BACKGROUND: Since 2010, nurses in Massachusetts public schools have conducted state-mandated Body Mass Index (BMI) screening of first, fourth, seventh, and tenth graders and communicated results in a letter to parents/caregivers. The objective of this study was to explore parents’ responses to the BMI letter and their experiences with weight-related language used by health professionals. These two areas were examined in the context of parents’ health literacy skills and readability of the letter. METHODS: Readability of the letter was calculated using five common formulas. One-hour focus groups were conducted using a semi-structured interview guide with a convenience sample of parents/caregivers of 8- to 14-year-old obese children participating in a weight management program. Parents were asked to share reactions to 10 weight terms in random order. Parents also completed a written version of the Newest Vital Sign (NVS) health literacy assessment. Focus group data were transcribed verbatim, and content analyses conducted to identify emergent themes. Descriptive statistics were calculated for NVS scores. RESULTS: Reading-level estimates of the BMI letter ranged from fifth to seventh grade. Twenty-nine individuals participated in eight focus groups (83% female, mean age 41 yrs+9 yrs, 59% self-identified as Hispanic/Latino). NVS scores for 12 participants (41%) indicated a possibility (n=7) or high likelihood (n=5) of limited health literacy. “Emotions” emerged as a major theme. Parents expressed concern, guilt, fear, anger, rationalization, skepticism, and acceptance regarding the letter and weight-related terms. Parents had mixed reactions to the letter: finding the information helpful, voicing concern about privacy and self-esteem, and displaying confusion when interpreting the weight status. A majority (67%) of parents who expressed confusion about the letter or weight terminology received an NVS score indicating a possibility or high likelihood of limited health literacy. Among the weight terms, parents preferred weight, weight problem, and unhealthy weight more than obese or extremely obese. CONCLUSIONS: This is the first known study to evaluate how parents respond to and comprehend the Massachusetts BMI letter. Emergent themes could be used to inform quantitative assessment of communication challenges associated with the letter. This study has implications for respectfully and effectively communicating BMI results nationwide.

Title Assessment of the 2nd Grade Elementary School Pupils in Ústí nad Labem Region and Their Attitude Towards Physical Education Problem Researches and investigations from the recent years have been indicating a decline in a physical activity of children during their free time. This fact is also reflected in physical education lessons, especially at the level of their skills, fitness and performance, but also in their overall interest in this subject. Physical education teachers often solve a fundamental problem in their classes and that is a low motivation of pupils to move. One part of the learning process is also an evaluation where the teacher takes into consideration a number of factors. An objective consideration of all partial factors, for which a student can be evaluated during physical education lessons, into an overall grade is a very complex and difficult process for the teacher. This thesis deals with the assessment in physical education, particularly with an effort to identify those variables that have a significant impact on the overall grade in this school subject. We observe gender and age differences, the relationship of students to physical education, an active attitude to sport outside the school environment, family influence, but also the lifestyle of a student and also the...

The purpose of this study was to determine the effect of leisure-based screen time on physical activity. Ninety-four families participated in this six-week study. Each family was randomly assigned to one of three screen time groups: (1) control group (2) 2-hour-limit group or (3) one-hour-limit group. Family members wore a Walk4Life LS 2505® pedometer to measure steps. Daily screen time logs were filled out each night and leisure-based screen time and steps were recorded. Analysis of variance (steps x group) was used to determine differences among the groups. Univariate tests showed there were no significant differences among any of the adult groups (F (2,101) = 1.02, p =.361). Similar to the adults, univariate tests in the 13 to 18-year-olds indicated there were no significant differences among any of the groups (F (2 ,62) = 368, p =.694). In the 5 to 12-year-olds, univariate tests determined significant group differences (F (2,164) = 3.35, p =.037). Estimated marginal mean differences indicated a significant difference between the control and 2-hour-limit groups (p =.011). In looking at all the children, males averaged more steps per day than females, and all groups in the 5 to 12-year-olds averaged more steps compared to the 13 to 18-year-olds (10,828 vs. 9,875 steps each day). The 5 to 12-year-olds in the 2-hour-limit and control groups viewed 72 minutes and 114 minutes of screen time each day, respectively. In conclusion, engaging in about 42 minutes less of screen time each day may increase physical activity by ~1,300 more steps each day.

Indiana University-Purdue University Indianapolis (IUPUI) / Pancreatic cancer is the third leading cause of cancer-related deaths and is projected to rank second by 2030 in the United States. However, the etiology of this malignancy remains elusive, with family history, chronic pancreatitis, type 2 diabetes, and cigarette smoking as only established risk factors. Therefore, it is urgent and important to identify risk factors, especially modifiable ones (e.g. diet), for the primary prevention of this lethal disease. In this dissertation, we have investigated the associations of mineral intake, dietary quality, and body adiposity with the risk of pancreatic cancer among participants in the Prostate, Lung, Colorectal, and Ovarian Cancer (PLCO) Screening Trial. Calcium, magnesium, and phosphorus are essential minerals that modulate energy metabolism and glucose homeostasis and may thus be involved in pancreatic carcinogenesis. In the first manuscript, we found that total calcium intake was associated with a reduced risk of pancreatic cancer. In addition, a significant linear inverse association was observed for total magnesium intake. The Healthy Eating Index, 2015 (HEI-2015) and the Dietary Quality Index- revised (DQI-R) have been developed to assess the overall quality or patterns of diet. In the second manuscript, we did not find significant associations between HEI-2015 or DQI-R scores and pancreatic cancer risk. However, a higher intake of some score components (i.e., calcium, vegetables, and whole grains) conferred a lower risk. Although mounting biological mechanisms have linked overweight and obesity to the development of pancreatic cancer, it is largely unclear whether prediagnostic body mass index (BMI) trajectory is associated with the risk of this disease. In the third manuscript, we revealed that prediagnostic adulthood BMI trajectory was not associated with pancreatic cancer risk, but a suggestively or significantly increased risk were identified for individuals who were overweight at age 20 or obese at age 50, compared with those who had a normal weight at the two respective time points. Taken together, the findings of research presented in this dissertation contribute to an improved understanding of the crucial roles of diet and adiposity in the etiology of pancreatic cancer, which may offer some new avenues for the prevention of this intractable malignancy.

Background: Suicidal behaviour devastates families, communities, and societies, as well as the millions of individuals who survive suicide attempts. This thesis addresses an urgent need to develop new treatment and intervention strategies for millions of at-risk people by exploring potential metabolic risk factors of suicidal behaviour. Methods: A systematic review and meta-analysis was performed to assess the association between BMI and suicidal behaviour. We explored the association between attempted suicide and various metabolic factors and health behaviours using data from the Determinants of Suicide Conventional and Emergent Risk (DISCOVER) study. DISCOVER is an age and sex matched case-control study comparing adult psychiatric inpatients who had made a recent suicide attempt (n=84) to psychiatric inpatients (n=104) and community members (n=93) who have never attempted suicide. The following potential risk factors were assessed using logistic regression analyses: BMI, waist-circumference, serum total cholesterol, physical activity, tobacco use, and dietary food groups. Results: The systematic review included 38 studies. A meta-analysis established an inverse association between BMI and completed suicide, whereby being underweight is associated with the greatest risk of suicide and being obese or overweight is associated with a deceased risk of suicide relative to normal weight. Evidence for an association between BMI and attempted suicide remains equivocal. The review suggests no association between BMI and suicidal ideation. Analysis of DISCOVER data demonstrated that even a small amount of regular physical activity is significantly associated with decreased risk of attempted suicide. Tobacco use was associated with an increased risk of attempted suicide. Contrary to prior research, obesity, serum-total cholesterol, and diet were not found to be significant risk factors. Conclusion: BMI is inversely related to completed suicide. Obese individuals may be more likely to choose less lethal methods of suicide or may be less susceptible to fatal overdose or self-poisonings. Clinicians should monitor underweight patients for increased risk of suicide. Contrary to prior research, serum total cholesterol, BMI, and waist-circumference were not significantly associated with risk of attempted suicide. Increased physical activity was associated with a decreased risk of attempted suicide, and tobacco use was associated with an increased risk of attempted suicide. While people at risk of attempting suicide tend to use more tobacco products and exercise less than non-suicidal community members, so do non-suicidal psychiatric patients. For this reason, it remains unclear whether smoking habits represent a useful clinical predictor of suicide risk. / Thesis / Master of Science (MSc)

Diet and lifestyle choices play a vital role in the overall health of an individual. There are many types of diets with varying instructions on what kind and how much of a food, or food group, should be eaten. This cross sectional study focused on possible health benefits of a vegetarian diet in regards to the body composition of non-vegetarian and vegetarian women. Total meat, poultry, seafood, and fish (MPSF) intake were separated into three categories to compare low-to-very-low, moderate, and high intake. Anthropometric measurements collected included waist to hip ratio (WHR), weight, height, and percentage of body fat. No significant differences were found between the vegetarian and non-vegetarian categories BMI, body fat percentage, or WHR. Conclusions found by previous research were not supported by the results of this research. Factors including geographic location and socioeconomic status could impact the availability of healthy food for both vegetarians and non-vegetarians.

No description available.

Anticipations of personalized medicine are primarily attributed to the recent advances in computational science and high-throughput technologies that enable the ever-more realistic modeling of complex diseases. These diseases result from the interplay between genes and environment that have limited our ability to predict, prevent, or treat them. While many envision the utility of integrated high-dimensional patient-specific information, basic research towards developing accurate and reliable frameworks for personalized medicine is relatively slow in progress. This thesis provides a state-of-the-art review of current challenges towards personalized medicine. There is a need for global investment in basic research that includes 1) cost-effective generation of high-quality high-throughput data, 2) hybrid education and multidisciplinary teams, 3) data storage and processing, 4) data integration and interpretation, and 5) individual and global economic relevance; to be followed by global investments into public health to adopt routine personalized medicine. This review also highlights that unknown or unadjusted interactions result in true heterogeneity in the effect and relevance of patient data. This limits our ability to integrate and reliably utilize high-dimensional patient-specific data. This thesis further investigates the true heterogeneity in marginal effects of known BMI genetic variants. This involved the development of the novel statistical method, meta-quantile regression (MQR), to identify variants with potential gene-gene / gene-environment interactions. Applying MQR on public and local data (75,230 European adults) showed that FTO, PCSK1, TCF7L2, MC4R, FANCL, GIPR, MAP2K5, and NT5C2 have potential interactions on BMI. In addition, a gene score of 37 BMI variants shows that the genetic architecture of BMI is shaped by gene-gene and gene-environment interactions. The computational cost of fitting MQR models was greatly reduced using unconditional quantile regression. The utility of MQR was further compared to variance heterogeneity tests in identifying variants with potential interactions. MQR tests were found to have a higher power of detecting synergetic and antagonistic interactions for skewed quantitative traits while maintaining nominal Type I error rates compared to variance heterogeneity tests. Overall, MQR is a valuable tool to detect potential interactions without imposing assumptions on the nature of interactions. / Thesis / Doctor of Philosophy (PhD) / The anticipations of personalized medicine are largely due to the recent advances in computational science and our capabilities to rapidly measure and generate biological data. These developments have enhanced our understanding of complex diseases, and should theoretically enable us to predict, prevent and treat such cases in a proactive personalized context. This thesis provides a state-of-the-art review of the challenges and opportunities that explain the relatively slow progress towards personalized medicine. It identifies data integration and interpretation as the main bottleneck and proposes a novel method, termed Meta-Quantile Regression (MQR), to identify genetic variations with potential interactions. Analyzes were conducted on a total of 75,230 individuals with European ancestry, and the genetic architecture of obesity was shown to be shaped by genetic interactions. Lastly, the computational cost of MQR was substantially reduced using linear approximations, and MQR was further shown to have better performance in identifying potential interactions compared to classic variance tests.

Obesity is a heterogeneous condition that can seriously impact the degree to which one is healthy and socially accepted. It is generally considered to be greatly influenced by genetic factors. Given that we cannot change our genes, it was the purpose of this study to try to further understand the variables related to obesity that are not genetic. Specifically, the purpose of this study was to investigate the impact of certain family systems variables and childhood feeding practices on Body Mass Index (BMI). The family variables of interest were intergenerational intimacy, intergenerational differentiation, intergenerational triangulation, spousal intimacy, spousal differentiation, nuclear family triangulation, and the relationship between eating and sex. The childhood feeding variables of interest related to the use of food as a reward, coercive use of food, parental disagreement about feeding, the expression of love through food, and feeding enmeshment (i.e., the perception of parental overcontrol in feeding). Because certain eating styles have been found to be related to obesity, further investigation revolved around the impact of the family and feeding variables on eating styles. The eating styles of interest were restrained eating, emotional eating, external eating, and binge eating. The variables were studied by surveying employees of a school system in southwest Virginia. Body Mass Index was found to be significantly positively correlated with feeding enmeshment, weight as a means of sexual avoidance, and eating in response to a lack of physical affection. Restrained eating was not found to be significantly related to any family or childhood feeding variable. Emotional eating, external eating, and binge eating were all significantly negatively correlated with intergenerational intimacy, spousal differentiation, and nuclear family triangulation health, significantly positively correlated with sexual avoidance and deprivation of affection. In addition, emotional eating and binge eating were significantly negatively correlated with intergenerational differentiation, while external eating and binge eating were significantly negatively correlated with spousal intimacy. Emotional eating was positively correlated with all of the childhood feeding practices, while external eating and binge eating were correlated with four and three, respectively, of the feeding practices. While there were many significant correlational findings, there were few significant coefficients in the hierarchical regression analyses, presumably because of the high intercorrelations between the predictor variables (the family and feeding variables). In general, it can be said that family functioning and childhood feeding behaviors are relevant to overeating and overweight. The family and feeding variables are better predictors of eating styles that can lead to obesity than of obesity per se. High levels of dysfunction in families and frequent use of food in non-nutritional ways are associated with high levels of emotional, external, and binge eating. These findings may have implications for physicians and therapists. / Ph. D.

Childhood overweight and obesity are serious health conditions affecting many children and adolescents worldwide. Depression is an equally serious diagnosis that is postulated as a precursor for obesity and overweight Screening for depression is recommended as a preventive measure to reduce the prevalence of obesity for persons of all ages. The purpose of this investigative review was to establish which interventions, if any, were being utilized to reduce this pandemic by screening for depression. Although no intervention studies were discovered that have been specifically utilized to screen for depression as a means of reducing obesity in children, multiple studies were analyzed that indicated positive connections between depression in childhood and obesity in adulthood. Interventions were determined that are effective and easy to use for nurses in clinical practice, both in the community and acute patient settings. Moreover, no studies were discovered where nurses are currently implementing the depression screening interventions recommended by nursing literature, generally due to clinical setbacks and a lack of education on proper screening and Body Mass Index calculation. If evidence based interventions are implemented, nurses along with other healthcare professionals can help decrease the incidence, prevalence, and severity of childhood overweight and obesity.