Addressing childhood obesity at school entry: qualitative experiences of school health professionals

School entry provides an opportune moment for health professionals to intervene with children who are overweight, yet identification and management of childhood obesity presents challenges in practice. This mixed-method qualitative study explored the experiences of 26 school health professionals of addressing childhood obesity at school entry. Methods included semi-structured interviews with service managers (n=3); focus groups with school nurses (n=12) and child health practitioners (n=6); and open-ended questionnaires with school nurses (n=4) and child health practitioners (n=1) who were unable to attend the focus groups. A thematic analysis revealed agreement between service managers, school nurses and child health practitioners. Whilst it was felt school health professionals have an important role to play in managing childhood obesity, efforts to address child weight were limited by a lack of capacity, lack of clear protocols, challenges of engaging parents and insufficient training in childhood obesity and related lifestyle issues. School health policy-makers need to recognize childhood obesity as a serious public health issue, allocate appropriate resources to nurse training and development, and ensure clear pathways are established to ensure consistency of care

“You’ve Got to Pick Your Battles”: A Mixed-Methods Investigation of Physical Activity Counselling and Referral within General Practice

One in four people say they would be more active if advised by a general practitioner (GP), yet 72% of GPs do not discuss physical activity (PA) with patients and 80% of GPs are unaware of the PA guidelines. The aim of this study was therefore to investigate GP perspectives on PA counselling and referral and interpret these within the context of the socio-ecological model (SEM). Fifty-six GPs completed an online survey to investigate factors influencing PA counselling and referral. Semi-structured interviews were then conducted with seven GPs to explore topics in more depth. Interview data were analysed thematically and mapped to the SEM. GPs were more likely to discuss PA with patients if they were physically active themselves (p = 0.004). Influences on PA counselling and referral were identified at the policy (provision of education, priority), organisational (feedback, e-referral), interpersonal (PA as everybody’s business, patient factors) and intrapersonal (knowledge, GP PA levels) levels of the SEM. Multi-level strategies are required to help GPs promote PA and make use of exercise referral schemes, including making PA a strategic priority, introducing systems for feedback from referrals, and involving other members of the care team in PA counselling and referral

Parental views of children's physical activity: a qualitative study with parents from multi-ethnic backgrounds living in England

Background: Guidelines recommend children and young people participate in at least 60 min of physical activity (PA) every day, however, findings from UK studies show PA levels of children vary across ethnic groups. Since parents play an instrumental role in determining children’s PA levels, this article aims to explore parental views of children’s PA in a multi-ethnic sample living in a large city in the North-West of England. Methods: Six single-ethnic focus groups were conducted with 36 parents of school-aged children (4 to 16 years) with a predominantly low socio-economic status (SES). Parents self-identified their ethnic background as Asian Bangladeshi (n = 5), Black African (n = 4), Black Somali (n = 7), Chinese (n = 6), White British (n = 8) and Yemeni (n = 6). Focus group topics included understanding of PA, awareness of PA guidelines, knowledge of benefits associated with PA and perceived influences on PA in childhood. Data were analysed thematically using QSR NVivo 9.0. Results: Parents from all ethnic groups valued PA and were aware of its benefits, however they lacked awareness of PA recommendations, perceived school to be the main provider for children’s PA, and reported challenges in motivating children to be active. At the environmental level, barriers to PA included safety concerns, adverse weather, lack of resources and lack of access. Additional barriers were noted for ethnic groups from cultures that prioritised educational attainment over PA (Asian Bangladeshi, Chinese, Yemeni) and with a Muslim faith (Asian Bangladeshi, Black Somali, Yemeni), who reported a lack of culturally appropriate PA opportunities for girls. Conclusion: Parents from multi-ethnic groups lacked awareness of children’s PA recommendations and faced barriers to promoting children’s PA out of school, with certain ethnic groups facing additional barriers due to cultural and religious factors. It is recommended children’s PA interventions address influences at all socio-ecological levels, and account for differences between ethnic groups

Benefits of daddy play

The Fathers’ Engagement Project was designed to assess the impact and feasibility of a six week physically active play based programme on fathers’ engagement with their three to five year old children. Sessions were held at City based Children’s Centres. Fathers’ engagement and attitudes to child PA were measured pre- and post-intervention via questionnaire. Acceptability of the intervention was explored through participant and staff focus groups. Results from questionnaires showed that fathers felt more in control of their children and had increased awareness of their role in motivating their child to play. Fathers also suggested that sessions provided opportunities to spend quality time with their children despite there being no significant increase in the overall time fathers self-reported spending with their child during the week or at the weekend. A number of recommendations for both research and practice are provided

Systematic review of the methods used in economic evaluations of targeted physical activity and sedentary behaviour interventions

The burden of noncommunicable diseases (NCD) on health systems worldwide is substantial. Physical inactivity and sedentary behaviour are major risk factors for NCD. Previous attempts to understand the value for money of preventative interventions targeting physically inactive individuals have proved to be challenging due to key methodological challenges associated with the conduct of economic evaluations in public health. A systematic review was carried out across six databases (Medline, SPORTSDiscus, EconLit, PsychINFO, NHS EED, HTA) along with supplementary searches. The review examines how economic evaluations published between 2009-March 2017 have addressed methodological challenges with the aim of bringing to light examples of good practice for future studies. Fifteen economic evaluations from four high-income countries were retrieved; there is a dearth of studies targeting sedentary behaviour as an independent risk factor from physical activity. Comparability of studies from the healthcare and societal perspectives were limited due to analysts’ choice in cost categories, valuation technique and time horizon differing substantially. The scarcity of and inconsistencies across economic evaluations for these two behaviours have exposed a mismatch between calls for more preventative action to tackle NCD and the lack of information available on how resources may be optimally allocated in practice. Consequently, this paper offers a table of recommendations on how future studies can be improved

Fourier, hyperbolic and relativistic heat transfer equations: a comparative analytical study

[EN] Parabolic heat equation based on Fourier's theory (FHE), and hyperbolic heat equation (HHE), has been used to mathematically model the temperature distributions of biological tissue during thermal ablation. However, both equations have certain theoretical limitations. The FHE assumes an infinite thermal energy propagation speed, whereas the HHE might possibly be in breach of the second law of thermodynamics. The relativistic heat equation (RHE) is a hyperbolic-like equation, whose theoretical model is based on the theory of relativity and which was designed to overcome these theoretical impediments. In this study, the three heat equations for modelling of thermal ablation of biological tissues (FHE, HHE and RHE) were solved analytically and the temperature distributions compared. We found that RHE temperature values were always lower than those of the FHE, while the HHE values were higher than the FHE, except for the early stages of heating and at points away from the electrode. Although both HHE and RHE are mathematically hyperbolic, peaks were only found in the HHE temperature profiles. The three solutions converged for infinite time or infinite distance from the electrode. The percentage differences between the FHE and the other equations were larger for higher values of thermal relaxation time in HHE.This work received financial support from the Spanish Government (Ministerio de Ciencia e Innovacion, Ref. TEC2011-27133-C02-01).López Molina, JA.; Rivera Ortun, MJ.; Berjano, E. (2014). Fourier, hyperbolic and relativistic heat transfer equations: a comparative analytical study. Proceedings of the Royal Society A: Mathematical, Physical and Engineering Sciences. 470:1-16. https://doi.org/10.1098/rspa.2014.0547S11647

Exploring the validity of estimating EQ-5D and SF-6D utility values from the health assessment questionnaire in patients with inflammatory arthritis

<p>Abstract</p> <p>Background</p> <p>Utility scores are used to estimate Quality Adjusted Life Years (QALYs), applied in determining the cost-effectiveness of health care interventions. In studies where no preference based measures are collected, indirect methods have been developed to estimate utilities from clinical instruments. The aim of this study was to evaluate a published method of estimating the EuroQol-5D (EQ-5D) and Short Form-6D (SF-6D) (preference based) utility scores from the Health Assessment Questionnaire (HAQ) in patients with inflammatory arthritis.</p> <p>Methods</p> <p>Data were used from 3 cohorts of patients with: early inflammatory arthritis (<10 weeks duration); established (>5 years duration) stable rheumatoid arthritis (RA); and RA being treated with anti-TNF therapy. Patients completed the EQ-5D, SF-6D and HAQ at baseline and a follow-up assessment. EQ-5D and SF-6D scores were predicted from the HAQ using a published method. Differences between predicted and observed EQ-5D and SF-6D scores were assessed using the paired t-test and linear regression.</p> <p>Results</p> <p>Predicted utility scores were generally higher than observed scores (range of differences: EQ-5D 0.01 - 0.06; SF-6D 0.05 - 0.10). Change between predicted values of the EQ-5D and SF-6D corresponded well with observed change in patients with established RA. Change in predicted SF-6D scores was, however, less than half of that in observed values (p < 0.001) in patients with more active disease. Predicted EQ-5D scores underestimated change in cohorts of patients with more active disease.</p> <p>Conclusion</p> <p>Predicted utility scores overestimated baseline values but underestimated change. Predicting utility values from the HAQ will therefore likely underestimate the QALYs of interventions, particularly for patients with active disease. We recommend the inclusion of at least one preference based measure in future clinical studies.</p

Facebook, relatedness and exercise motivation in university students: a mixed methods investigation

Objectives: To examine the relationship between Facebook(FB) use, relatedness and exercise motivation. Design: Two studies comprised a mixed-methods concurrent design. Study 1 was a cross-sectional quantitative assessment of the relationships between FB use, relatedness and exercise motivation. Study 2 explored qualitative perceptions of how FB influences exercise motivation. Method: Study 1: 311 undergraduate students completed a survey assessing FB use, exercise motivation and relatedness. Mediation analysis was conducted to examine relationships. Study 2: 19 participants took part in focus groups exploring experiences of exercise-related FB use and its perceived role in motivation. Results: Study 1: FB use was related to external and introjected regulation. Relatedness mediated the relationships between FB use, introjection, and autonomous forms of motivation. Study 2: Qualitative data suggested FB can either promote (through connection, positive social comparison) or discourage exercise (through disconnection, negative social comparison, health-negating features). Conclusion: FB use was related to external and introjected regulation. Positive relationships between FB and autonomous forms of motivation were mediated by relatedness, suggesting that interventions should focus on fostering feelings of connection with others. FB use that encourages relatedness with like-minded individuals has potential to promote autonomous motivation for exercise

Facilitators and challenges in delivering a peer-support physical activity intervention for older adults: a qualitative study with multiple stakeholders

Background:Involving peer volunteers in intervention delivery can provide social support and improve adherence. Whilst such interventions have the potential to reduce physical activity (PA) intervention costs, little is known about the process of delivering them in practice. This qualitative study explored the facilitators and challenges of delivering a peer-support PA intervention for older adults, with a view to making recommendations for the delivery of future interventions.Methods: Data were collected via (7) semi-structured interviews and a focus group with stakeholders involved in a peer-support PA intervention for older adults in a large city in the North-West of England. Participants included local authority staff (n = 3), peer volunteers (n= 2) and service users (n = 7). Audio data were transcribed verbatim and thematically coded to identify perceived facilitators and challenges.Results:Facilitators to delivery included social interaction, community referral pathways, suitable facilities, peer volunteers and high-quality instructors. Challenges surrounded inconsistent practice, staff capacity, safety and accountability, and awareness raising.Conclusions:Peer volunteers can provide an additional support mechanism alongside qualified instructors for increasing social interaction within PA interventions. For optimal intervention delivery, consideration needs to be given to equipment and space, safety and accountability and consistency of practice

Persistence with anti-tumour necrosis factor therapies in patients with psoriatic arthritis: observational study from the British Society of Rheumatology Biologics Register

Objectives. To evaluate the risk–benefit profile of anti-TNF therapies in PsA and to study the predictors of treatment response and disease remission [disease activity score (DAS)-28 < 2.6]. Methods. The study included PsA patients (n = 596) registered with the British Society for Rheumatology Biologics Register (BSRBR). Response was assessed using the European League against Rheumatism (EULAR) improvement criteria. Univariate and multivariate logistic regression models were developed to examine factors associated with EULAR response and disease remission using a range of covariates. Poisson regression was used to calculate incidence rate ratios (IRRs) for serious adverse events (SAEs) vs seronegative RA controls receiving DMARDs, adjusting for age, sex and baseline co-morbidity. Results. At baseline, the mean (s.d.) DAS-28 was 6.4 (5.6). Of the patients, 70.3% were EULAR responders at 12 months. At 6 months, older patients [adjusted odds ratio (OR) 0.97 per year; 95% CI 0.95, 0.99], females (adjusted OR 0.51; 95% CI 0.34, 0.78) and patients on corticosteroids (adjusted OR 0.45; 95% CI 0.28, 0.72) were less likely to achieve a EULAR response. Over 1776.2 person-years of follow-up (median 3.07 per person), the IRR of SAEs compared with controls was not increased (0.9; 95% CI 0.8, 1.3). Conclusions. Anti-TNF therapies have a good response rate in PsA, and have an adverse event profile similar to that seen in a control cohort of patients with seronegative arthritis receiving DMARD therapy