Stephanie Jc Taylor

Whole home exercise intervention for depression in older care home residents (the OPERA study): a process evaluation

BackgroundThe ‘Older People’s Exercise intervention in Residential and nursing Accommodation’ (OPERA) cluster randomised trial evaluated the impact of training for care home staff together with twice-weekly, physiotherapist-led exercise classes on depressive symptoms in care home residents, but found no effect. We report a process evaluation exploring potential explanations for the lack of effect.MethodsThe OPERA trial included over 1,000 residents in 78 care homes in the UK. We used a mixed methods approach including quantitative data collected from all homes. In eight case study homes, we carried out repeated periods of observation and interviews with residents, care staff and managers. At the end of the intervention, we held focus groups with OPERA research staff. We reported our first findings before the trial outcome was known.ResultsHomes showed large variations in activity at baseline and throughout the trial. Overall attendance rate at the group exercise sessions was low (50%). We considered two issues that might explain the negative outcome: whether the intervention changed the culture of the homes, and whether the residents engaged with the intervention. We found low levels of staff training, few home champions for the intervention and a culture that prioritised protecting residents from harm over encouraging activity. The trial team delivered 3,191 exercise groups but only 36% of participants attended at least 1 group per week and depressed residents attended significantly fewer groups than those who were not depressed. Residents were very frail and therefore most groups only included seated exercises.ConclusionsThe intervention did not change the culture of the homes and, in the case study homes, activity levels did not change outside the exercise groups. Residents did not engage in the exercise groups at a sufficient level, and this was particularly true for those with depressive symptoms at baseline. The physical and mental frailty of care home residents may make it impossible to deliver a sufficiently intense exercise intervention to impact on depressive symptoms.

Childhood size is more strongly related than size at birth to glucose and insulin levels in 10–11-year-old children

Summary In adults low birthweight and thinness at birth are associated with increased risk of glucose intolerance and non-insulin-dependent diabetes mellitus. We have examined the relations between size at birth (birthweight, thinness at birth) and levels of plasma glucose and serum insulin in children, and compared them with the effects of childhood size. We performed a school-based survey of 10–11-year-old British children (response rate 64 %) with measurements made after an overnight fast. One group of children (n = 591) was studied fasting while the other (n = 547) was studied 30 min after a standard oral glucose load (1.75 g/kg). Serum insulin was measured by a highly specific ELISA method. Birthweight was assessed by maternal recall and thinness at birth using birth records. Neither fasting nor post-load glucose levels showed any consistent relationship with birthweight or ponderal index at birth. After adjustment for childhood height and ponderal index, both fasting and post-load insulin levels fell with increasing birthweight. For each kg increase in birthweight, fasting insulin fell by 16.9 % (95 % confidence limits 7.1–25.8 %, p = 0.001) and post-load insulin by 11.6 % (95 % confidence limits 3.5–19.1 %, p = 0.007). However, the proportional change in insulin level for a 1 SD increase in childhood ponderal index was much greater than that for birthweight (27.2 % and − 8.8 %, respectively, for fasting insulin). We conclude that low birthweight is not related to glucose intolerance at 10–11 years, but may be related to the early development of insulin resistance. However, in contemporary children obesity is a stronger determinant of insulin level and insulin resistance than size at birth. [Diabetologia (1997) 40: 319–326]

How effective are expert patient (lay led) education programmes for chronic disease

Considerable hyperbole has surrounded the UK expert patient programme, and it has received considerable funding—but will its impact meet expectations?

Body mass, weight control behaviours, weight perception and emotional well being in a multiethnic sample of early adolescents

Objective:To investigate weight perception, dieting and emotional well being across the range of body mass index (BMI) in a population-based multiethnic sample of early adolescents.Design:Cross-sectional population-based survey.Subjects:In total, 2789 adolescents 11–14 years of age from three highly deprived regional authorities in East London, in 2001.Measurements:Data were collected by student-completed questionnaire on weight perception, dieting history, mental and physical health, health behaviours, social capital and sociodemographic factors. Height and weight were measured by trained researchers. Overweight was defined as BMI ⩾85th centile and obesity as BMI ⩾98th centile. Underweight was defined as BMI⩽15th centile.Results:In all, 73% were from ethnic groups other than white British. Valid BMI were available for 2522 subjects (90.4%) of whom 14% were obese. Only 20% of overweight boys and 51% of overweight girls assessed their weight accurately. Accuracy of weight perception did not vary between ethnic groups. In all, 42% of girls and 26% of boys reported current dieting to lose weight. Compared with white British teenagers, a history of dieting was more common among Bangladeshi, Indian and mixed ethnicity boys and less likely among Pakistani girls. Self-esteem was not associated with BMI in girls but was significantly lower in obese boys than those of normal weight (P=0.02). Within ethnic subgroups, self-esteem was significantly lower in overweight white British boys (P=0.03) and obese Bangladeshi boys (P=0.01) and Bangladeshi girls (P=0.04), but significantly higher in obese black African girls (P=0.01) than those of normal weight. Obese young people had a higher prevalence of psychological distress (P=0.04), except among Bangladeshi teenagers, where overweight and obese young people had less psychological distress than those of normal weight (P=0.02). Birth outside the UK was associated with reduced risk of obesity in girls (P=0.02) but not with history of dieting, weight perception or psychological factors in either gender.Conclusion:High levels of current dieting for weight control and inaccurate perception of body mass are common across all ethnic groups. However, dieting history and the associations of obesity with self-esteem and psychological distress vary between ethnic groups. Interventions to prevent or treat obesity in black or minority ethnicity groups must consider cultural differences in the relationship between body mass, self-esteem and psychological distress.

Age of menarche in contemporary British teenagers : survey of girls born between 1982 and 1986

The possibility that puberty is occurring earlier in Britain than previously has caused great interest.1 Despite the importance of menarcheal age as an indicator of puberty,2 there is little information on menarcheal age in contemporary teenagers to compare with data on girls born in the 1950s and 1960s. We report on the distribution of menarcheal age in a survey of British girls born between 1982 and 1986. In 1998-9 we studied the cardiovascular health of secondary school children aged 12-16 in schools in 10 British towns: five in southern England (Esher, Leatherhead, Chelmsford, Bath, Tunbridge Wells), three in north west England (Wigan, Burnley, Rochdale), and two in south Wales (Port Talbot, Rhondda). We approached those secondary schools corresponding to a stratified random sample of primary schools in our earlier study3; 62 of …

Size at birth and blood pressure: cross sectional study in 8-11 year old children.

Abstract Objective: To identify which patterns of fetal growth, represented by different measurements of size at birth, are associated with increased blood pressure in children aged 8-11 years. Design and setting: School based, cross sectional survey conducted in 10 towns in England and Wales in 1994. Subjects: 3010 singleton children (response rate 75%) with physical measurements and information on birth weight from parental questionnaires. Hospital birth records were examined for 1573. Main outcome measures: Systolic and diastolic blood pressure at age 8-11 years. Results: In the whole group birth weight was inversely related to systolic pressure (regression coefficient -1.48 mm Hg/kg; 95% confidence interval -2.20 to -0.76) after adjustment for current body size. There was no significant association between birth weight and diastolic pressure. The association with systolic pressure was much stronger in girls (-2.54 mm Hg/kg; -3.60 to -1.48) than in boys (-0.64 mm Hg/kg; -1.58 to 0.30), with a significant difference between the sexes (P=0.006). Among the other neonatal measures, head circumference and placental weight were inversely associated with subsequent blood pressure in girls, and placental ratio (placental weight:birth weight) was positively associated with blood pressure in boys. Neither ponderal index at birth nor length:head circumference ratio was related to blood pressure in either sex. Conclusions: In these contemporary children the association between birth weight and blood pressure was apparent only in girls. There was no evidence that measures of size at birth, which may be related to nutrition at critical periods of pregnancy (thinness at birth or shortness in relation to head circumference), are related to blood pressure in the offspring. Key messages This study confirms the well established inverse association between birth weight and childhood blood pressure, but there seems to be a strong difference between the sexes towards the end of the first decade of life—the association being strong in girls and weak or absent in boys Only highly correlated, simple measures of size at birth seem to be associated with blood pressure in girls; more complex measures of size at birth, including ponderal index and shortness in association to head circumference, are not associated with childhood blood pressure in either sex at 8-11 years The association between placental weight and placental ratio and blood pressure in children of 8-11 years is inconsistent These findings do not support the hypothesis that fetal undernutrition “programmes” raise blood pressure in the second and third trimesters Current body size is a much more important determinant of blood pressure in childhood than size at birth

Physical activity and depressive symptoms in adolescents: a prospective study

BackgroundThe frequency of mental illness amongst adolescents and its potential long-term consequences make it an important topic to research in relation to risk and protective factors. Research on the relationship between physical activity and depressive symptoms in adolescents is limited. There is a particular lack of evidence from longitudinal studies. This study examines the relationship between depression and physical activity using the Research with East London Adolescents: Community Health Survey (RELACHS).MethodsThis was a prospective cohort study. Participants were recruited from three Local Education Authority boroughs in East London in 2001 from year 7 (aged 11-12) and year 9 (aged 13-14) and were followed-up in 2003. All pupils in the 28 schools that took part were eligible for the study. Of the total 3,322 pupils eligible for the survey the overall response rate was 84% (2,789 pupils). A total of 2,093 (75%) pupils were also followed-up in 2003. The sample was multiethnic (73% of respondents were non-white) and deprived. Just under half of the sample was male (49%). Depressive symptoms were measured using the Short Moods and Feelings Questionnaire (SMFQ). Logistic regression analyses were used to examine the association between physical activity and depressive symptoms both cross-sectionally and longitudinally.ResultsAfter adjustments, there was evidence for a cross-sectional association between physical activity and depressive symptoms for both boys and girls at baseline, with a decrease in the odds of depressive symptoms of about 8% for each additional hour of exercise undertaken per week (boys: odds ratio (OR) = 0.92, 95% CI 0.85 to 0.99; girls: OR = 0.92, 95% CI 0.85 to 1.00). There was no evidence for an association between a change in physical activity from baseline to follow-up and depressive symptoms at follow-up.ConclusionsThis study provides some evidence for an association between level of physical activity and decreased depressive symptoms in adolescents. Further longitudinal research of these associations is required before physical activity can be recommended as an intervention for depression in adolescents.

Measuring activity levels of young people: the validity of pedometers.

The valid measurement of physical activity has the potential to be a very useful tool in countering the obesity epidemic. Previously, reviews have been carried out to investigate the validity of pedometers among adults. This paper aimed to carry out a similar review among children. A literature search was performed in PubMed, Web of Science, PsycINFO, CINAHL and SportDISCUS. Here, 25 papers investigating the validity, reliability and feasibility of pedometers for children were included in the study. Pedometers correlated highly in terms of both criterion (direct observation) and convergent validity (heart-rate monitor, accelerometer). Intra- and inter-unit reliability was also consistently high. Few studies report on feasibility issues of pedometer use in children, particularly compliance, reactivity and dealing with missing data. Given that they are both cheap and easy to use, pedometers can be effectively utilized as a valid determinant of physical activity levels among children and adolescents, particularly in large-scale epidemiological studies. There remains a need for accepted outliers and proper protocol regarding missing data.

Effective delivery styles and content for self-management interventions for chronic musculoskeletal pain: a systematic literature review

Objectives:The objective of the study was to report the evidence for effectiveness of different self-management course characteristics and components for chronic musculoskeletal pain. Methods:We searched 9 relevant electronic databases for randomized, controlled trials (RCTs). Two reviewers selected studies against inclusion criteria and assessed their quality. We classified RCTs according to type of course delivery (group, individual, mixed or remote), tutor (healthcare professional, lay or mixed), setting (medical, community or occupational), duration (more or less than 8 weeks), and the number and type of components (psychological, lifestyle, pain education, mind body therapies, and physical activity). We extracted data on pain intensity, physical function, self-efficacy, global health, and depression and compared these outcomes for self-management and usual care or waiting list control. We used random effects standardized mean difference meta-analysis. We looked for patterns of clinically important and statistically significant beneficial effects for courses with different delivery characteristics and the presence or absence of components across outcomes over 3 follow-up intervals. Results:We included 46 RCTs (N=8539). Group-delivered courses that had healthcare professional input showed more beneficial effects. Longer courses did not necessarily give better outcomes. There was mixed evidence of effectiveness for components of courses, but data for courses with a psychological component showed slightly more consistent beneficial effects over each follow-up period. Discussion:Serious consideration should be given to the development of short (<8 weeks) group and healthcare professional-delivered interventions but more research is required to establish the most effective and cost-effective course components.

Ethnicity, socio-economic status, overweight and underweight in East London adolescents.

Background The developed world is experiencing an ‘epidemic’ of childhood obesity but little is known about the prevalence of obesity, or underweight, amongst adolescents from minority ethnic groups in the UK. An understanding of the prevalence of obesity and overweight in these populations is important since some ethnic groups may be particularly vulnerable to the adverse health effects associated with obesity. Study Objectives To examine levels of extreme obesity, obesity, overweight and underweight amongst a representative sample of adolescents from different ethnic groups in East London and to explore the association between socio-economic status and body mass index (BMI). Design A school-based survey of adolescents aged 11–14. Obesity and overweight were estimated using the 1990 UK growth reference (UK 90) and the International Obesity Task Force (IOTF) cut-off points. Extreme obesity was defined as a BMI more than three SD above the UK 90 mean. Underweight was examined by looking at those with a BMI below the 15th or the 5th UK 90 percentiles. Main Results A total of 2,482 adolescents were surveyed (response rate 84%), 73% from non-white ethnic groups. Although there were significant differences in BMI between ethnic groups, high levels of overweight were seen in all ethnic groups. More than one-third were overweight and one-fifth were obese using the UK 90; and over a quarter were overweight and almost one-tenth were obese using the IOTF cut-offs. Two per cent were extremely obese. Indian males were at higher risk of being overweight than white British males. The prevalence of obesity and overweight was similar in white British and Bangladeshi males. Overall the prevalence of underweight was slightly lower than that predicted by the UK 90, but South Asian ethnic groups, especially males, had a higher prevalence of underweight than other groups. No associations between BMI and measures of socio-economic status were found in this relatively deprived population. Conclusions The ‘epidemic’ of childhood obesity observed in the UK involves adolescents from all ethnic groups, although there are some differences between ethnic groups in the prevalence of overweight. Indian males appear to be at increased risk of being overweight. There is no evidence of a simultaneous increase in underweight amongst this population overall, but Bangladeshi, Indian and Pakistani boys appear to be at increased risk of being underweight.