Shared care obesity management in 3-10 year old children: 12 month outcomes of HopSCOTCH randomised trial

Objective: To determine whether general practice surveillance for childhood obesity, followed by obesity management across primary and tertiary care settings using a shared care model, improves body mass index and related outcomes in obese children aged 3-10 years. Design: Randomised controlled trial. Setting: 22 family practices (35 participating general practitioners) and a tertiary weight management service (three paediatricians, two dietitians) in Melbourne, Australia. Participants: Children aged 3-10 years with body mass index above the 95th centile recruited through their general practice between July 2009 and April 2010. Intervention: Children were randomly allocated to one tertiary appointment followed by up to 11 general practice consultations over one year, supported by shared care, web based software (intervention) or “usual care” (control). Researchers collecting outcome measurements, but not participants, were blinded to group assignment. Main outcome measures: Children’s body mass index z score (primary outcome), body fat percentage, waist circumference, physical activity, quality of diet, health related quality of life, self esteem, and body dissatisfaction and parents’ body mass index (all 15 months post-enrolment). Results: 118 (60 intervention, 56 control) children were recruited and 107 (91%) were retained and analysed (56 intervention, 51 control). All retained intervention children attended the tertiary appointment and their general practitioner for at least one (mean 3.5 (SD 2.5, range 1-11)) weight management consultation. At outcome, children in the two trial arms had similar body mass index (adjusted mean difference −0.1 (95% confidence interval −0.7 to 0.5; P=0.7)) and body mass index z score (−0.05 (−0.14 to 0.03); P=0.2). Similarly, no evidence was found of benefit or harm on any secondary outcome. Outcomes varied widely in the combined cohort (mean change in body mass index z score −0.20 (SD 0.25, range −0.97-0.47); 26% of children resolved from obese to overweight and 2% to normal weight. Conclusions: Although feasible, not harmful, and highly rated by both families and general practitioners, the shared care model of primary and tertiary care management did not lead to better body mass index or other outcomes for the intervention group compared with the control group. Improvements in body mass index in both groups highlight the value of untreated controls when determining efficacy.Melissa Wake, Kate Lycett, Susan A Clifford, Matthew A Sabin, Jane Gunn, Kay Gibbons, Cathy Hutton, Zoë McCallum, Sarah J Arnup, Gary Witter

The quality of reporting in cluster randomised crossover trials: proposal for reporting items and an assessment of reporting quality

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.SA was supported in part by a Monash University Graduate Scholarship and a National Health and Medical Research Council of Australia Centre of Research Excellence grant (1035261) to the Victorian Centre for Biostatistics (ViCBiostat). Funding was provided to KM through a National Institute for Health Research (NIHR) research methods fellowship (MET-12-16). JM was supported by a National Health and Medical Research Council (NHMRC) Australian Public Health Fellowship (1072366)

Unknowable bodies, unthinkable sexualities: lesbian and transgender legal invisibility in the Toronto women's bathhouse raid

Although litigation involving sexual orientation and gender identity discrimination claims has generated considerable public attention in recent years, lesbian and transgender bodies and sexualities still remain largely invisible in Anglo-American courts. While such invisibility is generally attributed to social norms that fail to recognize lesbian and transgender experiences, the capacity to 'not see' or 'not know' queer bodies and sexualities also involves wilful acts of ignorance. Drawing from R. v Hornick (2002) a Canadian case involving the police raid of a women's bathhouse, this article explores how lesbian and transgender bodies and sexualities are actively rendered invisible via legal knowledge practices, norms and rationalities. It argues that limited knowledge and limited thinking not only regulate the borders of visibility and belonging, but play an active part in shaping identities, governing conduct and producing subjectivity

Formar bem as mães para criar e educar boas crianças: as revistas portuguesas de educação familiar e a difusão da maternidade científica (1945-1958)

Este artigo tem como principal objetivo contribuir para a compreensão do processo de construção da maternidade científica em Portugal. Neste sentido, foi analisado um conjunto de artigos (n=628), publicados em revistas de educação familiar, entre 1945 e 1958. A análise realizada permitiu compreender que as revistas analisadas contribuem para a difusão da maternidade científica, ou seja, da ideia de que a aquisição de conhecimento científico sobre a criação e educação das crianças é elemento indispensável ao adequado exercício da função maternal. Observou-se, ainda, a existência de diferentes estratégias de educação para a maternidade, às quais está subjacente um elemento de classe, assim como diferentes níveis de adesão, por parte das mulheres, à concepção de maternidade científica

Understanding the cluster randomised crossover design::a graphical illustraton of the components of variation and a sample size tutorial

Abstract Background In a cluster randomised crossover (CRXO) design, a sequence of interventions is assigned to a group, or ‘cluster’ of individuals. Each cluster receives each intervention in a separate period of time, forming ‘cluster-periods’. Sample size calculations for CRXO trials need to account for both the cluster randomisation and crossover aspects of the design. Formulae are available for the two-period, two-intervention, cross-sectional CRXO design, however implementation of these formulae is known to be suboptimal. The aims of this tutorial are to illustrate the intuition behind the design; and provide guidance on performing sample size calculations. Methods Graphical illustrations are used to describe the effect of the cluster randomisation and crossover aspects of the design on the correlation between individual responses in a CRXO trial. Sample size calculations for binary and continuous outcomes are illustrated using parameters estimated from the Australia and New Zealand Intensive Care Society – Adult Patient Database (ANZICS-APD) for patient mortality and length(s) of stay (LOS). Results The similarity between individual responses in a CRXO trial can be understood in terms of three components of variation: variation in cluster mean response; variation in the cluster-period mean response; and variation between individual responses within a cluster-period; or equivalently in terms of the correlation between individual responses in the same cluster-period (within-cluster within-period correlation, WPC), and between individual responses in the same cluster, but in different periods (within-cluster between-period correlation, BPC). The BPC lies between zero and the WPC. When the WPC and BPC are equal the precision gained by crossover aspect of the CRXO design equals the precision lost by cluster randomisation. When the BPC is zero there is no advantage in a CRXO over a parallel-group cluster randomised trial. Sample size calculations illustrate that small changes in the specification of the WPC or BPC can increase the required number of clusters. Conclusions By illustrating how the parameters required for sample size calculations arise from the CRXO design and by providing guidance on both how to choose values for the parameters and perform the sample size calculations, the implementation of the sample size formulae for CRXO trials may improve

Early childhood nutrition, active outdoor play and sources of information for families living in highly socially disadvantaged locations

Aims: To compare nutrition and active play of children aged 0–4 years attending Supported Playgroups and mainstream services and to compare access, understanding and application of health information within these families