic diseases, functional deficits and disability) and social differences in lifestyle, in particular smoking habit and use of health services for the prevention of some female tumours, are described. The study is based on the data collected in the National Interview Survey on Health Status and Use of Health Care Services, conducted by ISTAT in the 1994. The analysis has been performed separately for males and females, computing Prevalence Rate Ratios (PRR) standardized by age. Educational level and social class, based on Schizzerotto's classification, have been used as determinants of differences in health and lifestyle. Unfavourable perception of health status and most of chronic diseases, referred as diagnosed by a doctor, show an increasing prevalence with decreasing educational level. Less striking differences are observed in the occurrence of injuries and in the restriction of daily life activities caused by diseases. A lower educational level corresponds to a regular increase in the proportion of disabled subjects. Females show higher differences than males in overweight and underweight prevalences in favour of more educated. Smoking habit shows an inverse correlation with education in males and a direct correlation in females, while attempts to quit smoking are more common among more educated individuals. Among women, the tendency to use screening tests for the prevention of some tumours is directly proportional to the educational level. Similar findings were obtained using the social class, with small bourgeoisie and working class showing similar excess risks, compared to bourgeoisie. This study found significant social inequalities in health status and in lifestyle in Italian population in 1994. The discussion argues that in absence of preventive interventions on disadvantaged groups of the population an increase of social differences in health is predictable.