This study takes the form of exploratory and descriptive research in which children in middle childhoods’ experience of their obesity was explored and described. A case study research design was used in a qualitative approach and data was gathered through semi-structured interviews. The data analysis spiral of Cresswell was implemented in order to facilitate the research process. Empirical findings present the experiences obese children in middle childhood undergo with regard to different areas of their development. The researcher drew upon literature relating to obesity and middle childhood development in order to analyse and verify collected data in pursuit of describing children’s experience of their obesity. Emotional hideaway amongst obese children, the role of the family in an obese child’s life and the reason why obese children make the wrong food choices are some of the topics not addressed in the limited scope of this project. The possibility of exploring these final thoughts provides opportunity for future research. / Social Work / M.Diac. (Play Therapy)

This work builds on the use of several Mathematical Modeling tools to develop approaches that address relevant, real and previously unanswered questions related to the improvement of Public Health Systems, in three particular instances. First, this thesis analyzes the variation in state-level vaccination coverage during the emergency response to the 2009 H1N1 pandemic influenza outbreak in the United States. The analysis considers the overall adults population and two priority sub-populations: children and high-risk adults. We focus on quantifying the association between vaccination coverage and the supply chain and distribution system decisions, during the vaccine shortage period, while controlling for other commonly recognized factors such as previous vaccinations, socio-economic characteristics, health seeking behavior and health infrastructure. The variables analyzed are generally correlated, and the problem has a limited sample size with a much larger number of independent variables. The findings of this research have been published in Vaccine and presented to the Centers for Disease Control and Prevention. Second, the research approaches the problem of estimating childhood obesity prevalence in small geographic areas in the U. S. Obesity is recognized as one of the major health problems in the country, and attending this condition in children is of major importance to deal with the sources of the overall problem. The ability to target interventions to the most affected children populations is necessary to achieve cost effective solutions. But local accurate obesity data is hard to obtain and missing for most of the small areas in the country. The research focuses on estimating prevalence of obesity and overweight status in children in small geographical areas in the absence of surveillance and detailed sampling. Our modeling approach is built in two stages. The first one uses a logistic regression model that links individual characteristics to high-BMI status, and generates samples of the empirical distribution of its coefficients though bootstrap re-sampling. The second uses simulation to generate virtual population samples of the small areas, which are then combined with the logistic model samples to estimate prevalence. Confidence intervals are built though re-sampling. A very important feature of our approach is that all of its inputs are from publicly available data, which gives availability for the replication of the methodology to any health stakeholder in the US. The model estimates were validated by using separate models for adults and children in a state with available data. Estimates obtained from our modeling approach were used by a large healthcare provider to geographically target interventions for pediatric obesity. Third, the thesis presents an introductory analysis of the possible effects of partial disruptions to critical supply chains due to absenteeism caused by a generalized flu-like illness in the US. For this analysis, we first construct a plausible national food supply chain for milk and then we simulate its disruption. To build the supply chain we used public information regarding production, consumption, and major milk processors and bottlers, and fitted it into a supply network though optimization. Then, to analyze the effects of flow disruptions of the supply chain, we built a simulation of the operation of the network and virtually generated absenteeism, mildly disrupting the supply chain flows by the proportional absences. We used information on potential absenteeism in work groups from an influenza simulator. Our initial analysis shows that absenteeism may create variations along the supply chain, similar to those described in the bullwhip effect analysis literature, even in the absence of supply shortages and without variations in pricing or demand, for which we find no prior reference in the literature.

Background: Reviews of primary research in developed countries and policy in the UK demonstrate there is a lack of evidence from well conducted RCTs on lifestyle interventions for childhood obesity (NICE 2006, SIGN 2003, Oude Luttikhuis et al. 2009). Objectives: To develop, implement and evaluate the Y W8? family focused childhood obesity treatment programme using a randomized controlled trial. Methods: The programme was developed using Bartholomew’s Intervention Mapping framework. Using this stepped process a needs analysis was undertaken, a steering group formed, focus groups were completed in local schools and interviews took place with parents of obese children. The determinants identified by these processes were combined with relevant theories and information gathered through a literature review to develop the programme. Y W8? is a 12 week course for families with children aged 8–13 years designed to assist with weight management. The RCT was designed as an individually randomised parallel-group trial with a waiting-list control group. Children in the intervention group (n=59) had their height, weight, self-reported physical activity levels, self-reported fruit and vegetable consumption and a measure of self-esteem recorded at pre- and post-assessment, whilst only height and weight was collected from the children in the control group (n=55). Results: Twelve week (post course) results showed a significant difference in change in BMI z-score between the control and intervention group, mean difference = -0.12 (95% CI: 0.09 to 0.16, F (1, 98) = 54.04, p < 0.0005), with the control group increasing and the intervention group decreasing their BMI z-score. Analysis showed this positive effect on weight status did not adversely affect linear growth. For the intervention group 81% of children completed the programme. Implications: This RCT offers evidence to support the use of family-based treatment programmes in the treatment of childhood obesity and displays positive results in the short-term, at a lower cost than similar interventions. The thesis also demonstrates how a public health programme can be implemented and sustained in routine NHS practice.

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

Übergewicht und Adipositas bei Kindern und Jugendlichen ist ein weit verbreitetes Problem der Bundesrepublik Deutschland. Auch der Anästhesist sieht sich im täglichen klinischen Alltag mit diesem Patientenkollektiv und den damit verbundenen pathophysiologischen und pharmakologischen Besonderheiten konfrontiert. In dieser Dissertation werden Anästhesieverfahren, intraoperative und postoperative Analgesie, sowie die Inzidenz von postoperativer Übelkeit und Erbrechen bei nicht-übergewichtigen und übergewichtigen Kindern und Jugendlichen erhoben und untersucht. Im Rahmen einer Observationsstudie wurden Daten zur Prämedikation, zu den Anästhesieverfahren, dem Einsatz von Muskelrelaxanzien, zu regional- und lokalanästhetischen Verfahren, zur PONV-Prophylaxe und Inzidenz von PONV sowie zum Analgetikabedarf intra- und postoperativ erfasst und anhand des BMI verglichen. Es konnte nachgewiesen werden, dass bei nicht-übergewichtigen Kindern und Jugendlichen signifikant häufiger eine volatile Einleitung durchgeführt wird als eine intravenöse (p < 0,05). Hinsichtlich der Dosierungen der verwendeten Medikamente ergab sich für die Prämedikation mit Midazolam eine geringere Dosierungen pro kg KG (p < 0,05); dies konnte auch für die intraoperative Analgesie mittels Metamizol i.v. und postoperativ für Paracetamol p.o. im übergewichtigen Patientenkollektiv aufgezeigt werden (p < 0,05). Übergewichtige erhalten signifikant häufiger ein Muskelrelaxanz als Nicht-übergewichtige (p < 0,05). Dabei wird bei Übergewichtigen Rocuronium signifikant häufiger als andere Muskelrelaxanzien angewandt, während bei nicht-übergewichtigen Kindern häufiger Cis-Atracurium (p < 0,05) Verwendung findet. Übergewichtige und adipöse Kinder und Jugendliche weisen keine erhöhte Inzidenz für PONV auf. Als Risikofaktor für das Auftreten von PONV, unabhängig vom Gewicht des Kindes, ist die Applikation von Piritramid, innerhalb der ersten 24 h postoperativ, zu werten (p < 0,05). Hinsichtlich der Art des operativen Eingriffes konnte die Adenotomie als signifikanter Risikofaktor für die Inzidenz von postoperativem Erbrechen, unabhängig vom Gewicht, nachgewiesen werden (p < 0,05). Die Ergebnisse werden innerhalb der Promotionsschrift aufgelistet und es werden Gründe für Unterschiede beim nicht-übergewichtigen vs. übergewichtigen Kind diskutiert

Problematika výživy u dětí v rámci školní docházky je stále aktuální a upoutává pozornost. Obezita u dětí se stále zvyšuje. Je mnoho publikací na problematiku obezity u dětí a s tím spojený vyšší počet úrazů a vyšší problematika pozornosti (ADHD, ADD a jiné poruchy). V České republice se stále více vyskytují děti s obezitou, nezdravým životním stylem, který doprovází i nedostatek pohybu. Tyto faktory vedou ke zhoršení fyziologických funkcí, zatěžování statického a pohybového aparátu člověka a v neposlední řadě ke špatnému psychickému stavu jedince. V diplomové práci se zaměřím na stravování při školní docházce a možné stravovací návyky, které mohou přispívat k dětské obezitě, častějším zdravotním problémům. Pomocí anketního šetření práce zjistím, jak se stravují žáci základních škol na Slánsku (Základní škola Slaný, Komenského náměstí 618 a Základní škola Smečno, okres Kladno) při pobytu ve škole. Klíčová slova škola, snídaně, výživové návyky, obezita u dětí, prevence, vyvážená strava ABSTRACT The issue of children's nutrition in school attendance is still up to date and attracts attention. Children's obesity is increasing. There are many publications about children's obesity and associated with that higher number of accidents and higher attention issues (ADHD, ADD and other disorders). There are...

Childhood overweight and obesity is a significant and increasing health problem both nationally and globally. Yet few interventions for preventing obesity have been successful, particularly in the long-term, suggesting that important factors are being overlooked. The aims of this thesis were to investigate (a) the prevalence of childhood overweight, obesity, and binge eating; and (b) the relationships between body weight, binge eating behaviour, and a set of physical, psychological, and psychosocial variables including parent body size, body dissatisfaction, size-related teasing experiences, internalisation of sociocultural messages, depression, dieting attitudes and behaviour, and emotional eating. Participants were 569 grade five and six primary school children (272 boys and 297 girls) from Catholic and Government schools across metropolitan Melbourne, Australia. Almost 25% of participants were classified as overweight or obese. Thirteen percent of participants reported engaging in overeating (with or without loss of control), 14% reported loss of control (with or without overeating), and 6% reported engaging in binge eating (overeating and loss of control). Structural equation modelling analyses found that body weight and binge eating were indirectly related. Body weight was directly and positively associated with parent body size, size-related teasing experiences, body dissatisfaction, and internalisation of sociocultural messages, negatively associated with emotional eating, and indirectly associated with depression, and dieting attitudes and behaviour. Binge eating was directly and positively related to parent body size, emotional eating, depression, and body dissatisfaction, while indirect associations were found with size-related teasing experiences, internalisation of sociocultural messages, and dieting attitudes and behaviour. A direct relationship between body dissatisfaction and loss of control was also found. Some gender differences were detected. Multivariate analysis of variance also revealed that binge eaters scored significantly higher on measures of depression, size-related teasing experiences, internalisation of sociocultural messages, and angry and worried related emotional eating than non-binge eaters. Differences were also found for participants reporting the presence or absence of overeating (regardless of loss of control) and loss of control (regardless of overeating). Overall, the study demonstrated that psychological and psychosocial factors have a significant association with both weight and binge eating behaviour in a non-clinical sample of preadolescent Australian school children. As such, future intervention programs may benefit by addressing these factors. In addition, these results support the idea of working toward the prevention of obesity and eating disorders simultaneously in children, and of extending research in this area to examine causality.

Obesity has been described as a global health crisis due to the rapid increases seen worldwide (Whitlock et al., 2005; Harris et al., 2009; Yetter, 2009). The consequences of obesity are far-reaching and include the physiological and psychological implications for obese individuals, as well as the financial impact it has on both the individual and national health care. Children, especially those of minority ethnic background and lower socioeconomic status, are at increased risk for developing obesity (Yetter, 2009; Veldhuis et al., 2009). Intervention programs targeting underlying causes of childhood obesity have been developed, but little consistent success has been achieved (Summerbell et al., 2005; Sherry, 2005). One factor that could be influencing the lack of success is the stigmatization that can be felt by children taking part in intervention programs. Furthermore, many programs have targeted behavior change without determining underlying attitudes about behaviors. It is critical that effective obesity intervention programs be developed for children at high risk of developing obesity. This study used indirect messaging to address health issues related to overweight and obesity in children. An education program about animal health was presented to two groups of eight and nine year old children. The program included a combination of classroom instruction and practical application both in the classroom and at the Palm Beach Zoo with real animals. The children's attitude, knowledge, and practice of healthy behavior was measured before and after exposure to the program to evaluate its effect. It was hypothesized that learning about what being healthy entails for animals will have positive implications for the children's own health. It was found that children who participated in this study were already knowledgeable about healthy behaviors and also had overall positive attitudes towards health. However, they did not have high levels of health behavior practices. Participation in the program did not significantly improve the knowledge, attitudes, or practice of health behavior in the children. Zoos should consider designing program that specifically target increasing the practice of health behaviors in children.

Systematic reviews were conducted to investigate the relationships between anthropometric assessments of nutritional status (adiposity) and caries experience among preschool and school-age (aged 6-12 years) children. Four relevant databases were searched for publications up to December 2011. Qualitative assessments were conducted and rated according to STROBE statement. Where feasible, quantitative syntheses were conducted. From a total of 2013 studies, 39 effective studies were identified for preschool children and 53 effective studies for school-age children. The mean ‘quality of reporting’ were 20.4 (SD 3.8) for the preschool studies and 21.4 (SD 3.9) for school-age studies. Qualitative syntheses were inconclusive about their relationships. Meta-analyses identified that preschoolers with high BMI had a greater dmfs/defs than those with normal BMI: pooled mean difference 0.93, 95% CI 0.65, 1.22, P < 0.05; and that children with low BMI had a lower dmft than those with normal BMI: pooled mean difference - 0.29, 95% CI -0.42, -0.15, P < 0.05. Among school-age children meta-analyses failed to identify any significant association. Among a random sample of 5-year-old children in Hong Kong, with a response rate of 83.1% (324/390), caries experience was associated with general adiposity (as assessed by W/H) and central adiposity (as assessed by WC). Regression analyses (adjusted for oral health behaviours and socio-demographic factors) identified that W/H z-score was associated with having caries, OR 1.41, 95% CI1.04, 1.91, P = 0.03; and ‘very high’ caries OR 1.62, 95% CI 1.05, 2.50, P = 0.03. WC z-score was associated with ‘very high’ caries experience, OR 1.72, 95% CI 1.06, 2.81, P = 0.03. Oral hygiene status was not associated with adiposity. Among a random sample of 12-year-old children in Hong Kong, with a response rate of 76.9% (514/668), oral health status was associated with adiposity. Regression analyses (adjusted for oral health behaviours and socio-demographic factors) identified that WHR z-score was associated with caries experience: ‘high’ (OR 1.33, 95% CI 1.05, 1.70, P = 0.02), and ‘very high’ (OR 1.52, 95% CI 1.10, 2.11, P = 0.01). TRSKF z-score was associated with ‘very high’ caries experience (OR 1.47, 95% CI 1.10, 1.96, P = 0.01). WC z-score was associated with ‘unhealthy’ periodontal status (OR 1.33, 95% CI 1.01, 1.76, P = 0.04). Infant growth during the first year of life was associated with oral health at 12-year-old. Accounting for birth characteristics, socio-demographics and oral health behaviours, those with slow growth trajectories (Ⅰ- smallest birth weight and slow weight gain; and Ⅱ- smallest birth weight and average weight gain) had a greater likelihood of having a ‘high’ caries experience: OR 2.68, 95% CI 1.00, 7.16, P < 0.05 and OR 3.03, 95% CI 1.22, 7.51, P < 0.05, respectively, compared to average growth trajectory subjects. In addition, those with the fastest growth trajectory (heaviest birth weight and accelerated weight gain) had a greater likelihood of having a ‘high’ caries experience, OR 2.64, 95% CI 1.01, 6.91, P <0.05. Growth trajectories were not associated with periodontal health status at 12-year-old (P > 0.05). / published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy