Suchergebnisse

Purpose. Identify if outreach support increases school-aged children's participation in recreational activities. Design. Cluster randomized trial. Setting. Sixteen schools in economically vulnerable neighborhoods were randomized to either an intervention or control group. Subjects. Children in grades 3 to 5 and their families were invited to participate. Intervention. Children in intervention schools were assigned a "connector" (outreach worker) to facilitate participation in recreation activities. Measures. The Children's Assessment of Participation and Enjoyment (CAPE) was the primary measure at baseline, middle, and end of 1 year. Demographics, body mass index, child physical and psychosocial health, coordination, and self-esteem were measured. Analysis. A generalized linear model was used to test differences between intervention and control groups. Results. Three hundred and sixty children enrolled, and 306 (85 %) completed the study. A greater proportion of children in the intervention group compared with the control group increased participation in physical activity (21 % vs. 10%, p = .02). Children who increased their activity were more likely to have higher levels of contact with the connectors (31 % vs. 8%, p = .001). Study limitations included (I) 29% of eligible families participated, (2) first use of the CAPE instrument as a longitudinal measure, and (3) connectors were not blinded to group assignment. Conclusion. Children living in vulnerable neighborhoods benefit from outreach workers to connect them with physical activity programs.

Although family communication is important in clinical genetics only a small number of studies have specifically explored the passing on of genetic knowledge to family members. In addition, many of these present exploratory or tentative findings based upon small sample sizes, or data collected only a short time after testing. Nevertheless, if health professionals are to develop effective strategies to help patients' deal with communication issues, we need to know more about what actually happens in families. The aim of this commentary is to identify factors which appear to influence whether patients share information about genetic risk with relatives who are unaware of that risk, with whom they share it and how they go about it. The paper draws upon evidence and thinking from the disciplines of psychology (including family therapy), sociology, medicine and genetic counselling. It is presented under the following headings: disease factors, individual factors, family factors and sociocultural factors. It concludes by highlighting a number of key issues which are relevant for health professionals.

<b><i>Background:</i></b> Family history (FH) is a risk factor for many conditions in pediatric practice. There is no standard of care regarding FH taking, and only a few published studies about current practice. <b><i>Objectives:</i></b> To explore in depth pediatricians' perceptions, attitudes, beliefs, and practices regarding FH taking. <b><i>Methods:</i></b> The Theoretical Domains Framework (TDF) was used to develop a comprehensive interview scheme. Semi-structured interviews were conducted with community pediatricians. Interviews were audio-recorded, transcribed, and analyzed using a thematic approach and the constant comparison method. <b><i>Results:</i></b> Eleven pediatricians were interviewed. FH was found to be a firmly embedded, complex, and important aspect of pediatric practice. Participants described FH as part of regular holistic care. FH and social history were linked and often appeared to be part of the same concept to participants. FH was used for a range of purposes. In addition to risk assessment, FH information helped clarify diagnosis and select medication, tailor overall patient management based on family circumstance, and provide psychosocial support for parents. Participants expressed confidence in their FH skills and reported tailoring their approach with experience. Most were not concerned about formal evidence for FH and would not change their practice except for "good reason." <b><i>Conclusions:</i></b> The use of the TDF helped ensure a comprehensive approach to FH taking in pediatric practice. The findings suggest that FH taking in this setting is a complex activity, embedded in routine care. Efforts to make FH taking more systematic may founder if they fail to take into account pediatricians' attitudes, perspectives, and practices.

Conservation strategies require multifaceted approaches to monitor and protect primate populations, many of which are rapidly declining around the world. We propose that microbial ecology and next-generation microbiome analyses offer valuable perspectives and tools for investigating and monitoring primate health and improving conservation efforts. The microbial communities inhabiting primates and other taxa profoundly affect host health, nutrition, physiology, and immune systems, through relationships that range from commensal and mutualistic to pathogenic. Recent advances in DNA sequencing now make it feasible and economically viable to identify microbiomes among and within hosts. Herein, we highlight several examples in which microbial analyses of primates can aid conservation approaches that are broadly applicable across other taxa. First, we highlight evidence for clear spatial variation (e.g. biogeographic niche specificity, both within the anatomical regions of the host body, as well as in the geographic location of the host) and temporal (e.g. seasonal, ontogenetic) patterns in microbial distribution. We emphasize that microbial communities are sensitive to alterations in the external environment and that microbial diversity correlates with habitat quality, imposing direct health consequences. Incorporating microbial host and biogeographic variation holds great potential for forest corridor assessments and for reintroduction efforts. Finally, microbial pathogens transmitted between humans and wild primate populations carry both direct and indirect conservation implications. Principally, we argue that phylogenetic analyses of infectious pathogens (e.g., Ebola, dengue, Borellia, and Treponema) can aid our understanding of modes of disease transmission and aid conservation disease abatement efforts. The application of microbial analyses to conservation is currently in its infancy but holds enormous potential. To date, no conservation policy or legislation includes microbiome assessments. Integrating new ...

JCC holds the Sydney G Frankfort Chair in Family Medicine. JMG holds a Canada Research Chair in Health Knowledge Transfer and Uptake. Heather Howley provided research administrative support. Project funded by Canadian Institutes of Health Research Knowledge Translation Strategies grant KTS-62357. The Health Services Research Unit is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. ; Peer reviewed ; Publisher PDF