A High-Precision Protocol for Identification of Preschool Children at Risk for Persisting Obesity

BACKGROUND:Recent studies suggest that adolescent adiposity is established already in preadolescence. Earlier studies have confirmed a strong tracking of obesity from adolescence to adulthood. Our aim was to examine the diagnostic accuracy of a population-derived protocol for identification of preschool children at risk for obesity in preadolescence. METHODOLOGY/PRINCIPAL FINDINGS:We analysed data obtained for child health surveillance up to age 5 from 5778 children born in a Swedish county in 1991. The basic data set included age, sex, and weight and height measurements from the regular checkups between ages 1.5 and 5. Data not routinely collected in the child health centre setting were disregarded. The children were at age 10 randomly assigned to protocol derivation and validation cohorts and assessed for obesity according to IOTF criteria. The accuracy of predicting obesity in the validation cohort was measured using decision precision, specificity, and sensitivity. The decision protocol selected 1.4% of preschool children as being at obesity risk. The precision of the protocol at age 10 was 82% for girls and 80% for boys, and the specificity was 100% for both boys and girls. The sensitivity was higher for girls (41%) than for boys (21%). The relative risk for obesity at age 10 estimated by the odds ratio for individuals selected by the protocol compared to non-selected peers was 212.6 (95% confidence interval 56.6 to 798.4) for girls and 120.3 (95% CI 24.5 to 589.9) for boys. CONCLUSION/SIGNIFICANCE:A simple and inexpensive decision protocol based on BMI values proved to have high precision and specificity for identification of preschool children at risk for obesity persisting into adolescence, while the sensitivity was low especially for boys. Implementation and further evaluations of the protocol in child health centre settings are warranted

Family-based behavioural intervention programme for obese children: a feasibility study

OBJECTIVES: To assess a 2-year family-based behavioural intervention programme against child obesity. DESIGN: Single-group pre- and post-intervention feasibility study. SETTING: Swedish paediatric outpatient care. PARTICIPANTS: 26 obese children aged 8.3-12.0 years and their parents who had consented to actively participate in a 2-year intervention. INTERVENTIONS: 25 paediatric outpatient group sessions over a 2-year period with parallel groups for children and parents. The basis for the programme was a manual containing instructions for tutor-supervised group sessions with obese children and their parents. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was change in standardised body mass index between baseline and after 36 months. The secondary outcome measures were change in the waist:height ratio, metabolic parameters and programme adherence. The participants were examined at baseline and after 3, 12 and 24 months of therapy and at follow-up 12 months after completion of the programme. RESULTS: The primary outcome measure, standardised body mass index, declined from a mean of 3.3 (0.7 SD) at baseline to 2.9 (0.7 SD) (p<0.001) at follow-up 12 months after completion of the programme. There was no change in the waist:height ratio. Biomedical markers of blood glucose metabolism and lipid status remained in the normal range. 96% of the families completed the programme. CONCLUSIONS: This feasibility study of a 2-year family-based behavioural intervention programme in paediatric outpatient care showed promising results with regard to further weight gain and programme adherence. These findings must be confirmed in a randomised controlled trial with longer follow-up before the intervention programme can be implemented on a larger scale

Organizational approaches to the forming of strategic partnership of enterprises of region

Систематизовано організаційні підходи до формування стратегічного партнерства підприємств, що існують у вітчизняній та зарубіжній науковій літературі. Виділено цільовий, або проблемно-орієнтовний, підхід, первинним етапом якого є встановлення стратегічних цілей; ресурсно-компетенційний підхід, який засновано на визначенні наявних ресурсів та компетенцій підприємств – потенційних партнерів, та проектний підхід, згідно з яким формування стратегічного партнерства підприємств пов’язано з реалізацією сукупності проектів. Обґрунтовано функціональний, або структурний, підхід, що передбачає включення у партнерство підприємств тих галузей, які є ключовими та які визначають спеціалізацію регіону. Використання запропонованого підходу забезпечить комплексний соціально-економічний розвиток господарства регіону.Organizational approaches to forming of strategic partnership of enterprises which exist in domestic and foreign scientific literature are systematized. Target, or problem-orientated, approach the primary stage of which is establishment of strategic aims; resource-competent approach which is based on determination of present resources and jurisdictions of enterprises – potential partners, and project approach, according to which the forming of strategic partnership of enterprises is related with the realization of complex of projects are selected. Functional, or structural, approach, which foresees plugging in partnership of enterprises of those industries which are key and which determine specialization of region is grounded. Offered approach has the followings stages: determination of regional type and basic industries of industrial production, successful development of which will become the key factor of regional economic development; formulation of strategic aims of enterprises of priority industries according to norms and normative correlations, set the most perfect technologies, by organization of production on the whole and separate subsystems of enterprises which are utilized in the proper industries in Ukraine and world; estimation by the enterprises of present and necessary resources and jurisdictions, determination of potential partners after the criterion of presence of necessary resources and jurisdictions and choice of enterprises – potential partners, clarification of strategic and operative aims of strategic partnership that formalize the relations of enterprises-partners. The use of this approach will provide complex socio-economic development of economy of region

Family-based behavioural intervention program for obese children : an observational study of child and parent lifestyle interpretations

Background Family-based behavioural intervention programs (FBIPs) against childhood obesity have shown promising results, but the mediating mechanisms have not been identified. The aim of this study was to examine changes in obese childreńs lifestyle habits during a 2-year FBIP according to their own and parents’ reports, the concordance between these reports and the correlations to change in post-intervention z-BMI. Methods An observational study of 26 children (8.3–12.0 years) and their parents participating in a 2-year FBIP was performed. Weight and height were measured from baseline to 12 months after the end of the program. Eating habits and physical- and sedentary activity were reported separately by children and parents. Data were analysed with regard to concordance between parents’ and children’s reports and association between the lifestyle reports and change in z-BMI at the study endpoint using descriptive statistics and parametric and non-parametric tests. Results According to both children’s and parents’ reports, the level of physical activity among the children had increased after the intervention as well as the agreement between the informants’ reports. According to the children, eating habits had improved, while the parents’ reports showed an improvement only with regard to binge eating. The concordance between children and parents regarding eating habits was slight to fair also after the intervention. No statistically significant associations between changes in lifestyle reports and changes in z-BMI were observed. Conclusions Child and parent reports of physical activity were found to converge and display an improvement in a 2-year FBIP, while the reports on eating habits showed a more refractory pattern. Changes in concordance and agreement between children and parents reports did not correlate with weight reduction. Further methods development and studies of the processes during family-based interventions against childhood obesity are warranted

Diagnostic accuracy of decision protocol to be used at the age 5 checkup for selection of children at risk for persisting obesity.

<p>OR = odds ratio</p><p>95% CI = 95% confidence interval</p

Diagnostic accuracy of the three best performing decision rules extracted from the derivation cohort for selection of children at risk for persisting obesity at the 5-year checkup. All other rule combinations displayed poorer decision preformance.

<p>OR = odds ratio</p><p>95% CI = 95% confidence interval</p

Univariate logistic regression analyses using derivation cohort data with regard to association to obesity at age 10.

<p>OR = odds ratio</p><p>95% CI = 95% confidence interval</p><p>Early adiposity rebound = Adiposity rebound before age 5 (y/n)</p><p>Age at adiposity rebound = Adiposity rebound at age 2½ years, 4 years or at age 5 years and later.</p><p>BMI change = BMI at 5 years/BMI at 1½ years</p

Diagnostic accuracy at the age 10 of obesity prediction at age 5 using cut-off points at BMI values 16–20.

<p>OR = odds ratio</p><p>95% CI = 95% confidence interval</p><p>The variables in final inductive model extracted from the derivation cohort using stepwise logistic regression were BMI at age 5 and sex. Variables not included in the model were BMI at the ages 1½, 2½, and 4 years, age at adiposity rebound, BMI change, BMI at adiposity rebound, and early adiposity rebound.</p

Protocol assessment according to the STARD procedure.

<p>Protocol assessment according to the STARD procedure.</p