Aims With one in four children starting school overweight, prevention needs to start in the presc... more Aims With one in four children starting school overweight, prevention needs to start in the preschool years. BERTIE (Babies and Early-years Risk: Trying to Implement the Evidence) aims to help health professionals identify babies at risk of obesity to provide appropriate guidance. Methods Systematic review of the effect of selected perinatal factors associated with later obesity. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) method was used to evaluate and synthesise the evidence and rate the quality of evidence for recommendations. A consensus meeting of experts debated the findings and their suitability. Results The consensus meeting identified maternal obesity, infant weight centile, infant weight gain, and smoking in pregnancy as the factors that would be most helpful in identifying infants at the greatest risk of later obesity. Socioeconomic status and ethnicity merited further exploration, though it was recognised that usefully measuring these factors would present challenges. Evidence relating to the other factors (birth weight, diabetes in pregnancy, infant sleep pattern, breastfeeding and weight gain in pregnancy) was not considered strong enough to suggest they would be useful perinatal predictors of later obesity risk. Conclusion These findings provide guidance for how families might be targeted for obesity prevention. Given the importance of parental obesity, training health professionals to sensitively engage with families is needed to ensure those at high risk receive the intervention required.
Life expectancy for patients with thalassemia major (TM) has greatly improved, and their hopes ar... more Life expectancy for patients with thalassemia major (TM) has greatly improved, and their hopes are now directed towards attainment of better quality of life. The growth retardation of many of these patient becomes a major concern for the patients, their families, and the medical care-giver.
The Healthy Child Programme is the universal preventive programme that begins in pregnancy and co... more The Healthy Child Programme is the universal preventive programme that begins in pregnancy and continues through childhood. It is an evidence based programme of developmental reviews, screening, immunisations, health promotion and parenting support. This document aims to provide guidance and practical direction in a strategy to reduce the risks of obesity for babies, toddlers and preschool children. Nineteen themes for action are outlined that have the potential to encourage the development of lifelong healthy lifestyle and reduce the risk of obesity. These provide a framework for practitioners who work with parents and carers; offer some clear messages for parents on how to develop a healthy home environment for their young children, and provide a basis for guiding public health strategy. The last three themes relate to the enhancement of health and community practitioners’ skills to maximize their effectiveness when working in the area of lifestyle change.
Background Promoting healthy lifestyle is key to tackling lifestyle-induced diseases, yet many do... more Background Promoting healthy lifestyle is key to tackling lifestyle-induced diseases, yet many doctors feel unskilled and medical schools lack its inclusion in their curricula. The impact of a novel elective lifestyle course is described, where students provided 3 months’ coaching to at-risk patients. Methods Students’ attitudes, competence and lifestyle were assessed pre- and post the 18-month course. Patients’ health measures and behaviors were measured. Student and patient views were ascertained. Results Nineteen students, 13 controls, and 29 patients participated. Perception of physicians’ importance as lifestyle consultants increased in coaching students (mean ± SD 3.7 ± 0.4 vs. 3.2 ± 0.5; p = 0.05). Self-perceived competence remained high in coaching students (6.7 ± 1.8 vs. 6.7 ± 1.2; p = 0.66). Controls’ competence increased but did not attain coaching students’ levels (3.6 ± 2.1 vs. 5.5 ± 1.9; p = 0.009). Focus groups of students confirmed self-perceived acquisition of skill...
Background Unintentional childhood injuries are a leading cause of morbidity and mortality worldw... more Background Unintentional childhood injuries are a leading cause of morbidity and mortality worldwide. Attempts to prevent child home injuries have rarely been implemented in hospital settings which present an important opportunity for intervention. The SHABI (‘Keeping our Children Safe; SHomrim Al BetIchut Yeladenu’) program recruits at-risk families presenting with child injury to the Emergency Department. Medical/nursing students conduct two home visits and provide safety equipment and guidance. The objective of this study was to investigate the impact of SHABI on participating families’ home-safety. Methods The pilot was conducted between May 2019 and March 2020 in northern Israel, an area with high child injury rates. Eligibility included families with preschool children who incurred a home injury. Home-safety was assessed by observation through the ‘Beterem’ checklist. Parents' views, knowledge, awareness of dangers and report of home injuries were assessed at the start of ...
BackgroundBottom-up approaches to disparity reduction present a departure from traditional servic... more BackgroundBottom-up approaches to disparity reduction present a departure from traditional service models where health services are traditionally delivered top-down. Raphael, a novel bottom-up social incubator, was developed in a disadvantaged region with the aim of ‘hatching’ innovative health improvement interventions through academia-community partnership.MethodsCommunity organizations were invited to submit proposals for incubation. Selection was made using the criteria of innovation, population neediness and potential for health impact and sustainability. Raphael partnered with organizations to pilot and evaluate their intervention with $5000 seed-funding. The evaluation was guided by the conceptual framework of technological incubators. Outcomes and sustainability were ascertained through qualitative and quantitative analysis of records and interviews at 12 months and 3–5 years, and the Community Impact of Research Oriented Partnerships (CIROP) questionnaire was administered t...
Background Low health literacy underpins health inequality and leads to poor adherence to medical... more Background Low health literacy underpins health inequality and leads to poor adherence to medical care and higher risk of adverse events and rehospitalization. Communication in plain language, therefore, is an essential skill for health professionals to acquire. Most medical education communication skill programs focus on verbal communication, while written communication training is scarce. ETGAR is a student delivered service for vulnerable patients after hospital discharge in which, amongst other duties, students ‘translate’ the medical discharge letters into plain language and share them with patients at a home visit. This study ascertains how this plain language training impacted on students’ written communication skills using a tool designed for purpose. Methods Students, in pairs, wrote three plain language discharge letters over the course of a year for patients whom they encountered in hospital. The students handed over and shared the letters with the patients during a post-...
BACKGROUND Eating behaviours vary by culture and religion, and an understanding of attitudes and ... more BACKGROUND Eating behaviours vary by culture and religion, and an understanding of attitudes and practices are essential for providing culturally competent nutritional guidance. The Ultra-orthodox Jewish community is characterized by poor diet, high rates of obesity, anemia and diabetes. This study aimed to acquire insights that could influence the promotion of healthier eating in the Ultra-orthodox and other closed religious communities, particularly regarding children's eating habits and the food they consume. METHODS In depth face-to-face recorded interviews were conducted with 20 information-rich participants: religious leaders, opinion leaders and education/health professionals from Gur and Chabad, two Ultra-orthodox Jewish religious communities in Israel. The focus was on exploring young family eating behaviours and perceived challenges to encouraging healthier nutrition in the community. Interviews were transcribed and thematic analysis employed using grounded theory. RESULTS Seven themes were identified with findings that had clear implications for the promotion of health at both the community and individual level. These included spiritual aspects of eating, deficits in knowledge and awareness, less relevance of kashrut than previously thought, the centrality of motherhood and family meals, the quality of food in educational institutions, the significance and sensitivity of Sabbath and festive meals and pragmatic considerations. DISCUSSION AND CONCLUSIONS By illuminating attitudes and behaviors, the study broadens and enhances our understanding of the Ultra-orthodox communities' perspectives on eating behaviours in the family. The findings have the potential to contribute to strengths-based health promotion for children's nutrition. Recommendations regarding culturally competent guidance and implications for other secluded religious communities are discussed.
The ‘First Thousand Days’ refers to the period from conception to the child’s second birthday. It... more The ‘First Thousand Days’ refers to the period from conception to the child’s second birthday. It is increasingly gaining traction as a concept to guide public health policy. It is seen as a crucial window of opportunity for interventions that improve child and population health. This review outlines the origin and growth of the First Thousand Days concept, and the evidence behind it, particularly in the areas of brain development and cognition; mental and emotional health; nutrition and obesity; programming and economic benefits. The review then describes UK experience of use of the concept to inform policy, and a recent government inquiry that mandates more widespread implementation.
Aims To evaluate how often paediatricians recognise and manage obesity in children they see in ou... more Aims To evaluate how often paediatricians recognise and manage obesity in children they see in outpatient clinics. Methods An audit of outpatient clinic consultations during a calendar month in both general paediatrics and paediatric endocrinology. All children with a body mass index (BMI) ≤ 98th percentile had their notes reviewed for evidence that the clinician had recognised their obesity, arranged appropriate investigations for hormonal causes and co morbidities and given lifestyle advice or referral to a community obesity programme. The results were fed back during a post clinic meeting. Clinicians were given written material on the National Institute for Health and Clinical Excellence (NICE) obesity guidelines and the local community obesity programme. UK BMI management charts were displayed in all clinic rooms. A repeat audit evaluated any change in obesity recognition and management. Results A total of 157 patient visits occurred during the audit period, including 21 obese children. 6/10 and 5/11 of the obese children attending the paediatric endocrinology and general clinics, respectively, were recognised as having a weight problem. Fewer than half the children were asked for appropriate family history, had a body mass index (BMI) measurement, or investigations for hormonal causes or co morbidities; apart from in the endocrinology clinic where 8/10 obese children had thyroid function tested. 3/10 in the endocrinology clinic and 3/11 in the general clinic had lifestyle advice or referrals to the obesity service. In the repeat audit 15/147 patients attending either the endocrinology or general clinics were obese. 5/9 and 2/6 in the endocrine and general clinics, respectively, were recognised as obese; no statistical change from the initial audit. There was no increase in the numbers of diagnosed obese children being investigated or offered help with weight loss. Conclusion A large proportion of the obese children attending endocrinology and general clinics in a teaching hospital are not recognised as having a weight problem and less than half are investigated or managed in accordance with NICE guidance. Feedback of the audit results, displaying BMI charts in clinic rooms, and providing written information on the NICE guidelines and referral options, did not improve the results.
Aims With one in four children starting school overweight, prevention needs to start in the presc... more Aims With one in four children starting school overweight, prevention needs to start in the preschool years. BERTIE (Babies and Early-years Risk: Trying to Implement the Evidence) aims to help health professionals identify babies at risk of obesity to provide appropriate guidance. Methods Systematic review of the effect of selected perinatal factors associated with later obesity. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) method was used to evaluate and synthesise the evidence and rate the quality of evidence for recommendations. A consensus meeting of experts debated the findings and their suitability. Results The consensus meeting identified maternal obesity, infant weight centile, infant weight gain, and smoking in pregnancy as the factors that would be most helpful in identifying infants at the greatest risk of later obesity. Socioeconomic status and ethnicity merited further exploration, though it was recognised that usefully measuring these factors would present challenges. Evidence relating to the other factors (birth weight, diabetes in pregnancy, infant sleep pattern, breastfeeding and weight gain in pregnancy) was not considered strong enough to suggest they would be useful perinatal predictors of later obesity risk. Conclusion These findings provide guidance for how families might be targeted for obesity prevention. Given the importance of parental obesity, training health professionals to sensitively engage with families is needed to ensure those at high risk receive the intervention required.
Life expectancy for patients with thalassemia major (TM) has greatly improved, and their hopes ar... more Life expectancy for patients with thalassemia major (TM) has greatly improved, and their hopes are now directed towards attainment of better quality of life. The growth retardation of many of these patient becomes a major concern for the patients, their families, and the medical care-giver.
The Healthy Child Programme is the universal preventive programme that begins in pregnancy and co... more The Healthy Child Programme is the universal preventive programme that begins in pregnancy and continues through childhood. It is an evidence based programme of developmental reviews, screening, immunisations, health promotion and parenting support. This document aims to provide guidance and practical direction in a strategy to reduce the risks of obesity for babies, toddlers and preschool children. Nineteen themes for action are outlined that have the potential to encourage the development of lifelong healthy lifestyle and reduce the risk of obesity. These provide a framework for practitioners who work with parents and carers; offer some clear messages for parents on how to develop a healthy home environment for their young children, and provide a basis for guiding public health strategy. The last three themes relate to the enhancement of health and community practitioners’ skills to maximize their effectiveness when working in the area of lifestyle change.
Background Promoting healthy lifestyle is key to tackling lifestyle-induced diseases, yet many do... more Background Promoting healthy lifestyle is key to tackling lifestyle-induced diseases, yet many doctors feel unskilled and medical schools lack its inclusion in their curricula. The impact of a novel elective lifestyle course is described, where students provided 3 months’ coaching to at-risk patients. Methods Students’ attitudes, competence and lifestyle were assessed pre- and post the 18-month course. Patients’ health measures and behaviors were measured. Student and patient views were ascertained. Results Nineteen students, 13 controls, and 29 patients participated. Perception of physicians’ importance as lifestyle consultants increased in coaching students (mean ± SD 3.7 ± 0.4 vs. 3.2 ± 0.5; p = 0.05). Self-perceived competence remained high in coaching students (6.7 ± 1.8 vs. 6.7 ± 1.2; p = 0.66). Controls’ competence increased but did not attain coaching students’ levels (3.6 ± 2.1 vs. 5.5 ± 1.9; p = 0.009). Focus groups of students confirmed self-perceived acquisition of skill...
Background Unintentional childhood injuries are a leading cause of morbidity and mortality worldw... more Background Unintentional childhood injuries are a leading cause of morbidity and mortality worldwide. Attempts to prevent child home injuries have rarely been implemented in hospital settings which present an important opportunity for intervention. The SHABI (‘Keeping our Children Safe; SHomrim Al BetIchut Yeladenu’) program recruits at-risk families presenting with child injury to the Emergency Department. Medical/nursing students conduct two home visits and provide safety equipment and guidance. The objective of this study was to investigate the impact of SHABI on participating families’ home-safety. Methods The pilot was conducted between May 2019 and March 2020 in northern Israel, an area with high child injury rates. Eligibility included families with preschool children who incurred a home injury. Home-safety was assessed by observation through the ‘Beterem’ checklist. Parents' views, knowledge, awareness of dangers and report of home injuries were assessed at the start of ...
BackgroundBottom-up approaches to disparity reduction present a departure from traditional servic... more BackgroundBottom-up approaches to disparity reduction present a departure from traditional service models where health services are traditionally delivered top-down. Raphael, a novel bottom-up social incubator, was developed in a disadvantaged region with the aim of ‘hatching’ innovative health improvement interventions through academia-community partnership.MethodsCommunity organizations were invited to submit proposals for incubation. Selection was made using the criteria of innovation, population neediness and potential for health impact and sustainability. Raphael partnered with organizations to pilot and evaluate their intervention with $5000 seed-funding. The evaluation was guided by the conceptual framework of technological incubators. Outcomes and sustainability were ascertained through qualitative and quantitative analysis of records and interviews at 12 months and 3–5 years, and the Community Impact of Research Oriented Partnerships (CIROP) questionnaire was administered t...
Background Low health literacy underpins health inequality and leads to poor adherence to medical... more Background Low health literacy underpins health inequality and leads to poor adherence to medical care and higher risk of adverse events and rehospitalization. Communication in plain language, therefore, is an essential skill for health professionals to acquire. Most medical education communication skill programs focus on verbal communication, while written communication training is scarce. ETGAR is a student delivered service for vulnerable patients after hospital discharge in which, amongst other duties, students ‘translate’ the medical discharge letters into plain language and share them with patients at a home visit. This study ascertains how this plain language training impacted on students’ written communication skills using a tool designed for purpose. Methods Students, in pairs, wrote three plain language discharge letters over the course of a year for patients whom they encountered in hospital. The students handed over and shared the letters with the patients during a post-...
BACKGROUND Eating behaviours vary by culture and religion, and an understanding of attitudes and ... more BACKGROUND Eating behaviours vary by culture and religion, and an understanding of attitudes and practices are essential for providing culturally competent nutritional guidance. The Ultra-orthodox Jewish community is characterized by poor diet, high rates of obesity, anemia and diabetes. This study aimed to acquire insights that could influence the promotion of healthier eating in the Ultra-orthodox and other closed religious communities, particularly regarding children's eating habits and the food they consume. METHODS In depth face-to-face recorded interviews were conducted with 20 information-rich participants: religious leaders, opinion leaders and education/health professionals from Gur and Chabad, two Ultra-orthodox Jewish religious communities in Israel. The focus was on exploring young family eating behaviours and perceived challenges to encouraging healthier nutrition in the community. Interviews were transcribed and thematic analysis employed using grounded theory. RESULTS Seven themes were identified with findings that had clear implications for the promotion of health at both the community and individual level. These included spiritual aspects of eating, deficits in knowledge and awareness, less relevance of kashrut than previously thought, the centrality of motherhood and family meals, the quality of food in educational institutions, the significance and sensitivity of Sabbath and festive meals and pragmatic considerations. DISCUSSION AND CONCLUSIONS By illuminating attitudes and behaviors, the study broadens and enhances our understanding of the Ultra-orthodox communities' perspectives on eating behaviours in the family. The findings have the potential to contribute to strengths-based health promotion for children's nutrition. Recommendations regarding culturally competent guidance and implications for other secluded religious communities are discussed.
The ‘First Thousand Days’ refers to the period from conception to the child’s second birthday. It... more The ‘First Thousand Days’ refers to the period from conception to the child’s second birthday. It is increasingly gaining traction as a concept to guide public health policy. It is seen as a crucial window of opportunity for interventions that improve child and population health. This review outlines the origin and growth of the First Thousand Days concept, and the evidence behind it, particularly in the areas of brain development and cognition; mental and emotional health; nutrition and obesity; programming and economic benefits. The review then describes UK experience of use of the concept to inform policy, and a recent government inquiry that mandates more widespread implementation.
Aims To evaluate how often paediatricians recognise and manage obesity in children they see in ou... more Aims To evaluate how often paediatricians recognise and manage obesity in children they see in outpatient clinics. Methods An audit of outpatient clinic consultations during a calendar month in both general paediatrics and paediatric endocrinology. All children with a body mass index (BMI) ≤ 98th percentile had their notes reviewed for evidence that the clinician had recognised their obesity, arranged appropriate investigations for hormonal causes and co morbidities and given lifestyle advice or referral to a community obesity programme. The results were fed back during a post clinic meeting. Clinicians were given written material on the National Institute for Health and Clinical Excellence (NICE) obesity guidelines and the local community obesity programme. UK BMI management charts were displayed in all clinic rooms. A repeat audit evaluated any change in obesity recognition and management. Results A total of 157 patient visits occurred during the audit period, including 21 obese children. 6/10 and 5/11 of the obese children attending the paediatric endocrinology and general clinics, respectively, were recognised as having a weight problem. Fewer than half the children were asked for appropriate family history, had a body mass index (BMI) measurement, or investigations for hormonal causes or co morbidities; apart from in the endocrinology clinic where 8/10 obese children had thyroid function tested. 3/10 in the endocrinology clinic and 3/11 in the general clinic had lifestyle advice or referrals to the obesity service. In the repeat audit 15/147 patients attending either the endocrinology or general clinics were obese. 5/9 and 2/6 in the endocrine and general clinics, respectively, were recognised as obese; no statistical change from the initial audit. There was no increase in the numbers of diagnosed obese children being investigated or offered help with weight loss. Conclusion A large proportion of the obese children attending endocrinology and general clinics in a teaching hospital are not recognised as having a weight problem and less than half are investigated or managed in accordance with NICE guidance. Feedback of the audit results, displaying BMI charts in clinic rooms, and providing written information on the NICE guidelines and referral options, did not improve the results.
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