Medical Family Therapy Meets Childhood Obesity

The dissertation is a compilation of two journal articles. The first article is a literature review that addresses integrated care for childhood obesity with consideration for clinical, operational, and financial practices. The purpose of the first article is to explore the evolution of pediatric care for children who are overweight by addressing: 1) terms, recent expert recommendations, 2) a structure for synthesizing clinical, operational, and financial practices, and 3) recommendations that bridge medical and other healthcare options for pediatric overweight patients and their families. The second article is an exploration of longitudinal systemic experiences of childhood obesity with children and their families who participated in research at the Pediatric Healthy Weight Research and Treatment Center. The purpose of this article is to identify changes in outcomes from initial visits at the PHWRTC to follow-up visits. In addition, we explored variables associated with or predictive of the variability in changes from the initial visits to follow-up visits. Outcomes for children and caregivers included: quality of life, depression, and relative body mass index.  Ph.D

Quality of life and BMI changes in youth participating in an integrated pediatric obesity treatment program

Background Changes in Quality of Life (QOL) measures over time with treatment of obesity have not previously been described for youth. We describe the changes from baseline through two follow up visits in youth QOL (assessed by the Pediatric Quality Life Inventory, PedsQL4.0), teen depression (assessed by the Patient Health Questionnaire, PHQ9A), Body Mass Index (BMI) and BMI z-score. We also report caregiver proxy ratings of youth QOL. Methods A sample of 267 pairs of youth and caregiver participants were recruited at their first visit to an outpatient weight-treatment clinic that provides care integrated between a physician, dietician, and mental health provider; of the 267, 113 attended a visit two (V2) follow-up appointment, and 48 attended visit three (V3). We investigated multiple factors longitudinally experienced by youth who are overweight and their caregivers across up to three different integrated care visits. We determined relationships at baseline in QOL, PHQ9A, and BMI z-score, as well as changes in variables over time using linear mixed models with time as a covariate. Results Overall across three visits the results indicate that youth had slight declines in relative BMI, significant increases in their QOL and improvements in depression. Conclusions We encourage clinicians and researchers to track youth longitudinally throughout treatment to investigate not only youth’s BMI changes, but also psychosocial changes including QOL

Parents\u27 Reports of Children\u27s Physical and Sedentary Behavior Engagement among Parents in Weight Management

Background: The purpose of this study was to explore the associations between demographics, family exercise participation, family discouragement of exercise, and the children\u27s physical and sedentary behaviors to identify specific areas of physical activity intervention for children with parents engaged in medical weight management (MWM). Methods: Parents (n = 294) of children aged 2-18 years old were recruited from two university MWM programs to complete a one-time survey. Bivariate analyses tested associations. Results: Parents reported that sedentary activity was higher for children who identified as racial minorities (t(141) = -2.05, p \u3c 0.05). Mobile phone and tablet use was higher for adolescents compared to school age and young children (H(2) = 10.96, p \u3c 01) Exercise game use was higher for racial minority children compared to white children (U = 9440.5, z = 2.47, p ≤ 0.03). Male children (t(284) = 1.83, p \u3c 0.07), children perceived to have a healthy weight status (t(120) = 4.68, p \u3c 0.00), and younger children (t(289) = 1.79, p \u3c 0.08) all engaged in more strenuous physical activity. Family exercise participation (t(162) = -2.93, p \u3c 0.01) and family discouragement of exercise (U = 7813.50, z = -2.06, p ≤ 0.04) were significantly higher for children in racial minority families. Conclusions: Future work should determine methods to engage children and their parents participating in MWM in physical activities together to ensure that the changes the parents are making with MWM are sustainable

Towards understanding resprouting at the global scale

Understanding and predicting plant response to disturbance is of paramount importance in our changing world. Resprouting ability is often considered a simple qualitative trait and used in many ecological studies. Our aim is to show some of the complexities of resprouting while highlighting cautions that need be taken in using resprouting ability to predict vegetation responses across disturbance types and biomes. There are marked differences in resprouting depending on the disturbance type, and fire is often the most severe disturbance because it includes both defoliation and lethal temperatures. In the Mediterranean biome, there are differences in functional strategies to cope with water deficit between resprouters (dehydration avoiders) and nonresprouters (dehydration tolerators); however, there is little research to unambiguously extrapolate these results to other biomes. Furthermore, predictions of vegetation responses to changes in disturbance regimes require consideration not only of resprouting, but also other relevant traits (e.g. seeding, bark thickness) and the different correlations among traits observed in different biomes; models lacking these details would behave poorly at the global scale. Overall, the lessons learned from a given disturbance regime and biome (e.g. crown-fire Mediterranean ecosystems) can guide research in other ecosystems but should not be extrapolated at the global scale.This work was performed under the framework of the TREVOL projects (CGL2012-39938-C02-01 to J.G.P.) from the Spanish Government. A.L.J., R.B.P., A.V. and S.P. were supported by the following grants: IOS-1252232 (NSF), IOS-0845125 (NSF), CGL-2011-30531-CO2-02 (SURVIVE Project, Spain), ID-1120458 (Fondo Nacional de Desarrollo Científico y Tecnológico, FONDECYT, Chile), respectively

Promising insights into the health related quality of life for children with severe obesity

Background Childhood obesity is a growing health concern known to adversely affect quality of life in children and adolescents. The Patient Reported Outcomes Measurement Information System (PROMIS) pediatric measures were developed to capture child self-reports across a variety of health conditions experienced by children and adolescents. The purpose of this study is to begin the process of validation of the PROMIS pediatric measures in children and adolescents affected by obesity. Methods The pediatric PROMIS instruments were administered to 138 children and adolescents in a cross-sectional study of patient reported outcomes in children aged 8–17 years with age-adjusted body mass index (BMI) greater than the 85th percentile in a design to establish known-group validity. The children completed the depressive symptoms, anxiety, anger, peer relationships, pain interference, fatigue, upper extremity, and mobility PROMIS domains utilizing a computer interface. PROMIS domains and individual items were administered in random order and included a total of 95 items. Patient responses were compared between patients with BMI 85 to < 99th percentile versus ≥ 99th percentile. Results 136 participants were recruited and had all necessary clinical data for analysis. Of the 136 participants, 5% ended the survey early resulting in missing domain scores at the end of survey administration. In multivariate analysis, patients with BMI ≥ 99th percentile had worse scores for depressive symptoms, anger, fatigue, and mobility (p < 0.05). Parent-reported exercise was associated with better scores for depressive symptoms, anxiety, and fatigue (p < 0.05). Conclusions Children and adolescents ranging from overweight to severely obese can complete multiple PROMIS pediatric measures using a computer interface in the outpatient setting. In the 5% with missing domain scores, the missing scores were consistently found in the domains administered last, suggesting the length of the assessment is important. The differences in domain scores found in this study are consistent with previous reports investigating the quality of life in children and adolescents with obesity. We show that the PROMIS instrument represents a feasible and potentially valuable instrument for the future study of the effect of pediatric obesity on quality of life

Effects of management regimes on structure, composition and diversity of seasonally inundated herbaceous communities in the Mkomazi National Park, Tanzania

The effects of management regimes on structural composition and diversity of seasonally inundated herbaceous communities were investigated in the Mkomazi National Park, Tanzania. Three sites were selected based on management regimes, that is "fire-grazing" (FG), "fire-no grazing" (FNG) and "no fire-no grazing" (NFNG), and sampled in the 2015 wet season. The studied vegetation parameters resulted significantly different across the sites, with the exceptions of species abundance between NFNG versus FG and NFNG versus FNG sites and species evenness, which remained constant among sites. A significantly higher species richness, Shannon diversity Index, standing biomass and percentage vegetation cover was detected at FNG site, than in the other sites. No significant differences arose when comparing FG and NFNG sites. Although the responses we found may in part be caused by confounding underlying variables such as variation in soil type, soil moisture or elevation, the patterns found may contribute to a more general understanding of the effects of management regimes in seasonally inundated savannah, as well as to sound approaches in environmental conservation and management. However, further research is needed to support our findings, replicating the study in other areas under the same or similar management conditions and in a wider array of ecosystems. 2018 John Wiley & Sons Ltd

Promising insights into the health related quality of life for children with severe obesity

Abstract Background Childhood obesity is a growing health concern known to adversely affect quality of life in children and adolescents. The Patient Reported Outcomes Measurement Information System (PROMIS) pediatric measures were developed to capture child self-reports across a variety of health conditions experienced by children and adolescents. The purpose of this study is to begin the process of validation of the PROMIS pediatric measures in children and adolescents affected by obesity. Methods The pediatric PROMIS instruments were administered to 138 children and adolescents in a cross-sectional study of patient reported outcomes in children aged 8–17 years with age-adjusted body mass index (BMI) greater than the 85th percentile in a design to establish known-group validity. The children completed the depressive symptoms, anxiety, anger, peer relationships, pain interference, fatigue, upper extremity, and mobility PROMIS domains utilizing a computer interface. PROMIS domains and individual items were administered in random order and included a total of 95 items. Patient responses were compared between patients with BMI 85 to < 99th percentile versus ≥ 99th percentile. Results 136 participants were recruited and had all necessary clinical data for analysis. Of the 136 participants, 5% ended the survey early resulting in missing domain scores at the end of survey administration. In multivariate analysis, patients with BMI ≥ 99th percentile had worse scores for depressive symptoms, anger, fatigue, and mobility (p < 0.05). Parent-reported exercise was associated with better scores for depressive symptoms, anxiety, and fatigue (p < 0.05). Conclusions Children and adolescents ranging from overweight to severely obese can complete multiple PROMIS pediatric measures using a computer interface in the outpatient setting. In the 5% with missing domain scores, the missing scores were consistently found in the domains administered last, suggesting the length of the assessment is important. The differences in domain scores found in this study are consistent with previous reports investigating the quality of life in children and adolescents with obesity. We show that the PROMIS instrument represents a feasible and potentially valuable instrument for the future study of the effect of pediatric obesity on quality of life

Cumulative effects of fire and drought in Mediterranean ecosystems

Altres ajuts: Enric Batllori thanks the support of a Marie Curie International Incoming Fellowship (PIFF-GA-2013-625547) and Miquel De Caceres the support of a Spanish Ramon y Cajal Fellowship. Lluís Brotons and Francisco Lloret thank the support of the projects FORESTCAST, NEWFORESTS,INFORMED, SECADIN, and BIOCLIM.The occurrence of multiple disturbances can jointly affect the recovery capacity of ecosystems, potentially leading to changes in vegetation dynamics or loss of resilience. The effects of interacting disturbances on ecosystems are, however, not well understood. We use a model system based on Mediterranean-type ecosystems (MTEs) to examine how the interplay between vegetation regeneration traits and compound, stochastic disturbances modulate ecosystem dynamics. We developed a state-and-transition simulation model including two tree species with contrasting regeneration strategies (seeder vs. resprouter) and a shrubland formation. We aim to assess potential compositional switches under contrasted scenarios of compound fire-drought regimes, and to characterize the cumulative effects of fire-drought (synergism vs. antagonism) relative to the effects of individual disturbance regimes. Our simulation results indicate that interaction between moderate fire and sporadic drought recurrence-as opposed to chronic dryness-can act as a strong mechanism generating highly heterogeneous landscapes in which different regeneration types coexist, as observed in MTEs. Resprouters dominated under individual, moderate disturbance regimes of fire or drought, whereas the interaction of the two disturbances promoted the long-term coexistence of both tree regeneration strategies. However, shrubland expansion and persistence at the expanse of forests was favored by increases in drought recurrence and associated fire-drought interactions, highlighting the potential for important vegetation changes in MTEs under climate change. Overall, the cumulative effects of fire and drought can lead to distinct landscape configurations under moderate disturbance regimes that are otherwise only attained under high frequency of individual disturbances. At the ecosystem level, however, we suggest that disturbance-induced vegetation dynamics can modify vegetation sensitivity and resilience to further disturbances precluding the prevalence of synergistic effects of the two disturbances

Non-invasive assessment of adrenocortical activity as a measure of stress in giraffe (Giraffa camelopardalis)

Additional file 1: Full dataset in Microsoft Excel workbook format.BACKGROUND : Numbers of giraffes are declining rapidly in their native habitat. As giraffe research and conservation efforts increase, the demand for more complete measures of the impact of conservation interventions and the effects of captive environments on animal health and welfare have risen. We compared the ability of six different enzyme immunoassays to quantify changes in fecal glucocorticoid metabolites (FGM) resulting from three sources: adrenocorticotropic hormone stimulation test, transport, and time of day that samples were collected. RESULTS : Two male giraffes underwent ACTH injections; all six assays detected FGM increases following injection for Giraffe 1, while only three assays detected FGM increases following injection for Giraffe 2. Consistent with other ruminant species, the two 11-oxoetiocholanolone assays (one for 11,17-dioxoandrostanes and the other for 3α,11-oxo metabolites) measured the most pronounced and prolonged elevation of FGM, while an assay for 3β,11β-diol detected peaks of smaller magnitude and duration. Both of the 11-oxoetiocholanolone assays detected significant FGM increases after transport in Giraffes 3–7, and preliminary data suggest FGM detected by the assay for 11,17-dioxoandrostanes may differ across time of day. CONCLUSIONS : We conclude the assay for 11,17-dioxoandrostanes is the most sensitive assay tested for FGM in giraffes and the assay for FGM with a 5β-3α-ol-11-one structure is also effective. 11-oxoetiocholanolone enzyme immunoassays have now been demonstrated to be successful in a wide variety of ruminant species, providing indirect evidence that 5β-reduction may be a common metabolic pathway for glucocorticoids in ruminants. As FGM peaks were detected in at least some giraffes using all assays tested, giraffes appear to excrete a wide variety of different FGM. The assays validated here will provide a valuable tool for research on the health, welfare, and conservation of giraffes.The Association of Friends and Supporters of Goethe University Frankfurt provided financial support for F. Sicks to travel to Vienna to analyze fecal samples and von Opel Hessische Zoostiftung supported a studentship for F. Sicks. One commercial funder [Tierpark Berlin] provided support in the form of salary for F. Sicks during data analysis and preparation of this manuscript. The specific role of this author is articulated in the ‘Author Contributions’ section.http://www.biomedcentral.com/bmcvetresam2016Anatomy and PhysiologyParaclinical Science