Interventions in the first 1000 days to prevent childhood obesity: a systematic review and quantitative content analysis.

BACKGROUND: Childhood obesity poses a global health challenge. In recent years, there has been an increase in interventions that begin in pregnancy, putting the concept of early programming and early risk factors into practice. The present study aims to update the findings regarding interventions in the first 1000 days of life. METHODS: A systematic review based on the PRISMA guidelines was carried out in PubMed, WoS, Scopus and CINAHL to obtain the articles to be analysed. We included those studies published between 2016 and 2021. Human interventions that started within the first 1000 days of life and acted on at least one programming factor were included. Once selected, coding and quantitative content analysis was carried out to obtain a profile of the interventions during the first 1000 days. RESULTS: From all screened articles, 51 unique interventions, which met the selection criteria, were included. The majority of interventions (81%) took place in high-income areas. Almost all (86%) were targeted at the general population. The majority (54%) started in the second trimester of pregnancy. A clear majority (61%) ended at the time of birth. 44% of the interventions included all pregnant women. Only 48% of these interventions were focused on improving the nutritional status of the offspring in the short term. Most interventions collected the baby's weight at birth (68%). CONCLUSIONS: It can be concluded that current interventions are not covering as many aspects as they should. Future research should be conducted more frequently in developing countries and target disadvantaged groups. These interventions should include all pregnant women, regardless of their nutritional status, aiming to cover as many programming factors as possible and extending through the first 1000 days of life, with body mass index or skinfolds as measures of effectiveness during this period.

The Effect of Play on Pain and Anxiety in Children in the Field of Nursing: A Systematic Review.

PROBLEM: The role of play in the reduction of anxiety and pain and in the improvement of behaviours and overall wellbeing in children in the field of nursing care in hospital settings. ELIGIBILITY CRITERIA: Studies published during the period 2014-2019 including original articles in English, Spanish and Portuguese. Databases consulted: SCOPUS, MEDLINE/PubMed, WoS, and CUIDEN (Nursing database in Spanish). SAMPLE: Seventeen relevant records were selected. After critical reading using the CASPe (Critical Appraisal Skills Programme in Spanish) instrument, 7 articles were rejected and 10 were finally selected. RESULTS: Each of eight studies showed significant evidence for the role of therapeutic play in the reduction of anxiety and pain and in the overall wellbeing of paediatric patients. IMPLICATIONS: This review aimed to critically assess and synthesize the existing empirical evidence on the contributions of therapeutic play interventions for reducing anxiety, pain and improving the overall wellbeing of paediatric patients. CONCLUSIONS: Based on these findings, it may be safe to say that therapeutic play interventions are effective in reducing the negative emotional manifestations of children, decreasing preoperative anxiety and pain, improving compliance with the induction of anaesthesia and reducing anxiety and postoperative pain. There is also evidence that dramatic puppetry is an effective preoperative care and preparation strategy for reducing anxiety in children undergoing surgery.

The Dimensionality, Consistency, and Structural Validity of an Instrument Used to Measure Obesogenic Attitudes in Parents from Southern Spain (The PRELSA Scale).

(1) Background: We aimed to analyze the dimensionality, internal consistency, and structural validity of the Preschool Eating, Lifestyle, and Sleeping Attitudes Scale (PRELSA Scale), which is an instrument that was designed to measure obesogenic behaviors. (2) Methods: We carried out an observational study by means of an online survey. The PRELSA Scale consists of 13 dimensions and 60 items relating to the most common obesogenic behaviors and attitudes. Additionally, we obtained sociodemographic characteristics and concrete habits from the sample. We obtained the responses of 791 parents and caregivers of preschool children between 2 and 6 years of age in Andalusia (southern Spain). We analyzed dimensionality through an Exploratory Factor Analysis (EFA), consistency through Cronbach's Alpha, structural validity through a Confirmatory Factor Analysis (CFA), and measurement invariance with multigroup CFA models. (3) Results: The EFA showed a 14-dimensional structure with 48 items. The internal consistency was acceptable in all dimensions (Cronbach's Alpha range of 0.72 to 0.97). The structure was confirmed in the CFA with good fit indices (CFI and TLI > 0.9 and RMSEA < 0.05). We ensured that the scale had measurement invariance regarding education, income, and marital status. (4) Conclusions: The PRELSA Scale shows promising properties that have the potential to measure obesogenic behaviors in Spain, which could be the basis for future interventions associated with the prevention of childhood obesity in healthcare and educational settings.

Impact of an early 1000-day intervention for obesity prevention on adiposity and BMI at two years of age: A quasi-experimental study.

Background: The 1000-day period encompassing pregnancy and the first two years of postnatal life is critical for preventing childhood obesity. Existing interventions targeting this period have been characterised by great variability in duration, objectives, and evaluation indicators. We aimed to evaluate the impact of an intervention developed during the entire 1000-day period on body mass index and body fat percentage at two years of age. Methods: We designed a prospective, interventional, quasi-experimental study (ie, without randomisation or blinding of both groups) targeting mother-child pairs from the beginning of pregnancy up to two years of age belonging to the basic health area of Puerto Real (Cádiz). We developed and delivered an intervention from pregnancy to two years and assessed its effect. Results: The duration of breastfeeding and vitamin D supplementation increased significantly after the intervention. The intervention group showed lowed skinfolds values, a significantly lower body fat percentage, as well as a lower accumulation of factor at two years than the control group. Conclusions: The intervention has had an impact on body fat percentage at two years, potentially justified through its overall effect and the lower accumulation of early risk factors.

The Preschool Eating, Lifestyle, and Sleeping Attitudes Scale (PRELSA Scale): Construction and Pilot Testing of a Tool to Measure Factors Associated with Childhood Obesity.

(1) Background: Childhood obesity poses a global health challenge. In the period from two to six years, the fundamental risk factors are associated with modifiable habits, related to parental attitudes. In this study, we will analyze the construction and pilot test of the PRELSA Scale, designed to be a comprehensive tool that covers the whole problem of childhood obesity, from which we can later develop a brief instrument. (2) Methods: First, we described the scale construction process. After that, we conducted a pilot test on parents to check the instrument's comprehensibility, acceptability, and feasibility. We detected items to be modified or eliminated through two criteria: the frequencies of the categories of each item and responses in the Not Understood/Confused category. Finally, we sought expert opinion through a questionnaire to ensure the content validity of the scale. (3) Results: The pilot test on parents detected 20 possible items for modification and other changes in the instrument. The experts' questionnaire showed good values on the scale's content, highlighting some feasibility problems. The final version of the scale went from 69 items to 60. (4) Conclusions: Developing scales that detect parental attitudes associated with the onset of childhood obesity may be the basis for future interventions to address this health challenge.

Needs of patients with multi-morbidity and heart failure for the development of a mHealth to improve their self-management: A qualitative analysis.

Objective: To provide practical information regarding needs, preferences of content and format of an app to assist the self-management in patients with multi-morbidity and heart failure (HF). Methods: The three-phase study was conducted in Spain. Six integrative reviews, a qualitative methodology based on Van Manen's hermeneutic phenomenology through semi-structured interviews and user stories were used. Data collection continued until data saturation was reached. All data were transcribed verbatim and analysed using a framework approach. Thematic analysis technique following the methods of Braun and Clarke was used for emerging themes. Results: Integrative reviews conducted included practical recommendations to include in the content and format of the App and helped create the interview guide. Interviews revealed 15 subthemes that captured the meaning of narratives offering contextual insights into the development of the App. The main effective mechanisms of multicomponent interventions for patients with HF must contain (a) components that increase the patient's understanding of HF, (b) self-care, (c) self-efficacy and participation of the family/informal caregiver, (4) psychosocial well-being and (5) professional support and use of technology. User stories revealed that patients prioritized improvements in direct contact with health services in case of emergency (90%), nutritional information (70%), type of exercises in order to improve their physical condition (75%) and information about food and drug interaction (60%). The importance of motivation messages (60%) was highlighted by transversal way. Conclusions: The three-phase process integrating theoretical basis, evidence from integrative reviews and research findings from target users has been considered a guide for future app development.

Lockdown due to COVID-19 in Spanish Children Up to 6 Years: Consequences on Diet, Lifestyle, Screen Viewing, and Sleep.

Objectives: To record how the habits of children under 6 years of age in Cadiz have changed during lockdown, in order to identify those that could be a handicap for the problem of overweight and obesity. Methods: We developed a new questionnaire to analyse family living habits. The questionnaire was administered online to parents of children aged zero-six years. Eating habits, sedentary lifestyles, screen viewing, and sleep changes were evaluated. Results: Changes were found in family living habits, as shown by the results of McNemar's tests (p-value < 0.01 in all pairs except one, p-value = 0.097). A worsening of habits was also found to be more accentuated in families with low income, low educational level or small size of home. Some positive aspects associated with family meals and parental involvement were found. Conclusions: The lockdown has showed a significant break in the main routines of the children that could affect their health and may add to the worsening of the already poor childhood obesity situation. The positive aspects found can be instrumental in improving the situation in future similar situations.

Analysis of the Psychosocial Impact of the COVID-19 Pandemic on the Nursing Staff of the Intensive Care Units (ICU) in Spain.

(1) The public health emergency, caused by COVID-19, has resulted in strong physical and mental exhaustion in healthcare workers. This research has been designed with the aim to describe the psychosocial impact of the COVID-19 pandemic on nurses working in intensive care units (ICU) and identify the related risk factors. (2) This is a cross-sectional study, in which a self-administered questionnaire was designed to cover the dimensions of interest associated with psychosocial factors during the pandemic and their factor risks. (3) A total of 456 nursing professionals participated, and 88.4% were women. Most of the professionals had a temporary contract (71.3%) and person at risk close to them (88.8%). Regarding psychosocial factors, there was a worsening in most of the associated variables, especially in sleep problems, anxiety, stress, and job performance. Female nurses were more prone to anxiety. Those under 30, as well as those with temporary contracts, were more unfocused. Professionals with a person at risk in their environment felt much more worried. The degree of exposure was associated with greater fear. (4) Those nurses who were female, younger, and with a temporary employment contract were shown to be more vulnerable to the impact of the pandemic on their psychosocial health. Because of this, it is necessary to adopt effective strategies for the protection of nurses' health, focusing on the specific risk factors identified.

Early Risk Factors for Obesity in the First 1000 Days-Relationship with Body Fat and BMI at 2 Years.

(1) Background: Obesity is defined as an excessive accumulation of body fat. Several early developmental factors have been identified which are associated with an increased risk of childhood obesity and increased adiposity in childhood. The primary objective of the present study is to analyse the effect of various early risk factors on Body Mass Index (BMI) and body fat percentage at 2 years of age. (2) Methods: A prospective cohort study design was used, with the sample consisting of 109 mother-child pairs from whom data were collected between early pregnancy and 2 years old. Adiposity was determined based on skinfold measurements using the Brooks and Siri formulae. Mean comparison tests (Student's t-test and ANOVAs) and multiple linear regression models were used to analyse the relationship between early programming factors and dependent variables. (3) Results: Maternal excess weight during early pregnancy (ß = 0.203, p = 0.026), gestational smoking (ß = 0.192, p = 0.036), and accelerated weight gain in the first 2 years (ß = - 0.269, p = 0.004) were significantly associated with high body fat percentage. Pre-pregnancy BMI and accelerated weight gain in the first 2 years were associated with high BMI z-score (ß = 0.174, p = 0.047 and ß = 0.417, p = 0.000 respectively). The cumulative effect of these variables resulted in high values compared to the baseline zero-factor group, with significant differences in BMI z-score (F = 8.640, p = 0.000) and body fat percentage (F = 5.402, p = 0.002) when three factors were present. (4) Conclusions: The presence of several early risk factors related to obesity in infancy was significantly associated with higher BMI z-score and body fat percentage at 2 years of age. The presence of more than one of these variables was also associated with higher adiposity at 2 years of age. Early prevention strategies should address as many of these factors as possible.

Effectiveness of a Multifactorial Intervention in the First 1000 Days of Life to Prevent Obesity and Overweight in Childhood: Study Protocol.

(1) Background: Obesity is a global health problem, and its prevention must be a priority goal of public health, especially considering the seriousness of the problem among children. It is known that fetal and early postnatal environments may favor the appearance of obesity in later life. In recent years, the impact of the programs to prevent obesity in childhood has been scarce. The aim of this research is to evaluate the effectiveness of an intervention based on the concept of early programming. (2) Methods: Non-randomized controlled trial design. Inclusion criteria are: two-year-old infants whose gestational period begins in the 14 months following the start of the intervention, and whose mothers have made the complete follow-up of their pregnancy in the same clinical unit of the study. The intervention will be developed over all the known factors that affect early programming, during pregnancy up to 2 years of life. Data will be collected through a data collection sheet by the paediatricians. A unibivariate and multivariate analysis of the data will be carried out. (3) Ethics and dissemination: The trial does not involve any risk to participants and their offspring. Signed informed consent is obtained from all participants. Ethical approval has been obtained. (4) Results: It is expected that this study will provide evidence on the importance of the prevention of obesity from the critical period of the first 1000 days of life, being able to establish this as a standard intervention in primary care.

Teaching empathy to nursing students: A randomised controlled trial.

BACKGROUND: Empathy has been reported to produce a positive effect on improving patient health outcomes, becoming a fundamental skill in any health personnel-patient relationship. OBJECTIVE: To evaluate the effectiveness of an intervention designed to improve the nursing students´ empathy, the learning perception, the improvement of the perception in the understanding of the content, and in the degree of difficulty as well as the acquisition of skills. DESIGN: Multicentre randomised controlled trial. SETTING: This research was conducted at two schools of nursing at a public university in the Southwest of Spain. PARTICIPANTS: 116 nursing students were randomly assigned to an experimental or a control group (delayed intervention group once the post-training analysis was completed) during the second semester of the 2015/2016 academic year. METHODS: Pre-test, post-test, and follow-up data were obtained for each group using a simulated clinical interview. Empathy was the primary outcome (The Consultation and Relational Empathy Measure, Jefferson Scale of Empathy student version, Reynolds Empathy Scale, and Carkhuff Scale). The students' perceived knowledge, the learning perception, the self-esteem (Rosenberg Self-Esteem Scale) and the understanding of the content and acquisition of skills (ad-hoc questions) were also analysed. RESULTS: The results were improved in all the measures conducted in the experimental groups at the different centres after the intervention. The mean post-test simulation scores were higher than the pre-test with statistically significant differences. The results were maintained in the follow-up. The student's perception of learning and the perception of understanding of the content and the acquisition of skills were improved as well. CONCLUSION: The study support that training in empathic competence is effective.

Antibiotic-Resistant Salmonella, isolated from cloacal swab samples from turtles in Guatemala / Salmonella resistente a antibióticos, aislada de muestras de hisopados cloacales en tortugas de Guatemala

Salmonellosis is a relevant public health threat worldwide. Reptiles are commonly involved in human cases. A microbiological survey was conducted from August to October 2018 to isolate Salmonella bacteria and de-termine if they were resistant to regularly used antibiotics in eight species of pet turtles (Kinosternon acutum sp., K. leucostomum, K. scorpioides, Rhinoclemmys areolata sp., R. pulcherrima, Staurotypus salvinii sp., Trachemys scripta and T. venusta) in Guatemala city, San Lucas Sacatepéquez and Antigua Guatemala. Cloacal swabs were taken from 63 turtles and cultivated in the Microbiology Laboratory at the Veterinary Medicine and Animal Hus-bandry Faculty, University of San Carlos of Guatemala, in Guatemala City. Three samples were positive to the presence of Salmonella sp. One of these isolates (from Trachemys scripta) was resistant to gentamicin, penicillin and amikacin, other isolate (from T. scripta) was partially resistant to amoxicilin + clavulanic acid and penicillin, and other (from T. venusta) to penicillin. These findings highlight the need for better biosecurity practices and show the capacity of bacteria to develop survival strategies that involve resistance to harmful substances like antibiotics.

La salmonelosis es una importante enfermedad zoonótica considerada una amenaza a la salud pública a nivel mundial. Los reptiles están comúnmente involucrados en la transmisión animal-humano. Con el objetivo de determinar la presencia de Salmonella y determinar su resistencia a antibióticos de uso común, se realizó un estudio exploratorio en ocho especies de tortugas (Kinosternon acutum sp., K. leucostomum, K. scorpioides, Rhinoclem-mys areolata sp., R. pulcherrima, Staurotypus salvinii sp., Trachemys scripta y T. venusta) en Guatemala y en San Lucas Sacatepéquez. Se tomaron hisopados cloacales de 63 especímenes y se cultivaron en el Laboratorio de Microbiología de la Facultad de Medicina Veterinaria y Zootecnia de la Universidad de San Carlos de Guatemala. Tres muestras fueron positivas a la presencia de Salmonella sp. Uno de los aislados (de Trachemys scripta) fue resistente a gentamicina, penicilina y amikacina, otro aislado (de T. scripta) fue parcialmente resistente a amoxicilina + ácido clavulánico y a penicilina y un tercer aislado (de T. venusta) a penicilina. Estos hallazgos resaltan la necesidad de mejores prácticas de bioseguridad y muestran la capacidad de las bacterias para desarrollar estrategias de sobrevivencia que involucran la resistencia a sustancias que les son nocivas, como los antibióticos.