Kathy James

DETERMINANTS OF PHYSICAL ACTIVITY IN PRIMARY SCHOOL STUDENTS USING THE HEALTH BELIEF MODEL

Background Thailand is a middle-income country in which two-thirds of children demonstrate an insufficient level of physical activity. Physical inactivity is a major risk factor for obesity and many other health-related consequences in children. Thus, it is important to understand how primary school children perceive things in their daily life as determinants of physical activity. The purpose of this study was to investigate the impact of cues, perceived benefits, and perceived barriers on the level of physical activity among primary school students. Methods A cross-sectional study was conducted in Phitsanulok Province, Thailand, in 2011. Multistage sampling selected a total of 123 primary school students. The Physical Activity Questionnaire for Older Children and the Cues, Perceived Benefits, and Barriers to Physical Activity Questionnaire were used to assess the student levels of physical activity, as well as the perceived benefits, barriers, and cues to action. The association between these factors and the level of physical activity was determined by correlation statistics and confirmed by robust regression. Multivariate analysis of variance compared health belief model determinants: perceived benefits, perceived barriers, and cues to action on physical activity between male and female students. Self-administered questionnaires were validated and tested in a pilot study. Results The level of activity among primary school children was significantly influenced by perceived barriers, such as fear of strangers when playing outdoors, bad weather, and too much homework. However, activity was not influenced by cues to action or perceived benefits. Perceived benefits, barriers, and cues to physical activity did not differ by gender. Conclusion A safe environment and fewer barriers, such as amount of homework, could enhance physical activity in primary school children.

Supporting cardiovascular risk reduction in overweight and obese hypertensive patients through DASH diet and lifestyle education by primary care nurse practitioners.

Purpose: To describe an intervention among overweight and obese hypertensive patients, encouraging Dietary Approaches to Stop Hypertension (DASH) diet and lifestyle changes, designed and led by a primary care nurse practitioner (NP). Data sources: A pre‐ and postintervention quasi‐experimental time‐series design was implemented over 2 months. Intervention included three group classes and two individual counseling telephone calls. Forty‐five hypertensive patients enrolled, with a mean age of 55 years and mean initial BMI of 32. Twenty‐six (58%) completed the program. Standard instruments (Rapid Eating Assessment for Patients [REAP] and Partners in Health [PIH] questionnaires) were used to evaluate diet and lifestyle factors before and after the program. Conclusions: Participants had statistically significant improvements in diet and lifestyle scores on both REAP and PIH questionnaires, as well as statistically significant weight loss (average 3.6 pounds lost) over the 2‐month intervention period. Implications for practice: This NP‐led primary care intervention on diet and lifestyle showed early success in improving the health of overweight and obese hypertensive patients. Investment in NP‐led diet and lifestyle counseling should be considered among high‐risk patients in the primary care setting.

Ways to Enhance Children's Activity and Nutrition (WE CAN) - a pilot project with Latina mothers.

PURPOSE This article presents the feasibility and acceptability of the 4-week Ways to Enhance Childrens Activities and Nutrition (WE CAN) program. DESIGN AND METHOD Mixed methods were utilized. Quantitative data were collected from Latina mothers using self-administered surveys. RESULTS The program was positively received, although attrition was a concern. Mothers were concerned about their childrens weight and were receptive to being key role models for being more active, limiting screen time, buying less junk food, and increasing consumption of fruits and vegetables. PRACTICE IMPLICATIONS Findings provide nurses with knowledge on how mothers view appropriate nutrition and activity as important to their childrens health.

Guided imagery: an innovative approach to improving maternal sleep quality.

Mothers of preterm infants are at risk for poor sleep quality, which may adversely affect their health, maternal-infant attachment, and infant caretaking activities. This study examined the relationship of an 8-week relaxation guided imagery intervention on sleep quality and the association between sleep quality and maternal distress (perceived stress, depressive symptoms, and state anxiety) in 20 mothers of hospitalized preterm infants. Mothers received a CD (compact disc) with three 20-minutes recordings and were asked to listen to at least 1 recording daily for 8 weeks. This analysis used self-report data gathered at baseline and 8 weeks. Pearson correlations were used to examine the relationships between mean cumulative relaxation guided imagery use and measures of maternal distress and sleep quality scores at 8 weeks. Complete data on 19 mothers were available for analysis. At 8 weeks, higher mean relaxation guided imagery use was inversely correlated with sleep quality scores (r = −0.30); sleep quality scores were positively correlated with stress (r = 0.42), depressive symptoms (r = 0.34), and anxiety (r = 0.39) scores. In mothers of preterm infants, sleep quality was negatively affected by mental distress and may be improved by a guided imagery intervention.

People who were obese tried diets but felt they needed ongoing support to empower them to make lifestyle changes.

How do people who are obese describe their experiences with weight loss solutions? What do they think may help them to lose weight? Qualitative study. Victoria, Australia. Convenience and purposive sample of 76 people (mean age 47 y, 83% women) who had a body mass index ⩾30. Data were collected in face-to-face or telephone interviews. Interviews were audiotaped and transcribed. Data were analysed thematically using constant comparison. (1) Motivations for dieting included overall health and well-being, advice from healthcare professionals, and social acceptance. One participant stated, “…I really am sticking to the diet to get this weight off so I can fit into a skirt that I want to wear.” (2) Weight loss techniques . Participants progressed from “fad” diets as teenagers to more commercialised diets, such as Weight Watchers and Jenny Craig . For many, diet groups were a social activity shared with family and friends. Some participants felt a sense of belonging in such groups; however, groups could also reinforce low self-esteem, negative feelings, and self-blame. …

How Effective is a Simple Pre-Diabetes Screen for Clinical Practice?

Background: Diabetes is a global problem. According to WHO (2014) the global prevalence of diabetes was estimated to be 9% among adults aged 18+ years. In 2012, an estimated 1.5 million deaths were directly caused by diabetes. Of note, more than 80% of diabetes deaths occur in low- and middle-income countries. It is predicted that diabetes will be the 7th leading cause of death in 2030. Of concern is the vast majority of people living with pre diabetes are unaware they have it. Without lifestyle changes to improve their health, an estimated 15% to 30% of people with pre diabetes will develop type 2 diabetes within 5 years. Simple screening methods may identify risk and facilitate conversations with patients to identify specific barriers to making healthy lifestyle choices to decrease risk for diabetes. Purpose of the study: To examine the use of the CDC 7 item Pre-Diabetes Screening Test (PST) to identify “at risk” patients and their response to lifestyle education. Methods: A cross-sectional design with purposive sampling of overweight men and women attending a weight loss clinic located in Southern California. Using venipuncture, A1C was examined when patients were identified high risk based on the Pre Diabetes Screening Test. Follow up consultation was provided and data were collected at four months. Results: All participants (N=70) screened “high risk” PST >9,70.5% (49) were pre diabetic based on A1C levels. At 4 months follow-up findings indicated patient weight changes of 6-30 pounds, reductions in A1C levels, and increased physical activity. Significance: Realizing the predictability of simple screening abilities can help reinforce the ease in assessing, increase awareness of prediabetes risk in adults, and start a conversation for healthy behaviors.

Maternal Self-efficacy and Family Health Routines

Purpose: Family health is a system comprising routines or habitual practices. This study investigated the relationships between maternal self-efficacy (SE) and obesity, habitual smoking, breastfeeding, and children’s sleeping patterns. Methods: Participants (98 women) attending a weight loss clinic reported on themselves and their 172 biological children. Mothers provided demographic information for parents and children and completed the 20-item Family Nutrition and Physical Activity Scale (FNPA). Maternal SE was assessed with a 13-item Confidence Survey, which measures confidence to carry out activities related to healthy family meals and family activity. FNPA results have been reported in an earlier publication. Results: Normal-weight mothers had more favorable (higher) SE scores compared with overweight mothers. There were positive relationships between SE and the FNPA and children’s sleep patterns in younger children. There were no significant relationships between SE and children’s body mass index (B...

Childhood Obesity Risk in Overweight Mothers Support for Screening

Purpose. Family dietary and nutritional behaviors predispose children to obesity. The purpose of this study was to examine the childhood obesity risk among overweight women and to assess feasibility of using a screening tool in a busy clinic setting. Design. A cross-sectional study using the Family Nutrition Physical Activity (FNPA) tool was self-administered by 98 overweight mothers identifying risk factors for childhood obesity. Measures. Mothers completed demographic and a 20-item screening survey with subscales on family meal patterns, family eating habits, food choices, beverage choices, restriction/reward, screen time behavior and monitoring, healthy environment, family activity involvement, child activity involvement, and family routine. After completing the survey, a summary of recommended practices from the American Academy of Pediatrics was provided. Results. Ninety-eight mothers participated (of 172 children between 2 and 18 years old). Lower FNPA scores (obesogenic) were associated were higher...

Ways to Enhance Children’s Activity and Nutrition (We Can!): Hispanic Family Responses

Obesity in Hispanic children is epidemic. Recent recommendations are to focus on parent as role model as a means of prevention. Ways to Enhance Children’s Activity and Nutrition (We Can!) is a public education outreach program from a collaboration of 4 institutes at National Institutes of Health. The purpose of this study was to examine changes in Hispanic mothers’ behaviors, knowledge, and body mass index after participating in a 6-week We Can! program. Thirty-five Hispanic mothers participated in a 6-week program offered in Spanish at an elementary school setting. Height, weight, body mass index, and the We Can! survey were obtained preprogram and postprogram. Findings included significant changes in behaviors identified as risk behaviors for childhood obesity. Outcomes were similar to non-Spanish-speaking families with whom the program was first piloted. Lessons learned from this experience may benefit others who are trying to provide preventive care of Spanish-speaking families.

Exercise plus diet improved cholesterol concentrations in high risk adults

Patients 180 postmenopausal women and 197 men. Women were 45–64 years old, had HDL cholesterol concentrations < 1.55 mmol/l (60 mg/dl), and LDL cholesterol concentrations from > 3.23– 5.42 mmol/l ( > 125–209 mg/dl). Men were 30–64 years old, had HDL cholesterol concentrations < 1.14 mmol/l (45 mg/dl), and LDL cholesterol concentrations > 3.23–4.90 mmol/l ( > 125–189 mg/dl). Exclusion criteria were history of cardiovascular disease, diabetes, or other severe illness; treatment with insulin, cardiac medications, or cholesterol or blood pressure lowering drugs; smoking; high alcohol consumption; high blood glucose or triglyceride concentrations; or high body mass index. Follow up was 97%.