Patricia F. Pearce

Energy costs of physical activities in children and adolescents

PURPOSE The primary aim was to determine the energy expenditure (EE: kcal.kg(-1).h(-1)) in terms of caloric cost and metabolic equivalents of activities commonly performed by children and adolescents. Secondary aims were to determine at what age and pubertal developmental stage values approach those of adults. METHODS In this descriptive study, 295 volunteer youth 8-18 yr of age completed 18 common physical activities (including rest) while EE was measured continuously with a portable metabolic system. Three sets of activities were assigned in random order for each subject. Activities ranged from television viewing and video game play to running and rope skipping. Pubertal development was estimated from a self-report questionnaire. RESULTS At rest, VO(2) and EE were highest in the youngest children and decreased with advancing age and higher pubertal stage in both genders. The age-adjusted and puberty-adjusted energy expenditure values were generally lower than the compendium MET values for sedentary and moderate activities but were more varied for high-intensity activities. However, the ratio of activity EE to REE was comparable in children and adults. CONCLUSIONS Energy expenditure per kilogram of body mass at rest or during exercise is greater in children than adults and varies with pubertal status, thus using the definition of a MET in the compendium of physical activities without adjustment is inadequate for energy estimation in children, until a child reaches Tanner Stage 5. However, the ratio of activity EE to resting EE in children appears to be similar or slightly less than in the compendium, suggesting that the compendium MET increments used with our adjusted EE values more closely approximate the true EE of activities in children than present adult norms.

TextTB: A Mixed Method Pilot Study Evaluating Acceptance, Feasibility, and Exploring Initial Efficacy of a Text Messaging Intervention to Support TB Treatment Adherence

Objective. To assess a text messaging intervention to promote tuberculosis (TB) treatment adherence. Methods. A mixed-methods pilot study was conducted within a public pulmonary-specialized hospital in Argentina. Patients newly diagnosed with TB who were 18 or older, and had mobile phone access were recruited and randomized to usual care plus either medication calendar (n = 19) or text messaging intervention (n = 18) for the first two months of treatment. Primary outcomes were feasibility and acceptability; secondary outcomes explored initial efficacy. Results. Feasibility was evidenced by high access to mobile phones, familiarity with texting, most phones limited to basic features, a low rate of participant refusal, and many describing suboptimal TB understanding. Acceptability was evidenced by participants indicating feeling cared for, supported, responsible for their treatment, and many self-reporting adherence without a reminder. Participants in the texting group self-reported adherence on average 77% of the days whereas only 53% in calendar group returned diaries. Exploring initial efficacy, microscopy testing was low and treatment outcomes were similar in both groups. Conclusion. The texting intervention was well accepted and feasible with greater reporting of adherence using text messaging than the diary. Further evaluation of the texting intervention is warranted.

Middle-School Children’s Understanding of Physical Activity: “If You’re Moving, You’re Doing Physical Activity”

This qualitative descriptive study explored the understanding of physical activity from the perspectives of middle-school children (n = 12; ages 11-15 years) who participated in 15 collaborative exploratory meetings (approximately 1.5 hours/meeting) that were audiorecorded. Content analysis was completed; a pediatric nurse specialist and the participating children validated the findings. The children understood physical activity concretely, considering everything they did as physical activity based on their primary criterion of body movement. The children adeptly recalled activities and activity time duration, but struggled with categorizing the intensity of their activities. Domains of activity included home and school; social activities crossed both arenas. The study contributes to our knowledge of childrens understanding of physical activity, highlighting the concreteness of the childrens thinking, including their perspectives on evidence and conclusions based on their notions of evidence. Implications for nursing are discussed.

Fostering prevention in the pediatric population.

Although cardiovascular disease is seldom manifested clinically before the fourth or fifth decade of life, atherosclerotic cardiovascular disease processes begin in early childhood. Fatty streaks and atherosclerotic lesions have been found post-mortem in the aorta and coronary vessels of children as young as 6 years of age. The modifiable risk factors for heart and vascular disease that are found in adults, such as hypertension, dyslipidemia, smoking, obesity, and physical inactivity, are also present in children. Available evidence emphasizes the need for both population-based and individual approaches to primary prevention of CVD beginning in childhood. This article summarizes this evidence and outlines strategies for promoting primary prevention in children and adolescents.

Customization of Electronic Medical Record Templates to Improve End-User Satisfaction

Since 2004, increasing importance has been placed on the adoption of electronic medical records by healthcare providers for documentation of patient care. Recent federal regulations have shifted the focus from adoption alone to meaningful use of an electronic medical record system. As proposed by the Technology Acceptance Model, the behavioral intention to use technology is determined by the persons attitude toward usage. The purpose of this quality improvement project was to devise and implement customized templates into an existent electronic medical record system in a single clinic and measure the satisfaction of the clinic providers with the system before and after implementation. Provider satisfaction with the electronic medical record system was evaluated prior to and following template implementation using the current version 7.0 of the Questionnaire for User Interaction Satisfaction tool. Provider comments and improvement in the Questionnaire for User Interaction Satisfaction levels of rankings following template implementation indicated a positive perspective by the providers in regard to the templates and customization of the system.

The Children's Computerized Physical Activity Reporter: Children as Partners in the Design and Usability Evaluation of an Application for Self-reporting Physical Activity.

The objectives of this three-phased study were to design and evaluate the usability of a computerized questionnaire, The Childrens Computerized Physical Activity Reporter, designed with and for middle school childrens self-report of physical activity. Study design was qualitative, descriptive, and collaborative, framed in a usability engineering model, with 22 participating children (grades 6-8; mean age, 12.5 years; range, 11-15 years) of three ethnic backgrounds. In Phase 1, childrens understanding of physical activity and needs for reporting were determined, which were then translated in Phase 2 to the design features and content of the questionnaire; content validity, readability, and algorithm reliability were completed. Phase 3 involved childrens evaluation of the questionnaires usability (ease of use, efficiency, and aesthetics). The children all liked the questionnaire but identified several usability issues within instructions and reports. Working collaboratively with children was highly effective in ascertaining their understanding of physical activity and their self-reporting needs. Thus, the questionnaires design was created from childrens understanding of physical activity and their needs for recalling activities. The development of the questionnaire and its usability evaluation contribute to understanding childrens physical activity and to the importance of designing for usability. Additional research is needed to ascertain reliability and validity of data derived from its use and to explore its usefulness in clinical or research venues.

Qualitative Evaluation of a Text Messaging Intervention to Support Patients With Active Tuberculosis: Implementation Considerations

Background Tuberculosis (TB) remains a major global public health problem and mobile health (mHealth) interventions have been identified as a modality to improve TB outcomes. TextTB, an interactive text-based intervention to promote adherence with TB medication, was pilot-tested in Argentina with results supporting the implementation of trials at a larger scale. Objective The objective of this research was to understand issues encountered during pilot-testing in order to inform future implementation in a larger-scale trial. Methods A descriptive, observational qualitative design guided by a sociotechnical framework was used. The setting was a clinic within a public pulmonary-specialized hospital in Argentina. Data were collected through workflow observation over 115 days, text messages (n=2286), review of the study log, and stakeholder input. Emerging issues were categorized as organizational, human, technical, or sociotechnical considerations. Results Issues related to the intervention included workflow issues (eg, human, training, security), technical challenges (eg, data errors, platform shortcomings), and message delivery issues (eg, unintentional sending of multiple messages, auto-confirmation problems). System/contextual issues included variable mobile network coverage, electrical and Internet outages, and medication shortages. Conclusions Intervention challenges were largely manageable during pilot-testing, but need to be addressed systematically before proceeding with a larger-scale trial. Potential solutions are outlined. Findings may help others considering implementing an mHealth intervention to anticipate and mitigate certain challenges. Although some of the issues may be context dependent, other issues such as electrical/Internet outages and limited resources are not unique issues to our setting. Release of new software versions did not result in solutions for certain issues, as specific features used were removed. Therefore, other software options will need to be considered before expanding into a larger-scale endeavor. Improved automation of some features will be necessary, however, a goal will be to retain the intervention capability to be interactive, user friendly, and patient focused. Continued collaboration with stakeholders will be required to conduct further research and to understand how such an mHealth intervention can be effectively integrated into larger health systems.

Listening to Those at the Frontline: Patient and Healthcare Personnel Perspectives on Tuberculosis Treatment Barriers and Facilitators in High TB Burden Regions of Argentina

Purpose. In Argentina, tuberculosis (TB) control measures have not achieved key treatment targets. The purpose of this study was to identify modes of treatment delivery and explore patient and healthcare personnel perceptions of barriers and facilitators to treatment success. Methods. We used semistructured group and individual interviews for this descriptive qualitative study. Eight high burden municipalities were purposively selected. Patients in treatment for active TB (n = 16), multidisciplinary TB team members (n = 26), and TB program directors (n = 12) at local, municipal, regional, and national levels were interviewed. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Results. Modes of treatment delivery varied across municipalities and types of healthcare facility and were highly negotiated with patients. Self-administration of treatment was common in hospital-based and some community clinics. Barriers to TB treatment success were concentrated at the system level. This level relied heavily on individual personal commitment, and many system facilitators were operating in isolation or in limited settings. Conclusions. We outline experiences and perspectives of the facilitating and challenging factors at the individual, structural, social, and organizational levels. Establishing strong patient-healthcare personnel relationships, responding to patient needs, capitalizing on community resources, and maximizing established decentralized system could mitigate some of the barriers.