Satisfaction and attrition in paediatric weight management.

Paediatric obesity treatment experiences unacceptably high rates of attrition. Few studies have explored parent and child perspectives on dropout. This study sought to capture child and parent experience in treatment and expressed contributors to attrition. Children and parents enrolled in a single family-based weight management programme participated in semi-structured interviews, conducted either upon completion of the first intensive phase of treatment or program dropout. Interviews were recorded, transcribed and coded using a multistage inductive approach. Interviews were obtained from 57 parents and 30 children, nearly equal between 'completers' or 'dropouts'. Five themes emerged: overall positive experience with programme; logistical challenges of participation; improved health; discrepancies between child and parent experience and perception, and importance of structure and expectations of weight loss. Primary reasons given for dropout were time commitment; distance from clinic; missed school and work; lack of dedicated adolescent programme; clinic hours; and stress. Few parents or children expressed dissatisfaction. Children reportedly enjoyed 'having someone to talk to' about weight, and spending increased time with family. Children and parents overall reported positive experiences in this weight management programme. Attrition appears more related to logistical issues than low satisfaction. Innovative approaches to help overcome logistical challenges and preserve positive aspects may help in decreasing programme attrition.

Pes planus and paediatric obesity: a systematic review of the literature.

Children with obesity report musculoskeletal pain more than normal-weight children; this may be linked with literature suggesting children with obesity have higher prevalence of pes planus (flatfoot). To further elucidate whether this relation occurs, we conducted a systematic literature review on the co-occurrence of pes planus and paediatric obesity. Empirical articles published until September 2013 were obtained through an electronic search of MEDLINE and SPORTDiscus; included articles examined the association between body weight and pes planus in children. Thirteen cross-sectional studies of varied designs were identified. Methods used to diagnose pes planus varied between studies: imaging modalities, anthropometric measurements and clinical examination. Across all studies, pes planus prevalence among children with obesity ranged widely from 14 to 67%. Nearly all studies indicated increasing pes planus in children with increasing weight. No studies evaluated pain/complications related to pes planus. Our review suggests increased prevalence of pes planus among children with obesity or increasing weight status. Because of differing methodologies, lack of consensus regarding the pes planus definition, the dearth of investigation into pain/complications and the few existing studies, more research is needed to determine a relation between children's body weight, pes planus and associated effects on pain and function.

Where are family theories in family-based obesity treatment?: conceptualizing the study of families in pediatric weight management.

Family-based approaches to pediatric obesity treatment are considered the 'gold-standard,' and are recommended for facilitating behavior change to improve child weight status and health. If family-based approaches are to be truly rooted in the family, clinicians and researchers must consider family process and function in designing effective interventions. To bring a better understanding of family complexities to family-based treatment, two relevant reviews were conducted and are presented: (1) a review of prominent and established theories of the family that may provide a more comprehensive and in-depth approach for addressing pediatric obesity; and (2) a systematic review of the literature to identify the use of prominent family theories in pediatric obesity research, which found little use of theories in intervention studies. Overlapping concepts across theories include: families are a system, with interdependence of units; the idea that families are goal-directed and seek balance; and the physical and social environment imposes demands on families. Family-focused theories provide valuable insight into the complexities of families. Increased use of these theories in both research and practice may identify key leverage points in family process and function to prevent the development of or more effectively treat obesity. The field of family studies provides an innovative approach to the difficult problem of pediatric obesity, building on the long-established approach of family-based treatment.

Evaluation of three fixation techniques for repair of mandibular fractures in dogs.

Bilateral midbody hemimandibular osteotomies were performed between premolars 3 and 4 in 18 adult dogs. Hemimandibles were repaired by use of monocortically applied bone plates (n = 6), an interdental fixator composed of an Erich arch bar and acrylic (n = 6), or a type I external skeletal fixator (n = 6). At the immediate postoperative evaluation, hemimandibles stabilized with interdental fixators had an osteotomy gap distance (mean +/- SEM, 1.6 +/- 0.2 mm) that was significantly (P < 0.05) greater than for hemimandibles stabilized with external skeletal fixators (1.2 +/- 0.3 mm). Osteotomy gap distance of hemimandibles stabilized with external skeletal fixators (1.5 +/- 0.2 mm) was significantly (P < 0.05) greater at weeks 4 (1.1 +/- 0.2 mm) and 8 (0.8 +/- 0.3 mm) after surgery than the osteotomy gap distance of hemimandibles stabilized by application of bone plates. By week 16, significant differences in osteotomy gap distance were not detected between groups. Immediately after surgery, mandibular alignment measurements were not significantly different for dogs with bone plates (0.3 +/- 0.1 mm), interdental fixators (0.3 +/- 0.1 mm), and external skeletal fixators (0.9 +/- 0.5 mm). Mandibular alignment scores were not significantly different between treatment groups during the remaining postoperative period. Occlusal measurements were not significantly different between evaluations performed before surgery and 16 weeks after surgery, regardless of treatment group. Radiographic evidence of healing in hemimandibles stabilized with external skeletal fixators was significantly (P < 0.05) less at 4 and 8 weeks, compared with hemimandibles stabilized with bone plates and interdental fixators; however, radiographic evidence of bone healing was not significantly different between fixation groups at 16 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

The sensitivity, specificity and predictive value of measuring calcium carbonate in mares' prepartum mammary secretions.

A colorimetric test kit marketed for water quality analysis was used to measure calcium carbonate changes in diluted prefoaling mammary secretions. Daily samples (1 to 3 ml/day) were obtained from 59 Thoroughbred and Warmblood mares starting 14 days prior to foaling to the day of parturition. The sensitivity, specificity, and positive and negative predictive values of the test were calculated on the data collected from 56 mares and 377 prefoaling mammary secretion samples. The results indicate that this test is both sensitive and specific. The predictive value of a positive test (PVPT; positive test defined as the first occurrence that prefoaling mammary secretion calcium carbonate >/= 200 ppm) indicated that 51.4% of late term pregnant mares would foal within the ensuing 24-hour period, 84.1% within 48 hours and 97.2% within 72 hours. The predictive value of a negative test (PVNT; negative test defined as prefoaling mammary secretion calcium carbonate < 200 ppm) indicated that 99.6% of late term pregnant mares would not be expected to foal within the ensuing 24 hour period, % within 48 hours and 81.8% within 72 hours. This test is helpful as a prognostic tool in indicating the mare's approaching readiness for birth. It is also an accurate prognostic tool to predict that the mare is not likely to foal within 24h when calcium carbonate < 200 ppm in the diluted prefoaling mammary secretion.

Pharmacokinetic disposition of intravenous and oral pentoxifylline in horses.

The pharmacokinetics of pentoxifylline (P) and its alcohol metabolite I (MI) were determined after administration of intravenous pentoxifylline, sustained release pentoxifylline tablets (Trental), and crushed pentoxifylline tablets in corn syrup, to five healthy adult horses. Pharmacokinetics were evaluated in a model-independent manner. After intravenous administration, pentoxifylline was rapidly eliminated (mean residence time 1.09 +/- 0.67 h), had a large steady-state volume of distribution (2.81 +/- 1.16 l/kg), and high clearance (3.06 +/- 1.05 l/kg/h). Oral absorption of pentoxifylline from both dose forms varied considerably between individuals. Times to peak concentration ranged from 1-10 h for either dose form. There was no difference in relative bioavailability (F') between whole (0.98 +/- 0.30) and crushed Trental tablets. Ratios between areas under the curve (AUC) for pentoxifylline and MI were different following administration of oral versus intravenous doses. This finding suggests that route of administration may affect the metabolic profile of pentoxifylline. Given the extreme differences in absorption characteristics between individuals in this study, recommendations are not made as to appropriate dose, dose interval, or dose form for administration of pentoxifylline to horses.

A survey of whole blood selenium concentrations of horses in Maryland.

We surveyed the whole blood selenium status of a randomly sampled population of horses from 4 contiguous counties in northern Maryland. Two hundred and two horses from 74 farms were sampled. Whole blood selenium levels greater than or equal to 0.100 parts per million (ppm) were considered adequate; blood levels less than 0.100 ppm were considered marginal or deficient. The average blood selenium concentration of the horses sampled was 0.137 ppm, with a standard deviation of 0.041 ppm. Blood selenium concentrations ranged from 0.050-0.266 ppm. Thirty-eight of 202 horses (18.8%) had a selenium level less than or equal to 0.099 ppm. Twenty-one of 74 farms (28.4%) had at least 1 horse with a selenium level less than or equal to 0.099 ppm. Animal husbandry practices had a significant influence on selenium status. Horses were more prone to having an abnormal selenium status if they were either maintained on pasture or used infrequently, or if their diet did not include mineral and vitamin supplements.

An instrument to assess the quality of maternal behavior.

Early assessment, detection, and therapeutic intervention in maladaptive maternal behavior can be facilitated by a simple nursing appraisal instrument employed initially on the third postpartum day. The Funke-Irby Interactional Assessment not only discriminates between early adaptive and maladaptive maternal behaviors, but it also illustrates a mother's progress or lack of progress toward adaptive mothering, making the instrument useful to the community health nurse during the early postdelivery weeks. This instrument has been effectively used as a screening device for nurses making decisions about the need for further referral for family therapy.