Randomized controlled trial evaluating a virtual parenting intervention for young children at risk of obesity: study protocol for Parenting Addressing Early Years Intervention with Coaching Visits in Toronto (PARENT) trial.

BACKGROUND: The prevalence of overweight (15%) and obesity (6%) in children under 5 years of age in Canada are high, and young children with overweight and obesity are at increased risk of the development of chronic disease(s) in adulthood. Prior research has demonstrated very few published trials on effective obesity prevention interventions in young children at risk of obesity, within primary healthcare settings. The aim of this study is to determine if 18-48-month-old children at risk for obesity, who are randomized to receive the Parents Together program (i.e., intervention group), have reduced body mass index z-score (zBMI), compared to those not receiving the intervention, at a 12-month follow-up. Secondary clinical outcomes between the intervention and control groups will be compared at 12 months. METHODS: A pragmatic, parallel group, 1:1, superiority, randomized control trial (RCT) through the TARGetKids! Practice Based Research Network will be conducted. Young children (ages 18-48 months) who are at increased risk for childhood obesity will be invited to participate. Parents who are enrolled in the intervention group will participate in eight weekly group sessions and 4-5 coaching visits, facilitated by a trained public health nurse. Children and parents who are enrolled in the control group will receive the usual health care. The primary outcome will be compared between intervention arms using an analysis of covariance (ANCOVA). Feasibility and acceptability will be assessed by parent focus groups and interviews, and fidelity to the intervention will be measured using nurse-completed checklists. A cost-effectiveness analysis (CEA) will be conducted. DISCUSSION: This study will aim to reflect the social, cultural, and geographic diversity of children in primary care in Toronto, Ontario, represented by an innovative collaboration among applied child health researchers, community health researchers, and primary care providers (i.e., pediatricians and family physicians in three different models of primary care). Clinical and implementation outcomes will be used to inform future research to test this intervention in a larger number, and diverse practices across diverse geographic settings in Ontario. TRIAL REGISTRATION: ClinicalTrials.gov NCT03219697. Registered on June 27, 2017.

Children with medical complexities: Addressing the gaps in respite care during transition from paediatrics to adult health care in Ontario.

Respite care is one integral component of the transition process from paediatric to adult health care, and is of particular importance to individuals with medical complexities. Numerous gaps that exist within the current system limit a child and family's ability to access quality respite care during a time when it is often most needed. Identifying and addressing these gaps in a systematic and collaborative way presents an opportunity to improve the quality of life for this vulnerable, ever growing population and their families.

Creating a student-led health magazine with an urban, multicultural, resource-restricted elementary school: Approach, process and impact.

BACKGROUND: Health magazines effectively deliver health information. No data regarding student-led magazines to promote health exist. OBJECTIVE: To evaluate whether children's health knowledge, interests and lifestyle choices improve following distribution of a student-led health magazine. METHODS: Elementary students worked with teachers and paediatric residents to publish a health magazine. A healthy lifestyle challenge page promoted reduction in soda pop consumption. Pre- and poststudent questionnaires explored knowledge, interests and behaviours related to health. RESULTS: Sex and grade distributions were similar in pre- and post-questionnaires. Ninety-seven percent of children reported the magazine helped them learn about health. Pre- and postknowledge scores did not differ (P=0.36). Following distribution, the percentage of students who reported drinking no soda increased from 43% to 67% (P=0.004), and those who reported drinking <2 glasses of soda per day increased from 66% to 85% (P=0.01). CONCLUSIONS: A student-led health magazine was effective in motivating short-term student-reported behavioural change.

HISTORIQUE: Les magazines sur la santé transmettent avec efficacité de l'information en matière de santé. Il n'existe aucune donnée relative aux magazines dirigés par des élèves pour promouvoir la santé. OBJECTIF: Évaluer si les connaissances des enfants en matière de santé, leurs intérêts et leurs choix de vie s'améliorent après la distribution d'un magazine sur la santé dirigé par des élèves. MÉTHODOLOGIE: Aidés de leurs enseignants et de résidents en pédiatrie, des élèves du primaire ont publié un magazine sur la santé. Une page présentant un défi santé incitait les élèves à réduire leur consommation de boissons gazeuses. Les questionnaires remplis avant et après la distribution du magazine évaluaient les connaissances, les intérêts et les comportements liés à la santé. RÉSULTATS: La répartition selon le sexe et le degré scolaire était similaire dans les questionnaires avant et après la distribution du magazine. De plus, 97 % des enfants ont déclaré que le magazine les avait aidés à acquérir des connaissances sur la santé. Les scores de connaissances avant et après la distribution du questionnaire n'ont pas changé (P=0,36). Après la distribution, le pourcentage d'élèves qui déclaraient ne pas boire de boissons gazeuses est passé de 43 % à 67 % (P=0,004), et ceux qui déclaraient en boire moins de deux verres par jour est passé de 66 % à 85 % (P=0,01). CONCLUSIONS: Un magazine sur la santé dirigé par des élèves a réussi à motiver un changement à court terme dans le comportement déclaré des élèves.

A qualitative description of the development and evaluation of our voice, a health promotion magazine created by pediatric patients for hospitalized pediatric patients.

OBJECTIVES: To facilitate a peer-developed health promotion magazine that provides health education and engages hospitalized pediatric patients during a hospital admission. To evaluate patient satisfaction with the content and layout of the magazine and its impact on patients' attitudes toward healthy living. METHODS: A pediatric resident-led multidisciplinary team collaborated with the Children's Council at The Hospital for Sick Children to create a health promotion magazine for inpatients. Articles included a scavenger hunt, healthy recipes, physical activities, hospital staff interviews, and patient stories. Patients 7 to 18 years of age admitted to Pediatric Medicine or Respirology were invited to read the magazine and complete a questionnaire 24 hours later on their satisfaction with the magazine and their attitudes regarding healthy living. RESULTS: Thirty-seven patients received a copy of the magazine, and 24 patients completed the questionnaire (mean 13.4 years, 54% female, 25% overweight/obese). Eleven of 24 (46%) read the entire magazine, and 19 of 23 (83%) reported learning. The exercises, recipes, and patient stories were most liked. Ten of 24 (42%) participants performed the exercises; the most common reason for not trying an exercise was pain. After reading the magazine, 15 of 24 (65%) patients reported that they will try to be more active, and 11 of 23 (48%) reported that they will try to eat more fruits and vegetables. Eighty-three percent were interested in a future edition. CONCLUSIONS: A health promotion magazine created by patients for patients changed patient-reported attitudes about healthy living. Peer-led interventions in the inpatient setting may be an important opportunity to promote healthy lifestyles and require further study.

The Quality of My Life questionnaire: the minimal clinically important difference for pediatric rheumatology patients.

OBJECTIVE: To determine parent-child agreement for the Quality of My Life (QoML) questionnaire. To establish construct validity of the QoML questionnaire. To determine the minimal clinically important difference (MCID) for the Quality of Life (QOL) and Health-Related Quality of Life (HRQOL) scales. METHODS: A total of 136 families of children with inflammatory arthritis were interviewed. The QoML questionnaire was completed for the child's current state of health, and under 2 hypothetical scenarios, where (1) there is a hypothetical small improvement, and (2) there is a hypothetical small deterioration in health. The differences between the original QOL and HRQOL scores and hypothetical improvement and deterioration scores, respectively, were calculated to give MCID scores. RESULTS: In total, 131 families completed the questionnaires. Intraclass correlation coefficients for parent proxy report and patient self-report of the QOL and HRQOL were 0.63 and 0.40, respectively. Correlations of QOL with pain and disease severity were moderately negative (r = -0.55 and -0.56, respectively, p < 0.0001). Correlations of HRQOL with pain and disease severity were strongly negative (r = -0.66 and r = -0.68, respectively, p < 0.0001). The MCID for improvement on the QOL was 7 mm, and for the HRQOL 11 mm. The MCID for deterioration in QOL was -33 mm, and for HRQOL -38 mm. CONCLUSION: The QoML questionnaire demonstrated fair parent-child agreement and good convergent construct validity. MCID scores will enable clinicians to interpret QoML questionnaire results in a clinically meaningful way.