Factors Associated with Excess Skin After Bariatric Surgery: a Mixed-Method Study.

PURPOSE: After metabolic and bariatric surgery (MBS), many patients have excess skin (ES), which can cause inconveniences. Identifying factors related to ES quantity and inconveniences is crucial to inform interventions. The aim of this study was to identify sociodemographic, physical, psychosocial, and behavioral factors associated with ES quantity and inconveniences. MATERIALS AND METHODS: A mixed-method study with a sequential explanatory design was conducted with 124 adults (92% women, Mage 46.5 ± 9.9 years, Mtime post-MBS 34.2 ± 27.6 months). During phase I, ES quantity (arms, abdomen, thighs) and inconveniences and sociodemographic, anthropometric, clinical, and behavioral outcomes were assessed. In phase II, 7 focus groups were performed with 37 participants from phase I. A triangulation protocol was completed to identify convergences, complementarities, and dissonances from quantitative and qualitative data. RESULTS: Quantitative data indicate only ES quantity on arms was associated with ES inconveniences on arms (r = .36, p < .01). Total ES quantity was associated with maximal body mass index (BMI) reached pre-MBS (r = .48, p < .05) and current BMI (r = .35, p < .05). Greater ES inconvenience was associated with higher social physique anxiety and age (R2 = .50, p < .01). Qualitative data were summarized into 4 themes: psychosocial experiences living with ES, physical ailments due to ES, essential support and unmet needs, and beliefs of ES quantity causes. CONCLUSION: Measured ES quantity is related to higher BMI, but not reported inconveniences. Greater self-reported ES quantity and inconveniences were associated with body image concerns.

Living with severe obesity: adults' physical activity preferences, self-efficacy to overcome barriers and motives.

BACKGROUND: This study aimed to explore the preferences, self-efficacy to overcome barriers and motives for physical activity of individuals with severe obesity (body mass index ≥35 kg/m2). METHODS: 44 adults with severe obesity (50.5 ± 13.3 years, 80% female) consented to participate in this study. Accelerometers, the 6-minute walking test, and questionnaires were used to collect data on participants' sociodemographic and medical characteristics, physical fitness, physical activity behaviour, preferences for physical activity, self-efficacy to overcome physical activity barriers and motives for physical activity. RESULTS: A preference for walking (89%) and engaging in supervised physical activity (61%) at moderate intensity (46%) was reported. Most participants (71%) preferred engaging in physical activity outdoors for a duration of 30 to 60 min (84%), either in the morning (64%) or in the evening (48%). Participants had the lowest self-efficacy to overcome physical activity barriers when they had poor health and pain. The two most frequently reported physical activity motives were: preventing health problems and having better health. CONCLUSIONS: A preference-based program focusing on health motives and addressing health and pain issues may help to promote physical activity behaviour among adults with severe obesity. Nevertheless, experimental studies are needed to determine if such strategies effectively increase physical activity behaviour in this population.Implications for rehabilitationPhysical activity preferences (i.e., walking, biking and swimming performed at a moderate intensity and outdoors for a duration of 30 minutes to 1 hour with supervision) can be used to enhance motivation in people with severe obesity.Addressing the main barriers of regular physical activity (e.g., poor health, pain, depression) could ensure better adherence to physical activity in people with severe obesity.Using motives of health improvement and health problems prevention could lead to increased physical activity in people with severe obesity.

[Parent's social representations of preschool childrens' weight and lifestyle]. / Représentations sociales parentales du poids et des habitudes de vie des enfants âgés de 4-5 ans.

BACKGROUND: For preschool children aged four-five years, parents play a key role in the adoption of a healthy lifestyle. Social representations is central to understanding the choice of health behaviours promoted by the parent in their child's life. OBJECTIVE: To describe the social representations of parents with respect to the weight and lifestyle of children aged four to five. METHODS: In their descriptive qualitative study, two semi-structured interviews were conducted with a purposive sample of 14 parents who had either normal weight or (overweight or obese) children aged four to five until data saturation was achieved. The collected data was analyzed using inductive analysis. RESULTS: Some parents view weight as a health issue while others consider a chubby appearance as normal for child aged four to five. All participating parents view lifestyle as a demanding challenge. CONCLUSION: The results provide guidance for developing healthy lifestyle strategies that are consistent with parental obligations.

[Comparison of three weight classification systems for preschool children in a region of Quebec]. / Comparaison de trois systèmes de classification du poids de l'enfant d'âge préscolaire d'une région québécoise.

INTRODUCTION: Overweight in children is a serious public health problem. The use of different weight classification systems in research and clinical practice results in variable the estimate of prevalences of overweight, which complicates follow-up of this health problem in the population. The study compared three child body weight classification systems by estimating the prevalence of overweight established by each system. METHOD: In 2010, a study was conducted in 259 five-year-old children at the time of routine childhood vaccination. The children's height and weight were measured. The prevalence of overweight was determined and compared to the International Obesity Task Force (IOTF), the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) criteria. RESULTS: According to the IOTF, 16.6% of children of the study were overweight (obesity 3.1%). According to the CDC, 24.3% of children were overweight (obesity 9.1%) and according to WHO, the prevalence was 26.3% (obesity 6.2%). According to the IOTF criteria, obesity affected more girls than boys (2.7% vs. 0.4%), whereas similar proportions were observed with the other two systems. CONCLUSION: This study demonstrates that the prevalence of overweight in children varies considerably depending on the classification system used. These results support the need to consider the system used in clinical practice and in research when monitoring the course of the prevalence of this health problem.

Supporting parents of preschool children in adopting a healthy lifestyle.

BACKGROUND: Childhood obesity is a public health epidemic. In Canada 21.5% of children aged 2-5 are overweight, with psychological and physical consequences for the child and economic consequences for society. Parents often do not view their children as overweight. One way to prevent overweight is to adopt a healthy lifestyle (HL). Nurses with direct access to young families could assess overweight and support parents in adopting HL. But what is the best way to support them if they do not view their child as overweight? A better understanding of parents' representation of children's overweight might guide the development of solutions tailored to their needs. METHODS/DESIGN: This study uses an action research design, a participatory approach mobilizing all stakeholders around a problem to be solved. The general objective is to identify, with nurses working with families, ways to promote HL among parents of preschoolers. Specific objectives are to: 1) describe the prevalence of overweight in preschoolers at vaccination time; 2) describe the representation of overweight and HL, as reported by preschoolers' parents; 3) explore the views of nurses working with young families regarding possible solutions that could become a clinical tool to promote HL; and 4) try to identify a direction concerning the proposed strategies that could be used by nurses working with this population. First, an epidemiological study will be conducted in vaccination clinics: 288 4-5-year-olds will be weighed and measured. Next, semi-structured interviews will be conducted with 20 parents to describe their representation of HL and their child's weight. Based on the results from these two steps, by means of a focus group nurses will identify possible strategies to the problem. Finally, focus groups of parents, then nurses and finally experts will give their opinions of these strategies in order to find a direction for these strategies. Descriptive and correlational statistical analyses will be done on the quantitative survey data using SPSS. Qualitative data will be analyzed using Huberman and Miles' (2003) approach. NVivo will be used for the analysis and data management. DISCUSSION: The anticipated benefits of this rigorous approach will be to identify and develop potential intervention strategies in partnership with preschoolers' parents and produce a clinical tool reflecting the views of parents and nurses working with preschoolers' parents.

Workplace violence reported by Canadian nurses.

The purpose of this study was to determine the prevalence, origins, and forms of workplace violence reported by nurses working in acute-care settings in the Canadian province of Quebec. The Quebec health-care system is currently undergoing a shortage of qualified nurses that has resulted in an oppressive work environment marked by violence towards nurses.A descriptive study design was used with a sample of 181 nurses (out of a possible 300).The data, collected in 2003 using a French translation of the Workplace Violence Events Questionnaire, show that 86.5% of the nurses were victims of violent incidents on more than 1 occasion.The nature of the abuse was physical (10.6%), psychological (86.4%), or sexual (30.7%), inflicted by a colleague (65.9%), a superior (59.6%), or a physician (59.1%). Nurses should be made aware of the prevalence of workplace violence. Preventive measures are urgently needed for the well-being of the nursing profession.