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1.
Public Health Nutr ; 27(1): e110, 2024 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-38576146

RESUMO

OBJECTIVE: To explore the differences in social norms around parents' food provision in different provision contexts and by demographics. DESIGN: Qualitative study using story completion methodology via an online survey in September 2021. Adults 18+ with or without children were randomised to one of three story stems focusing on food provision in different contexts; food provision at home (non-visitor), with visitors present and with the involvement of sport. Stories were coded and themed using thematic analysis. A content analysis was performed to determine count and frequency of codes in stories by participant demographics and story assumptions. SETTING: Australia. PARTICIPANTS: Adults (n 196). RESULTS: Nine themes were identified from the data resulting in four social norms around providing healthy foods and justifying non-adherence to healthy eating guidelines, evolution of family life and mealtime values, the presence of others influencing how we engage with food provision and unhealthy foods used as incentives/rewards in sport. Following content analysis, no differences of themes or norms by participant demographics or story assumptions were found. CONCLUSIONS: We identified pervasive social norms around family food provision and further identified how contextual factors resulted in variations or distinct norms. This highlights the impact context may have on the social norms parents face when providing food to their children and the opportunities and risks of leveraging these social norms to influence food choice in these contexts. Public health interventions and practitioners should understand the influence of context and social environments when promoting behaviour change and providing individualised advice. Future research could explore parents' experiences of these norms and to what extent they impact food choice.


Assuntos
Alimentos , Normas Sociais , Criança , Adulto , Humanos , Austrália , Pais , Preferências Alimentares
2.
Public Health Res Pract ; 34(1)2024 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-38569576

RESUMO

BACKGROUND: Evidence synthesis is an important tool to inform decision-making in public health policy and practice. Collaborative approaches to evidence synthesis involving researchers and the end-users of their research can enhance the relevance of the evidence for policy and practice and overcome the limitations of traditional evidence synthesis methods. Despite its benefits, collaboration is not consistently integrated into evidence-synthesis methods. Type of program or service: Collaborative evidence synthesis for public health policy and practice. METHODS: Reflecting on our experiences of undertaking collaborative evidence syntheses with end-users to inform policy and practice around preventive health in the first 2000 days of life, we have collated our key learnings to inform future collaborations in public health research. RESULTS: Key themes generated from our reflections were: 1) establish genuine partnerships early on with stakeholders, leveraging existing trusted relationships; 2) identify common goals; 3) prioritise evidence synthesis aims and objectives to ensure they are policy and practice relevant; and 4) maintain transparent, two-way communication. LESSONS LEARNT: Collaboration involving researchers and end-users enhances knowledge synthesis methodologies, increases relevance and accessibility of the evidence for end-users, and strengthens research-policy relationships.


Assuntos
Comunicação , Política Pública , Humanos , Saúde Pública
3.
BMC Public Health ; 24(1): 890, 2024 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-38528500

RESUMO

BACKGROUND: The early years is a critical stage to establish optimal nutrition and movement behaviours. Community playgroups are a relaxed environment for parents with a focus on social connection and supporting parents in their role as 'First Teachers'. Playgroups are therefore an opportunistic setting to promote health behaviours in the early years. To support parents with young children around healthy lifestyle behaviours, the Healthy Conversations @ Playgroup program was delivered in urban and regional areas, across three Australian jurisdictions between 2021-2023. OBJECTIVE: This qualitative evaluation aimed to understand how the Healthy Conversations @ Playgroup program was experienced by parents, playgroup coordinators and peer facilitators. DESIGN: Semi-structured virtual interviews and focus groups were conducted with parents, playgroup coordinators (i.e., person responsible for coordinating the playgroup) and peer facilitators (i.e., trained facilitator for the program) that participated in the Healthy Conversations @ Playgroup study. Transcripts were analysed following a thematic analysis approach. RESULTS: Twenty-eight playgroup parents, coordinators or peer facilitators participated in one of 8 focus groups or 5 interviews. Four themes were developed: Program strengths and challenges; Setting strengths and challenges; Factors that impact program delivery; Participant's suggestions for future program delivery. CONCLUSIONS: The Healthy Conversations @ Playgroup program was valued by parents, providing validation and normalisation of parenting practices, and fostering a shared experience of parenting. Playgroups are a convenient setting for families to attend. The dynamic and distracting nature of the playgroup setting were carefully considered when designing the program. Strategies to further enhance program engagement could include use of coordinator or parent champions, tailored delivery, and extending the reach to other family members. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12621000055808, registered 22 January 2021, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380890.


Assuntos
Promoção da Saúde , Pais , Pré-Escolar , Humanos , Austrália , Comportamentos Relacionados com a Saúde , Poder Familiar , Pesquisa Qualitativa , Ensaios Clínicos como Assunto
4.
Public Health Nutr ; 27(1): e87, 2024 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-38404253

RESUMO

OBJECTIVE: To determine the reach, adoption, implementation and effectiveness of an intervention to increase children's vegetable intake in long day care (LDC). DESIGN: A 12-week pragmatic cluster randomised controlled trial, informed by the multiphase optimisation strategy (MOST), targeting the mealtime environment and curriculum. Children's vegetable intake and variety was measured at follow-up using a modified Short Food Survey for early childhood education and care and analysed using a two-part mixed model for non-vegetable and vegetable consumers. Outcome measures were based on the RE-AIM framework. SETTING: Australian LDC centres. PARTICIPANTS: Thirty-nine centres, 120 educators and 719 children at follow-up. RESULTS: There was no difference between intervention and waitlist control groups in the likelihood of consuming any vegetables when compared with non-vegetable consumers for intake (OR = 0·70, (95 % CI 0·34-1·43), P = 0·32) or variety (OR = 0·73 (95 % CI 0·40-1·32), P = 0·29). Among vegetable consumers (n 652), there was no difference between groups in vegetable variety (exp(b): 1·07 (95 % CI:0·88-1·32, P = 0·49) or vegetable intake (exp(b): 1·06 (95 % CI: 0·78, 1·43)), P = 0·71) with an average of 1·51 (95 % CI 1·20-1·82) and 1·40 (95 % CI 1·08-1·72) serves of vegetables per day in the intervention and control group, respectively. Intervention educators reported higher skills for promoting vegetables at mealtimes, and knowledge and skills for teaching the curriculum, than control (all P < 0·001). Intervention fidelity was moderate (n 16/20 and n 15/16 centres used the Mealtime environment and Curriculum, respectively) with good acceptability among educators. The intervention reached 307/8556 centres nationally and was adopted by 22 % eligible centres. CONCLUSIONS: The pragmatic self-delivered online intervention positively impacted educator's knowledge and skills and was considered acceptable and feasible. Intervention adaptations, using the MOST cyclic approach, could improve intervention impact on children' vegetable intake.


Assuntos
Dieta , Verduras , Criança , Pré-Escolar , Humanos , Austrália , Currículo , Hospital Dia , Comportamento Alimentar , Frutas , Refeições , Análise por Conglomerados
5.
Obes Rev ; 25(4): e13694, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38192203

RESUMO

BACKGROUND: Child health behaviour screening tools have potential to enhance the effectiveness of health promotion and early intervention. This systematic review aimed to examine the effectiveness, acceptability and feasibility of child health behaviour screening tools used in primary health care settings. METHODS: A systematic review of studies published in English in five databases (CINAHL, Medline, Scopus, PsycINFO and Web of Science) prior to July 2022 was undertaken. Eligible studies described: 1) screening tools for health behaviours (dietary, physical activity, sedentary or sleep-related behaviours) used in primary health care settings in children birth to 16 years; 2) tool effectiveness for identifying child health behaviours and changing practitioner behaviour; 3) tool acceptability or feasibility from child, caregiver or practitioner perspective and/or 4) implementation of the screening tool. RESULTS: Of the 7145 papers identified, 22 studies describing 14 screening tools were included. Only four screening tools measured all four behaviour domains. Fourteen studies reported changes in practitioner self-reported behaviour, knowledge and practice. Practitioners and caregivers identified numerous benefits and challenges to screening. CONCLUSIONS: Health behaviour screening can be an acceptable and feasible strategy to assess children's health behaviours in primary health care. Further evaluation is needed to determine effectiveness on child health outcomes.


Assuntos
Dieta , Comportamentos Relacionados com a Saúde , Criança , Humanos , Estudos de Viabilidade , Exercício Físico , Atenção Primária à Saúde
6.
Health Promot Int ; 39(1)2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38198723

RESUMO

Ninety per cent of Australian school children bring a home-packed lunch to school, with 44% of the food consumed during school hours being unhealthy. Among other factors, cost is a key consideration for food provision; however, the costs to Australian families are not well understood. Therefore, we aimed to determine what families are currently paying for school lunchboxes in Australian primary schools and to examine associations between food costs and socio-demographic factors with dietary quality. An audit of local retail outlets was used to determine the food costs of lunchbox contents. Costs (AUD) were adjusted for inflation as of early 2023. The lunchboxes of 1026 children aged 4-12 years at 12 Catholic primary schools in New South Wales, Australia, were assessed at the start of the day, using photography assessment methods and a validated School Food Checklist. The mean cost of lunchbox contents was $4.48 AUD (SD 1.53), containing a mean energy of 2699 kJ (SD 859), with 37.3% (SD 23.9) of energy sourced from unhealthy foods. Multiple linear regression analyses found that the strongest predictors of higher lunchbox cost (P < 0.05) were a higher proportion of energy from unhealthy foods (B = 0.016) and lower Socio-Economic Indexes for Areas (B = -0.178), when controlling for child socio-demographics. The results indicated that lunchbox food costs to Australian families are comparable to alternative school food service models in Australia and internationally. Results demonstrate the cost of food is not the only barrier to providing a healthy school lunchbox. Demonstrating a need for cost-considerate systematic interventions addressing food provision challenges and socio-economic disparities faced by families.


Assuntos
Serviços de Alimentação , Alimentos , Criança , Humanos , Austrália , New South Wales , Marketing
7.
Public Health Nutr ; 27(1): e16, 2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-38037708

RESUMO

OBJECTIVE: This study aimed to examine the theoretical potential of meal kit subscription services in Australia to promote parental food literacy using the retrospective application of behaviour change frameworks. DESIGN: A one-week subscription was purchased for all Australian-based meal kit subscription services (n 9) to access content and features available to subscribers. Behaviour change techniques (BCTs) identified in the subscription and meal planning features, meal kit delivery (i.e. ingredients and recipes) and website were coded using the behaviour change technique taxonomy (BCTTv1) and associated behaviour change frameworks. Identified BCTs were mapped to the theoretical domains framework to identify potential mechanisms of action for influencing parental food literacy development. SETTING: Australia. RESULTS: Thirty-five BCTs were identified across the nine meal kit services reviewed, ranging from nineteen to twenty-nine BCTs per company. Sixteen BCTs were common to all meal kits services, from the hierarchical clusters of 'goals and planning', 'shaping knowledge', 'social support', 'natural consequences', 'comparison of behaviour', 'repetitions and substitution', 'associations', 'reward and threat', 'antecedents' and 'regulation'. Across the meal kit services, the most frequently identified mechanisms of action were motivation (n 27) and capability (n 19). CONCLUSION: These findings support the applicability of behaviour change frameworks to commercial meal kit subscription services and provide a theory-informed process for identifying BCTs that may be relevant for promoting parental food literacy within this context. Further research is required to explore how families engage with meal kit subscription services to determine the exposure and delivery of identified BCT content and to evaluate the potential influence on food literacy development.


Assuntos
Terapia Comportamental , Alfabetização , Humanos , Estudos Retrospectivos , Austrália , Terapia Comportamental/métodos , Apoio Social
8.
Health Promot Int ; 38(5)2023 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-37788435

RESUMO

Children in Australia currently bring a packed lunch to school from home. Many children are not consuming a healthy diet at school. There is interest from key stakeholders (e.g. education and the non-government sector, food service and parents/caregivers) to transform the Australian system to a school-provided model to improve children's diets, reduce parental burden and address food insecurity. To facilitate a successful transition to this system, it is important to consider the views of the children. We aimed to explore Australian primary school children's perceptions of a hypothetical school-provided lunch model. To achieve this aim, we undertook a qualitative study using the story completion method. Twenty-one grade-five children, from one public primary school in South Australia, participated in a once-off data collection session. Children were given a brief story stem and asked to complete a story about a hypothetical school-provided lunch scenario. The story data were analysed using thematic analysis. Four main themes were generated: the eating environment, the food provided, processes of the mealtime and time. The desire for choice was an additional overarching theme that cut across all themes. Our study provides the first exploration of South Australian children's perceptions of hypothetical school-provided meals. These insights can be used to co-design an acceptable school food system with children to create a positive eating environment that supports healthy eating habits they can carry forward into adulthood.


Assuntos
Serviços de Alimentação , Almoço , Humanos , Criança , Austrália , Dieta , Instituições Acadêmicas , Comportamento Alimentar
9.
J Pain Palliat Care Pharmacother ; 37(4): 314-316, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37640398

RESUMO

Buprenorphine, a partial mu-opioid receptor agonist, is a commonly prescribed medication for opioid use disorder (OUD). There is evidence that drugs may enter the male genitourinary tract by an ion-trapping process, based on the lipid solubility and degree of ionization (1). While little is known about the pharmacokinetics of drugs in seminal fluid, pH is thought to play an integral role. Limited evidence exists surrounding cervical absorption of drugs via seminal fluid transmission. This also prompts survey of the frequency of this event and the influence on treatment within this population.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Síndrome de Abstinência a Substâncias , Humanos , Masculino , Analgésicos Opioides/efeitos adversos , Buprenorfina/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Síndrome de Abstinência a Substâncias/tratamento farmacológico
10.
HCA Healthc J Med ; 4(2): 139-149, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37424975

RESUMO

Background: A significant impediment to opioid cessation or dose reduction is mitigating withdrawal severity that has been shown to affect the course of opioid dependence. Current guidelines recommend the use of buprenorphine and methadone over alpha-2 adrenergic agonists. Baclofen, a GABA-B agonist, has promising results as an adjunct agent for opioid withdrawal but has not been compared to buprenorphine. This study compared the ability of buprenorphine and baclofen to mitigate acute opioid withdrawal. Methods: This was a single-center, retrospective chart review of 63 patients with diagnosed opioid use disorder that received scheduled buprenorphine or baclofen for 3 days, in addition to as-needed medications during 2 distinct time periods (pre-2017 and 2017-2020). Patients were admitted to the inpatient detoxification unit at Gateway Community Services in Jacksonville, FL. Results: The results showed that patients achieving detoxification success were 11.2 times more likely to be exposed to baclofen than buprenorphine (95% CI 3.32 - 37.83, P < .001). Completion of detoxification protocol (baclofen 63.2% vs buprenorphine 72%, P = .649) and incidence of orthostatic hypotension (15.8% versus 0%, P = .073) were not significantly different between the 2 groups. Conclusion: Patients treated with baclofen had a lower frequency of secondary medication use for acute opioid withdrawal than patients treated with buprenorphine. This raises an interesting question of whether baclofen is comparable to buprenorphine for treating opioid withdrawal. A prospective, randomized, controlled trial in a larger patient population is warranted to determine this difference.

11.
PLoS One ; 18(7): e0282401, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37428754

RESUMO

The Eating Disorders In weight-related Therapy (EDIT) Collaboration brings together data from randomised controlled trials of behavioural weight management interventions to identify individual participant risk factors and intervention strategies that contribute to eating disorder risk. We present a protocol for a systematic review and individual participant data (IPD) meta-analysis which aims to identify participants at risk of developing eating disorders, or related symptoms, during or after weight management interventions conducted in adolescents or adults with overweight or obesity. We systematically searched four databases up to March 2022 and clinical trials registries to May 2022 to identify randomised controlled trials of weight management interventions conducted in adolescents or adults with overweight or obesity that measured eating disorder risk at pre- and post-intervention or follow-up. Authors from eligible trials have been invited to share their deidentified IPD. Two IPD meta-analyses will be conducted. The first IPD meta-analysis aims to examine participant level factors associated with a change in eating disorder scores during and following a weight management intervention. To do this we will examine baseline variables that predict change in eating disorder risk within intervention arms. The second IPD meta-analysis aims to assess whether there are participant level factors that predict whether participation in an intervention is more or less likely than no intervention to lead to a change in eating disorder risk. To do this, we will examine if there are differences in predictors of eating disorder risk between intervention and no-treatment control arms. The primary outcome will be a standardised mean difference in global eating disorder score from baseline to immediately post-intervention and at 6- and 12- months follow-up. Identifying participant level risk factors predicting eating disorder risk will inform screening and monitoring protocols to allow early identification and intervention for those at risk.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos , Sobrepeso , Adulto , Adolescente , Humanos , Sobrepeso/complicações , Sobrepeso/terapia , Obesidade , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Terapia Comportamental , Revisões Sistemáticas como Assunto , Metanálise como Assunto
13.
Nutrients ; 15(8)2023 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-37111044

RESUMO

Sales of plant-based 'meat' and 'milk'-products that mimic the visual and functional characteristics of animal-source foods-have increased rapidly during the past decade and are predicted to continue to increase. As plant-based 'meat' and 'milk' are nutritionally dissimilar to the animal-source originals, this study aimed to estimate the nutritional implications for the Australian population of substituting 'Easily Swappable' animal-source meat and dairy milk with plant-based imitation products. Computer simulation modelling was undertaken using dietary intake data collected in 2011-12 from a nationally representative survey sample. Conservative and Accelerated dietary transition scenarios were modelled in which various amounts of dairy milk and animal-source meat were replaced with plant-based 'milk' and plant-based 'meat', for the entire population and for various sub-populations. The scenarios were based on sales reports and economic projections. Modelling revealed that the intake of nutrients already at risk of inadequate intake, such as iodine and vitamin B12 (particularly for females), zinc (particularly for males) and n-3 long-chain fatty acids (for adults), would likely be adversely impacted in an Accelerated scenario. In conclusion, widespread replacement of dairy milk and animal-source meat with plant-based 'milk' and 'meat' may increase the risk of nutritional inadequacies in the Australian population. Messages and policy actions promoting the transition to more environmentally sustainable diets should be designed to avoid such adverse nutritional impacts.


Assuntos
Dieta , Leite , Masculino , Animais , Feminino , Simulação por Computador , Austrália , Carne
14.
Nutrients ; 15(6)2023 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-36986143

RESUMO

(1) Background: weight-management interventions vary in their delivery features and intervention strategies. We aimed to establish a protocol to identify these intervention components. (2) Methods: a framework was developed through literature searches and stakeholder consultation. Six studies were independently coded by two reviewers. Consensus included recording conflict resolutions and framework changes. (3) Results: more conflicts occurred for intervention strategies compared to delivery features; both required the updating of definitions. The average coding times were 78 min (SD: 48) for delivery features and 54 min (SD: 29) for intervention strategies. (4) Conclusions: this study developed a detailed framework and highlights the complexities in objectively mapping weight-management trials.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos , Obesidade , Humanos , Obesidade/terapia , Exercício Físico , Dieta Redutora , Transtornos da Alimentação e da Ingestão de Alimentos/terapia
15.
Psychol Rep ; : 332941231165444, 2023 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-36939462

RESUMO

This study's purpose is to evaluate the effectiveness of anticipatory coping as a possible mechanism to reduce daily self-reported physical health consequences of forecasting election-related stress. Elections are often stressful for people. However, the research on possible physical consequences of anticipated election-related stress and ways to counter its impact is limited. We used data from the 2018 U.S. Midterm Election Stress Coping and Prevention Every Day (ESCAPED) study, which provided daily diary responses from 140 participants across the U.S. and American Samoa, ages 19-86. Participants were recruited using Amazon's Mechanical Turk (mTurk) and were asked to fill out an online survey each day for 22 days before, the day of, and 7 days after the 2018 U.S. midterm election, which fell on November 6, 2018. Questions involved forecasting election-related stress, four forms of anticipatory coping, and daily self-reported physical health. Results from multilevel models suggested that on days when participants experienced an increase in their forecasting of election-related stressors and also experienced a decrease in their anticipatory coping related to problem analysis, their daily self-reported physical health decreased. These results highlight the role that future-oriented tactics could play in managing the physical consequences of election-related stress.

16.
Nutrients ; 15(5)2023 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-36904085

RESUMO

This study aimed to understand clinician, researcher and consumer views regarding factors which influence eating disorder (ED) risk during behavioral weight management, including individual risk factors, intervention strategies and delivery features. Eighty-seven participants were recruited internationally through professional and consumer organizations and social media and completed an online survey. Individual characteristics, intervention strategies (5-point scale) and delivery features (important/unimportant/unsure) were rated. Participants were mostly women (n = 81), aged 35-49 y, from Australia or United States, were clinicians and/or reported lived experience of overweight/obesity and/or ED. There was agreement (64% to 99%) that individual characteristics were relevant to ED risk, with history of ED, weight-based teasing/stigma and weight bias internalization having the highest agreement. Intervention strategies most frequently rated as likely to increase ED risk included those with a focus on weight, prescription (structured diets, exercise plans) and monitoring strategies, e.g., calorie counting. Strategies most frequently rated as likely to decrease ED risk included having a health focus, flexibility and inclusion of psychosocial support. Delivery features considered most important were who delivered the intervention (profession, qualifications) and support (frequency, duration). Findings will inform future research to quantitatively assess which of these factors predict eating disorder risk, to inform screening and monitoring protocols.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos , Obesidade , Sobrepeso , Adulto , Pessoa de Meia-Idade , Controle Comportamental , Consenso , Obesidade/psicologia , Sobrepeso/psicologia , Estigma Social , Inquéritos e Questionários , Humanos , Manutenção do Peso Corporal , Masculino , Feminino
17.
Nutr Res Rev ; : 1-11, 2023 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-36788665

RESUMO

The cornerstone of obesity treatment is behavioural weight management, resulting in significant improvements in cardio-metabolic and psychosocial health. However, there is ongoing concern that dietary interventions used for weight management may precipitate the development of eating disorders. Systematic reviews demonstrate that, while for most participants medically supervised obesity treatment improves risk scores related to eating disorders, a subset of people who undergo obesity treatment may have poor outcomes for eating disorders. This review summarises the background and rationale for the formation of the Eating Disorders In weight-related Therapy (EDIT) Collaboration. The EDIT Collaboration will explore the complex risk factor interactions that precede changes to eating disorder risk following weight management. In this review, we also outline the programme of work and design of studies for the EDIT Collaboration, including expected knowledge gains. The EDIT studies explore risk factors and the interactions between them using individual-level data from international weight management trials. Combining all available data on eating disorder risk from weight management trials will allow sufficient sample size to interrogate our hypothesis: that individuals undertaking weight management interventions will vary in their eating disorder risk profile, on the basis of personal characteristics and intervention strategies available to them. The collaboration includes the integration of health consumers in project development and translation. An important knowledge gain from this project is a comprehensive understanding of the impact of weight management interventions on eating disorder risk.

18.
J Pediatr Surg ; 58(9): 1789-1795, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36841704

RESUMO

BACKGROUND: Child physical abuse (CPA) may have subtle presenting signs and can be challenging to identify, especially at emergency centers that do not treat many children. The purpose of this study is to determine the performance of a simple CPA screening tool to identify children most at risk. METHODS: A screening tool ("Red Flag Scorecard") was developed utilizing available evidence-based presenting findings and expert consensus. Retrospective chart review of children treated for injuries between 2014 and 2018 with suspected or confirmed CPA at a level I pediatric trauma center was then performed to validate the screening tool. Descriptive statistics and chi square tests were used to analyze the data. RESULTS: Of 408 cases, median age was 7 months and 60% were male. The majority (69%) were under 1 year of age. The most common history finding was delay in seeking care (58%, 236/408; p = <0.0001), the most common physical exam finding was bruising located away from bony prominences (45%, 182/408), and the most common imaging finding was unexplained brain injury (49%, 201/408). The majority, 84% (343/408), had at least 2 history findings. The combination score of at least 2 history findings and 1 physical/imaging finding was most sensitive (79%). The scorecard would have identified 94% of children who presented with no trauma history (198/211). CONCLUSION: The Red Flag Scorecard may serve as a quick and effective screening tool to raise suspicion for child physical abuse in emergency centers. Prospective study is planned to validate these results. LEVEL OF EVIDENCE: IV.


Assuntos
Maus-Tratos Infantis , Abuso Físico , Criança , Humanos , Masculino , Lactente , Feminino , Estudos Retrospectivos , Estudos Prospectivos , Maus-Tratos Infantis/diagnóstico , Serviço Hospitalar de Emergência
19.
J Pediatr Surg ; 58(1): 153-160, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36283845

RESUMO

PURPOSE: Children undergoing open oncologic surgery can have significant post-operative pain. The purpose of this trial was to compare a surgeon-placed subcutaneous analgesic system (SAS) to epidural analgesia. METHODS: Single center randomized controlled trial including children ≤18 years undergoing open tumor resection between October 2018 and April 2021. Randomization to SAS or epidural was done preoperatively and perioperative pain management was standardized. Families were blinded to the modality. Comparisons of oral morphine equivalents (OME) and pain scores for three postoperative days, clinical outcome parameters, and parental satisfaction following unblinding were completed using non-parametric analyses. RESULTS: Of 36 patients (SAS 18, Epidural 18), median age was 5 years (range <1-17). The Epidural cohort had less OME demand on postoperative day one (SAS 0.76 mg/kg, Epidural 0.11 mg/kg; p<0.01) and two (SAS 0.48 mg/kg, Epidural 0.07 mg/kg, p = 0.03). Pain scores were similar on postoperative days 1-3 (0-2 in both groups). The Epidural cohort had more device complications (SAS 11%, Epidural 50%; p = 0.03) and higher urinary catheter use (SAS 50%, Epidural 89%; p = 0.03). More than 80% of parents would use the same device in the future (SAS 100%, Epidural 84%, p = 0.23). CONCLUSION: For children undergoing open oncologic abdominal or thoracic surgery, early post-operative pain control appears to be better with epidural analgesia; however, SAS has decreased incidence of device complications and urinary catheter use. Parental satisfaction is excellent with both modalities. SAS could be considered as an alternative to epidural, especially in settings when epidural placement is not available or contraindicated. TYPE OF STUDY: Treatment study, Randomized controlled trial. LEVEL OF EVIDENCE: Level 1.


Assuntos
Analgesia Epidural , Criança , Humanos , Lactente , Pré-Escolar , Adolescente , Analgesia Epidural/efeitos adversos , Analgésicos Opioides/uso terapêutico , Resultado do Tratamento , Analgésicos/uso terapêutico , Morfina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle
20.
Prev Med Rep ; 29: 101928, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35928597

RESUMO

Behaviour change technique (BCT) taxonomies provide one approach to unpack the complexity of childhood obesity prevention interventions. This scoping review sought to examine how BCT taxonomies have been applied to understand childhood obesity prevention interventions targeting children aged 12 years or under and/or their caregivers. A systematic search was conducted in Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL and PROSPERO, to capture all eligible research up to February 2021. No limits were placed on country, language, publication dates, or full text availability. Eligible studies included any study design that applied a BCT taxonomy and evaluated behavioural childhood obesity prevention interventions targeting children aged 12 years or under and/or their parents or caregivers. Sixty-three records, describing 54 discrete studies were included; 32 applied a BCT taxonomy prospectively (i.e., to design interventions) and 23 retrospectively (i.e., to assess interventions), 1 study did both. There was substantial variation in the methods used to apply BCT taxonomies and to report BCT-related methods and results. There was a paucity of detail reported in how BCTs were selected in studies applying BCT taxonomies prospectively. Our review provides important insight into the application of BCT taxonomies in childhood obesity prevention and several ongoing challenges, pointing to the need for best practice reporting guidance.

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