Deborah Christie

Assessing the efficacy of the Healthy Eating and Lifestyle Programme (HELP) compared with enhanced standard care of the obese adolescent in the community: study protocol for a randomized controlled trial

BackgroundThe childhood obesity epidemic is one of the foremost UK health priorities. Childhood obesity tracks into adult life and places individuals at considerable risk for diabetes, cardiovascular disease, liver disease and other morbidities. There is widespread need for paediatric lifestyle programmes as change may be easier to accomplish in childhood than later in life.Study Design/MethodThe study will evaluate the management of adolescent obesity by conducting a Medical Research Council complex intervention phase III efficacy randomised clinical trial of the Healthy Eating Lifestyle Programme within primary care. The study tests a community delivered multi-component intervention designed for adolescents developed from best practice as identified by National Institute for Health and Clinical Excellence. The hospital based pilot reduced body mass index and improved health-related quality of life.Subjects will be individually randomised to receiving either the Healthy Eating Lifestyle Programme (12 fortnightly family sessions) or enhanced standard care. Baseline and follow up assessments will be undertaken blind to allocation status. A health economic evaluation is also being conducted.200 obese young people (13-17 years, body mass index > 98th centile for age and sex) will be recruited from primary care within the greater London area.The primary hypothesis is that a motivational and solution-focused family-based weight management programme delivered over 6 months is more efficacious in reducing body mass index in obese adolescents identified in the community than enhanced standard care.The primary outcome will be body mass index at the end of the intervention, adjusted for baseline body mass index, age and sex.The secondary hypothesis is that the Healthy Eating Lifestyle Programme is more efficacious in improving quality of life and psychological function and reducing waist circumference and cardiovascular risk factors in obese adolescents than enhanced standard care assessed at 6 and 12 months post baseline assessment.Improvement in quality of life predicts on-going lifestyle change and maximises the chances of long-term weight reduction. We will explore whether improvement in QOL may be intermediate on the pathway between the intervention and body mass index change.Trial registrationISRCTN: ISRCTN99840111

Outcomes of meningococcal serogroup B disease: findings from a nationally representative case-control study

Aims There remain over 1000 cases of meningococcal serogroup B (MenB) disease in the UK each year. Vaccines to prevent other causes of meningitis and septicaemia have been successfully introduced into many countries. Estimates of the sequelae of MenB disease in the modern era are needed to inform the development and introduction of future vaccines. Methods The authors present interim results from a nationally representative case-control study from five English regions. Cases were identified via the Meningococcal Reference Laboratory and controls via case general practitioners. Consenting subjects underwent a 2.5-h standardised assessment of hearing (audiometry), IQ and other cognitive function, psychological function and quality of life. Analyses were undertaken adjusted for age and sex. The study received ethics approval and was funded by the Meningitis Trust. Results Data were available for 153 cases and 100 controls. Compared with controls, MenB survivors had lower verbal IQ (case mean 99, control mean 104; p=0.02), performance IQ (98 vs 102; p=0.04), were more likely to have any mental health disorder (24% vs 11%; p=0.04) and had poorer memory (p=0.008). Three survivors (2%) had cochlear implants compared with no controls. However, there were no significant differences between survivors and controls in proportions with mild or moderate hearing loss. Survivors were also more likely to receive Disability Living Allowance (9% vs 1%; p=0.009) and additional educational support (19% vs 6%; p=0.01). Conclusions These interim results suggest MenB disease is associated with a significant burden of sequelae in survivors. These data will form the basis for cost-effectiveness analyses of new MenB vaccines.

Child and adolescent mental and physical health: two sides of the same coin

Child health has been marked by three chapters thus far in human society, and this is true in most countries. The first began in the nineteenth and early twentieth century, with the recognition that children were different and not just small versions of adults, with particular health needs, and was marked by the introduction of specialists, children’s hospitals and texts in most high-income countries of the time (Ligon-Borden, 2003). From this platform, a second chapter began after the Second World War, spurred on from the destruction and inequalities which had emerged following two world wars, with formal and organised recognition of human rights. This second chapter was marked by the importance of preventative medicine – vaccination, education, welfare, maternal health, in particular in the under 5s. And did not they do well? Recent data have shown that death rates have dropped dramatically in the last 50 years (Viner et al., 2011).