Effectiveness of an educational intervention on vulvo-vaginal discharge for family healthcare workers: A nonrandomized controlled trial.

Women's delay in seeking medical advice for abnormal vaginal discharge can cause serious effects such as infertility, ectopic pregnancy, and advanced cervical cancer. Family healthcare workers are in a unique position to help in the promotion of vaginal health. A nonrandomized controlled trial was conducted among a sample of family healthcare workers in the intervention (n = 37) and a control (n = 37) group to assess the effectiveness of an educational intervention, which was a 2-day intensive workshop combining reading materials. Data were analyzed using SPSS software (version 20), and the effectiveness of the intervention was determined using a mixed between-within subjects analysis of variance. The total knowledge and attitude scores were significantly greater for family healthcare workers in the intervention group immediately and at 3 and 6 months after the educational intervention, compared to the control group. A substantial main effect was observed concerning the time, showing an increase in family healthcare workers' knowledge and attitude scores across the four time periods. A statistically significant difference in the median overall health education competency score across the two groups was also observed. The mean score differences in all sub-competencies in health education were significantly higher among the intervention group, compared to the control group between second postintervention and the baseline. The educational intervention had revealed successful and sustainable improvements in family healthcare workers' knowledge, attitude on vaginal discharge, and health education competency. This can be implemented as an in-service program for family healthcare workers to improve health education practices.

Infant illness severity and family adjustment in the aftermath of NICU hospitalization.

Up to 15% of parents have an infant who will spend time in a neonatal intensive care unit (NICU). After discharge, parents may care for a medically fragile infant and worry about their development. The current study examined how infant illness severity is associated with family adjustment. Participants included parents with infants who had been discharged from the NICU 6 months to 3 years prior to study participation (N = 199). Via a Qualtrics online survey, parents reported their infants' medical history, parenting stress, family burden, couple functioning, and access to resources. Multivariable regression analyses revealed that more severe infant medical issues during hospitalization (e.g., longer length of stay and more medical devices) were associated with greater family burden, but not stress or couple functioning. Infant health issues following hospitalization (i.e., medical diagnosis and more medical specialists) were associated with greater stress, poorer couple functioning, and greater family burden. Less time for parents was associated with increased stress and poorer couple functioning. Surprisingly, parents of infants who were rehospitalized reported less stress and better couple functioning, but greater family burden. Family-focused interventions that incorporate psychoeducation about provider-patient communication, partner support, and self-care may be effective to prevent negative psychosocial sequelae among families.

Hasta un 15% de progenitores tiene un infante que pasará un tiempo en una Unidad de Cuidado Intensivo Neonatal (NICU). Después de la salida, los progenitores deben cuidar de un infante médicamente débil y preocuparse por su desarrollo. El presente estudio examinó cómo la severidad de la enfermedad del infante se asocia con la adaptabilidad familiar. Los participantes eran progenitores con infantes que habían salido de la Unidad de Cuidado Intensivo Neonatal entre 6 meses y 3 años antes de participar en el estudio (N = 199). Por medio de una encuesta electrónica tipo Qualtrics, los progenitores reportaron el historial médico de su infante, el estrés de la crianza, la carga familiar, el funcionamiento como pareja y el acceso a recursos. Los análisis de regresión de variables múltiples revelaron que asuntos médicos más severos del infante durante la hospitalización (v.g. período más largo de hospitalización, más aparatos médicos) se asociaban con mayor carga familiar, aunque no así con estrés o el funcionamiento como pareja. Los asuntos de salud infantil posteriores a la hospitalización (v.g. diagnóstico médico, más médicos especialistas) se asociaron con mayor estrés, un más pobre funcionamiento como pareja y mayor carga familiar. Menos tiempo para los progenitores se asoció con un aumento en el estrés y un más pobre funcionamiento como pareja. De modo sorprendente, los progenitores de infantes que habían sido hospitalizados otra vez reportaron menos estrés y mejor funcionamiento como pareja, pero mayor carga familiar. Las intervenciones con enfoque familiar que incorporan educación sicológica acerca de la comunicación entre proveedor y paciente, apoyo a la propia pareja y el cuidado propio pudieran ser eficaces para prevenir la secuela sicosocial entre familias.

Jusqu'à 15% des parents ont un bébé qui passera du temps en Unité Néonatale de Soins Intensifs. A la sortie de l'hôpital les parents peuvent se retrouver à prendre soin d'un bébé fragile du point de vue médical et s'inquiéter de son développement. Cette étude a examiné comment la sévérité de la maladie du bébé est liée à l'ajustement de la famille. Les participants ont inclu des parents avec des bébés étant sortis de l'Unité Néonatale de Soins Intensifs 6 mois à trois ans avant la participation à l'étude (N = 199). Au travers d'un questionnaire Qualtrics en ligne, les parents ont fait état de l'histoire médicale des bébés, du stress de parentage, du poids sur la famille, du fonctionnement du couple et de l'accès aux ressources. Des analyses de régression multivariables ont révélé que les problèmes médicaux du bébé durant l'hospitalisation les plus graves (i.e. durée plus longue du séjour, plus de dispositifs médicaux) étaient liés à un poids sur la famille plus fort, mais pas au stress ni n'affectait le fonctionnement du couple. Les problèmes de santé du bébé après l'hospitalisation (soit un diagnostic médical, plus de spécialistes médicaux) étaient liés à un stress plus élevé, à un fonctionnement du couple moins bon, et à un poids sur la famille plus fort. Moins de temps pour les parents était lié à un stress supplémentaire et à un fonctionnement du couple moins bon. Avec surprise, les parents de bébés qui étaient réhospitalisés ont fait état de moins de stress et d'un meilleur fonctionnement de couple, mais d'un poids plus fort sur la famille. Les interventions centrées sur la famille qui incorporent une psychoéducation sur la communication médecin-parent, le soutien du partenaire et le soin de soi peut s'avérer efficace afin d'éviter des séquelles psychosociales négatives chez les familles.

Enhancing Outcomes of Low-Intensity Parenting Groups Through Sufficient Exemplar Training: A Randomized Control Trial.

Low-intensity parenting groups, such as the Triple P-Positive Parenting Program Discussion Groups, appear to be a cost-effective intervention for child conduct problems. Several studies evaluating a Triple P Discussion Group on disobedience found promising results for improving child and parent outcomes. However, a sufficient exemplar training approach that incorporates generalization promotion strategies may assist parents to more flexibly apply positive parenting principles to a broader range of child target behaviors and settings, leading to greater change. We compared the effects of sufficient exemplar training to an existing narrowly focused low-intensity intervention. Participants were 78 families with a 5-8 year-old child. Sufficient exemplar training resulted in more robust changes in child behavior and superior outcomes for mothers on measures of parenting behavior, parenting self-efficacy, mental health, and perceptions of partner support at post-intervention and 6-month follow-up. These results indicate that teaching sufficient exemplars may promote generalization leading to enhanced intervention outcomes.

Connecting Families to Their Health Record and Care Team: The Use, Utility, and Impact of a Client/Family Health Portal at a Children's Rehabilitation Hospital.

BACKGROUND: Health care portals have the potential to provide consumers with timely, transparent access to health care information and engage them in the care process. OBJECTIVE: The objective was to examine the use, utility, and impact on engagement in care and caregiver-provider communication of a client/family portal providing access to electronic health records (EHRs) and secure, 2-way e-messaging with care providers. METHODS: We conducted a prospective, mixed-methods study involving collection of caregivers' portal usage information over a 14-month period (from portal introduction in January 2015 to the end of the study period in March 2016), a Web-based survey for caregivers administered after a minimum of 2 months' exposure to the portal and repeated 2 months later, and focus groups or individual interviews held with caregivers and service providers at the same points in time. The survey assessed caregivers' perceptions of the utility of and satisfaction with the EHR and e-messaging, and the portal's impact on client engagement and perceptions of caregiver-provider communication. A total of 18 caregivers (parents) completed surveys and 6 also took part in focus groups or interviews. In addition, 5 service providers from different disciplines took part in focus groups or interviews. RESULTS: Although usage patterns varied, the typical pattern was a steady level of use (2.5 times a month over an average of 9 months), which is higher than typically reported use. The portal pages most frequently accessed were the home page, health record main page, appointment main page, and reports main page. The Web-based survey captured caregivers' perceptions of usefulness of and satisfaction with the EHR and portal messaging, as well as the portal's impact on their engagement in care and perceptions of caregiver-provider communication. The surveys indicated a moderate degree of utility of and satisfaction with the portal features, and a low but emerging impact on engagement in care and caregiver-provider communication (survey scales measuring these outcomes displayed excellent internal consistency, with Cronbach alpha ranging from .89 to .95). Qualitative themes from focus groups and interviews supported and extended the survey findings. Caregivers and service providers saw appreciable information benefits and provided recommendations to increase portal use and utility. Caregivers focused on the scope of organizational adoption of the portal system and indicated their hopes for the future of the portal, whereas service providers were concerned about how to best manage their investment of time and effort in preparing client-friendly reports and messaging clients via the portal. CONCLUSIONS: Overall, the findings show the promise of the portal and the need for ongoing evaluation to show the portal's ultimate potential in enhancing engagement in care and communication with care providers.

Evaluation of continuing education of family health strategy teams for the early identification of suspected cases of cancer in children.

BACKGROUND: This study evaluated the influence of continuing education of family health strategy teams by the Ronald McDonald Institute program on the early diagnosis of cancer in children and adolescents. METHODS: The study applied Habicht's model to evaluate the adequacy and plausibility of continuing education by using as outcome the number of children with suspected cancer who were referred to the hospital of references in the 1 year before and 1 year after intervention and the number of patients referred by intervention group and control group family health strategy teams. Medical records from each hospital of reference were used to collect information of suspect cases of cancer. Descriptive analyses were performed using frequencies and mean values. Chi-square tests were used to assess statistically significant differences between the groups and periods by using p-values < 0.05. RESULTS: The results showed a 30.6% increase in the number of children referred to the hospital of reference for suspected cancer in the post-intervention period; in addition, the family health strategy teams that underwent the intervention referred 3.6 times more number of children to hospital of references than did the control group. Only the intervention group showed an increase in the number of confirmed cases. CONCLUSIONS: This evaluation of a continuing education program for early identification of pediatric cancer showed that the program was adequate in achieving the established goals and that the results could be attributed to the program.

Healthy Families: A Family-Based Community Intervention To Address Childhood Obesity.

The objective of this study was to determine the effectiveness of Healthy Families, a family-based community intervention, in improving the knowledge, self-efficacy, and health behaviors of overweight/obese children and their families as well as to explore the lessons learned. Results showed families who completed the program had significant improvements for children and parents in areas such as nutrition knowledge and self-efficacy in making healthy eating choices as well as participating in physical activity. Additionally, families reported decreasing their intake of sugar-sweetened beverages. Participating families and community partners provided valuable lessons for other communities seeking to implement a similar program.

Pedagogical monitoring as a tool to reduce dropout in distance learning in family health.

BACKGROUND: This paper presents the results of a study of the Monsys monitoring system, an educational support tool designed to prevent and control the dropout rate in a distance learning course in family health. Developed by UNA-SUS/UFMA, Monsys was created to enable data mining in the virtual learning environment known as Moodle. METHODS: This is an exploratory study using documentary and bibliographic research and analysis of the Monsys database. Two classes (2010 and 2011) were selected as research subjects, one with Monsys intervention and the other without. The samples were matched (using a ration of 1:1) by gender, age, marital status, graduation year, previous graduation status, location and profession. Statistical analysis was performed using the chi-square test and a multivariate logistic regression model with a 5 % significance level. RESULTS: The findings show that the dropout rate in the class in which Monsys was not employed (2010) was 43.2 %. However, the dropout rate in the class of 2011, in which the tool was employed as a pedagogical team aid, was 30.6 %. After statistical adjustment, the Monsys monitoring system remained in correlation with the course completion variable (adjusted OR = 1.74, IC95% = 1.17-2.59; p = 0.005), suggesting that the use of the Monsys tool, isolated to the adjusted variables, can enhance the likelihood that students will complete the course. Using the chi-square test, a profile analysis of students revealed a higher completion rate among women (67.7 %) than men (52.2 %). Analysis of age demonstrated that students between 40 and 49 years dropped out the least (32.1 %) and, with regard to professional training, nurses have the lowest dropout rates (36.3 %). CONCLUSIONS: The use of Monsys significantly reduced the dropout, with results showing greater association between the variables denoting presence of the monitoring system and female gender.

Systematic review of randomised controlled trials of interventions that aim to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood.

The risk factors for childhood overweight and obesity are known and can be identified antenatally or during infancy, however, the majority of effective interventions are designed for older children. This review identified interventions designed to reduce the risk of overweight/obesity that were delivered antenatally or during the first 2 years of life, with outcomes reported from birth to 7 years of age. Six electronic databases were searched for papers reporting randomised controlled trials of interventions published from January 1990 to September 2013. A total of 35 eligible studies were identified, describing 27 unique trials of which 24 were behavioural and three were non-behavioural. The 24 behavioural trials were categorised by type of intervention: (1) nutritional and/or responsive feeding interventions targeted at parents of infants, which improved feeding practices and had some impact on child weight (n = 12); (2) breastfeeding promotion and lactation support for mothers, which had a positive effect on breastfeeding but not child weight (n = 5); (3) parenting and family lifestyle (n = 4); and (4) maternal health (n = 3) interventions that had some impact on feeding practices but not child weight. The non-behavioural trials comprised interventions manipulating formula milk composition (n = 3). Of these, lower/hydrolysed protein formula milk had a positive effect on weight outcomes. Interventions that aim to improve diet and parental responsiveness to infant cues showed most promise in terms of self-reported behavioural change. Despite the known risk factors, there were very few intervention studies for pregnant women that continue during infancy which should be a priority for future research.

Learning globally to enhance local practice: an international programme in primary care & family health.

PURPOSE: In a global context of growing health inequities, international learning experiences have become a popular strategy for equipping health professionals with skills, knowledge, and competencies required to work with the populations they serve. This study sought to analyse the Chilean Interprofessional Programme in Primary Health Care (CIPPHC), a 5 week international learning experience funded by the Ministry of Health in Chile targeted at Chilean primary care providers and delivered in Toronto by the Department of Family and Community Medicine at the University of Toronto. METHOD: The study focused on three cohorts of students (2010-2012). Anonymous programme evaluations were analysed and semi-structured interviews conducted with programme alumni. Simple descriptive statistics were gathered from the evaluations and the interviews were analysed via thematic content analysis. RESULTS: The majority of participants reported high levels of satisfaction with the training programme, knowledge gain, particularly in the areas of the Canadian model of primary care, and found the materials delivered to be applicable to their local context. CONCLUSIONS: The CIPPHC has proven to be a successful educational initiative and provides valuable lessons for other academic centres in developing international interprofessional training programmes for primary care health care providers.

Using area health education centers to promote interest in rural practice.

INTRODUCTON: In the USA, area health education centers (AHECs) work to recruit and educate students to serve in medically underserved communities, primary care, and rural settings. One important aspect of their work is connecting students with rural clinical experiences. Within these experiences, AHECs incorporate a community health/socioeconomic experience within the family medicine clerkship that may not be as prevalent in the standard family medicine clerkship experiences. The purpose of the study was to assess the relationship between AHEC-sponsored family medicine clerkships with a self-reported intent to practice in a rural setting upon graduation. METHODS: The study compared third-year medical students with the Indiana University School of Medicine, which participated in AHEC-sponsored family medicine clerkships to the standard family medicine clerkship. Following the 4-week clerkship, students were asked to report their intent to work in a rural setting using a five-point Likert scale. A χ2 test was used to determine the association of AHEC sponsorship, clerkship site location (rural/urban) and intent to practice in a rural setting. RESULTS: The study consisted of 587 students. There was a statistically significant association between self-reported intent and rural clerkship site, χ2 (1, N=587)=6.542, p=0.01. Furthermore, 21.6% (n=25) of students with a rural clerkship experience reported a greater intent compared to 12.3% (n=58) of students with non-rural clerkship experience. CONCLUSIONS: The study confirmed a significantly positive association between participation in medical clerkship experiences in a rural primary care setting and the intent to practice in a rural setting upon graduation. The results also support the potential value-added benefits through academic-community partnerships with AHECs, family medical and other primary care specialty clerkship programs may perhaps succeed in increasing student interest in pursuing a practice serving in rural communities upon graduation.

A national survey of eating disorder training.

OBJECTIVE: Eating disorders (EDs) result in the highest mortality rate of all psychiatric disorders, and in the United States, approximately one in twenty females suffers from an eating disorder. However, training provided within residency programs to address the needs of these patients is sparse. The objective of this study was to conduct a national survey that assesses the amount of EDs training for trainees across five ACGME accredited specialties: internal medicine, pediatrics, family medicine, psychiatry, and child and adolescent psychiatry. The results of the survey will be used to develop strategies to improve eating disorder education among residents. METHOD: Eight hundred eighty training coordinators were contacted using information available on the ACGME website and asked to complete the survey. RESULTS: Of the 637 responding programs, 514 did not offer any scheduled or elective rotations for EDs. Of the 123 programs offering rotations, only 42 offered a formal, scheduled rotation. Child and adolescent psychiatry offered the most clinical experiences, and pediatric programs offered the greatest number of didactic hours on EDs. DISCUSSION: Training in EDs is limited. Simulated patient encounters, massive open online courses, web-based curricula, dedicated rotations and clinical experiences, didactic curricula, and brief-training programs may help to improve eating disorder diagnostic and treatment skills among trainees.

An exploration and comparison of food and drink availability in homes in a sample of families of White and Pakistani origin within the UK.

OBJECTIVE: Knowledge of the types and quantities of foods and drinks available in family homes supports the development of targeted intervention programmes for obesity prevention or management, or for overall diet improvement. In the UK, contemporary data on foods that are available within family homes are lacking. The present study aimed to explore home food and drink availability in UK homes. DESIGN: An exploratory study using researcher-conducted home food availability inventories, measuring all foods and drinks within the categories of fruits, vegetables, snack foods and beverages. SETTING: Bradford, a town in the north of the UK. SUBJECTS: Opportunistic sample of mixed ethnicity families with infants approximately 18 months old from the Born in Bradford birth cohort. RESULTS: All homes had at least one type of fruit, vegetable and snack available. Fresh fruits commonly available were oranges, bananas, apples, satsumas and grapes. Commonly available fresh vegetables included potatoes, cucumber, tomatoes and carrots. The single greatest non-fresh fruit available in homes was raisins. Non-fresh vegetables contributing the most were frozen mixed vegetables, tinned tomatoes and tinned peas. Ethnic differences were found for the availability of fresh fruits and sugar-sweetened beverages, which were both found in higher amounts in Pakistani homes compared with White homes. CONCLUSIONS: These data contribute to international data on availability and provide an insight into food availability within family homes in the UK. They have also supported a needs assessment of the development of a culturally specific obesity prevention intervention in which fruits and vegetables and sugar-sweetened beverages are targeted.

Reflections on Aboriginal perinatal mental health, mothers, babies, families and community: A South Australian trainee's experience.

OBJECTIVE: This paper explores novel training opportunities that the Expanded Setting Training Program (ESTP) provides for advanced psychiatry trainees. It is a reflection of a trainee's learning experiences during a year-long posting in Aboriginal Perinatal Mental Health, working alongside the Aboriginal Family Birthing Program, coupled with reflection and supervision. CONCLUSIONS: ESTP provided a fertile area to hone an advanced trainee's skills in the niche areas of Aboriginal mental health, perinatal mental health, culture and psychiatry. In addition, it provided skills in the area of leadership, health advocacy and the establishment and maintenance of successful programs in disadvantaged, culturally and linguistically diverse communities. The ESTP Aboriginal Mental Health rotation provides a unique experience for training, and the learning opportunities are limited only by the creativity of the trainee and supervisor.

The development and implementation of an interdisciplinary on-line academic course using a life course perspective.

The University of Wisconsin-Madison Pediatric Pulmonary Center (UW PPC) provides interdisciplinary leadership training for graduate students and postgraduate professionals. The training includes a three-credit on-line course entitled Interdisciplinary Care of Children with Special Health Care Needs. This paper describes the course, the content and organization of which was guided by the life course perspective (LCP). The UW PPC team used the LCP to guide course organization, content development, and evaluation approaches. UW PPC trainees took responsibility for content areas, performed literature reviews and reviews of resources, and suggested student activities. Course content was focused on the child with special health care needs (CSHCN) embedded in contextual environments of family, community, culture, and larger social and public policy arenas. The content included three case-study videos that followed a child with cystic fibrosis from birth to age 18. Key concepts of the LCP were woven in throughout the videos and other course materials. Emphasis was on representing development of the individual during critical/sensitive periods and on social determinants of health. At semester's end, qualitative and quantitative student evaluation results were very positive for all areas of the course. The final course paper, organized similarly to course modules, synthesized all aspects of the course. A successful paper included LCP concepts woven throughout to show integration of course content. The LCP provided a useful framework for course organization and content, and served as a lens through which students came to understand the care needs of CSHCN and their families. A course such as this can serve the important goal of educating future maternal child health professionals in using the LCP to understand how multiple determinants of health interact across the life span to produce health outcomes in this population.

Evaluation of a family systems intervention for managing pediatric chronic illness: Mastering Each New Direction (MEND).

Family systems play a crucial, albeit complex, role in pediatric chronic illness. Unfortunately, very few psychosocial interventions are available to help these stressed families navigate the developmental steps of chronic illness. A new intervention (MEND) addresses the needs of these families and applies to a broad range of chronic illnesses. This article presents this family systems intervention as well as includes preliminary program evaluation data on 22 families that graduated from the program. Results show consistently strong effects across an array of psychosocial measures. Conclusions from this preliminary study suggest that families entering MEND present with high levels of stress due to the child's chronic illness, but after MEND, the level of stress and other functioning measures are comparable to those seen in healthy families, suggesting that the program offers a significant benefit to families with pediatric chronic illness.

Strategies to prevent and reduce diabetes and obesity in Sacramento, California: the African American Leadership Coalition and University of California, Davis.

BACKGROUND: Diabetes is one of the leading causes of illness and death for African Americans and people of African descent throughout the United States and in the city and county of Sacramento, California. The involvement of families and communities in developing prevention strategies can increase the likelihood that behavioral changes will be sustained. CONTEXT: Three member organizations of the African American Leadership Coalition (AALC) entered into a partnership with the University of California, Davis (UC Davis) to engage families in developing a process to identify barriers to diabetes and obesity prevention and reduction, exchange strategies, and create action plans for prevention. METHODS: The intervention comprised 3 phases: 1) coalition formation and training; 2) data collection, analysis, and dissemination of results; and 3) development of family and community action plans. Academic and community partners planned and implemented all project phases together. OUTCOMES: Sources of information about diabetes and obesity were primarily doctors and the Internet; barriers were related to lack of time needed to prepare healthy meals, high food costs, transportation to fresh markets, motivation around healthy habits, and unsafe environments. Action plans addressed behavioral change and family cohesion. The group discussion format encouraged mutual support and suggestions for better eating and physical exercise habits. INTERPRETATION: This collaborative partnership model can strengthen existing group relationships or promote new affiliations that form the basis for future action coalitions. Participants worked both within and across groups to exchange information, stories of success and challenges, and specific health improvement strategies.

[Communication in the coordination practices of socioeducational groups in family health]. / Comunicação nas práticas de coordena o de grupos socioeducativos na saúde da família.

The purpose of this study was to assess the forms of communication used by coordinators in socioeducational groups in family health programmes. This qualitative, descriptive and exploratory study was conducted with 25 coordinators of groups in eight basic health units from Belo Horizonte, Brazil. Data collection comprised non-participant observation and semistructured interviews with the coordinators. The theoretical basis for research was Bakhtin's formulations and references on communication and health. The gathered information showed that the body, health and disease triad was communicated in groups through different channels and at different levels of discourse. Our conclusion is that coordinators must adopt an approach that values the expression of participants, not just regarding the physical dimensions of health, but also the life of each participant, and should use various forms of communication to foster dialogical educational actions and means for interaction in groups.

The adolescent family life program: a multisite evaluation of federally funded projects serving pregnant and parenting adolescents.

OBJECTIVES: We evaluated the effectiveness of care demonstration projects supported by the Title XX Adolescent Family Life (AFL) program, which serves pregnant and parenting adolescents in an effort to mitigate the risks associated with adolescent childbearing. METHODS: This cross-site evaluation involved 12 projects and 1038 adolescents who received either enhanced services funded by the AFL program or usual care. We examined the effects of enhanced services on health, educational, and child care outcomes approximately 6 months to 2 years after intake and explored moderation of program effects by time since intake and project characteristics associated with outcomes. RESULTS: The odds of using long-acting reversible contraception (odds ratio [OR] = 1.58) and receiving regular child care (OR = 1.50) in the past month were higher in the intervention group than in the comparison group. Odds of a repeat pregnancy were lower (OR = 0.39) among intervention group adolescents than among comparison group adolescents within 12 months of intake. Several project characteristics were associated with adolescent health outcomes. CONCLUSIONS: These projects show promise in improving effective contraceptive use, increasing routine child care, and yielding short-term decreases in repeat pregnancy.

Children, parents, and pets exercising together (CPET) randomised controlled trial: study rationale, design, and methods.

BACKGROUND: Objectively measured physical activity is low in British children, and declines as childhood progresses. Observational studies suggest that dog-walking might be a useful approach to physical activity promotion in children and adults, but there are no published public health interventions based on dog-walking with children. The Children, Parents, and Pets Exercising Together Study aims to develop and evaluate a theory driven, generalisable, family-based, dog walking intervention for 9-11 year olds. METHODS/DESIGN: The Children, Parents, and Pets Exercising Together Study is an exploratory, assessor-blinded, randomised controlled trial as defined in the UK MRC Framework on the development and evaluation of complex interventions in public health. The trial will follow CONSORT guidance. Approximately 40 dog-owning families will be allocated randomly in a ratio of 1.5:1 to receive a simple behavioural intervention lasting for 10 weeks or to a 'waiting list' control group. The primary outcome is change in objectively measured child physical activity using Actigraph accelerometry. Secondary outcomes in the child, included in part to shape a future more definitive randomised controlled trial, are: total time spent sedentary and patterning of sedentary behaviour (Actigraph accelerometry); body composition and bone health from dual energy x-ray absorptiometry; body weight, height and BMI; and finally, health-related quality of life using the PedsQL. Secondary outcomes in parents and dogs are: changes in body weight; changes in Actigraph accelerometry measured physical activity and sedentary behaviour. Process evaluation will consist of assessment of simultaneous child, parent, and dog accelerometry data and brief interviews with participating families. DISCUSSION: The Children, Parents, and Pets Exercising Together trial should be the first randomised controlled study to establish and evaluate an intervention aimed at dog-based physical activity promotion in families. It should advance our understanding of whether and how to use pet dogs to promote physical activity and/or to reduce sedentary behaviour in children and adults. The trial is intended to lead to a subsequent more definitive randomised controlled trial, and the work should inform future dog-based public health interventions such as secondary prevention interventions in children or adults. TRIAL REGISTRATION NUMBER: ISRCTN85939423.

The Family Education Diabetes Series: improving health in an urban-dwelling American Indian community.

Community-based participatory research has shown great promise as a mutually engaging and respectful way to partner contemporary biomedical knowledge with the lived experience, wisdom, and customs of American Indian people. Designed and implemented through this approach, our Family Education Diabetes Series (FEDS) has evidenced pilot and longitudinal physiological data supporting its effectiveness. However, the multifaceted nature of the program makes it difficult to know which factors are responsible for its success. This difficulty hinders efforts to improve the FEDS and/or inform others' work to advance similar projects. In this study, we conducted a qualitative investigation using talking circles to explore participants' views about what elements of the FEDS are most salient. Our findings suggest that social support and group-oriented sequences hold the most value. We conclude that an emphasis on these processes (instead of program content per se) is most indicated in effecting behavior change and facilitating ongoing disease management.