Amy C. McPherson

Asthma as a Barrier to Children's Physical Activity: Implications for Body Mass Index and Mental Health

OBJECTIVES. The purpose of this work was to identify barriers to physical activity in children with asthma and to compare their customary activity levels, BMI and emotional well-being with that of children with other medical conditions. It was hypothesized that children with asthma would have higher BMI and lower levels of customary activity. PATIENTS AND METHODS. We studied children aged 7 to 14 years attending hospital outpatient clinics for either asthma (asthma group: n = 56) or for otorhinolaryngology or dermatological conditions (nonasthma group: n = 61). In this cross-sectional survey, childrens weight and height were recorded and their BMI classified according to International Obesity Task Force classification of obesity. Child mental health was assessed by the parent-rated Strengths and Difficulties Questionnaire. The child-rated Physical Activity Questionnaire assessed total sedentary and physical activities during the previous 24 hours. RESULTS. The asthma group had a higher mean BMI (20.78 vs 18.82) and higher rates of obesity (21.4% vs 6.6%). Children with asthma reported fewer physical activities than the nonasthma group (median 4 per day vs 6 per day) but comparable levels of sedentary activities. Asthma was the strongest predictor of lower activity scores, followed by younger age. The asthma group had higher levels of emotional difficulties and, within this group, more active children had better mental health. More parents in the asthma group identified the childs health as a barrier to exercise (60.7% vs 11%). The same was true of children (66.1% vs 11.5%). CONCLUSIONS. We found that children attending a hospital clinic for asthma were more likely to be obese and were significantly less active than a comparison group with other medical conditions. Asthma was identified as a barrier to exercise by parents and children. Strategies to promote exercise within pediatric asthma care are needed to protect both mental and physical health.

A randomized, controlled trial of an interactive educational computer package for children with asthma.

OBJECTIVE. The purpose of this study was to evaluate the impact and acceptability of an educational multimedia program designed to promote self-management skills in children with asthma. METHODS. We conducted a randomized, controlled trial with measures at baseline and 1- and 6-month follow-up. The trial was conducted in pediatric outpatient respiratory clinics in 3 United Kingdom hospitals. Participants included 101 children aged 7 to 14 years under the care of hospital-based asthma services. The children were randomly assigned to receive an asthma information booklet alone or the booklet plus The Asthma Files, an interactive CD-ROM for children with asthma. Asthma knowledge was the primary outcome measure. Other measures included asthma locus of control, lung function, use of oral steroids, and school absence. RESULTS. At the 1-month follow-up (n = 99), children in the computer group had improved knowledge compared with the control group and a more internal locus of control. There were no differences in objective lung-function measures, hospitalizations, or oral steroid use. The study participants were positive in their evaluation of the intervention. At the 6-month follow-up (n = 90), significantly fewer children in the intervention group had required oral steroids and had had time off school for asthma in the previous 6 months. The difference did not reach statistical significance in the intention-to-treat analysis for both steroid use and school absence. CONCLUSION. The Asthma Files was found to be an effective and popular health education tool for promoting asthma self-management skills within pediatric care.

Experiences of social exclusion and bullying at school among children and youth with cerebral palsy

Purpose: Although bullying amongst typically developing school-aged children has been well explored, it is under-researched for children with disabilities. The purpose of this study was to understand the experiences of exclusion and bullying among children with disabilities. Method: We draw on qualitative in-depth interviews and a focus group with children and youth with disabilities (n = 15) to explore their experiences of exclusion and bullying. Results: Our results showed that restrictions in the socio-contextual environment influenced the social exclusion that children experienced. Youth encountered social exclusion from both teachers and peers. Children reported that teachers’ attitudes toward children with disabilities often influenced the social exclusion experienced by peers. Bullies engaged in both implicit and explicit forms of social exclusion toward children with disabilities which often lead to verbal and physical bullying. Conclusions: Children with cerebral palsy are victims of bullying and social exclusion within the school context. More opportunities for social inclusion are needed. Implications for Rehabilitation Children and youth with cerebral palsy experience verbal and physical bullying at school. Rehabilitation health care providers and educators should be cognizant of the symptoms of childhood bullying and be prepared to provide children and their parents with resources on how to cope. Health care providers and educators should teach children how to explain their disability and their specific needs to their teachers and peers to create more awareness and understanding about their condition.

Mobile Apps for Weight Management: A Scoping Review

Background Obesity remains a major public health concern. Mobile apps for weight loss/management are found to be effective for improving health outcomes in adults and adolescents, and are pursued as a cost-effective and scalable intervention for combating overweight and obesity. In recent years, the commercial market for ‘weight loss apps’ has expanded at rapid pace, yet little is known regarding the evidence-based quality of these tools for weight control. Objective To characterize the inclusion of evidence-based strategies, health care expert involvement, and scientific evaluation of commercial mobile apps for weight loss/management. Methods An electronic search was conducted between July 2014 and July 2015 of the official app stores for four major mobile operating systems. Three raters independently identified apps with a stated goal of weight loss/management, as well as weight loss/management apps targeted to pediatric users. All discrepancies regarding selection were resolved through discussion with a fourth rater. Metadata from all included apps were abstracted into a standard assessment criteria form and the evidence-based strategies, health care expert involvement, and scientific evaluation of included apps was assessed. Evidence-based strategies included: self-monitoring, goal-setting, physical activity support, healthy eating support, weight and/or health assessment, personalized feedback, motivational strategies, and social support. Results A total of 393 apps were included in this review. Self-monitoring was most common (139/393, 35.3%), followed by physical activity support (108/393, 27.5%), weight assessment (100/393, 25.4%), healthy eating support (91/393, 23.2%), goal-setting (84/393, 21.4%), motivational strategies (28/393, 7.1%), social support (21/393, 5.3%), and personalized feedback (7/393, 1.8%). Of apps, 0.8% (3/393) underwent scientific evaluation and 0.3% (1/393) reported health care expert involvement. No apps were comprehensive in the assessment criteria, with the majority of apps meeting less than two criteria. Conclusions Commercial mobile apps for weight loss/management lack important evidence-based features, do not involve health care experts in their development process, and have not undergone rigorous scientific testing. This calls into question the validity of apps’ claims regarding their effectiveness and safety, at a time when the availability and growth in adoption of these tools is rapidly increasing. Collaborative efforts between developers, researchers, clinicians, and patients are needed to develop and test high-quality, evidence-based mobile apps for weight loss/management before they are widely disseminated in commercial markets.

The Effectiveness of Interventions Aimed at Reducing Anxiety in Health Care Waiting Spaces: A Systematic Review of Randomized and Nonrandomized Trials

BACKGROUND:Reducing waiting anxiety is an important objective of patient-centered care. Anxiety is linked to negative health outcomes, including longer recovery periods, lowered pain thresholds, and for children in particular, resistance to treatment, nightmares, and separation anxiety. The goals of this study were (1) to systematically review published research aimed at reducing preprocedural waiting anxiety, and (2) to provide directions for future research and development of strategies to manage preprocedural waiting anxiety in health care environments. METHODS:We performed a systematic review of the literature via ISI Web of Knowledge, PubMed, PsycINFO, EMBASE, CINAHL, and Medline. Included in this review were studies describing measurable outcomes in response to interventions specifically intended to improve the waiting experience of patients in health care settings. Primary outcomes of interest were stress and anxiety. Exclusion criteria included (a) studies aimed at reducing wait times and management of waiting lists only, (b) waiting in non–health care settings, (c) design of health care facilities with nonspecific strategies pertaining to waiting spaces, (d) strategies to reduce pain or anxiety during the course of medical procedures, and (e) interventions such as massage, acupuncture, or hypnosis that require dedicated staff and/or private waiting environments to administer. RESULTS:We identified 8690 studies. Forty-one articles met the inclusion criteria. In adult populations, 33 studies were identified, wherein the effects of music (n = 25), aromatherapy (n = 6), and interior design features (n = 2) were examined. Eight pediatric studies were identified investigating play opportunities (n = 2), media distractions (n = 2), combined play opportunities and media distractions (n = 3), and music (n = 1). Based on results from 1129 adult participants in the 14 studies that evaluated music and permitted meta-analysis, patients who listened to music before a medical procedure exhibited a lowered-state anxiety (−5.1 ± 0.53 points on the State Trait Anxiety Scale) than those who received standard care. The efficacy of aromatherapy was inconclusive. Studies reporting on the impact of improved interior design of waiting areas, while positive, are minimal and heterogeneous. For children, insufficient evidence is available to corroborate the effectiveness of play opportunities, media distractions, and music for mitigating anxiety in children awaiting medical procedures. CONCLUSIONS:Music is a well-established means of decreasing anxiety in adult patients awaiting medical interventions. The effect of music on children’s anxiety is not known. Limited studies and heterogeneity of interventions and methods in the areas of aromatherapy, interior design, digital media, and play opportunities (for children) suggest the need for future research.

Strategies for improving disability awareness and social inclusion of children and young people with cerebral palsy

BACKGROUND Children and youth with disabilities are at a higher risk of being socially excluded or bullied while at school compared with their typically developing peers. This study explored disabled childrens suggestions for improving social inclusion. METHODS Fifteen children with cerebral palsy were interviewed or took part in a group discussion about social inclusion and bullying. All interviews and focus groups were audio-recorded and transcribed verbatim. RESULTS The children and youth described several strategies to help improve social inclusion at school including: (1) disclosure of condition and creating awareness of disability; (2) awareness of bullying; (3) developing a peer support network and building self-confidence; and (4) suggestions on what teachers can do. CONCLUSIONS It is recommended that childrens suggestions be considered within the classroom context to enhance the social inclusion and participation of children with disabilities.

Obesity prevention for children with physical disabilities: a scoping review of physical activity and nutrition interventions

Abstract Purpose: Children with disabilities are at higher risk of obesity, engage in less physical activity and report poorer quality dietary habits than their non-disabled peers. This study reviewed current evidence on interventions designed to facilitate weight management and/or weight-related behaviors (i.e. physical activity and/or healthy eating habits) in children with physical disabilities. Methods: A scoping review was performed using established methodology. Data from studies meeting specific inclusion criteria were extracted and analyzed using summary statistics, and common characteristics thematically identified. Results: Thirty-four articles were included in the synthesis. No long-term obesity prevention interventions were identified. The majority of research focused upon children with cerebral palsy, and had case study, quasi- or non-experimental designs. All interventions reporting positive outcomes (n = 18) addressed physical activity, with common themes including using motivational strategies for the child and child self-direction. Incremental increases in workload and engaging in strength training for longer than 15 minutes were also effective. Interventions targeting body weight/composition did not report success in the long term. Conclusions: A robust evidence base is lacking for long-lasting obesity interventions for children with physical disabilities. Current research provides some insights into the specific components that should be considered when planning such interventions in the future. Implications for Rehabilitation Clinicians should be aware of the high risk of obesity, physical inactivity and poor diet in children with physical disabilities. The use of motivational strategies, child direction in activities and incremental increases in workload all appear promising approaches, yet require further evaluation. Evidence-based interventions are needed to improve both short- and long-term health and quality of life for children with physical disabilities.

A qualitative exploration of the experiences of children with spina bifida and their parents around incontinence and social participation

BACKGROUND Urinary incontinence is frequently experienced by children with spina bifida, putting them at increased risk for low self-esteem and impacting upon participation in home, school and leisure activities. However, little is known about childrens experiences of these continence issues. OBJECTIVE This study explored the experiences of children and young people with spina bifida around continence issues, social participation and peer relationships, in order to identify potential areas of support healthcare professionals can provide. METHODS Children and youth aged 6-18 years with diagnoses of spina bifida and neurogenic bladder and their parents were invited to participate in semi-structured interviews. Descriptive thematic analysis was employed. RESULTS Eleven children (with a range of mobility levels, types of spina bifida and degrees of bladder control) and their parents participated in the study. Three broad themes were identified, which encompassed the following: (1) normal versus different; (2) independence, ownership and the road to continence; and (3) peer relationships and acceptance. DISCUSSION The experiences discussed by the children and parents in this study ranged from minimal impact of incontinence on their day-to-day living to significant social isolation and rejection. The stigma of incontinence was apparent in all interviews. Children and youth who were able to control their bladder with minimal accidents had greater independence and more opportunities for social participation. Healthcare professionals need to take into account that parents and their children may differ in attitudes and desires about the management of incontinence.

How and why should we engage parents as co-researchers in health research? A scoping review of current practices

The importance of engaging parents in health research as co‐researchers is gaining growing recognition. While a number of benefits of involving parents as co‐researchers have been proposed, guidelines on exactly how effective engagement can be achieved are lacking. The objectives of this scoping review were to (i) synthesize current evidence on engaging parents as co‐researchers in health research; (ii) identify the potential benefits and challenges of engaging parent co‐researchers; and (iii) identify gaps in the literature.

The assessment of weight status in children and young people attending a spina bifida outpatient clinic: a retrospective medical record review

Abstract Purpose: Children with disabilities are two to three times more likely to become overweight or obese than typically developing children. Children with spina bifida (SB) are at particular risk, yet obesity prevalence and weight management with this population are under-researched. This retrospective chart review explored how weight is assessed and discussed in a children’s SB outpatient clinic. Method: Height/weight data were extracted from records of children aged 2–18 with a diagnosis of SB attending an outpatient clinic at least once between June 2009–2011. Body mass index was calculated and classified using Centers for Disease Control and Prevention cut-offs. Notes around weight, diet and physical/sedentary activities were transcribed verbatim and analysed using descriptive thematic analysis. Results: Of 180 eligible patients identified, only 63 records had sufficient data to calculate BMI; 15 patients were overweight (23.81%) and 11 obese (17.46%). Weight and physical activity discussions were typically related to function (e.g. mobility, pain). Diet discussions focused on bowel and bladder function and dietary challenges. Conclusions: Anthropometrics were infrequently recorded, leaving an incomplete picture of weight status in children with SB and suggesting that weight is not prioritised. Bowel/bladder function was highlighted over other benefits of a healthy body weight, indicating that health promotion opportunities are being missed. Implications for Rehabilitation It is important to assess, categorise and record anthropometric data for children and youth with spina bifida as they may be at particular risk of excess weight. Information around weight categorisation should be discussed openly and non-judgmentally with children and their families. Health promotion opportunities may be missed by focusing solely on symptom management or function. Healthcare professionals should emphasise the broad benefits of healthy eating and physical activity, offering strategies to enable the child to incorporate healthy lifestyle behaviours appropriate to their level of ability.