No description available.

<p><strong>Background:</strong> Over the past two decades the prevalence of childhood obesity has reached epidemic proportions. In Canada recent population growth has relied heavily on immigration. In some instances, immigrant youth exhibit better health overall and may be at less risk for obesity. There is a paucity of literature on the health of immigrant youth in Canada.</p> <p><strong>Objectives:</strong> The objectives of this study are: (i) to examine differences in body mass index and prevalence of overweight/obesity between immigrant versus non-immigrant youth and (ii) to identify the extent to which (a) lifestyle and (b) socio-demographic factors, account for between-group differences.</p> <p><strong>Methods:</strong> Data for this study was obtained from the Canadian Community Health Survey (CCHS). The associations between standardized BMI score (zBMI) and prevalence of overweight/obesity, immigrant status, socio-demographic and lifestyle covariates were analyzed using multilevel linear and logistic regression, respectively.</p> <p><strong>Results:</strong> The CCHS sample included 63509 participants, aged 12 to 19 years. 6.4% respondents identified themselves as being born outside of Canada. Immigrant youth had a lower zBMI by 0.441 compared to Canadian-born youth (p < 0.001). The odds of being overweight/obese were 34% lower (OR 0.66, 95% confidence interval (CI) 0.45, 0.86) among immigrant versus non-immigrant respondents. Measures of diet, activity level and sedentary behaviour did not account for the differences in body composition between immigrant and Canadian born youth.</p> <p><strong>Conclusion:</strong> Immigrant youth had a lower rate of overweight/obesity and lower zBMI scores compared to Canadian-born youth.</p> / Master of Science (MSc)

The relationship between human health and nutrition is complex and limited widely accepted guidance on proper methods of evidence synthesis is available for nutritional issues. While concepts and methods of evidence synthesis in pharmacological treatments can be mostly applied to nutritional interventions, characteristics unique to the nutrition- and dietetics-related topics can lead to distinct challenges that may not be encountered in evidence synthesis of traditional medical interventions. In addition to traditional methods for pooling the results, state-of-the-art methodologies such as GRADE or network meta-analysis, while being widely used in many medical fields, their use in the field of nutrition and food science is surprisingly rare. This thesis begins with the assessment of methodological quality of available public health guidelines on sugar intake to determine the extent to which nutritional guidelines follow currently available guidance in evidence synthesis and making practice recommendations. Subsequently, we present two examples of proper implementation of evidence synthesis methods in standard pairwise meta-analysis and indirect treatment comparison and handling of relevant challenges including applications of GRADE approach. Further, this thesis presents a network meta-analysis in the field of nutrition and child health in which the challenges of conducting multiple treatment comparison are tackled and a new approach for presenting and making conclusion from network meta-analysis results is proposed. / Thesis / Doctor of Philosophy (PhD)

Background The use of vaccines is among the most cost-effective tools for preventing infectious diseases and their complications. However, poor uptake and increasing exemption to routine childhood vaccination have been linked with outbreaks of infectious diseases such as measles, pertussis, and more recently poliomyelitis in the US. The objective of the study is to determine the prevalence, pattern, and predisposing factors of vaccine exemptions to childhood immunization amongst parents of children in the Northeast Region from 2017 to 2021. Methods The routine immunization data of children between 1-24 months in the Northeast region, Tennessee from 2017- 2021 was extracted. Based on the population of children within the birth cohort, a random sample of children was selected from birth certificates of children born in the first three months of 2 years prior in Tennessee’s eight counties in the Northeast region. Descriptive statistics with trends, Chi-square, and logistic regression were conducted to delineate factors associated with vaccine exemption in the region. Result The prevalence of vaccine exemption was 2% on average, but the vaccine exemption rate increased significantly from 1.5% in 2019 (pre-COVID pandemic) to 2.5% in 2020 (peri-COVID period). However, the mother’s level of education (aOR=2.37; CI=0.55-10.17), mother’s age (aOR=0.59; CI=0.14-2.51), TennCare attendance (aOR=0.57; CI=0.15-2.21) do not show statistically significant association with exemption to childhood vaccination in Northeast region in Tennessee. Conclusion There appears to be an increasing trend in the vaccine exemption to routine childhood immunizations in the Northeast region of Tennessee over the years. However, the impact of other factors associated with exemptions to childhood vaccinations needs further research.

No / Objectives: A review of the literature reveals little description of the advisory role of the health visitor in the child health clinic. This paper describes a study which examined content, clients' recall and value to the client of their discussion with the health visitor. Design: Descriptive study; non-participant observation; semi-structured interviews. Setting: One predominantly urban community Trust involving seven volunteer health visitors from seven different child health clinics. A total of 24 clinics were observed. Participants: One hundred clients attending seven child health clinics. Findings: Most mothers reported that speaking with the health visitor had been fairly or very important. Clients' discussion with the health visitors covered a wide range of child-centred issues and concerns. Mothers recalled 79% of all topics discussed during the clinic visit and initiated nearly 59%. Although weighing was considered an important reason for attending clinic by most mothers it did not preclude wanting to speak with the health visitor. However, some mothers did not wish to speak to the health visitor. Conclusion: The health visitor provided an advisory and support service for many of the attending mothers. Most clients reported valuing this intervention. This study support the notion that mothers do not attend the clinic simply for medical services or screening. Attention should be focused on research and development of services which reflect this consumer agenda. Consideration should be given to the appropriateness of health visitors weighing children.

Yes / Economic, physical, built, cultural, learning, social and service environments have a profound effect on lifelong health. However, policy thinking about health research is dominated by the 'biomedical model' which promotes medicalisation and an emphasis on diagnosis and treatment at the expense of prevention. Prevention research has tended to focus on 'downstream' interventions that rely on individual behaviour change, frequently increasing inequalities. Preventive strategies often focus on isolated leverage points and are scattered across different settings. This paper describes a major new prevention research programme that aims to create City Collaboratory testbeds to support the identification, implementation and evaluation of upstream interventions within a whole system city setting. Prevention of physical and mental ill-health will come from the cumulative effect of multiple system-wide interventions. Rather than scatter these interventions across many settings and evaluate single outcomes, we will test their collective impact across multiple outcomes with the goal of achieving a tipping point for better health. Our focus is on early life (ActEarly) in recognition of childhood and adolescence being such critical periods for influencing lifelong health and wellbeing. / UK Prevention Research Partnership (MR/S037527/1), which is funded by the British Heart Foundation, Cancer Research UK, Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Health and Social Care Research and Development Division (Welsh Government), Medical Research Council, National Institute for Health Research, Natural Environment Research Council, Public Health Agency (Northern Ireland), The Health Foundation and Wellcome.

Background: Evidence from population-level studies demonstrates that adolescent sexual health outcomes are associated with social exclusion, and that certain groups, including young people looked after by local authorities often experience poorer sexual health outcomes. The poorer sexual health outcomes observed for looked after young people has led to the Scottish Government recommending that looked after young people be prioritised for the delivery of sexual health and relationships education, and that residential carers, foster carers and social workers should play a key role in the delivery of sexual health and relationships information to looked after young people. This recommendation builds on existing policy initiatives that have emphasised that parents should be routinely talking to their children about sexual health and relationships. Despite a growing research interest in the health of looked after young people, there is currently little known about how sexual health and relationships discussions are undertaken within the care setting. This is because much of the research that has been published to date has focussed upon identifying barriers to communication rather than establishing how communications are shaped by the characteristics of carers, looked after children and the wider context of the care system. In this thesis I hope to address this research gap by exploring what factors shape communications about sexual health and relationships within the care setting, and examining the extent to which connectedness, monitoring and supervision — parenting factors identified as promoting positive sexual health outcomes for adolescents within the wider literature — mediate these discussions. Methods: 54 in-depth qualitative interviews were conducted with looked after young people (aged 14-18), care leavers (aged 16-23), residential workers, foster carers and social workers in one local authority in Scotland between August and December 2011. Data were analysed thematically, with data collected from corporate parents and looked after young people used to compare and contrast experiences of talking about sexual health within the care setting. Findings: The results presented in this study demonstrate that there has been a perceived shift in attitudes towards talking to looked after young people about their sexual health, and that residential carers, foster carers and social workers believe that talking to young people about sexual health and relationships should be a core responsibility of the corporate parent. Despite this, the results of this study demonstrate that talking to young people about sexual health and relationship is a subject that is fraught with tensions, with many of the corporate parents interviewed expressing difficulties reconciling their own views about the appropriateness of talking to young people about sexual behaviours with their professional responsibility to inform and protect looked after young people from risk. Looking specifically at how communications about sexual health and relationships were undertaken within the care setting, the results of this study show that talking to young people in care about sexual health and relationships is mediated by the impact or pre-care and care histories, in particular maltreatment and poor attachment security, upon young people’s understandings of relationships and their ability to trust other people and seek out help and support. Whilst corporate parents emphasised the need for training to help them identify strategies for talking to young people about sexual health and relationships, the results of this study show that corporate parents are already undertaking sexual health and relationships work that is tailored to the age and stage of the child, and is balanced by the provision of monitoring and supervision to minimise risk. Conclusions: The results of this thesis show that discussions about sexual health and relationships need to be underpinned by a trusting relationship between corporate parents and looked after children. As such, an emphasis needs to be placed upon improving young people’s ability to trust other people. Improving permanency for young people in the care system, in conjunction with the development of attachment based sexual health practices, may result in the promotion of positive outcomes for looked after young people. Future policies and training relating to the provision of sexual health and relationships education within the care system should reflect this fact.

Bakgrund Barns övervikt och fetma är en av vår tids största folkhälsoutmaningar, vilket kan påverka barnens hälsa och livskvalitet negativt och kan även orsaka allvarliga konsekvenser. Barn som har övervikt och fetma kan även uppleva utanförskap, osäkerhet, låg självkänsla och psykisk ohälsa. Dessa barn har också en ökad risk för hjärt-kärlsjukdomar samt att i förlängningen drabbas av en förtidig död. Syftet var att beskriva BVC-sjuksköterskans erfarenheter och reflektioner i arbetet kring övervikt och fetma hos barn mellan 3-5 år. Metoden var en intervjustudie med beskrivande design och en kvalitativ ansats med sammanlagt åtta deltagare. Kvalitativ innehållsanalys användes som dataanalys. Resultatet visade att BVC-sköterskan arbetade med att identifiera barns övervikt och fetma med hjälp av tillväxtkurvan och genom stödjande hälsosamtal men använde även sin erfarenhet och en klinisk blick för att fånga upp de barn som har övervikt och fetma. Övervikt och fetma hos barn är ett känsligt ämne och resultatet betonade att det var viktigt att ha modet att lyfta frågan med barnens föräldrar samtidigt som samtalet måste vara varsamt och anpassat efter barnens och föräldrarnas behov. Resultatet belyste även att BVC-sköterskorna upplevde att de kunde göra skillnad när de arbetade med föräldrar med en positiv inställning och en vilja till förändring. Slutsats Övervikt hos barn handlar oftast om en osund livsstil inom hela familjen och föräldrarna bär ansvaret för barnets hälsa. Tydligare lokala riktlinjer behövs för att öka tryggheten för BVC-sköterskan i sitt arbete med barns övervikt och fetma samt med deras föräldrar. / Background Children's overweight and obesity is one of the greatest public health challenges, which can affect children's health and quality of life negatively and can also cause serious consequences. Children who are overweighed and obese may also experience alienation, insecurity, low self-esteem and mental health. These children have an increased risk of cardiovascular disease and to ultimately suffer an untimely death. The aim was to describe the child health care nurse's experiences and reflections in the work on overweight and obesity among children aged 3-5 years. The method consisted of interviews, with in total eight participants. The study had a descriptive design with a qualitative approach and qualitative content analysis was used for the data analysis. The result showed that the child health care nurse worked to identify children with overweight and obesity by using the growth curve and supporting health calls. Experiences and a clinical eye were also used while capturing overweighed and obese children. Overweight and obesity in children is a sensitive topic and the results emphasize that it is important to have the courage to raise the issue with the parents, at the same time the call must be prudent and adapted to the children's and parents' needs. The results also highlighted that the child health care nurses felt that they could make a difference when they are working with parents with a positive attitude and a willingness to change. Conclusion Obesity in children is usually about an unhealthy lifestyle of the whole family and parents are responsible for the child's health. Clearer local guidelines are needed to increase security for the child health care nurse in her work with children overweight and obesity and their parents.

Tidigare studier har visat att pappor upplever att de känner sig utanför i kontakten med barnavårdscentralen. En av barnhälsovårdens uppgifter är att ge stöd och råd till föräldrar, för att främja barns utveckling. Pappor som inte är delaktiga, kan leda till otrygg anknytning mellan barnet och föräldern, vilket kan påverka barnets fortsatta utveckling. Syftet med studien var att undersöka distriktssköterskors upplevelser av pappors delaktighet i samband med kontakt med barnavårdscentralen. Studien hade en kvalitativ ansats. Individuella semistrukturerade intervjuer gjordes med tolv distriktssköterskor som arbetade på olika barnavårdscentraler i södra Sverige. Intervjuerna analyserades med en kvalitativ innehållsanalys. I resultatet framkom tre kategorier: Möjligheter att vara närvarande, pappans känslor kan påverka delaktigheten och pappor som är aktiva på BVC (barnavårdscentralen). Resultatet visade att distriktssköterskorna upplevde att papporna inte var särskilt delaktiga i kontakten med barnavårdscentralen, vilket ofta berodde på att pappan arbetade. Distriktssköterskorna upplevde att papporna kunde känna sig bortglömda, när fokus främst var på mamman och barnet. Distriktssköterskorna upplevde att papporna hade andra frågor och var intresserade av andra ämnen än mammorna. Majoriteten av distriktssköterskorna upplevde att pappornas delaktighet i kontakten med barnavårdscentralen ökade, och att det delvis berodde på att distriktssköterskan själv hade ändrat inställning till pappors delaktighet och därmed mer aktivt bjöd in papporna nuförtiden. / Previous studies has shown that fathers feel left out of the contact with the child health centre. One of the assignments of the child health services is that of giving support and advice to parents, in order to promote the development of the child. When the father is not involved it can lead to insecure attachment, and also affect the development of the child in a negative way. The aim of this study was to describe district nurses experience of fathers participation in contact with the child health centre. A qualitative approach was used. Individual semi-structured interviews were conducted with twelve district nurses working in child health centres. The interviews were analysed with a qualitative content analysis. Analysis of the interviews resulted in three categories: The ability of being present, fathers feelings could affect the participation, fathers who are active in the child health centre. The result of this study showed that the district nurses experienced that fathers could feel forgotten, when the main focus was of the mother and child. The district nurses experienced that fathers had different questions and were interested in other subjects than the mothers. The majority of the district nurses experienced that fathers participation in the contact with the child health centres increased, in part of the district nurses change of attitudes towards fathers participation, leading to more active invitation of the fathers.

Section A provides an overview of the role of family caregivers of individuals with chronic illness, and describes key conceptualisations and theories posited in the caregiver literature. This is followed by an overview of research conducted with caregivers of children with chronic kidney disease (CKD), a summary of the limitations of this research, and suggestions for future research. Section B Despite a recognised need to monitor caregiver burden in caregivers of children with CKD, there is no measurement tool currently available to meet this aim. The present research documents the development of a measure of caregiver burden specific to family caregivers of children with CKD. Methods: Interviews were conducted with 16 caregivers of children with CKD and 10 healthcare professionals in order to generate measure items. A provisional version of the measure was developed and piloted with 18 caregivers of children with CKD and five healthcare professionals. Results: An initial pool of 97 items was generated from the content of interviews, which was reduced to 60 items following review for item redundancy. A piloting exercise provided preliminary evidence for the usability, readability, and relevance of measure items; adaptations further to piloting resulted in the 51-item ‘Paediatric Renal Caregiver Burden Scale’ (PR-CBS). Conclusions: It is hoped that the PR-CBS will serve to identify areas of need amongst caregivers of children with CKD, and in turn improve outcomes for this caregiver population and children with CKD. Section C is a critical appraisal of the conducted research study, and includes an overview of research abilities acquired during its completion, reflections on how the research may have been conducted differently, implications for future clinical practice, and ideas for future research.