The role of motivation on physical activity and screen time behaviors among parent-adolescent dyads: The FLASHE study.

Behavioral theories inform the development of lifestyle interventions to address low participation in physical activity (PA); however, relatively little is known about the value of self-determination theory (SDT) for explaining screen time (ST) behaviors or in extending SDT into a dyadic context. Actor-partner (i.e., parent-adolescent) interdependence models (APIMs) allow for examination of these interpersonal relationships. The purpose of this study was to examine PA and ST among parent-adolescent dyads using the cross-sectional Family Life, Activity, Sun, Health, and Eating (FLASHE) Study. Parent-adolescent dyads provided responses to online surveys addressing PA (n = 1177 dyads) and ST (n = 1489 dyads) behaviors. We examined the influence of SDT-based constructs (perceived competence and motivation) on PA and ST behaviors. Structural equations were used to estimate APIMs in STATA 15.1. Full models provided a good fit to the data. For both PA and ST, perceived competence was more strongly associated with motivation among adolescents compared with parents (PA: ß = 0.72 vs. 0.58, ST: ß = 0.34 vs. 0.22, p's < 0.001). Parental motivation was associated with parental PA and both adolescent motivation for PA and ST (p's < 0.001). Parental motivation was not associated with adolescent ST-behavior. Adolescent motivation was only associated with parent motivation for PA. In the FLASHE study, SDT constructs extend acceptably to the dyadic setting, with PA models providing a slightly better fit to the data than ST models. Longitudinal studies that target perceived competence and the self-regulation of motivation in parents and their adolescents are a next logical step to understanding both PA and ST behaviors.

Where are family theories in family-based obesity treatment?: conceptualizing the study of families in pediatric weight management.

Family-based approaches to pediatric obesity treatment are considered the 'gold-standard,' and are recommended for facilitating behavior change to improve child weight status and health. If family-based approaches are to be truly rooted in the family, clinicians and researchers must consider family process and function in designing effective interventions. To bring a better understanding of family complexities to family-based treatment, two relevant reviews were conducted and are presented: (1) a review of prominent and established theories of the family that may provide a more comprehensive and in-depth approach for addressing pediatric obesity; and (2) a systematic review of the literature to identify the use of prominent family theories in pediatric obesity research, which found little use of theories in intervention studies. Overlapping concepts across theories include: families are a system, with interdependence of units; the idea that families are goal-directed and seek balance; and the physical and social environment imposes demands on families. Family-focused theories provide valuable insight into the complexities of families. Increased use of these theories in both research and practice may identify key leverage points in family process and function to prevent the development of or more effectively treat obesity. The field of family studies provides an innovative approach to the difficult problem of pediatric obesity, building on the long-established approach of family-based treatment.

Healthy Body, Healthy Mind: A Mindset Intervention for Obese Youth.

As growth mindset intervention research continues to develop, more work is needed to understand how to most effectively implement these interventions to encourage healthy cognitions and behaviors. The present study details the initial testing of a single-session, online mindset intervention (Healthy Body, Healthy Mind) for obese children and adolescents enrolled in obesity treatment clinics. Using a pre to post-test design, results indicated that growth mindsets of health and cognitions related to health behavior (nutrition and exercise self-efficacy and perceived control) increased significantly. However, despite efforts to mitigate feelings of culpability, blame also increased from pretest to post-test. Yet, body dissatisfaction decreased significantly. Intrinsic value for health behaviors remained unchanged from pretest to post-test. Analysis of narratives suggests that youth were engaged with the intervention content. Additionally, when youth's narratives incorporated themes related to the changeable nature of the attribute, they also self-reported stronger growth mindsets. In the discussion, we note implications of findings for the development of large-scale health-based growth mindset interventions that are developmentally-appropriate for children and adolescents.

Physical activity and family-based obesity treatment: a review of expert recommendations on physical activity in youth.

Targeting physical inactivity in children is pertinent to aiding in the decrease of childhood obesity rates. Only 33% of adolescents are obtaining the recommended goal of at least 60 min of physical activity per day. The objectives of this review are to summarize professional recommendations for physical activity and exercise in children and adolescents, and identify family-centred strategies that can be implemented by weight management clinicians. Clinically oriented recommendations and policy statements from professional organizations were identified through literature and internet searches, summarized using rubrics of aerobic, muscle strengthening and bone strengthening exercise, then examined for details on family-based focus, inclusion of child developmental stage and age, and application to the prevention and treatment of obesity. Current recommendations give guidelines for the amount of physical activity that children should acquire and how many days a week activities should occur. However, available guidelines need an improved approach to addressing the role of the parents and caregivers in targeting physical activity and weight management in youth. Efforts must be taken in order to make sure that the types of physical activity offered are both suitable and enjoyable. Sports, games, free play and other age appropriate activities are adequate ways to increase moderate to vigorous physical activity in children. Differentiating physical activities types in accordance with developmental stage, level of enjoyment, and family characteristics is needed to establish sustainable habits. One paediatric obesity program has developed approaches to teaching families fun and engaging ways to be active together.

Satisfaction and attrition in paediatric weight management.

Paediatric obesity treatment experiences unacceptably high rates of attrition. Few studies have explored parent and child perspectives on dropout. This study sought to capture child and parent experience in treatment and expressed contributors to attrition. Children and parents enrolled in a single family-based weight management programme participated in semi-structured interviews, conducted either upon completion of the first intensive phase of treatment or program dropout. Interviews were recorded, transcribed and coded using a multistage inductive approach. Interviews were obtained from 57 parents and 30 children, nearly equal between 'completers' or 'dropouts'. Five themes emerged: overall positive experience with programme; logistical challenges of participation; improved health; discrepancies between child and parent experience and perception, and importance of structure and expectations of weight loss. Primary reasons given for dropout were time commitment; distance from clinic; missed school and work; lack of dedicated adolescent programme; clinic hours; and stress. Few parents or children expressed dissatisfaction. Children reportedly enjoyed 'having someone to talk to' about weight, and spending increased time with family. Children and parents overall reported positive experiences in this weight management programme. Attrition appears more related to logistical issues than low satisfaction. Innovative approaches to help overcome logistical challenges and preserve positive aspects may help in decreasing programme attrition.

Pes planus and paediatric obesity: a systematic review of the literature.

Children with obesity report musculoskeletal pain more than normal-weight children; this may be linked with literature suggesting children with obesity have higher prevalence of pes planus (flatfoot). To further elucidate whether this relation occurs, we conducted a systematic literature review on the co-occurrence of pes planus and paediatric obesity. Empirical articles published until September 2013 were obtained through an electronic search of MEDLINE and SPORTDiscus; included articles examined the association between body weight and pes planus in children. Thirteen cross-sectional studies of varied designs were identified. Methods used to diagnose pes planus varied between studies: imaging modalities, anthropometric measurements and clinical examination. Across all studies, pes planus prevalence among children with obesity ranged widely from 14 to 67%. Nearly all studies indicated increasing pes planus in children with increasing weight. No studies evaluated pain/complications related to pes planus. Our review suggests increased prevalence of pes planus among children with obesity or increasing weight status. Because of differing methodologies, lack of consensus regarding the pes planus definition, the dearth of investigation into pain/complications and the few existing studies, more research is needed to determine a relation between children's body weight, pes planus and associated effects on pain and function.

Stability of self-report measures of improvement in chronic pain: a five-year follow-up.

Seventy patients with chronic low-back pain not due to malignancy returned a questionnaire assessing functional status 5 years following treatment with epidural or subarachnoid nerve blocks. One hundred fifty-one patients had been surveyed 3 years earlier in an initial follow-up. The respondents to the present survey were older and more able to bend and took more medication for pain than non-respondents. The results revealed a tendency for gender-associated differences in improvement noted in the initial survey to be maintained, with women showing greater absolute improvement than men, particularly in vocational abilities. Men were somewhat more improved as a group on the current follow-up than on the initial follow-up. The use of medication for pain remained generally unchanged over time, but the number of respondents reporting the need for additional surgical treatments declined. The results were seen as indicating the need for using multiple, functional criteria in assessing response to treatment, including both global pain ratings and functional-behavioral measures of improvement.

Selective monitoring of physical sensations.

Two experiments demonstrated that the experience of physical sensations is the result of hypothesis-guided selective search and encoding. In the first experiment, subjects listened to a stimulus that was said to increase, decrease, or have no effect on skin temperature. The results indicated that subjects selectively monitored only those changes in skin temperature congruent with the experimentally induced hypotheses, thus resulting in self-reports of change in skin temperature in the suggested directions. Two replications using heart rate and nasal congestion-which imposed search strategies-produced comparable results. In Experiment 2, subjects viewed a heartbeat chart and assessed the degree to which a hypothetical drug influenced a target person's heart rate. Perceptions of change in heart rate were influenced by both experimentally induced hypotheses as well as subjects' perceptions of their own heart rate. That is, if prior to the experiment subjects believed their own pulse was accelerated, they were more likely to perceive the graphed heartbeat accelerating as well. The findings point to parallels between perception of internal state and the external environment. Finally, the roles of hypothesis-guided selective search are extended to placebo effectiveness.

Attrition in paediatric weight management: a review of the literature and new directions.

Paediatric obesity continues to be one of the most important health issues facing children and families today, and there remains a need for effective treatment options. There are a few reports in the literature demonstrating high rates of attrition from paediatric weight management programmes, ranging from 27% to 73%. While some studies show that racial/ethnic minorities, the economically disadvantaged and those with higher levels of obesity are at risk, other studies do not. There is some consistency in reasons given by families for attrition from treatment, most often scheduling issues and programmes not meeting family needs or expectations. This review highlights identified contributors to attrition from paediatric weight management and provides a framework to study this problem, based on models of adherence to paediatric medical regimens.

Duration of pain condition and physical pathology as determinants of nurses' assessments of patients in pain.

This article is based on an experiment that examined features distinguishing chronic from acute pain syndromes, and their influence on nurses' estimates of patient suffering, pain relief actions, and attitudes toward patients. Two hundred sixty-eight nurses received one-paragraph descriptions of patients complaining of severe pain. Descriptions varied on the dimensions of duration (acute vs. chronic), signs of physical pathology (positive vs. negative), signs of depression (positive vs. negative), and diagnostic category (low back vs. headache vs. joint pain). Subjects estimated the intensity of the hypothetical patient's suffering, indicated priorities for specific pain relief actions, and rated the patient on a series of trait dimensions. Subjects attributed less intense pain when the patient had no signs of pathology and when duration was long-termed and chronic. They also assigned lower priorities to medication-related nursing actions when signs of pathology were negative. Finally, more negative personality and behavioral traits were attributed to the patient when signs of pathology were negative. The results reflect a dichotomous, organic versus psychogenic model of pain on the part of health care staff. Since the data indicate the chronic pain sufferer is negatively stereotyped by staff, a need exists to develop and disseminate more integrative models of the pain experience.