Interventions for Childhood Obesity Control in Cyprus: An analysis and Evaluation of Programmes and Protocols

In the last twenty years, there has been an increase in the prevalence of obesity with a simultaneous increase in chronic diseases.Aim: The aim of this literature review is to discuss available interventions for childhood obesity (2-11 years) and to propose effective prevention policies for the Republic of Cyprus.Methods: Childhood obesity prevention and intervention programs in Cyprus were analysed using SWOT analysis and evaluation protocols for compatibility and sustainability among health professionals andgovernment partners.Results: The preliminary literature review reveals that there are specific short comings with regards to the existing NHS and public health. The sustainability of existing health policies and implemented programs is questionable as there are no coherent monitoring systems in place. There are many worthwhile programsand organizations that are often delayed due to conflict of interest.Conclusions: Analysis shows that the implementation, via a Cypriot National Health System, of public health strategies could be effective means of addressing specifically childhood obesity. This includes a more active role for the family physician and policies of a multi- level strategy, aiming as fostering innovative public-private healthcare collaborations, supported by educational institutions, infrastructure, legislation and the wider society.However, such strategies are needed on a long-term basis and throughout a person’s life span

International Physical Activity and Built Environment Study of Adolescents : IPEN Adolescent design, protocol and measures

Introduction: Only international studies can provide the full variability of built environments and accurately estimate effect sizes of relations between contrasting environments and health-related outcomes. The aims of the International Physical Activity and Environment Study of Adolescents (IPEN Adolescent) are to estimate the strength, shape and generalisability of associations of the community environment (geographic information systems (GIS)-based and self-reported) with physical activity and sedentary behaviour (accelerometer-measured and self-reported) and weight status (normal/overweight/obese). Methods and analysis: The IPEN Adolescent observational, cross-sectional, multicountry study involves recruiting adolescent participants (ages 11-19 years) and one parent/guardian from neighbourhoods selected to ensure wide variations in walkability and socioeconomic status using common protocols and measures. Fifteen geographically, economically and culturally diverse countries, from six continents, participated: Australia, Bangladesh, Belgium, Brazil, Czech Republic, Denmark, Hong Kong SAR, India, Israel, Malaysia, New Zealand, Nigeria, Portugal, Spain and USA. Countries provided survey and accelerometer data (15 countries), GIS data (11), global positioning system data (10), and pedestrian environment audit data (8). A sample of n=6950 (52.6% female; mean age=14.5, SD=1.7) adolescents provided survey data, n=4852 had 4 or more 8+ hours valid days of accelerometer data, and n=5473 had GIS measures. Physical activity and sedentary behaviour were measured by waist-worn ActiGraph accelerometers and self-reports, and body mass index was used to categorise weight status. Ethics and dissemination: Ethical approval was received from each study site's Institutional Review Board for their in-country studies. Informed assent by adolescents and consent by parents was obtained for all participants. No personally identifiable information was transferred to the IPEN coordinating centre for pooled datasets. Results will be communicated through standard scientific channels and findings used to advance the science of environmental correlates of physical activity, sedentary behaviour and weight status, with the ultimate goal to stimulate and guide actions to create more activity-supportive environments internationally

Exploring the effectiveness of the design-led intervention in reducing screen time and enhancing exercise for children in the home environment

Considering the rapid rise in obesity, this thesis suggests the notion that obesity can be tackled beyond conventional ways. It is widely reported in the literature that the epidemic of obesity is only going to get worse in the next 10 years. A change is needed to allow people to have more control over living healthier through improving physical and social environments, as these have a strong influence in shaping lifestyles. Existing research is converging on the view that modifying lifestyle behaviours is a viable approach to tackling this global epidemic. Therefore, this thesis proposes a unique intervention approach, focused on instigating sustainable behaviour through a design-led intervention. This novel approach attempted to facilitate a change in participants' sedentary lifestyles and prompt daily exercise behaviours. Physical inactivity amongst children and young people has been identified as a serious public health concern in relation to increases in obesity, with figures on screen time reaching a worrisome peak. The current study demonstrated that making small changes to people's daily routine could result in habitualising healthier behaviours. This thesis further analysed some fundamental theories/models that have been applied in stimulating behaviour changes in different disciplines. Following a thorough literature review of a broad range of behavioural change studies, including reported case studies, a framework was developed. It proposed the stages of intended habitualisation of this new behaviour and informed the development of a research tool artefact which was employed for the main study of this thesis. To evaluate the effectiveness of this intervention, a longitudinal study called the Domestic User Study (DUS) was undertaken to discover the habitual changes over time in home environments. A total of 20 households participated in DUS and used the prototype (design-led intervention) for a total duration of three months. Their behaviour change data were captured through means of monitoring, pre/post interviews, and mid/post surveys. The evaluation explored three fundamental research questions: 1) Did the design-led intervention help in building exercise behaviour? 2) Has the user's TV watching behaviour changed as a result of the design-led intervention? 3) Has Knudgbox created habitualised sustainable behaviour? Some key constructs were emerged to form the theoretical framework of this thesis and were measured throughout the DUS. The results uncovered the key determinants that influenced participants' behaviour when exposed to the design-led intervention. After a comprehensive analysis, three main dimensions are presented that constitute the user habitualisation process: visual feedback, user empowerment, and regulation. The joint impact of these dimensions on sustainable behaviour suggests that, when incorporated, they can bring forth habitual changes in the target demographic and beyond. Overall, this study suggests that design-led interventions can have a positive effect on instigating exercise behaviour in the home environment. The recommended behaviour habitualisation model should be considered in the future implementation of design led approaches in order to improve the chances of success

Parenting in the 21st Century

In this Special Issue, we present a collection of articles that cover the unique opportunities and challenges of parenting in the 21st century. We have identified three themes across the articles: managing stress; support for effective parenting; and emphasis on fostering competence for an uncertain future. First, although the studies did not use data to test for differences between cohorts of parents, the results suggested that stress is a normal state for parents today, and especially for certain groups of parents. Second, despite high stress among parents, the articles point at some important support systems for parents in the 21st century. For example, although technology can be a stressor, it can also be a useful tool to enhance the parent-child relationship for parents of adolescents or young adults. Finally, in the third theme, we saw an emphasis on promoting a mix of competencies emphasizing both autonomy and relatedness in children and speculate that parents see these competences as tools to help the child to deal with an uncertain future.Results from this Special Issue illustrate the impact of societal changes on parenting. The findings can be used to develop programs and policies to provide support to diverse parents in handling today’s stressors, ranging from technology to racism to excessive pressures for parental “success”. They also point to important research gaps in understanding the task of parenting in the 21st century

P06. Clinical Reasoning in Medicine: Developing Students' metacognitive skills

This poster outlines the introduction of formal Clinical Reasoning Skills sessions - initially a Student Selected Component (SSC) - as compulsory sessions in the core second year curriculum. Observations of 4th and 5th Year students’ performances in live examinations and student feedback indicated that, despite having excellent core communication skills, students struggled with the skills needed for effective analytical thinking when faced with complex diagnostic challenges.A three week SSC was designed around current research introducing students to the concepts underpinning the process of clinical reasoning. This SSC is founded on experiential practice where students analyse their thought processes and hypothetico-deductive reasoning governing the choices and conclusions reached whilst interviewing patients. All sessions are conducted in small interactive groups with experienced simulated patients and academic clinician tutors. Student feedback was extremely positive; all students felt these sessions must become part of the core undergraduate curriculum. The iterative processes required for developing higher order thinking skills in students are described