Nurses in child health care (CHC) centers in Sweden play a key role in the early detection and management of childhood overweight/obesity, through meeting families early, regularly and over many ...years. However, research focusing on CHC nurses' perceptions of their role in childhood overweight/obesity management is scarce. As part of the EU-funded project "Science and Technology in childhood Obesity Policy" (STOP), this study examines CHC nurses' perceptions of speaking to parents about children's overweight/obesity and of their role in referring children to treatment for overweight/obesity.
All registered CHC nurses in Stockholm County (n = 442) received an email invitation letter explaining the study. Individual face-to-face visits (n = 15) in selected centers, and phone calls (n = 24) to nurses working in these centres were also conducted. In total, 17 CHC nurses (all female, average work experience 6.7 years (SD ± 4.9 years)) from 10 municipalities (including four of the top five municipalities with the highest prevalence of overweight and obesity) in Stockholm County were interviewed. The interviews were conducted by phone, transcribed and analyzed using thematic analysis.
Two main themes were developed through the analysis: 1) The relationship between the nurse and the parent and 2) Glitch in the system. Under the first theme, nurses reported that weight-related discussions were facilitated by building and maintaining trust with parents. However, nurses also said they were reluctant to address children's weights if this could compromise parents' trust. Under the second theme, nurses highlighted several organizational barriers to addressing a child's weight with parents, including insufficient cooperation with other healthcare providers and limited time for visits. Nurses also identified lack of sufficient knowledge about what to offer the family and lack of confidence in their communication skills as additional barriers.
We found that pediatric nurses perceive relational and organizational factors as barriers to address childhood obesity with parents. To improve care, it is necessary to provide nurses with continuing education about obesity and communication skills and organizational support to improve communication within the healthcare system.
ClinicalTrials.gov NCT03800823; 11 Jan 2019, prospectively registered.
Physical activity (PA) monitoring is applied in a growing number of studies within cancer research. However, no consensus exists on how many days PA should be monitored to obtain reliable estimates ...in the cancer population. The objective of the present study was to determine the minimum number of monitoring days required for reliable estimates of different PA intensities in cancer survivors when using a six-days protocol. Furthermore, reliability of monitoring days was assessed stratified on sex, age, cancer type, weight status, and educational level.
Data was obtained from two studies where PA was monitored for seven days using the SenseWear Armband Mini in a total of 984 cancer survivors diagnosed with breast, colorectal or prostate cancer. Participants with ≥22 hours monitor wear-time for six days were included in the reliability analysis (n = 736). The intra-class correlation coefficient (ICC) and the Spearman Brown prophecy formula were used to assess the reliability of different number of monitoring days.
For time in light PA, two monitoring days resulted in reliable estimates (ICC >0.80). Participants with BMI ≥25, low-medium education, colorectal cancer, or age ≥60 years required one additional monitoring day. For moderate and moderate-to-vigorous PA, three monitoring days yielded reliable estimates. Participants with BMI ≥25 or breast cancer required one additional monitoring day. Vigorous PA showed the largest within subject variations and reliable estimates were not obtained for the sample as a whole. However, reliable estimates were obtained for breast cancer survivors (4 days), females, BMI ≥30, and age <60 years (6 days).
Shorter monitoring periods may provide reliable estimates of PA levels in cancer survivors when monitored continuously with a wearable device. This could potentially lower the participant burden and allow for less exclusion of participants not adhering to longer protocols.
Abstract Weight-related discussions during childhood may have long-lasting effects on children’s body image and well-being. However, little is known about how parents frame these discussions with ...children who have undergone treatment for obesity. Our study aimed to explore how parents perceive weight-related discussions, several years after their children started obesity treatment. This qualitative study is part of the 4-year follow-up of the More and Less study, a randomized controlled trial examining the effectiveness of a parental support program as part of obesity treatment for preschool-aged children in Stockholm, Sweden. Semi-structured interviews were conducted with 33 parents (79% mothers, 48% with a university degree, 47% with foreign background) of 33 children (mean age 9.3 years (SD 0.7), 46% girls), transcribed and analyzed using realist informed thematic analysis. Three main themes, encompassing three subthemes were developed. Under the first theme, Parental attitudes and concerns , parents emphasized the importance of discussing weight and health behaviors with their children, yet found it challenging due to uncertainties about how to approach it safely and sensitively. A few parents found the conversation manageable, citing their own experiences of having overweight or their style of communication with the child as facilitating the conversation. Under the second theme, The significance of time and context , parents said they engaged in weight-related conversations with their children more frequently as the children matured, driven by their growing self-awareness. Parents also expressed how contextual factors, such as gender and the presence of others, shaped conversations. Parents perceived boys as more resilient, thus exposing them to more negative weight talk. The third theme, Navigating weight stigma , revealed how parents employed strategies such as nurturing their children’s self-confidence, downplaying the significance of appearance and emphasizing health when discussing weight to shield their children from weight stigma. Taken together, we found that many parents need support to navigate weight-related discussions. Addressing weight stigma is part of children’s obesity management process, as children may be bullied, teased, or experience discrimination in different social settings. More research is needed to explore how young children undergoing obesity treatment experience weight stigma and to understand gendered differences in these experiences.
Abstract
Background
In primary healthcare, conversations between clinicians and parents about young children’s overweight are key to providing support and initiating weight management. However, given ...the sensitivity of this topic, these conversations are difficult for both clinicians and parents and are sometimes delayed or avoided. To understand the emotional impact of these conversations, this study aims to shed light on parents’ experiences following conversations with primary care nurses about their child’s overweight.
Methods
Participants were recruited through a childhood obesity randomized controlled trial (RCT) conducted in Sweden. Telephone-based semi-structured interviews were conducted with 17 parents (mean age 40; the majority were women (
n
= 12/17), had a university degree (
n
= 14/17) and were born in Sweden (
n
= 13/16)). Their children were between 3 and 7 years old (mean age 4.8 years) with overweight (
n
= 7) or obesity (
n
= 10). The interviews were recorded, transcribed, and analyzed using thematic analysis.
Results
Two main themes were developed. Theme 1, ‘
Receiving the overweight/obesity diagnosis
’, explores parents’ reactions to the conversation with the primary care nurse. Depending on how the nurse presented the topic, conversations either fostered an alliance between the parent and the nurse, encouraging parents to reflect and develop insights about the child’s and the family’s needs (subtheme
Conversations that empower
), or felt limited, uncomfortable, or belittling (subtheme
Conversations that provoke resistance
). Theme 2, ‘
Parenting a child with a formal diagnosis of obesity
’, explores challenges parents faced following the weight conversations, including managing their own feelings and concerns (subtheme
Fear of transferring weight anxiety
), dealing with others’ reactions (subtheme
Involve family and manage surroundings
) and asking for and receiving support from health care professionals (subtheme
Obtain support from health care professionals
).
Conclusions
While conversations with primary care nurses about children’s weight were often emotional, most parents felt these conversations were ultimately helpful, as they encouraged them to enact positive lifestyle changes. Importantly, when nurses initiated conversations in a responsive, non-blaming way, inviting parents to reflect on their situation, parents felt more supported and empowered. These findings convey the importance of providing communication skills training to pediatric healthcare professionals, with particular focus on childhood overweight and obesity.
Trial registration number
ClinicalTrials.gov
NCT03800823
; 11 Jan 2019.
Current knowledge about the promotion of long-term physical activity (PA) maintenance in cancer survivors is limited. The aims of this study were to 1) determine the effect of self-regulatory BCTs on ...long-term PA maintenance, and 2) identify predictors of long-term PA maintenance in cancer survivors 12 months after participating in a six-month exercise intervention during cancer treatment.
In a multicentre study with a 2 × 2 factorial design, the Phys-Can RCT, 577 participants with curable breast, colorectal or prostate cancer and starting their cancer treatment, were randomized to high intensity exercise with or without self-regulatory behaviour change techniques (BCTs; e.g. goal-setting and self-monitoring) or low-to-moderate intensity exercise with or without self-regulatory BCTs. Participants' level of PA was assessed at the end of the exercise intervention and 12 months later (i.e. 12-month follow-up), using a PA monitor and a PA diary. Participants were categorized as either maintainers (change in minutes/week of aerobic PA ≥ 0 and/or change in number of sessions/week of resistance training ≥0) or non-maintainers. Data on potential predictors were collected at baseline and at the end of the exercise intervention. Multiple logistic regression analyses were performed to answer both research questions.
A total of 301 participants (52%) completed the data assessments. A main effect of BCTs on PA maintenance was found (OR = 1.80, 95%CI 1.05-3.08) at 12-month follow-up. Participants reporting higher health-related quality-of-life (HRQoL) (OR = 1.03, 95%CI 1.00-1.06 and higher exercise motivation (OR = 1.02, 95%CI 1.00-1.04) at baseline were more likely to maintain PA levels at 12-month follow-up. Participants with higher exercise expectations (OR = 0.88, 95%CI 0.78-0.99) and a history of tobacco use at baseline (OR = 0.43, 95%CI 0.21-0.86) were less likely to maintain PA levels at 12-month follow-up. Finally, participants with greater BMI increases over the course of the exercise intervention (OR = 0.63, 95%CI 0.44-0.90) were less likely to maintain their PA levels at 12-month follow-up.
Self-regulatory BCTs improved PA maintenance at 12-month follow-up and can be recommended to cancer survivors for long-term PA maintenance. Such support should be considered especially for patients with low HRQoL, low exercise motivation, high exercise expectations or with a history of tobacco use at the start of their cancer treatment, as well as for those gaining weight during their treatment. However, more experimental studies are needed to investigate the efficacy of individual or combinations of BCTs in broader clinical populations.
NCT02473003 (10/10/2014).
Today, there is considerable interest in integrated forest biorefineries which, besides pulp, produce high-value-added products, such as, polymers and carbon fibres. Lignin is the major ...non-cellulosic constituent of wood. It is a complex, amorphous highly crosslinked polyphenolic. Lignosulphonate in spent liquor in sulphite mills has long been isolated using ultrafiltration. Generally, precipitation is used to extract the lignin from kraft black liquor. The liquor is commonly withdrawn from the evaporation unit in the recovery system, where the dry substance is optimal for precipitation. Lately, interest in the isolation of lignin by ultrafiltration of kraft black liquor has arisen. The concentration of the liquor is not that critical, and there is therefore considerable freedom in the choice of liquor for treatment with ultrafiltration. In this work, the influence of membrane cut-off, transmembrane pressure and cross-flow velocity during ultrafiltration of cooking liquor and black liquor was studied. The extraction of lignin from hardwood black liquor withdrawn before the evaporation unit was investigated. A hybrid ultrafiltration/nanofiltration process was used. The lignin concentration was 60
g/l in the black liquor and 165
g/l in the product stream (the nanofiltration retentate). A cost estimate indicates a production cost of €33 per tonne of lignin.
The practice of eating together, commensality, is rarely explored in the context of childhood obesity treatment. This is noteworthy given long-standing debates about the physical, psychosocial, and ...societal benefits of meals, especially family meals. Moreover, as children with obesity experience weight bias and stigma both within and outside the home, it is important to examine meals as a locus of social exchange around food and the body. Our study is based on the premises that eating together (i) matters and (ii) occurs in different environments with diverse social organization, where food-related interactions create varying arrangements of individuals, groups, their statuses, and their actions.
The study explores children's experiences of meals in different social contexts. Thirty-two children (age 8-10 years) living in Sweden were interviewed, 4 years after they entered an obesity intervention trial. Thematic analysis was applied to the data.
We thematized three meal types, with each meal type having two subthemes: (i) "The family meal", with "Shared routines, rituals, and rules" and "Individual solutions and choices"; (ii) "The school meal", with "Rules and norms of the school" and "Strategies of the child"; and (iii) "The friend meal", with "Handling food that was disliked" and "Enjoyment of food". These three different meal types carried different experiences of and knowledge about how they were socially organized.
While the children spoke about the family and school meals as meaningful, the friend meal stood out as particularly positive. Contrary to our expectations, the children did not express experiences of weight bias or obesity stigma around meals, nor did they speak negatively about parental control of their food intake. Our findings, especially regarding the friend meal, have implications for further research into commensality and social influences on eating among children with obesity, from early childhood into adolescence.
When it comes to intimate partner violence, words matter. The abuse terminology used in efforts to target collegiate victims of intimate partner violence (IPV) can impact the effectiveness of ...prevention messages. The purpose of this study is twofold: first, to identify the relationship between abuse labels (such as domestic violence, dating violence, and IPV), and bystander intervention recommendations. Second, this study aims to understand how situational factors (perpetrator gender, couple marital status, provocation) impact the perceived appropriateness of those terms. Perceptions of severity, victim/perpetrator blame, and bystander intervention recommendations were also measured. In all, 498 college students from a large southern public university participated in a 2 × 2 × 2 experiment where they read a vignette depicting IPV. Participants were then asked a serious of questions about the appropriateness of the abuse terminology, what actions they would recommend for a bystander, the severity of the incident, and the degree to which they blamed victim and perpetrator. Results indicated the bystander intervention actions that are perceived as appropriate are related to what the most appropriate label is for the situation. Contextual factors surrounding the IPV situation, such as perpetrator gender, couple marital status, and provocation, influenced bystander recommendations and what labels were considered appropriate. The results of the study indicate the need to expand collegiate definition of what “counts” as IPV and point to ways in which IPV context can be a barrier to bystander intervention. Implications of the study argue that efforts to increase bystander intervention must include training on how to identify IPV situations with a broad variety of contexts. Limitations of the study and implications for theory and practice are discussed.
Background
Chemotherapy efficacy is largely dependent on treatment adherence, defined by the relative dose intensity (RDI). Identification of new modifiable risk factors associated with low RDI might ...improve chemotherapy delivery. Here, we evaluated the association between low RDI and pre-chemotherapy factors, including patient- and treatment-related characteristics and markers of inflammation.
Methods
This exploratory analysis assessed data from 267 patients with early-stage breast cancer scheduled to undergo (neo-)adjuvant chemotherapy included in the Physical training and Cancer (Phys-Can) trial. The association between low RDI, defined as < 85%, patient-related (age, body mass index, co-morbid condition, body surface area) and treatment-related factors (cancer stage, receptor status, chemotherapy duration, chemotherapy dose, granulocyte colony-stimulating factor) was investigated. Analyses further included the association between RDI and pre-chemotherapy levels of interleukin (IL)-6, IL-8, IL-10, C-reactive protein (CRP) and Tumor Necrosis Factor-alpha (TNF-α) in 172 patients with available blood samples.
Results
An RDI of < 85% occurred in 31 patients (12%). Univariable analysis revealed a significant association with a chemotherapy duration above 20 weeks (
p
< 0.001), chemotherapy dose (
p
= 0.006), pre-chemotherapy IL-8 (OR 1.61; 95% CI (1.01; 2.58);
p
= 0.040) and TNF-α (OR 2.2 (1.17; 4.53);
p
= 0.019). In multivariable analyses, inflammatory cytokines were significant association with low RDI for IL-8 (OR: 1.65 0.99; 2.69;
p
= 0.044) and TNF-α (OR 2.95 1.41; 7.19;
p
= 0.007).
Conclusions
This exploratory analysis highlights the association of pre-chemotherapy IL-8 and TNF-α with low RDI of chemotherapy for breast cancer. IL-8 and TNF-α may therefore potentially help to identify patients at risk for experiencing dose reductions.
Clinical trial number
NCT02473003 (registration: June 16, 2015).
Childhood overweight and obesity is a serious public health issue with an increase being observed in preschool-aged children. Treating childhood obesity is difficult and few countries use ...standardized treatments. Therefore, there is a need to find effective approaches that are feasible for both health care providers and families. Thus, the overall aim of this study is to assess the acceptance and effectiveness of a parent support program (the More and Less, ML) for the management of overweight and obesity followed by a mobile health (mHealth) program (the MINISTOP application) in a socially diverse population of families.
A two-arm, parallel design randomized controlled trial in 300 2-to 6-year-old children with overweight and obesity from Romania, Spain and Sweden (n = 100 from each). Following baseline assessments children are randomized into the intervention or control group in a 1:1 ratio. The intervention, the ML program, consists of 10-weekly group sessions which focus on evidence-based parenting practices, followed by the previously validated MINISTOP application for 6-months to support healthy eating and physical activity behaviors. The primary outcome is change in body mass index (BMI) z-score after 9-months and secondary outcomes include: waist circumference, eating behavior (Child Eating Behavior Questionnaire), parenting behavior (Comprehensive Feeding Practices Questionnaire), physical activity (ActiGraph wGT3x-BT), dietary patterns (based on metabolic markers from urine and 24 h dietary recalls), epigenetic and gut hormones (fasting blood samples), and the overall acceptance of the overweight and obesity management in young children (semi-structured interviews). Outcomes are measured at baseline and after: 10-weeks (only BMI z-score, waist circumference), 9-months (all outcomes), 15- and 21-months (all outcomes except physical activity, dietary patterns, epigenetics and gut hormones) post-baseline.
This study will evaluate a parent support program for weight management in young children in three European countries. To boost the effect of the ML program the families will be supported by an app for 6-months. If the program is found to be effective, it has the potential to be implemented into routine care to reduce overweight and obesity in young children and the app could prove to be a viable option for sustained effects of the care provided.
ClinicalTrials.gov NCT03800823; 11 Jan 2019.
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