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Quality of life in patients and in family members of those receiving home parenteral support with intestinal failure: A systematic review.
Sowerbutts, AM, Jones, D, Lal, S, Burden, S
Clinical nutrition (Edinburgh, Scotland). 2021;(5):3210-3220
Abstract
BACKGROUND & AIMS People with type 3 intestinal failure require regular home parenteral support (HPS) for survival. Intestinal failure is a long term condition and HPS is a burdensome treatment so understanding quality of life (QoL) and how people live with HPS over time is essential. The aim of this review was to assess the impact of HPS on QoL in adults receiving HPS and their family members. METHODS A systematic review (PROSPERO 2020 CRD42020166197) of the literature was performed using MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trails, PsycInfo, Web of Science and PROSPERO. Included articles were hand searched to identify any other relevant studies. Eligibility assessment was performed independently by two reviewers in an unblinded standardised manner. Quality was assessed using appropriate Joanna Briggs Institute critical appraisal tools. Data were extracted independently by two reviewers using predefined data fields. Certainty of evidence was assessed using GradePro. RESULTS Included in this review were 12 studies with 1236 patients receiving HPS. There were 10 observational studies and 2 randomised controlled trials. Only studies examining QoL in adults receiving HPS were found. There were no studies examining QoL in family carers of these patients. The quality of evidence was graded as low to high and the certainty of evidence for QoL was graded as very low to low. It was not possible to perform a meta-analysis so a narrative review was conducted. All of the studies considered quality of life using validated questionnaires. QoL of patients receiving HPS was lower than the general population regarding physical functioning. Patients had a higher QoL the fewer nights each week they received HPS. CONCLUSIONS HPS prescriptions seemed to influence QoL. However, the certainty of evidence was very low to low so there is very little to limited confidence about the effect of HPS on patient QoL. Research into family members' QoL is lacking and requires further investigation.
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Feasibility, acceptability, and effectiveness of a multidisciplinary intervention in childhood obesity from primary care: Nutrition, physical activity, emotional regulation, and family.
Sepúlveda, AR, Solano, S, Blanco, M, Lacruz, T, Veiga, O
European eating disorders review : the journal of the Eating Disorders Association. 2020;(2):184-198
Abstract
Childhood obesity is a growing problem with a complex aetiology, for which multidisciplinary interventions are required. Our programme describes a novel structured psychosocial family-based intervention targeting the emotional regulation in childhood obesity, using a train trip metaphor aimed at improving healthy lifestyles for the family. The aims were (a) to describe the feasibility and acceptability of this psychosocial family-based intervention among children with overweight or obesity in primary care and (b) to examine the effectiveness of the "ENTREN-F" programme (with family intervention) compared with the "ENTREN" programme (without family intervention) among Spanish children regarding anthropometric variables, physical activity, emotional well-being, and family functioning. Children were randomly allocated to either ENTREN-F programme (n = 30) or psychological intervention for children (ENTREN, n = 40), and assessments were carried out over time (T0 baseline vs. T1 post/6-month vs. T2 6-month follow-up). Both parent groups expressed high levels of satisfaction with the interventions. ENTREN-F resulted in higher adherence to treatment and was more effective in improving z-body mass index, reducing children's anxiety, and increasing family adaptability than the ENTREN programme. There were no significant changes in parents' emotional well-being and expressed emotion. Both groups improved in the children's emotional well-being and light physical activity. In summary, this multidisciplinary psychosocial family-based intervention was succesful.
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ADHD symptoms across adolescence: the role of the family and school climate and the DRD4 and 5-HTTLPR genotype.
Brinksma, DM, Dietrich, A, de Bildt, A, Buitelaar, JK, van den Hoofdakker, BJ, Hoekstra, PJ, Hartman, CA
European child & adolescent psychiatry. 2020;(8):1049-1061
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Abstract
We examined bidirectional relations between attention-deficit/hyperactivity disorder (ADHD) symptoms and family and school climate, and the possible role of DRD4 and/or 5-HTTLPR genotypes herein. Three-wave longitudinal data of 1860 adolescents (mean ages 11, 13.5, and 16 years) from the general population and clinic-referred cohort of TRacking Adolescents' Individual Lives Survey were used. Using a multigroup Random Intercept Cross-Lagged Panel Model, we tested between-person (i.e., stable trait levels) and within-person (i.e., causal processes) associations across ADHD symptoms, family and school climate, and the extent to which these depended on genotype. Findings indicated no influence of genotype. Results did show significant between-person differences (ADHD symptoms with family climate r = .38; and school climate r = .23, p values < .001), indicating that higher stable levels of ADHD symptoms were associated with a less favorable family and school climate. Regarding within-person causal processes, ADHD symptoms predicted a less favorable family climate in early adolescence (β = .16, p < .01), while ADHD symptoms predicted a more favorable family climate in the later phase of adolescence (β = - .11, p < .01), a finding which we explain by normative developmental changes during adolescence. Overall, this study showed that negative associations between ADHD symptoms and both family and school climate are largely explained by stable between-person differences. We recommend applying the Random Intercept Cross-Lagged Path Model to developmental data to tease stable associations and change processes apart.
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Results of the 3 Pillars Study (3PS), a relationship-based programme targeting parent-child interactions, healthy lifestyle behaviours, and the home environment in parents of preschool-aged children: A pilot randomised controlled trial.
Marsh, S, Taylor, R, Galland, B, Gerritsen, S, Parag, V, Maddison, R
PloS one. 2020;(9):e0238977
Abstract
BACKGROUND Early childhood is a critical period for the development of obesity, with new approaches to prevent obesity in this age group needed. We designed and piloted the 3 Pillars Study (3PS), a healthy lifestyle programme informed by attachment theory for parents of preschool-aged children. METHODS A 2-arm, randomised controlled pilot study was conducted to assess the effectiveness of 3PS, a 6-week programme involving a half-day workshop plus 6-week access to a study website. The programme was designed to promote routines around healthy lifestyle behaviours, including sleep, limited screen use, and family meals, within the context of positive, reciprocal parent-child interactions. Parents (n = 54) of children aged 2-4 years who regularly exceeded screen use recommendations (≥1 hour per day), were randomised to the 3PS programme (n = 27) or a wait-list control group (n = 27). Child screen time at 6 weeks was the primary endpoint. Frequency of family meals, parent feeding practices, diet quality, sleep, Child Routine Inventory (to assess predictability of commonly occurring routines), and household chaos were also assessed. Study data were collected online at baseline, 6 weeks, and 12 weeks via REDCap. RESULTS No group differences were observed for changes from baseline in screen time (primary endpoint), feeding behaviour scores, Child Routine Inventory scores, or total night time sleep duration at 6 and 12 weeks, although all measures improved in the hypothesised direction in the 3PS group. Compared with controls, the intervention group demonstrated significant improvements from baseline in household chaos scores (i.e. a reduction in chaos) and a number of measures of sleep outcomes, indicating improved sleep continuity. The programme was highly acceptable to parents. CONCLUSIONS AND RECOMMENDATIONS A relational approach appears promising as a novel way to promote healthy lifestyle behaviours associated with the prevention of childhood obesity in children aged 2-4 years. A larger study is warranted.
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Predictors of the dietary inflammatory index in children and associations with childhood weight status: A longitudinal analysis in the Lifeways Cross-Generation Cohort Study.
Navarro, P, Shivappa, N, Hébert, JR, Mehegan, J, Murrin, CM, Kelleher, CC, Phillips, CM, ,
Clinical nutrition (Edinburgh, Scotland). 2020;(7):2169-2179
Abstract
BACKGROUND & AIMS The family environment can influence offspring diet and weight status. Obesity is a pro-inflammatory state, which is associated with the dietary inflammatory index (DII®). Predictors of the DII in children (C-DII™) and its associations with childhood obesity are relatively unknown. We evaluated the intergenerational relationships between the energy-adjusted DII (E-DII) scores in adults, predictors of C-DII and associations with childhood weight status. METHODS The study comprises 551 children and index-child's mothers, fathers and grandparents in the Lifeways Cross-Generation Cohort Study. E-DII scores were generated at baseline for expectant mothers, fathers, and grandparents, and at 5-year follow-up for the mothers and children, using a validated food frequency questionnaire. Body mass index (BMI) and waist circumference were determined at age 5 and 9 years. Associations were assessed by logistic regression and mediation analysis. RESULTS Higher C-DII scores indicating a more pro-inflammatory diet among children, were associated with greater risk of childhood obesity at age 5 (OR:1.09; 95%CI:1.00-1.37; P = 0.02) and overweight/obese status at 5 and 9 years (OR:1.06; 95%CI:1.01-1.09; P = 0.01 and OR:1.12; 95%CI:1.07-1.18; P = 0.01, respectively). Maternal and paternal smoking during pregnancy (OR:1.98; 95%CI:1.19-3.03; P = 0.001 and OR:1.64; 95%CI:1.12-2.49; P = 0.006, respectively) increased likelihood of higher C-DII at age 5. Child BMI, TV watching and all meals given by the childcare provider were associated with a more pro-inflammatory diet (P < 0.05), whereas breastfeeding and family meals at home were associated with a more anti-inflammatory diet (P < 0.04). Higher maternal, but not paternal, E-DII scores during pregnancy (P < 0.001) and at 5-year follow-up (P = 0.008) were associated with more pro-inflammatory diet at age 5. Results from the mediation analysis suggest that maternal grandmothers E-DII scores may influence C-DII indirectly via the mothers E-DII scores. CONCLUSIONS A more pro-inflammatory dietary score was associated with childhood overweight and obesity. Parental, familial and personal factors independently influenced the C-DII score.
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A RE-AIM evaluation of Healthy Together: a family-centred program to support children's healthy weights.
Bottorff, JL, Huisken, A, Hopkins, M, Nesmith, C
BMC public health. 2020;(1):1754
Abstract
BACKGROUND Healthy Together (HT) is family-centered program to support healthy eating and physical activity designed for implementation in community organizations serving families who may be experiencing vulnerabilities (e.g., related to low income, isolation, ethnicity, immigrant/refugee status, and/or Indigenous background). The purpose of this study was to conduct an evaluation of HT in a real-world, scale-up phase using the RE-AIM framework. METHODS Using a cross-sectional, non-comparative design, a community-based program evaluation was conducted in 29 organizations implementing HT as part of their core service programs. Data were collected using questionnaires with program participants and facilitators, and interviews with directors of participating organizations. Quantitative data were analyzed using descriptive statistics and qualitative data were content analyzed. RESULTS With regards to Reach, over 3400 caregivers, children and youth attended community programming that offered HT. Among those attending on the scheduled day for the evaluation, 663 completed the questionnaires. The majority of caregiver respondents (n = 431) were female (92%) and attended with children 0-6 years. Respondents also included children 4-6 years (n = 142) and 7-12 years (n = 65), and youth 13-18 years (n = 25). Effectiveness was demonstrated in reported improvements in physical activity, healthy eating, and strengthened social connections. HT was also widely supported by participants and facilitators. Adoption was influenced by the desire to enrich core service programs for families, HT's fit within existing programs, organizational commitment, and funding support. Implementation experiences indicated that fidelity to the HT program was generally maintained, with some setting specific adaptations. Maintenance of HT was influenced by financial and non-financial resources within community organizations. Most organizations also introduced new initiatives to extend support for healthy eating and physical activity. CONCLUSION Our findings indicate improvements in healthy eating and physical activity, and social connections among program participants, as well as efforts by community organizations to create environments to support healthy weights. HT was successfully delivered in "real-world" community settings across multiple contexts and with families with diverse backgrounds. This along with strategies to support program implementation and sustainability indicate that HT provides a model for other public health interventions to promote family health and wellbeing. TRIAL REGISTRATION ClincialTrials.gov NCT03550248. Registered May 25, 2018.
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Keys to healthy family child care homes: Results from a cluster randomized trial.
Ward, DS, Vaughn, AE, Burney, RV, Hales, D, Benjamin-Neelon, SE, Tovar, A, Østbye, T
Preventive medicine. 2020;:105974
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Early care and education settings, such as family child care homes (FCCHs), are important venues for children's health promotion. Keys to Healthy Family Child Care Homes evaluated a FCCH-based intervention's impact on children's diet and physical activity. This study enrolled 496 children aged 1.5-4 years and 166 FCCH providers into a cluster-randomized control trial (intervention = 242 children/83 FCCHs, control = 254 children/83 FCCHs) conducted during 2013-2016. The 9-month intervention addressed provider health, health of the FCCH environment, and business practices, and was delivered through three workshops, three home visits, and nine phone calls. The attention control arm received a business-focused intervention. Primary outcomes were children's diet quality (2 days of observed intakes summarized into Healthy Eating Index scores) and moderate to vigorous physical activity (3 days of accelerometry) at the FCCH. Secondary outcomes were child body mass index (BMI), FCCH provider health behaviors, and FCCH nutrition and physical activity environments and business practices. Repeated measures analysis, using an intent-to-treat approach, accounting for clustering of children within FCCHs and adjusting for child age, sex, and BMI, was used to evaluate change (completed in 2018). Compared to controls, intervention children significantly improved their diet quality (5.39, p = .0002, CI = 2.53, 8.26) but not MVPA (0.31, p = .195, CI = -0.16, 0.79). Intervention FCCH providers significantly improved their diet quality and several components of their FCCH environment (i.e., time provided for physical activity, use of supportive physical activity practices, and engagement in nutrition and physical activity education/professional development). FCCHs are malleable settings for health promotion, especially diet quality. TRIAL REGISTRATION This study is registered at www.clinicaltrials.govNCT01814215.
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Mental and physical health effects of meaningful work and rewarding family responsibilities.
Dich, N, Lund, R, Hansen, ÅM, Rod, NH
PloS one. 2019;(4):e0214916
Abstract
Positive feelings about work and family responsibilities benefit psychological well-being, but their physical health effects remain unexplored. The study assessed whether meaningful work and reward from taking care of family benefitted physical health to the same degree as mental health. Participants were 181 Danes aged 49-51. Participants reported on working conditions, providing care to family, depressive symptoms, and perceived stress. Physical health was operationalized as a physiological dysregulation (e.g., hypertension, high levels of blood sugar and cholesterol, high body mass index). A multidimensional index of physiological dysregulation was created using parameters of cardiovascular, metabolic, and immune function. As expected, meaningful work and sense of reward from taking care of family members were associated with better mental health. However, in women, the very same factors were positively associated with higher physiological dysregulation. We conclude that work and family factors promoting psychological well-being may have physical health trade-offs, particularly in women.
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Development of the DAGIS intervention study: a preschool-based family-involving study promoting preschoolers' energy balance-related behaviours and self-regulation skills.
Ray, C, Kaukonen, R, Lehto, E, Vepsäläinen, H, Sajaniemi, N, Erkkola, M, Roos, E
BMC public health. 2019;(1):1670
Abstract
BACKGROUND Preschoolers' energy balance-related behaviours (EBRBs) and self-regulation skills are important for their later health. Few preschool-based interventions aiming to promote preschoolers' EBRBs and self-regulation skills, simultaneously reducing differences in EBRBs, due to children's socio-economic status (SES) background, have been conducted. This study will present the Increased Health and Wellbeing in Preschools (DAGIS) intervention development process applying the Intervention Mapping (IM) framework. METHODS The development of the DAGIS intervention study, a preschool level clustered randomized controlled trial (RCT), was based on the IM framework. The protocol in IM guides the development process of an intervention through six steps: needs assessment and logic model of the problem, programme outcomes and objectives, design of the programme, production, implementation plan, and evaluation plan. RESULTS The needs assessment, part of the step 1 in IM, yielded the base for the DAGIS logic model of change. The model includes objectives related to changes in children's EBRBs, self-regulation skills, and in psychosocial and physical environment that is determined by parents and early educators. A 22-week programme was developed, and materials for preschools and families were produced. A feasibility study of the recruitment processes, acceptability of the materials and methods, and implementation was conducted. The DAGIS intervention study was conducted September 2017-May 2018 as a clustered RCT including a comprehensive effectiveness and process evaluation. The process evaluation was run throughout the intervention targeting preschools and families. CONCLUSION A preschool-based family-involving programme was developed in the DAGIS intervention study by applying the IM protocol. It was a time- and resource-consuming process. However, the systematic planning, development, and running of the programme have reinforced a comprehensive evaluation, which is a strength in the intervention. The results from the evaluation will enhance the knowledge of how to promote EBRBs and self-regulation skills among preschoolers, and diminish SES differences in them. TRIAL REGISTRATION ISRCTN57165350 (Prospectively registered January the 8th, 2015).
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Requirements for improving health and well-being of children with Prader-Willi syndrome and their families.
Mackay, J, McCallum, Z, Ambler, GR, Vora, K, Nixon, G, Bergman, P, Shields, N, Milner, K, Kapur, N, Crock, P, et al
Journal of paediatrics and child health. 2019;(9):1029-1037
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Prader-Willi syndrome (PWS) is a rare genetic condition with multi-system involvement. The literature was reviewed to describe neurodevelopment and the behavioural phenotype, endocrine and metabolic disorders and respiratory and sleep functioning. Implications for child and family quality of life were explored. Challenging behaviours contribute to poorer well-being and quality of life for both the child and caregiver. Recent evidence indicates healthy outcomes of weight and height can be achieved with growth hormone therapy and dietary restriction and should be the current target for all individuals with PWS. Gaps in the literature included therapies to manage challenging behaviours, as well as understanding the effects of growth hormone on respiratory and sleep function. New knowledge regarding the transition of children and families from schooling and paediatric health services to employment, accommodation and adult health services is also needed. Developing a national population-based registry could address these knowledge gaps and inform advocacy for support services that improve the well-being of individuals with PWS and their families.