The implementation of a family-focused lifestyle programme for managing childhood obesity in the community setting in Ireland

Background and aim: Childhood obesity is a significant public health issue. International guidelines continue to recommend family-focused, multicomponent, childhood weight management programmes despite limited evidence on their effectiveness or implementation in real-world settings. In 2014, the Irish Health Service proposed a national pilot of the W82GO-community programme. The overall aim of this thesis was to investigate the barriers and facilitators to the implementation of W82GO-community and explore the factors influencing family engagement. Methods: W82GO-community aimed to improve nutrition, increase physical activity and facilitate behaviour change in children aged 5-7 years who measured ≥98th percentile over one year. It was piloted in two community sites by two multidisciplinary teams from April 2015 to April 2016. Firstly, a qualitative study was conducted to explore implementation from the perspective of 29 national and local level stakeholders responsible for implementing the programme including professionals from dietetics, psychology, public health nursing, physiotherapy, health promotion and administration. Framework analysis was used to identify barriers and facilitators which were mapped onto a well-known implementation framework. Secondly, a systematic review of international literature was carried out to investigate what factors influence attendance at similar community-based lifestyle programmes among families of overweight or obese children. This was followed by another qualitative study exploring public health nurses (PHNs) experiences of referring families to, and families’ feelings of being referred to, W82GO-community. It also investigated families’ motivation to participate in and complete treatment. Finally, in light of findings from the aforementioned studies a cross-sectional analysis of data collected as part of the Cork Children’s Lifestyle Survey (CCLaS) was conducted to identify factors influencing parent and child misperception of child weight. Results: For all stakeholders, barriers to the implementation of W82GO-community arose due to the multidisciplinary nature of the programme, including the lack of role clarity and added complexity of working in different locations. Furthermore, a lack of parental engagement, as evidenced by low enrolment and retention rates, presented a further challenge for programme implementation. Of the 121 children who were eligible for initial assessment, less than half of families accepted the invitation and of those who presented, 19 subsequently started the programme. Just eight families completed the W82GO-community programme. The systematic review on barriers and facilitators to family attendance and retention found that parents are largely driven to enrol because of a concern for their child’s psychological health and wellbeing. However, the stigma surrounding excess weight and the denial of the issue amongst some parents presents significant barriers to enrolment. The systematic review findings also suggest that over the course of a programme, children’s positive social experiences such as having fun and making friends foster the desire to continue participating in treatment. Results from our qualitative study involving PHNs and parents who participated in W82GO-community found that both PHNs and parents were fearful of the referral process. They had concerns about both the practicality of making the referral and the significance of the referral on the health and wellbeing of the child, respectively. Despite these initial fears, parents concern for their child’s future was a major driver behind their participation. Finally, the cross-sectional analysis of CCLaS data highlighted that 45% of parents of overweight/obese children underestimated their child’s weight and this was influenced by child age and child misperception of own weight. 77% of overweight/obese children misclassified their own weight. Conclusion: This thesis provides critical evidence on the complexities associated with implementing a multidisciplinary childhood weight management programme in real-world settings. It provides practical recommendations to guide future policy makers, programme delivery teams and researchers, in particular, when developing strategies to boost recruitment, minimise attrition and subsequently enhance effectiveness. Findings highlight the profound limitations of family-focused, community-based, weight management programmes and confirm the critical need for broader societal intervention

Barriers and facilitators to the implementation of a community-based, multidisciplinary, family focused childhood weight management programme in Ireland: a qualitative study

Objective: To explore the barriers and facilitators experienced by those implementing a government-funded, community-based childhood weight management programme. Design: Qualitative using semistructured interviews. Setting Two geographical regions in the south and west of Ireland. Participants 29 national-level and local-level stakeholders responsible for implementing the programme, including professionals from dietetics, psychology, public health nursing, physiotherapy, health promotion and administration. Methods Framework analysis was used to identify barriers and facilitators, which were mapped onto six levels of factors influencing implementation outlined by Grol and Wensing: the innovation, the individual professional, the patient, the social context, the organisational context and the external environment. Results Most barriers occurred at the level of the organisational context. For all stakeholders, barriers arose due to the multidisciplinary nature of the programme, including the lack of role clarity and added complexity of working in different locations. Health professionals’ low-perceived self-efficacy in approaching the subject of weight with parents and parental resistance to hearing about their child’s weight status were barriers to programme implementation at the individual professional and patient levels, respectively. The main facilitators of implementation, occurring at the level of the health professional, included stakeholders’ recognition of the need for a weight management programme and personal interest in the area of childhood obesity. Having a local lead and supportive colleagues were further implementation drivers. Conclusions This study highlights the complexities associated with implementing a multidisciplinary childhood weight management programme, particularly translating such a programme to a community setting. Our results suggest the assignment of clear roles and responsibilities, the provision of sufficient practical training and resources, and organisational support play pivotal roles in overcoming barriers to change. This evidence can be used to develop an implementation plan to support the translation of interventions into real-world settings

Barriers and facilitators to initial and continued attendance at community-based lifestyle programmes among families of overweight and obese children: a systematic review

The success of childhood weight management programmes relies on family engagement. While attendance offers many benefits including the support to make positive lifestyle changes, the majority of families referred to treatment decline. Moreover, for those who do attend, benefits are often compromised by high programme attrition. This systematic review investigated factors influencing attendance at community-based lifestyle programmes among families of over-weight or obese children. A narrative synthesis approach was used to allow for the inclusion of quantitative, qualitative and mixed-method study designs. Thirteen studies met the inclusion criteria. Results suggest that parents provided the impetus for programme initiation, and this was driven largely by a concern for their child's psychological health and wellbeing. More often than not, children went along without any real reason or interest in attending. Over the course of the programme, however, children's positive social experiences such as having fun and making friends fostered the desire to continue. The stigma surrounding excess weight and the denial of the issue amongst some parents presented barriers to enrolment and warrant further study. This study provides practical recommendations to guide future policy makers, programme delivery teams and researchers in developing strategies to boost recruitment and minimise attrition

Understanding engagement in a family-focused, multicomponent, childhood weight management programme delivered in the community setting

Objective: To describe public health nurses’ (PHN) experiences of referring to, and families’ experiences of being referred to, a multicomponent, community-based, childhood weight management programme and to provide insight into families’ motivation to participate in and complete treatment. Design: Qualitative study using semi-structured interviews and the draw-and-write technique. Setting: Two geographical regions in the south and west of Ireland. Participants: Nine PHN involved in the referral process, as well as ten parents and nine children who were referred to and completed the programme, participated in the present study. Results: PHN were afraid of misclassifying children as obese and of approaching the subject of excess weight with parents. Peer support from other PHN as well as training in how best to talk about weight with parents were potential strategies suggested to alleviate these fears. Parents recalled the anxiety provoked by the ‘medical terminology’ used during referral and their difficulty interpreting what it meant for the health of their child. Despite initial fears, concern for their children’s future health was a major driver behind their participation. Children’s enjoyment, the social support experienced by parents as well as staff enthusiasm were key to programme completion. Conclusions: The present study identifies the difficulties of referring families to community weight management programmes and provides practical suggestions on how to support practitioners in making referrals. It also identifies key positive factors influencing parents’ decisions to enrol in community weight management programmes. These should be maximised by staff and policy makers when developing similar programmes

Telephone delivered incentives for encouraging adherence to supervised methadone consumption (TIES): study protocol for a feasibility study for an RCT of clinical and cost effectiveness

The majority of people receiving treatment for their heroin addiction, are prescribed methadone; for which there is an extensive evidence base. When treatment starts, people take their daily dose of methadone under supervision at a community pharmacy. Supervision guarantees methadone is taken as directed by the individual for whom it has been prescribed, helps to ensure individuals take their correct dose every day, and safeguards against diversion and overdose. However, individuals often fail to attend the pharmacy to take their methadone. Each missed dose is of concern. If a patient misses their daily dose of methadone, they will start to experience opiate withdrawal and cravings and are more likely to use heroin. If they miss three days dose, there are concerns that they may lose tolerance to the drug and may be at risk of overdose when the next dose is taken. Hence there is an urgent need to develop effective interventions for medication adherence. Research suggests that incentive-based medication adherence interventions may be very effective, but there are few controlled trials and the provision of incentives requires time and organisational systems which can be challenging in pharmacies. The investigators have developed the technology to deliver incentives by mobile telephone. This cluster randomised trial will test the feasibility of conducting a future trial evaluating the clinical and cost effectiveness of using telephone delivered incentives (praise and modest financial rewards via text messaging) to encourage adherence with supervised consumption of methadone in community pharmacies. Three drug services (each with two or three community pharmacies supervising methadone consumption that will enrol 20 individuals, a total of 60 participants) will be recruited and randomly allocated to deliver either i) telephone delivered incentives, ii) telephone delivered reminders or iii) no telephone system. Acceptability, recruitment, follow-up, and suitable measures of clinical and cost effectiveness will be assessed. Findings from this feasibility study will be assessed against stated progression criteria and used to inform a future confirmatory trial of the clinical and cost effectiveness of telephone delivered incentives to encourage medication adherence. ISRCTN58958179 (retrospectively registered). [Abstract copyright: © 2019 Published by Elsevier Inc.

How do men in the United Kingdom decide to dispose of banked sperm following cancer treatment?

Current policy in the UK recommends that men bank sperm prior to cancer treatment, but very few return to use it for reproductive purposes or agree to elective disposal even when their fertility recovers and their families are complete. We assessed the demographic, medical and psychological variables that influence the decision to dispose by contacting men (n = 499) who banked sperm more than five years previously, and asked them to complete questionnaires about their views on sperm banking, fertility and disposal. From 193 responses (38.7% response rate), 19 men (9.8%) requested disposal within four months of completing the questionnaire. Compared with men who wanted their sperm to remain in storage, they were significantly more confident that their fertility had recovered (OR = 1.78, 95% CI = 1.05-3.03, p = 0.034), saw fertility monitoring (semen analysis) as less important (OR = 0.61, 95% CI = 0.39-0.94, p = 0.026), held more positive attitudes to disposal (OR = 5.71, 95% CI = 2.89-11.27, p < 0.001), were more likely to have experienced adverse treatment side-effects (OR = 4.37, CI = 1.61-11.85, p = 0.004) and had less desire for children in the future (OR = 0.41, 95% CI = 0.26-0.64, p < 0.001). Information about men's reasons to dispose of banked sperm may be helpful in devising new strategies to encourage men to engage with sperm banking clinics and make timely decisions about the fate of their samples

The 1 April 2014 Iquique, Chile, M w

On 1 April 2014, a great (Mw8.1) interplate thrust earthquake ruptured in the northern portion of the 1877 earthquake seismic gap in northern Chile. The sequence commenced on 16 March 2014 with a magnitude 6.7 thrust event, followed by thrust-faulting aftershocks that migrated northward ~40km over 2weeks to near the main shock hypocenter. Guided by short-period teleseismic P wave backprojections and inversion of deepwater tsunami wave recordings, a finite-fault inversion of teleseismic P and SH waves using a geometry consistent with long-period seismic waves resolves a spatially compact large-slip (~2-6.7m) zone located ~30km downdip and ~30km along-strike south of the hypocenter, downdip of the foreshock sequence. The main shock seismic moment is 1.7×1021N m with a fault dip of 18°, radiated seismic energy of 4.5-8.4×1016J, and static stress drop of ~2.5MPa. Most of the 1877 gap remains unbroken and hazardous. © 2014. American Geophysical Union. All Rights Reserved

How many human proteoforms are there?

Despite decades of accumulated knowledge about proteins and their post-translational modifications (PTMs), numerous questions remain regarding their molecular composition and biological function. One of the most fundamental queries is the extent to which the combinations of DNA-, RNA- and PTM-level variations explode the complexity of the human proteome. Here, we outline what we know from current databases and measurement strategies including mass spectrometry-based proteomics. In doing so, we examine prevailing notions about the number of modifications displayed on human proteins and how they combine to generate the protein diversity underlying health and disease. We frame central issues regarding determination of protein-level variation and PTMs, including some paradoxes present in the field today. We use this framework to assess existing data and to ask the question, "How many distinct primary structures of proteins (proteoforms) are created from the 20,300 human genes?" We also explore prospects for improving measurements to better regularize protein-level biology and efficiently associate PTMs to function and phenotype