Wendy Robertson

Pilot of 'Families for Health': community-based family intervention for obesity

Objective: To develop and evaluate “Families for Health”, a new community based family intervention for childhood obesity. Design: Programme development, pilot study and evaluation using intention-to-treat analysis. Setting: Coventry, England. Participants: 27 overweight or obese children aged 7–13 years (18 girls, 9 boys) and their parents, from 21 families. Intervention: Families for Health is a 12-week programme with parallel groups for parents and children, addressing parenting, lifestyle change and social and emotional development. Main outcome measures: Change in baseline BMI z score at the end of the programme (3 months) and 9-month follow-up. Attendance, drop-out, parents’ perception of the programme, child’s quality of life and self-esteem, parental mental health, parent–child relationships and lifestyle changes were also measured. Results: Attendance rate was 62%, with 18 of the 27 (67%) children completing the programme. For the 22 children with follow-up data (including four who dropped out), BMI z score was reduced by −0.18 (95% CI −0.30 to −0.05) at 3 months and −0.21 (−0.35 to −0.07) at 9 months. Statistically significant improvements were observed in children’s quality of life and lifestyle (reduced sedentary behaviour, increased steps and reduced exposure to unhealthy foods), child–parent relationships and parents’ mental health. Fruit and vegetable consumption, participation in moderate/vigorous exercise and children’s self-esteem did not change significantly. Topics on parenting skills, activity and food were rated as helpful and used with confidence by most parents. Conclusions: Families for Health is a promising new childhood obesity intervention. Definitive evaluation of its clinical effectiveness by randomised controlled trial is now required.

Clinical investigation of an outbreak of alveolitis and asthma in a car engine manufacturing plant

Background: Exposure to metal working fluid (MWF) has been associated with outbreaks of extrinsic allergic alveolitis (EAA) in the USA, with bacterial contamination of MWF being a possible cause, but is uncommon in the UK. Twelve workers developed EAA in a car engine manufacturing plant in the UK, presenting clinically between December 2003 and May 2004. This paper reports the subsequent epidemiological investigation of the whole workforce. The study had three aims: (1) to measure the extent of the outbreak by identifying other workers who may have developed EAA or other work-related respiratory diseases; (2) to provide case detection so that those affected could be treated; and (3) to provide epidemiological data to identify the cause of the outbreak. Methods: The outbreak was investigated in a three-phase cross-sectional survey of the workforce. In phase I a respiratory screening questionnaire was completed by 808/836 workers (96.7%) in May 2004. In phase II 481 employees with at least one respiratory symptom on screening and 50 asymptomatic controls were invited for investigation at the factory in June 2004. This included a questionnaire, spirometry and clinical opinion. 454/481 (94.4%) responded and 48/50 (96%) controls. Workers were identified who needed further investigation and serial measurements of peak expiratory flow (PEF). In phase III 162 employees were seen at the Birmingham Occupational Lung Disease clinic. 198 employees returned PEF records, including 141 of the 162 who attended for clinical investigation. Case definitions for diagnoses were agreed. Results: 87 workers (10.4% of the workforce) met case definitions for occupational lung disease, comprising EAA (n = 19), occupational asthma (n = 74) and humidifier fever (n = 7). 12 workers had more than one diagnosis. The peak onset of work-related breathlessness was Spring 2003. The proportion of workers affected was higher for those using MWF from a large sump (27.3%) than for those working all over the manufacturing area (7.9%) (OR = 4.39, p<0.001). Two workers had positive specific provocation tests to the used but not the unused MWF solution. Conclusions: Extensive investigation of the outbreak of EAA detected a large number of affected workers, not only with EAA but also occupational asthma. This is the largest reported outbreak in Europe. Mist from used MWF is the likely cause. In workplaces using MWF there is a need to carry out risk assessments, to monitor and maintain fluid quality, to control mist and to carry out respiratory health surveillance.

Utility of accelerometers to measure physical activity in children attending an obesity treatment intervention.

Objectives. To investigate the use of accelerometers to monitor change in physical activity in a childhood obesity treatment intervention. Methods. 28 children aged 7–13 taking part in “Families for Health” were asked to wear an accelerometer (Actigraph) for 7-days, and complete an accompanying activity diary, at baseline, 3-months and 9-months. Interviews with 12 parents asked about research measurements. Results. Over 90% of children provided 4 days of accelerometer data, and around half of children provided 7 days. Adequately completed diaries were collected from 60% of children. Children partake in a wide range of physical activity which uniaxial monitors may undermonitor (cycling, nonmotorised scootering) or overmonitor (trampolining). Two different cutoffs (4 METS or 3200 counts·min−1) for minutes spent in moderate and vigorous physical activity (MVPA) yielded very different results, although reached the same conclusion regarding a lack of change in MVPA after the intervention. Some children were unwilling to wear accelerometers at school and during sport because they felt they put them at risk of stigma and bullying. Conclusion. Accelerometers are acceptable to a majority of children, although their use at school is problematic for some, but they may underestimate childrens physical activity.

Parent-only interventions in the treatment of childhood obesity: a systematic review of randomized controlled trials

BACKGROUND An effective and cost-effective treatment is required for the treatment of childhood obesity. Comparing parent-only interventions with interventions including the child may help determine this. METHODS A systematic review of published and ongoing studies until 2013, using electronic database and manual searches. INCLUSION CRITERIA randomized controlled trials, overweight/obese children aged 5-12 years, parent-only intervention compared with an intervention that included the child, 6 months or more follow-up. Outcomes included measures of overweight. RESULTS Ten papers from 6 completed studies, and 2 protocols for ongoing studies, were identified. Parent-only groups are either more effective than or similarly effective as child-only or parent-child interventions, in the change in degree of overweight. Most studies were at unclear risk of bias for randomization, allocation concealment and blinding of outcome assessors. Two trials were at high risk of bias for incomplete outcome data. Four studies showed higher dropout from parent-only interventions. One study examined programme costs and found parent-only interventions to be cheaper. CONCLUSIONS Parent-only interventions appear to be as effective as parent-child interventions in the treatment of childhood overweight/obesity, and may be less expensive. Reasons for higher attrition rates in parent-only interventions need further investigation.

Young People's Views on Accelerometer Use in Physical Activity Research: Findings from a User Involvement Investigation

The use of accelerometers to objectively measure physical activity is important in understanding young peoples behaviours, as physical activity plays a key part in obesity prevention and treatment. A user-involvement qualitative study with young people aged 7–18 years (n = 35) was carried out to investigate views on accelerometer use to inform an obesity treatment research study. First impressions were often negative, with issues related to size and comfort reported. Unwanted attention from wearing an accelerometer and bullying risk were also noted. Other disadvantages included feeling embarrassed and not being able to wear the device for certain activities. Positive aspects included feeling “special” and having increased attention from friends. Views on the best time to wear accelerometers were mixed. Advice was offered on how to make accelerometers more appealing, including presenting them in a positive way, using a clip rather than elastic belt to attach, personalising the device, and having feedback on activity levels. Judgements over the way in which accelerometers are used should be made at the study development stage and based on the individual population. In particular, introducing accelerometers in a clear and positive way is important. Including a trial wearing period, considering practical issues, and providing incentives may help increase compliance.

Complete Motion Control of a Serious Game against Obesity in Children

Childhood obesity is a major problem in most developed countries, with significant negative impacts on childrens health. A suggested method for reducing obesity, especially for children, are serious games. These could promote healthy eating and increased physical activity. Ideally, they should also increase energy expenditure during play, and not be a sedentary experience. In the preliminary work described here, we produced a demonstration serious game designed to combat childhood obesity. All user interaction for the game was supplied via movement using re-appropriated Wii input devices to maximize physical activity whilst playing. We describe the problems of implementing such an interface, in particular that of overlearning.

Hypersensitivity pneumonitis in workers exposed to metalworking fluids

Background This study used data from a large UK outbreak investigation, to develop and validate a new case definition for hypersensitivity pneumonitis due to metalworking fluid exposure (MWF-HP). Methods The clinical data from all workers with suspected MWF-HP were reviewed by an experienced panel of clinicians. A new MWF-HP Score was then developed to match the “gold standard” clinical opinion as closely as possible, using standard diagnostic criteria that were relatively weighted by their positive predictive value. Results The new case definition was reproducible, and agreed with expert panel opinion in 30/37 cases. This level of agreement was greater than with any of the three previously utilized case definitions (agreement in 16–24 cases). Where it was possible to calculate, the MWF-HP Score also performed well when applied to 50 unrelated MWF-HP cases. Conclusions The MWF-HP Score offers a new case definition for use in future outbreaks. Am. J. Ind. Med. 57:872–880, 2014.

Socio-economic status and overweight or obesity among school-age children in sub-Saharan Africa - a systematic review.

Childhood overweight and obesity have emerged as a public health concern in sub‐Saharan Africa. We conducted a systematic review with the aim to examine the association between socio‐economic status (SES) and overweight or obesity among school‐age children in sub‐Saharan Africa. In March 2014 we searched five electronic databases for reports which presented cross‐sectional data on prevalence levels of overweight or obesity stratified by SES groups among school‐age children in sub‐Saharan Africa. We used a random‐effect model to pool the relative indexes of inequality of the association from the individual studies. In total, 20 reports satisfied the inclusion criteria providing results of 21 datasets. The risk of overweight or obesity in children from highest SES households was 5.28 times as high as that of children from lowest SES households (95% confidence interval [CI] 2.62 to 10.66). On subgroup analysis, this association was statistically significant for household income and composite SES measures but not for parental educational attainment and occupation type. Similarly, the risk of overweight or obesity in children attending affluent (private) schools was 15.94 times as high as that of children going to either urban or rural public schools (95% CI 5.82 to 43.68). The magnitude of the association tended to be stronger for area or school‐type compared with composite measures. In summary, children from higher SES households and those attending private schools tended to be overweight and obese.

Can serial PEF measurements separate occupational asthma from allergic alveolitis

BACKGROUND Occupational asthma commonly results in work-related changes in serial peak expiratory flow (PEF) measurements. Whether alveolitis can result in similar changes is unknown. AIMS To identify differences and similarities of serial PEF between workers with occupational alveolitis and asthma seen during an outbreak investigation in a factory with metal-working fluid exposure. METHODS Workers with respiratory symptoms and rest-day improvement were identified by questionnaire. Each was asked to measure PEF 8 times daily for 4 weeks at home and work. Alveolitis was subsequently diagnosed from a validated scoring system including radiological changes, carbon monoxide diffusing capacity, bronchoalveolar lavage and biopsy results. Occupational asthma was confirmed with a positive Oasys score >2.5 and a mean rest-work PEF >16 l/min from serial 2-hourly PEF measurements. The Oasys PEF plotter calculated differences between rest and workdays for mean PEF, diurnal variation and the scores were used to confirm an occupational effect (Oasys, area between curve and time point). Records were compared between the alveolitis group and the group with occupational asthma without alveolitis. RESULTS Forty workers with occupational asthma and 16 with alveolitis had indistinguishable PEF changes on workdays in terms of magnitude (median reduction 18.5 and 16.1 l/min, respectively) and diurnal variation. Immediate reactions were more common with occupational asthma and late reactions more common with alveolitis. CONCLUSIONS PEF responses to metal-working fluid aerosols do not distinguish occupational asthma from alveolitis except in timing. They can be used to identify the workplace as the cause of asthma and also alveolitis.

Young people's views on accelerometer use in physical activity research: findings from a user-involvement investigation

Abstract Background The benefits of physical activity in young people are well documented. Understanding of young peoples physical activity behaviours is therefore important in promotion of participation in this group. Objective measures are increasingly used to quantify the amount and intensity of physical activity, and accelerometers are currently the favoured device. Previous studies have found some parents reporting their children as unwilling to wear accelerometers at school and during sports because of the risk of stigma and bullying. There is however, little evidence for how young people themselves feel about wearing accelerometers for physical activity research. We aimed to investigate young peoples views on accelerometer use. Methods We undertook a user-involvement qualitative study, involving five focus group discussions with young people aged 7–18 years (n=35). Participants were members of two Medicines for Children Research Network (MCRN) young persons advisory groups and pupils from two local primary schools. Focus groups allowed for differences between participants to be revealed. Young peoples views were analysed by thematic analysis. Findings Five broad themes emerged from the focus group discussions: first impressions, how it feels to wear an accelerometer, best time to wear an accelerometer, disadvantages of wearing an accelerometer, and how accelerometers can be made more appealing or incentives for use. First impressions of accelerometers were often negative, with issues related to size and comfort reported. In particular, participants felt that the accelerometer could be too bulky and that the elastic waistband used to attach it could be uncomfortable. Unwanted attention from wearing the device and the risk of bullying were also noted. Other disadvantages included feeling embarrassed and not being able to wear the device for certain activities (eg, swimming or contact sports). Many young people felt that they would find it difficult to keep an activity diary alongside their accelerometer use. Positive aspects included feeling special or having increased attention or curiosity from friends. Views on the best time to wear accelerometers (eg, term time or holidays) were mixed. Young people offered advice on how to make wearing accelerometers more appealing, including presenting the device in a positive way, using a clip rather than an elastic band to attach it, personalising the device, and being able to see activity levels via feedback afterwards. Interpretation There has been little focus on young peoples views on wearing accelerometers in physical activity research. This small-scale user-involvement study provides initial data and provides practical issues for researchers to consider when embarking on accelerometer research in this group. Young peoples views on accelerometer use are varied. Judgments over the way in which accelerometers are used should be made at the study development stage, and based on the individual population, to increase compliance. This study presents practical ideas for researchers to help to increase acceptability of accelerometer use in young people. This is a small-scale study within a specific group of young people in the West Midlands, UK, but initial findings are revealing and certainly warrant further exploration. Funding National Institute for Health Research Health Technology Assessment.