The Feasibility of the Strengthening Family and an Adapted American Indian Nutrition and Physical Activity Program: A Pilot Study.

PROBLEM: Excessive weight and obesity have been identified as the most serious health problems facing American Indian (AI) children. Thirty-eight percent of the preschool and kindergarten children who participated in this study were either overweight or obese. Potential reasons for this prevalence include the physical activity transition of AI people to sedentary lifestyles, in utero exposure to diabetes, and social determinants of health, especially poverty. In 2013, 29.8 percent of single-race AI/Alaska Native people were living in poverty. Childhood trauma and stress have also been linked to obesity. The experience of numerous negative life events in childhood increases the risk for being overweight by age 15. PURPOSE: Early-life home and preschool interventions with children between the ages of five and 14 have a greater impact on preventing childhood obesity, primarily with children who enter kindergarten already overweight. The purpose of this study was to examine the feasibility and preliminary effects of the Strengthening Family Program (SFP) on the physical health (primarily weight) of AI young children. The goal of this study was to promote strong AI families and improve childhood health; however, the nutrition and exercise activities within the SFP were minimal and not adapted to the AI culture. Therefore, a nutrition and exercise program for AI children between the ages of three to five was developed. The primary objective for this study was then revised to evaluate the feasibility and preliminary effects of the newly developed AI physical activity and nutrition adjunct program for preschool and kindergarten children. METHOD: Two 14-week sessions of the SFP were implemented with an AI activity and nutrition program that incorporated curricula from the Eagle Books and Health is Life in Balance. A mixed methods approach was used with a quasi-experimental wait-list control group design. Quantitative data gathered included child BMI pre- and post-intervention. A focus group was then conducted to identify the strengths and weaknesses of the SFP and the AI activity and nutrition program. RESULTS: Twenty-five children participated in either one of two intervention groups or one waitlist control group. The obesity rates of the preschool and kindergarten intervention groups stayed at 14 percent and at 38 percent pre- and post-intervention, respectively. The obesity rates for the waitlist control group, however, increased from 30 percent at pre-test to 50 percent at post-test. Focus group narratives resulted in two categories of strengths (positive child behaviors and meaning to child) and one weakness (adult disconnect). CONCLUSION: Caregiver participation was limited and challenging. Further community-based dialogue is needed to ensure sustainability.

Treatment of Pediatric Bipolar Disorder: A Review.

AIM: To review the diagnosis and the pharmacologic and psychosocial interventions for pediatric bipolar disorder (PBD). METHODS: A comprehensive literature review of studies discussing the diagnosis and treatment of PBD was conducted. RESULTS: A context for understanding controversies and difficulties in the diagnosis of PBD is provided. An evidence-based assessment protocol for PBD is reviewed. The evidence for the following three categories of pharmacologic interventions are reviewed: Lithium, antiepileptics, and second generation antipsychotics. Algorithms for medication decisions are briefly reviewed. Existing psychosocial treatments and the evidence for those treatments are also reviewed. CONCLUSION: Despite recent developments in understanding the phenomenology of PBD and in identifying pharmacologic and psychosocial interventions, critical gaps remain.