Development and Implementation of an Interactive Text Messaging Campaign to Support Behavior Change in a Childhood Obesity Randomized Controlled Trial.

Text messaging is a promising means of intervening on an array of health issues among varied populations, but little has been published about the development of such interventions. The authors describe the development and implementation of an interactive text messaging campaign for parents to support behavior change among children in a childhood obesity randomized controlled trial. The authors invited 160 parents to participate in a text messaging intervention that provided behavior change support in conjunction with health coaching phone calls and mailed materials on behavioral goals. Throughout the 1-year intervention, the authors sent 1-2 text messages per week. The first asked how the child did with a target behavior the day before; parents who replied received an immediate feedback message tailored to their response. The second included a tip about how to work toward a behavioral goal. Baseline surveys indicate that text messaging is a common means of communication for parents, and many are willing to use text messaging to support behavior change for their child. Results at 1 year indicate a high level of engagement with the text messaging intervention, with nearly two thirds responding to 75% or more of the questions they were sent by text.

Spatiotemporal trends and covariates of Lyme borreliosis incidence in Poland, 2010-2019.

Lyme borreliosis (LB) is the most commonly diagnosed tick-borne disease in the northern hemisphere. Since an efficient vaccine is not yet available, prevention of transmission is essential. This, in turn, requires a thorough comprehension of the spatiotemporal dynamics of LB transmission as well as underlying drivers. This study aims to identify spatiotemporal trends and unravel environmental and socio-economic covariates of LB incidence in Poland, using consistent monitoring data from 2010 through 2019 obtained for 320 (aggregated) districts. Using yearly LB incidence values, we identified an overall increase in LB incidence from 2010 to 2019. Additionally, we observed a large variation of LB incidences between the Polish districts, with the highest risks of LB in the eastern districts. We applied spatiotemporal Bayesian models in an all-subsets modeling framework to evaluate potential associations between LB incidence and various potentially relevant environmental and socio-economic variables, including climatic conditions as well as characteristics of the vegetation and the density of tick host species. The best-supported spatiotemporal model identified positive relationships between LB incidence and forest cover, the share of parks and green areas, minimum monthly temperature, mean monthly precipitation, and gross primary productivity. A negative relationship was found with human population density. The findings of our study indicate that LB incidence in Poland might increase as a result of ongoing climate change, notably increases in minimum monthly temperature. Our results may aid in the development of targeted prevention strategies.

Healthy Habits, Happy Homes: methods and baseline data of a randomized controlled trial to improve household routines for obesity prevention.

OBJECTIVE: To develop a home-based intervention for parents of 2-5 year old children to promote household routines to prevent overweight/obesity. METHODS: We recruited 121 children from health centers in Boston between 2011 and 2012 and randomized 62 to intervention and 59 to the control condition. The 6-month intervention included 1) motivational coaching at home and by phone with a health educator, 2) mailed educational materials, and 3) weekly text messages. The intervention promoted three household routines: eating meals as a family, obtaining adequate sleep, and limiting screen time. RESULTS: Of the 121 children, mean (SD) age was 4.0 (1.1) years; 52% were Hispanic, 34% Black, and 14% White/Other. Nearly 60% of the sample had annual household incomes ≤ $20,000. Approximately 64% of families reported eating together ≥ 7 times per week, however, many meals were eaten in front of a TV. Over half of the children slept less than the recommended 11h/night and 78% viewed ≥ 2 h/day of screen time. CONCLUSIONS: Household routines that increase obesity risk were prevalent among low-income families in this study. If proven to be effective, promotion of household routines related to family meals, sleep, and screen time may prevent young children from becoming overweight/obese.

[Prevalence of anti-HCV antibodies among adults in Poland--results of cross-sectional study in general population]. / Rozpowszechnienie przeciwcial anty-HCV wsród osób doroslych w Polsce--wyniki badania przekrojowego w populacji ogólnej.

UNLABELLED: According to WHO data, there are 130-170 million hepatitis C virus (HCV) infected persons world-wide. Data on the prevalence of HCV infection in Poland is still insufficient. OBJECTIVE: The aim of study was to determine the prevalence of HCV infection in the general population in Poland and to characterize the positive predictive value of the ELISA screening test. MATERIAL AND METHODS: A total of 4822 persons aged 18+ and hospitalized on surgical, trauma-orthopedic and laryngological wards in Lubelskie, Mazowieckie, Swietokrzyskie, Warminsko-Mazurskie and Wielkopolskie voivodeships were enrolled into the study. The scheme of cluster sampling was applied. Hospitals wards were selected randomly from Health Care Units Registers. Detection of anti-HCV antibodies was performed using the 4th generation qualitative ELISA test (Dia Sorin, Murex). All positives samples were subject to further testing by Western Blot and retested by ELISA. According to ELISA test producers instructions, samples that were repeatedly reactive were considered as positive (reactive). Using the confirmation test (Western Blot), antibodies directed against specific antigens of HCV (C1, C2, E2, NS3, NS4, NS5) were determined. To determine the prevalence of HCV infections, repeatedly reactive ELISA samples, confirmed by Western Blot (WB) were used. In order to estimate the prevalence of anti-HCV antibodies in general population, indirect standardization according to age groups (<30, 30-49, 50-69, >or =70), gender and place of residence (urban/rural) was employed. RESULTS: Initially positive ELISA test results were obtained in 92/4822 patients (1.91%) and repeatedly positive results--in 46/4822 patients (0.95%). The presence of anti-HCV was confirmed by WB in 54/4822 (1.12%), which constituted 58.7% (54/92) of single-reactive samples and 95.7% (44/46) of double-reactive samples. The positive results of Western Blot were obtained for 10 samples, which were not repeatedly reactive in ELISA test. The standardized prevalence of anti-HCV antibodies amounted to 0.86% (95% CI: 0.59-1.14%). Positive predictive value for a single reactive ELISA test accounted for 47.8% (95% CI: 37.4-58.2%). CONCLUSIONS: Given the low predictive value of the single-positive ELISA, performance of repeated ELISA tests, even for epidemiological purpose, would be recommended.

Tick Infestation in Migratory Birds of the Vistula River Valley, Poland.

Migratory birds play an important role in the eco-epidemiology of tick-borne diseases due to their ability to carry ticks for long distances. The aim of the present study was to investigate the prevalence and factors influencing the intensity of tick infestation in migratory birds. The study was conducted in a locality situated in the Vistula River valley, eastern Poland, during autumn, when the high migratory activity of birds is registered in the region. The birds were captured using ornithological nets and identified at the species level. In the next step, they were carefully inspected for attached ticks. Tick infestation was observed in 4.43% of the captured birds. The highest mean intensity of tick infestation was observed in birds foraging on the ground or in low shrubs and by long- and medium-distance migrants, i.e., Turdus merula (2.73), T. philomelos (2.04), and Erithacus rubecula (1.58). Ixodes ricinus was found to infest the birds most frequently. However, other tick species, i.e., I. trianguliceps, I. crenulatus (synonym I. canisuga), and I. apronophorus, rarely found in eastern Poland, were also found parasitizing birds. The occurrence of I. persulcatus, I. frontalis, and I. acuminatus (synonym I. redikorzevi) was confirmed in the region for the first time. The results of the study suggest that captured bird species are susceptible to tick infestation and could play an important role in the circulation of some tick-borne pathogens. They also play a significant role in the spread of ticks. The ecology and ethology of birds, including their foraging styles and migratory habits, are factors determining the risk of exposure of birds to tick attacks.

Parental guidance advised: associations between parental television limits and health behaviors among obese children.

OBJECTIVE: To examine associations between parental limits on TV viewing and child health behaviors. METHODS: We surveyed 816 parents of children 6 to 12 years of age who were participating in a primary care-based obesity intervention. The main exposures were parental limits placed on child TV viewing time and TV content. Outcomes included screen-related behaviors, sleep habits, eating routines, and physical activity. We performed bivariate and multivariable analyses to examine independent associations of parental TV viewing rules with our outcomes. RESULTS: In multivariable analyses adjusted for child age, sex, race/ethnicity; parental education and US-born status; income and primary language, children whose parents set limits on TV time were less likely to have a TV in their bedroom (odds ratio [OR] 0.45; 95% confidence interval [CI] 0.31, 0.64) or to fall asleep while watching TV (OR 0.47; 95% CI 0.34, 0.67). Children with parental limits spent fewer weekday hours watching TV (-0.38 hours/day; 95% CI -0.54, -0.21), playing video or computer games (-0.15 hours/day; 95% CI -0.25, -0.04), and using the Internet (-0.08 hours/day; 95% CI -0.15, -0.006). In addition, children with limits on TV time were less likely to eat breakfast (OR 0.73; 95% CI 0.53, 0.99) or dinner (OR 0.53; 95% CI 0.39, 0.73) with the TV on, and they slept longer during weeknights: 0.21 hours/day (95% CI 0.05, 0.36). Moreover, children whose parents set rules on TV programming content were also less likely to have a TV in their bedroom (OR 0.37; 95% CI 0.18, 0.79). CONCLUSIONS: The relationship between parental limits on TV viewing and obesogenic child behaviors deserves further investigation.

Exploring innovative approaches and patient-centered outcomes from positive outliers in childhood obesity.

OBJECTIVE: New approaches for obesity prevention and management can be gleaned from positive outliers-that is, individuals who have succeeded in changing health behaviors and reducing their body mass index (BMI) in the context of adverse built and social environments. We explored perspectives and strategies of parents of positive outlier children living in high-risk neighborhoods. METHODS: We collected up to 5 years of height/weight data from the electronic health records of 22,443 Massachusetts children, ages 6 to 12 years, seen for well-child care. We identified children with any history of BMI in the 95th percentile or higher (n = 4007) and generated a BMI z-score slope for each child using a linear mixed effects model. We recruited parents for focus groups from the subsample of children with negative slopes who also lived in zip codes where >15% of children were obese. We analyzed focus group transcripts using an immersion/crystallization approach. RESULTS: We reached thematic saturation after 5 focus groups with 41 parents. Commonly cited outcomes that mattered most to parents and motivated change were child inactivity, above-average clothing sizes, exercise intolerance, and negative peer interactions; few reported BMI as a motivator. Convergent strategies among positive outlier families were family-level changes, parent modeling, consistency, household rules/limits, and creativity in overcoming resistance. Parents voiced preferences for obesity interventions that include tailored education and support that extend outside clinical settings and are delivered by both health care professionals and successful peers. CONCLUSIONS: Successful strategies learned from positive outlier families can be generalized and tested to accelerate progress in reducing childhood obesity.

Improving children's obesity-related health care quality: process outcomes of a cluster-randomized controlled trial.

OBJECTIVE: To examine the extent to which an intervention using electronic decision support delivered to pediatricians at the point-of-care of obese children, with or without direct-to-parent outreach, improved health care quality measures for child obesity. DESIGN AND METHODS: Process outcomes from a three-arm, cluster-randomized trial from 14 pediatric practices in Massachusetts were reported. Participants were 549 children aged 6-12 years with body mass index (BMI) ≥ 95th percentile. In five practices (Intervention-1), pediatricians receive electronic decision support at the point-of-care. In five other practices (Intervention-2), pediatricians receive point-of-care decision support and parents receive information about their child's prior BMI before their scheduled visit. Four practices receive usual care. The main outcomes were Healthcare Effectiveness Data and Information Set (HEDIS) performance measures for child obesity: documentation of BMI percentile and use of counseling codes for nutrition or physical activity. RESULTS: Compared to the usual care condition, participants in Intervention-2, but not Intervention-1, had substantially higher odds of use of HEDIS codes for BMI percentile documentation (adjusted OR: 3.97; 95% CI: 1.92, 8.23) and higher prevalence of use of HEDIS codes for counseling for nutrition or physical activity (adjusted predicted prevalence 20.3% [95% CI 8.5, 41.2] for Intervention -2 vs. 0.0% [0.0, 2.0] for usual care). CONCLUSION: An intervention that included both decision support for clinicians and outreach to parents resulted in improved health care quality measures for child obesity.

Rationale and design of the STAR randomized controlled trial to accelerate adoption of childhood obesity comparative effectiveness research.

BACKGROUND: Comparative effectiveness research (CER) evidence on childhood obesity provides the basis for effective screening and management strategies in pediatric primary care. The uses of health information technology including decision support tools in the electronic health records (EHRs), as well as remote and mobile support to families, offer the potential to accelerate the adoption of childhood obesity CER evidence. METHODS/DESIGN: The Study of Technology to Accelerate Research (STAR) is a three-arm, cluster-randomized controlled trial being conducted in 14 pediatric offices in Massachusetts designed to enroll 800, 6 to 12 year old children with a body mass index (BMI)≥ 95th percentile seen in primary care at those practices. We will examine the extent to which computerized decision support tools in the EHR delivered to primary care providers at the point of care, with or without direct-to-parent support and coaching, will increase adoption of CER evidence for management of obese children. Direct-to-parent intervention components include telephone coaching and twice-weekly text messages. Point-of-care outcomes include obesity diagnosis, nutrition and physical activity counseling, and referral to weight management. One-year child-level outcomes include changes in BMI and improvements in diet, physical activity, screen time, and sleep behaviors, as well as cost and cost-effectiveness. CONCLUSIONS: STAR will determine the extent to which decision support tools in EHRs with or without direct-to-parent support will increase adoption of evidence-based obesity management strategies in pediatric practice and improve childhood obesity-related outcomes.