Economic and other barriers to adopting recommendations to prevent childhood obesity: results of a focus group study with parents

Abstract Background Parents are integral to the implementation of obesity prevention and management recommendations for children. Exploration of barriers to and facilitators of parental decisions to adopt obesity prevention recommendations will inform future efforts to reduce childhood obesity. Methods We conducted 4 focus groups (2 English, 2 Spanish) among a total of 19 parents of overweight (BMI ≥ 85th percentile) children aged 5-17 years. The main discussion focused on 7 common obesity prevention recommendations: reducing television (TV) watching, removing TV from child's bedroom, increasing physically active games, participating in community or school-based athletics, walking to school, walking more in general, and eating less fast food. Parents were asked to discuss what factors would make each recommendation more difficult (barriers) or easier (facilitators) to follow. Participants were also asked about the relative importance of economic (time and dollar costs/savings) barriers and facilitators if these were not brought into the discussion unprompted. Results Parents identified many barriers but few facilitators to adopting obesity prevention recommendations for their children. Members of all groups identified economic barriers (time and dollar costs) among a variety of pertinent barriers, although the discussion of dollar costs often required prompting. Parents cited other barriers including child preference, difficulty with changing habits, lack of information, lack of transportation, difficulty with monitoring child behavior, need for assistance from family members, parity with other family members, and neighborhood walking safety. Facilitators identified included access to physical activity programs, availability of alternatives to fast food and TV which are acceptable to the child, enlisting outside support, dietary information, involving the child, setting limits, making behavior changes gradually, and parental change in shopping behaviors and own eating behaviors. Conclusions Parents identify numerous barriers to adopting obesity prevention recommendations, most notably child and family preferences and resistance to change, but also economic barriers. Intervention programs should consider the context of family priorities and how to overcome barriers and make use of relevant facilitators during program development.http://deepblue.lib.umich.edu/bitstream/2027.42/78270/1/1471-2431-9-81.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78270/2/1471-2431-9-81.pdfPeer Reviewe

The formation and evolution of binary systems. III. Low-mass binaries in the Praesepe cluster

With the aim of investigating the binary population of the 700 Myr old Praesepe cluster, we have observed 149 G and K-type cluster members using adaptive optics. We detected 26 binary systems with an angular separation ranging from less than 0.08 to 3.3 arcsec (15-600 AU). After correcting for detection biases, we derive a binary frequency (BF) in the logP (days) range from 4.4 to 6.9 of 25.3 +/- 5.4%, which is similar to that of field G-type dwarfs (23.8%, Duquennoy & Mayor 1991). This result, complemented by similar ones obtained for the 2 Myr old star forming cluster IC 348 (Paper II) and the 120 Myr old Pleiades open cluster (Paper I), indicates that the fraction of long-period binaries does not significantly evolve over the lifetime of galactic open clusters. We compare the distribution of cluster binaries to the binary populations of star forming regions, most notably Orion and Taurus, to critically review current ideas regarding the binary formation process. We conclude that it is still unclear whether the lower binary fraction observed in young clusters compared to T associations is purely the result of the early dynamical disruption of primordial binaries in dense clusters or whether it reflects intrinsically different modes of star formation in clusters and associations. We also note that if Taurus binaries result from the dynamical decay of small-N protostellar aggregates, one would predict the existence of a yet to be found dispersed population of mostly single substellar objects in the Taurus cloud.Comment: 10 pages, 3 figure

Time to incorporate time in cost-effectiveness analysis

Cost-effectiveness analysis as a means to evaluate medical innovations has become well accepted in the UK and several other Western countries. An important assumption underlying this method is that costs and effects are constant over time. In reality, however, and especially in the short run, variations in costs and effects are likely to occur. These variations can lead to considerable deviations from the outcome of a conventional economic evaluation, which in turn may lead to serious implementation problems at a local level. Taking time into account explicitly in economic evaluations in health care may enhance their utility for both societal and local decision making, and may ultimately smooth the adoption of new and basically cost-effective health care technologies

Photometry and membership for low mass stars in the young open cluster NGC 2516

We present the results of a 0.86 square degree CCD photometric survey of the open cluster NGC 2516, which has an age of about 150 Myr and may have a much lower metallicity than the similarly-aged Pleiades. We select a preliminary catalogue of 1254 low mass (between 0.2 and 2.0M_{sun}) cluster candidates, of which about 70--80 percent are expected to be genuine. The mass function is metallicity dependent, but consistent with a Salpeter-like law (dN/dlog M ~ M^{-alpha}, alpha=+1.47+/-0.11 or alpha=+1.67+/-0.11 for solar and half-solar metallicities) between 0.7 and 3.0M_{sun}. At lower masses (between 0.3 and 0.7M_{sun}) there is a sharp fall in the mass function, with alpha=-0.75+/-0.20 (solar metallicity) or alpha=-0.49+/-0.13 (half-solar metallicity), which seems inconsistent with the much flatter mass functions seen in the Pleiades and field populations. We explain this by demonstrating that mass segregation has been at work in NGC 2516 -- more than half the cluster low mass stars are expected to lie outside out survey. The mass of NGC 2516 stars with mass greater than 0.3M_{sun} inside our survey is 950-1200M_{sun}, depending on metallicity and what corrections are applied for unresolved binarity. Correcting for mass segregation increases this to ~1240-1560M_{sun}, about twice the total mass of the Pleiades.Comment: 27 pages, accepted for Astronomy & Astrophysic

The Impact of Pandemic Influenza H1N1 on Health-Related Quality of Life: A Prospective Population-Based Study

BACKGROUND: While the H1N1v influenza pandemic in 2009 was clinically mild, with a low case-fatality rate, the overall disease burden measured in quality-adjusted life years (QALY) lost has not been estimated. Such a measure would allow comparison with other diseases and assessment of the cost-effectiveness of pandemic control measures. METHODS AND FINDINGS: Cases of H1N1v confirmed by polymerase chain reaction (PCR) and PCR negative cases with similar influenza-like illness (ILI controls) in 7 regions of England were sent two questionnaires, one within a week of symptom onset and one two weeks later, requesting information on duration of illness, work loss and antiviral use together with EQ-5D questionnaires. Results were compared with those for seasonal influenza from a systematic literature review. A total QALY loss for the 2009 pandemic in England was calculated based on the estimated total clinical cases and reported deaths. A total of 655 questionnaires were sent and 296 (45%) returned. Symptoms and average illness duration were similar between confirmed cases and ILI controls (8.8 days and 8.7 days respectively). Days off work were greater for cases than ILI controls (7.3 and 4.9 days respectively, p  =  0.003). The quality-adjusted life days lost was 2.92 for confirmed cases and 2.74 for ILI controls, with a reduction in QALY loss after prompt use of antivirals in confirmed cases. The overall QALY loss in the pandemic was estimated at 28,126 QALYs (22,267 discounted) of which 40% was due to deaths (24% with discounting). CONCLUSION: Given the global public health significance of influenza, it is remarkable that no previous prospective study of the QALY loss of influenza using standardised and well validated methods has been performed. Although the QALY loss was minor for individual patients, the estimated total burden of influenza over the pandemic was substantial when compared to other infectious diseases

On the universal outcome of star-formation: Is there a link between stars and brown-dwarfs?

(abridged) The recent evidence obtained by Briceno et al. that star-formation in Taurus-Auriga (TA) may be producing significantly fewer brown dwarfs (BDs) per star than the ONC is investigated by setting up a realistic model stellar plus BD population and explicitly taking into account a high binary proportion and dynamical evolution in the TA groups and the ONC. The Briceno result is reproduced almost exactly despite an identical IMF in both systems because many BD-BD and star-BD binaries are disrupted in the ONC thus freeing BDs, while the TA groups remain unevolved dynamically. However, the resulting populations do not have the correct star-star, star-BD and expecially BD-BD binary properties, even if a variable BD IMF is allowed for. The conclusion is therefore that BDs need to be added as a separate population which has its own binary properties. Such an extra population can have various origins which are briefly discussed in this contribution but more fully in an associated paper.Comment: MNRAS, accepted, 23 pages, 14 figures, LaTeX, two references adde