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Kevin Z Chen - One of the best experts on this subject based on the ideXlab platform.
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the effect of comprehensive Intervention for childhood obesity on dietary diversity among younger children evidence from a school based randomized controlled trial in china
PLOS ONE, 2020Co-Authors: Olivier Ecker, Qian Zhang, Ailing Liu, Hongwei Guo, Weijia Liu, Junmao Sun, Kevin Z ChenAbstract:Background Little evidence from developing countries on dietary transition demonstrates the effects of comprehensive childhood obesity Interventions on dietary diversity and food variety among younger children. This study aimed to evaluate the effects of comprehensive childhood obesity Interventions on dietary diversity among younger children. Methods A total of 4846 children aged 7–13 years were included based on a multicenter randomized controlled trial for childhood obesity Interventions in 38 primary schools. Nutrition education Intervention (NE), physical activity Intervention (PA) and comprehensive Intervention including both NE and PA (CNP) were carried out separately for 2 semesters. Dietary Diversity Score (DDS9 and DDS28 for 9 and 28 food groupings, respectively), Food Variety Score (FVS, the number of food items) and the proportions of different foods consumed were calculated according to the food intake records collected with the 24-h dietary recall method. Results The Intervention effects per day of comprehensive Intervention group were 0 (95% Confidence Interval (CI): 0, 0.1; p = 0.382) on DDS9, 0.1 (95% CI: -0.1, 0.2; p = 0.374) on DDS28 and 0.1 (95% CI: -0.1, 0.3; p = 0.186) on FVS of overall diet, which was 0.1 (95% CI: 0, 0.1; p < 0.001) on DDS9, 0 (95% CI: 0, 0.1; p = 0.168) on DDS28 and 0.1 (95% CI: 0, 0.1; p = 0.067) on FVS of dietary scores of breakfast only. Additionally, CNP group had greater increases in cereals, meat and fruits, and more decreases in eggs, fish and dried legumes consumption proportions as compared with the control group. Decreasing side effect on dietary diversity and food variety were found for PA Intervention, but not for NE Intervention only. Conclusions Though the comprehensive obesity Intervention didn’t improve the overall dietary diversity per day, the Positive Intervention effects were observed on breakfast foods and some foods’ consumption.
Derek Stewart - One of the best experts on this subject based on the ideXlab platform.
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non medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care
Cochrane Database of Systematic Reviews, 2016Co-Authors: Greg Weeks, Johnson George, Katie Maclure, Derek StewartAbstract:Background A range of health workforce strategies are needed to address health service demands in low-, middle- and high-income countries. Non-medical prescribing involves nurses, pharmacists, allied health professionals, and physician assistants substituting for doctors in a prescribing role, and this is one approach to improve access to medicines. Objectives To assess clinical, patient-reported, and resource use outcomes of non-medical prescribing for managing acute and chronic health conditions in primary and secondary care settings compared with medical prescribing (usual care). Search methods We searched databases including CENTRAL, MEDLINE, Embase, and five other databases on 19 July 2016. We also searched the grey literature and handsearched bibliographies of relevant papers and publications. Selection criteria Randomised controlled trials (RCTs), cluster-RCTs, controlled before-and-after (CBA) studies (with at least two Intervention and two control sites) and interrupted time series analysis (with at least three observations before and after the Intervention) comparing: 1. non-medical prescribing versus medical prescribing in acute care; 2. non-medical prescribing versus medical prescribing in chronic care; 3. non-medical prescribing versus medical prescribing in secondary care; 4 non-medical prescribing versus medical prescribing in primary care; 5. comparisons between different non-medical prescriber groups; and 6. non-medical healthcare providers with formal prescribing training versus those without formal prescribing training. Data collection and analysis We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed studies for inclusion, extracted data, and assessed study quality with discrepancies resolved by discussion. Two review authors independently assessed risk of bias for the included studies according to EPOC criteria. We undertook meta-analyses using the fixed-effect model where studies were examining the same treatment effect and to account for small sample sizes. We compared outcomes to a random-effects model where clinical or statistical heterogeneity existed. Main results We included 46 studies (37,337 participants); non-medical prescribing was undertaken by nurses in 26 studies and pharmacists in 20 studies. In 45 studies non-medical prescribing as a component of care was compared with usual care medical prescribing. A further study compared nurse prescribing supported by guidelines with usual nurse prescribing care. No studies were found with non-medical prescribing being undertaken by other health professionals. The education requirement for non-medical prescribing varied with country and location. A meta-analysis of surrogate markers of chronic disease (systolic blood pressure, glycated haemoglobin, and low-density lipoprotein) showed Positive Intervention group effects. There was a moderate-certainty of evidence for studies of blood pressure at 12 months (mean difference (MD) -5.31 mmHg, 95% confidence interval (CI) -6.46 to -4.16; 12 studies, 4229 participants) and low-density lipoprotein (MD -0.21, 95% CI -0.29 to -0.14; 7 studies, 1469 participants); we downgraded the certainty of evidence from high due to considerations of serious inconsistency (considerable heterogeneity), multifaceted Interventions, and variable prescribing autonomy. A high-certainty of evidence existed for comparative studies of glycated haemoglobin management at 12 months (MD -0.62, 95% CI -0.85 to -0.38; 6 studies, 775 participants). While there appeared little difference in medication adherence across studies, a meta-analysis of continuous outcome data from four studies showed an effect favouring patient adherence in the non-medical prescribing group (MD 0.15, 95% CI 0.00 to 0.30; 4 studies, 700 participants). We downgraded the certainty of evidence for adherence to moderate due to the serious risk of performance bias. While little difference was seen in patient-related adverse events between treatment groups, we downgraded the certainty of evidence to low due to indirectness, as the range of adverse events may not be related to the Intervention and selective reporting failed to adequately report adverse events in many studies. Patients were generally satisfied with non-medical prescriber care (14 studies, 7514 participants). We downgraded the certainty of evidence from high to moderate due to indirectness, in that satisfaction with the prescribing component of care was only addressed in one study, and there was variability of satisfaction measures with little use of validated tools. A meta-analysis of health-related quality of life scores (SF-12 and SF-36) found a difference favouring non-medical prescriber care for the physical component score (MD 1.17, 95% CI 0.16 to 2.17), and the mental component score (MD 0.58, 95% CI -0.40 to 1.55). However, the quality of life measurement may more appropriately reflect composite care rather than the prescribing component of care, and for this reason we downgraded the certainty of evidence to moderate due to indirectness of the measure of effect. A wide variety of resource use measures were reported across studies with little difference between groups for hospitalisations, emergency department visits, and outpatient visits. In the majority of studies reporting medication use, non-medical prescribers prescribed more drugs, intensified drug doses, and used a greater variety of drugs compared to usual care medical prescribers. The risk of bias across studies was generally low for selection bias (random sequence generation), detection bias (blinding of outcome assessment), attrition bias (incomplete outcome data), and reporting bias (selective reporting). There was an unclear risk of selection bias (allocation concealment) and for other biases. A high risk of performance bias (blinding of participants and personnel) existed. Authors' conclusions The findings suggest that non-medical prescribers, practising with varying but high levels of prescribing autonomy, in a range of settings, were as effective as usual care medical prescribers. Non-medical prescribers can deliver comparable outcomes for systolic blood pressure, glycated haemoglobin, low-density lipoprotein, medication adherence, patient satisfaction, and health-related quality of life. It was difficult to determine the impact of non-medical prescribing compared to medical prescribing for adverse events and resource use outcomes due to the inconsistency and variability in reporting across studies. Future efforts should be directed towards more rigorous studies that can clearly identify the clinical, patient-reported, resource use, and economic outcomes of non-medical prescribing, in both high-income and low-income countries.
Ilse De Bourdeaudhuij - One of the best experts on this subject based on the ideXlab platform.
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effect and process evaluation of a kindergarten based family involved Intervention with a randomized cluster design on sedentary behaviour in 4 to 6 year old european preschool children the toybox study
PLOS ONE, 2017Co-Authors: Julie Latomme, Luis A Moreno, Greet Cardon, Ilse De Bourdeaudhuij, Violeta Iotova, Berthold Koletzko, Piotr Socha, Odysseas Androutsos, Yannis Manios, Marieke De CraemerAbstract:Background The aim of the present study evaluated the effect and process of the ToyBox-Intervention on proxy-reported sedentary behaviours in 4- to 6-year-old preschoolers from six European countries. Methods In total, 2434 preschoolers’ parents/primary caregivers (mean age: 4.7±0.4 years, 52.2% boys) filled out a questionnaire, assessing preschoolers’ sedentary behaviours (TV/DVD/video viewing, computer/video games use and quiet play) on weekdays and weekend days. Multilevel repeated measures analyses were conducted to measure the Intervention effects. Additionally, process evaluation data were included to better understand the Intervention effects. Results Positive Intervention effects were found for computer/video games use. In the total sample, the Intervention group showed a smaller increase in computer/video games use on weekdays (s = -3.40, p = 0.06; Intervention: +5.48 min/day, control: +8.89 min/day) and on weekend days (s = -5.97, p = 0.05; Intervention: +9.46 min/day, control: +15.43 min/day) from baseline to follow-up, compared to the control group. Country-specific analyses showed similar effects in Belgium and Bulgaria, while no significant Intervention effects were found in the other countries. Process evaluation data showed relatively low teachers’ and low parents’ process evaluation scores for the sedentary behaviour component of the Intervention (mean: 15.6/24, range: 2.5–23.5 and mean: 8.7/17, range: 0–17, respectively). Higher parents’ process evaluation scores were related to a larger Intervention effect, but higher teachers’ process evaluation scores were not. Conclusions The ToyBox-Intervention had a small, Positive effect on European preschoolers’ computer/video games use on both weekdays and weekend days, but not on TV/DVD/video viewing or quiet play. The lack of larger effects can possibly be due to the fact that parents were only passively involved in the Intervention and to the fact that the Intervention was too demanding for the teachers. Future Interventions targeting preschoolers' behaviours should involve parents more actively in both the development and the implementation of the Intervention and, when involving schools, less demanding activities for teachers should be developed. Trial registration clinicaltrials.gov NCT02116296
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evaluation of a real world Intervention using professional football players to promote a healthy diet and physical activity in children and adolescents from a lower socio economic background a controlled pretest posttest design
BMC Public Health, 2014Co-Authors: Veerle Dubuy, Lea Maes, Ilse De Bourdeaudhuij, Katrien De Cocker, Jan Seghers, Johan Lefevre, Kristine De Martelaer, Hannah L Brooke, Greet CardonAbstract:Background: The increasing rates of obesity among children and adolescents, especially in those from lower socioeconomic backgrounds, emphasise the need for Interventions promoting a healthy diet and physical activity. The present study aimed to examine the effectiveness of the ‘Health Scores!’ program, which combined professional football player role models with a school-based program to promote a healthy diet and physical activity to socially vulnerable children and adolescents. Methods: The Intervention was implemented in two settings: professional football clubs and schools. Socially vulnerable children and adolescents (n = 165 Intervention group, n = 440 control group, aged 10-14 year) provided self-reported data on dietary habits and physical activity before and after the four-month Intervention. Intervention effects were evaluated using repeated measures analysis of variance. In addition, a process evaluation was conducted. Results: No Intervention effects were found for several dietary behaviours, including consumption of breakfast, fruit, soft drinks or sweet and savoury snacks. Positive Intervention effects were found for self-efficacy for having a daily breakfast (p< 0.01), Positive attitude towards vegetables consumption (p<0.01) and towards lower soft drink consumption (p<0.001). A trend towards significance (p<0.10) was found for self-efficacy for reaching the physical activity guidelines. For sports participation no significant Intervention effect was found. In total, 92 pupils completed the process evaluation, the feedback was largely Positive. Conclusions: The ‘Health Scores!’ Intervention was successful in increasing psychosocial correlates of a healthy diet and PA. The use of professional football players as a credible source for health promotion was appealing to socially vulnerable children and adolescents.
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evaluation of a 2 year physical activity and healthy eating Intervention in middle school children
Health Education Research, 2006Co-Authors: Leen Haerens, Lea Maes, Benedicte Deforche, Greet Cardon, Veerle Stevens, Ilse De BourdeaudhuijAbstract:The aim of the present study was to evaluate the effects of a middle school physical activity and healthy eating Intervention, including an environmental and computer-tailored component, and to investigate the effects of parental involvement. A random sample of 15 schools with seventh and eight graders was randomly assigned to one of three conditions: (i) Intervention with parental involvement, (ii) Intervention alone and (iii) control group. In 10 schools, an Intervention, combining environmental changes with computer-tailored feedback, was implemented over 2 school years. In five Intervention schools, increased parental support was added. Physical activity was measured with questionnaires in the total sample and with accelerometers in a sub-sample of children. Fat intake, fruit, water and soft drink consumption were measured using food-frequency questionnaires. Results showed significant Positive Intervention effects on physical activity in both genders and on fat intake in girls. Parental involvement did not increase Intervention effects. It can be concluded that physical activity and eating behaviours of middle school children can be improved by school-based strategies combining environmental and personal Interventions. The use of personalized computertailored Interventions seems to be a promising tool for targeting adolescents but needs to be further explored.
Greet Cardon - One of the best experts on this subject based on the ideXlab platform.
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effect and process evaluation of a kindergarten based family involved Intervention with a randomized cluster design on sedentary behaviour in 4 to 6 year old european preschool children the toybox study
PLOS ONE, 2017Co-Authors: Julie Latomme, Luis A Moreno, Greet Cardon, Ilse De Bourdeaudhuij, Violeta Iotova, Berthold Koletzko, Piotr Socha, Odysseas Androutsos, Yannis Manios, Marieke De CraemerAbstract:Background The aim of the present study evaluated the effect and process of the ToyBox-Intervention on proxy-reported sedentary behaviours in 4- to 6-year-old preschoolers from six European countries. Methods In total, 2434 preschoolers’ parents/primary caregivers (mean age: 4.7±0.4 years, 52.2% boys) filled out a questionnaire, assessing preschoolers’ sedentary behaviours (TV/DVD/video viewing, computer/video games use and quiet play) on weekdays and weekend days. Multilevel repeated measures analyses were conducted to measure the Intervention effects. Additionally, process evaluation data were included to better understand the Intervention effects. Results Positive Intervention effects were found for computer/video games use. In the total sample, the Intervention group showed a smaller increase in computer/video games use on weekdays (s = -3.40, p = 0.06; Intervention: +5.48 min/day, control: +8.89 min/day) and on weekend days (s = -5.97, p = 0.05; Intervention: +9.46 min/day, control: +15.43 min/day) from baseline to follow-up, compared to the control group. Country-specific analyses showed similar effects in Belgium and Bulgaria, while no significant Intervention effects were found in the other countries. Process evaluation data showed relatively low teachers’ and low parents’ process evaluation scores for the sedentary behaviour component of the Intervention (mean: 15.6/24, range: 2.5–23.5 and mean: 8.7/17, range: 0–17, respectively). Higher parents’ process evaluation scores were related to a larger Intervention effect, but higher teachers’ process evaluation scores were not. Conclusions The ToyBox-Intervention had a small, Positive effect on European preschoolers’ computer/video games use on both weekdays and weekend days, but not on TV/DVD/video viewing or quiet play. The lack of larger effects can possibly be due to the fact that parents were only passively involved in the Intervention and to the fact that the Intervention was too demanding for the teachers. Future Interventions targeting preschoolers' behaviours should involve parents more actively in both the development and the implementation of the Intervention and, when involving schools, less demanding activities for teachers should be developed. Trial registration clinicaltrials.gov NCT02116296
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evaluation of a real world Intervention using professional football players to promote a healthy diet and physical activity in children and adolescents from a lower socio economic background a controlled pretest posttest design
BMC Public Health, 2014Co-Authors: Veerle Dubuy, Lea Maes, Ilse De Bourdeaudhuij, Katrien De Cocker, Jan Seghers, Johan Lefevre, Kristine De Martelaer, Hannah L Brooke, Greet CardonAbstract:Background: The increasing rates of obesity among children and adolescents, especially in those from lower socioeconomic backgrounds, emphasise the need for Interventions promoting a healthy diet and physical activity. The present study aimed to examine the effectiveness of the ‘Health Scores!’ program, which combined professional football player role models with a school-based program to promote a healthy diet and physical activity to socially vulnerable children and adolescents. Methods: The Intervention was implemented in two settings: professional football clubs and schools. Socially vulnerable children and adolescents (n = 165 Intervention group, n = 440 control group, aged 10-14 year) provided self-reported data on dietary habits and physical activity before and after the four-month Intervention. Intervention effects were evaluated using repeated measures analysis of variance. In addition, a process evaluation was conducted. Results: No Intervention effects were found for several dietary behaviours, including consumption of breakfast, fruit, soft drinks or sweet and savoury snacks. Positive Intervention effects were found for self-efficacy for having a daily breakfast (p< 0.01), Positive attitude towards vegetables consumption (p<0.01) and towards lower soft drink consumption (p<0.001). A trend towards significance (p<0.10) was found for self-efficacy for reaching the physical activity guidelines. For sports participation no significant Intervention effect was found. In total, 92 pupils completed the process evaluation, the feedback was largely Positive. Conclusions: The ‘Health Scores!’ Intervention was successful in increasing psychosocial correlates of a healthy diet and PA. The use of professional football players as a credible source for health promotion was appealing to socially vulnerable children and adolescents.
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evaluation of a 2 year physical activity and healthy eating Intervention in middle school children
Health Education Research, 2006Co-Authors: Leen Haerens, Lea Maes, Benedicte Deforche, Greet Cardon, Veerle Stevens, Ilse De BourdeaudhuijAbstract:The aim of the present study was to evaluate the effects of a middle school physical activity and healthy eating Intervention, including an environmental and computer-tailored component, and to investigate the effects of parental involvement. A random sample of 15 schools with seventh and eight graders was randomly assigned to one of three conditions: (i) Intervention with parental involvement, (ii) Intervention alone and (iii) control group. In 10 schools, an Intervention, combining environmental changes with computer-tailored feedback, was implemented over 2 school years. In five Intervention schools, increased parental support was added. Physical activity was measured with questionnaires in the total sample and with accelerometers in a sub-sample of children. Fat intake, fruit, water and soft drink consumption were measured using food-frequency questionnaires. Results showed significant Positive Intervention effects on physical activity in both genders and on fat intake in girls. Parental involvement did not increase Intervention effects. It can be concluded that physical activity and eating behaviours of middle school children can be improved by school-based strategies combining environmental and personal Interventions. The use of personalized computertailored Interventions seems to be a promising tool for targeting adolescents but needs to be further explored.
Greg Weeks - One of the best experts on this subject based on the ideXlab platform.
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non medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care
Cochrane Database of Systematic Reviews, 2016Co-Authors: Greg Weeks, Johnson George, Katie Maclure, Derek StewartAbstract:Background A range of health workforce strategies are needed to address health service demands in low-, middle- and high-income countries. Non-medical prescribing involves nurses, pharmacists, allied health professionals, and physician assistants substituting for doctors in a prescribing role, and this is one approach to improve access to medicines. Objectives To assess clinical, patient-reported, and resource use outcomes of non-medical prescribing for managing acute and chronic health conditions in primary and secondary care settings compared with medical prescribing (usual care). Search methods We searched databases including CENTRAL, MEDLINE, Embase, and five other databases on 19 July 2016. We also searched the grey literature and handsearched bibliographies of relevant papers and publications. Selection criteria Randomised controlled trials (RCTs), cluster-RCTs, controlled before-and-after (CBA) studies (with at least two Intervention and two control sites) and interrupted time series analysis (with at least three observations before and after the Intervention) comparing: 1. non-medical prescribing versus medical prescribing in acute care; 2. non-medical prescribing versus medical prescribing in chronic care; 3. non-medical prescribing versus medical prescribing in secondary care; 4 non-medical prescribing versus medical prescribing in primary care; 5. comparisons between different non-medical prescriber groups; and 6. non-medical healthcare providers with formal prescribing training versus those without formal prescribing training. Data collection and analysis We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed studies for inclusion, extracted data, and assessed study quality with discrepancies resolved by discussion. Two review authors independently assessed risk of bias for the included studies according to EPOC criteria. We undertook meta-analyses using the fixed-effect model where studies were examining the same treatment effect and to account for small sample sizes. We compared outcomes to a random-effects model where clinical or statistical heterogeneity existed. Main results We included 46 studies (37,337 participants); non-medical prescribing was undertaken by nurses in 26 studies and pharmacists in 20 studies. In 45 studies non-medical prescribing as a component of care was compared with usual care medical prescribing. A further study compared nurse prescribing supported by guidelines with usual nurse prescribing care. No studies were found with non-medical prescribing being undertaken by other health professionals. The education requirement for non-medical prescribing varied with country and location. A meta-analysis of surrogate markers of chronic disease (systolic blood pressure, glycated haemoglobin, and low-density lipoprotein) showed Positive Intervention group effects. There was a moderate-certainty of evidence for studies of blood pressure at 12 months (mean difference (MD) -5.31 mmHg, 95% confidence interval (CI) -6.46 to -4.16; 12 studies, 4229 participants) and low-density lipoprotein (MD -0.21, 95% CI -0.29 to -0.14; 7 studies, 1469 participants); we downgraded the certainty of evidence from high due to considerations of serious inconsistency (considerable heterogeneity), multifaceted Interventions, and variable prescribing autonomy. A high-certainty of evidence existed for comparative studies of glycated haemoglobin management at 12 months (MD -0.62, 95% CI -0.85 to -0.38; 6 studies, 775 participants). While there appeared little difference in medication adherence across studies, a meta-analysis of continuous outcome data from four studies showed an effect favouring patient adherence in the non-medical prescribing group (MD 0.15, 95% CI 0.00 to 0.30; 4 studies, 700 participants). We downgraded the certainty of evidence for adherence to moderate due to the serious risk of performance bias. While little difference was seen in patient-related adverse events between treatment groups, we downgraded the certainty of evidence to low due to indirectness, as the range of adverse events may not be related to the Intervention and selective reporting failed to adequately report adverse events in many studies. Patients were generally satisfied with non-medical prescriber care (14 studies, 7514 participants). We downgraded the certainty of evidence from high to moderate due to indirectness, in that satisfaction with the prescribing component of care was only addressed in one study, and there was variability of satisfaction measures with little use of validated tools. A meta-analysis of health-related quality of life scores (SF-12 and SF-36) found a difference favouring non-medical prescriber care for the physical component score (MD 1.17, 95% CI 0.16 to 2.17), and the mental component score (MD 0.58, 95% CI -0.40 to 1.55). However, the quality of life measurement may more appropriately reflect composite care rather than the prescribing component of care, and for this reason we downgraded the certainty of evidence to moderate due to indirectness of the measure of effect. A wide variety of resource use measures were reported across studies with little difference between groups for hospitalisations, emergency department visits, and outpatient visits. In the majority of studies reporting medication use, non-medical prescribers prescribed more drugs, intensified drug doses, and used a greater variety of drugs compared to usual care medical prescribers. The risk of bias across studies was generally low for selection bias (random sequence generation), detection bias (blinding of outcome assessment), attrition bias (incomplete outcome data), and reporting bias (selective reporting). There was an unclear risk of selection bias (allocation concealment) and for other biases. A high risk of performance bias (blinding of participants and personnel) existed. Authors' conclusions The findings suggest that non-medical prescribers, practising with varying but high levels of prescribing autonomy, in a range of settings, were as effective as usual care medical prescribers. Non-medical prescribers can deliver comparable outcomes for systolic blood pressure, glycated haemoglobin, low-density lipoprotein, medication adherence, patient satisfaction, and health-related quality of life. It was difficult to determine the impact of non-medical prescribing compared to medical prescribing for adverse events and resource use outcomes due to the inconsistency and variability in reporting across studies. Future efforts should be directed towards more rigorous studies that can clearly identify the clinical, patient-reported, resource use, and economic outcomes of non-medical prescribing, in both high-income and low-income countries.
