Why don't low-income mothers worry about their preschoolers being overweight?

CONTEXT: Mothers are in an important position to prevent obesity in their children by shaping early diet and activity patterns. However, many mothers of overweight preschool children are not worried about their child's weight. OBJECTIVE: To explore mothers' perceptions about how they determine when a child is overweight, why children become overweight, and what barriers exist to preventing or managing childhood obesity. DESIGN: Three focus groups with 6 participants in each. Participant comments were transcribed and analyzed. Themes were coded independently by the 6 authors who then agreed on common themes. SETTING: A clinic of the Special Supplemental Nutrition Program for Women, Infants, and Children in Cincinnati, Ohio. PARTICIPANTS: Eighteen low-income mothers (13 black, 5 white) of preschool children (mean age of 44 months) who were at-risk for later obesity. All but 1 mother had a body mass index (BMI) >/=25 kg/m(2), and 12 mothers had a BMI >/=30 kg/m(2). All but 1 child had a BMI >/=85th percentile for age and sex, and 7 had a BMI >/=95th percentile. Results. Mothers did not define overweight or obese in their children according to how height and weight measurements were plotted on the standard growth charts used by health professionals. Instead, mothers were more likely to consider being teased about weight or developing limitations in physical activity as indicators of their child being overweight. Children were not believed to be overweight if they were active and had a healthy diet and/or a good appetite. Mothers described overweight children as thick or solid. Mothers believed that an inherited tendency to be overweight was likely to be expressed in the child regardless of environmental factors. In trying to shape their children's eating, mothers believed that their control over the child's diet was challenged by other family members. If a child was hungry, despite having just eaten, it was emotionally difficult for mothers to deny additional food. CONCLUSIONS: Health professionals should not assume that defining overweight according to the growth charts has meaning for all mothers. Despite differing perceptions between mothers and health professionals about the definition of overweight, both groups agree that children should be physically active and have healthy diets. Health professionals may be more effective in preventing childhood obesity by focusing on these goals that they share with mothers, rather than on labeling children as overweight.

The will to live among HIV-infected patients.

BACKGROUND: Patients infected with HIV value both longevity and health. OBJECTIVE: To understand how HIV-infected patients value their health. DESIGN: Interview study. SETTING: Regional treatment center for HIV. PATIENTS: 51 patients with HIV infection. MEASUREMENTS: Life-satisfaction, health rating, time-tradeoff, and standard-gamble scores. RESULTS: Of the 51 patients, 49% (95% CI, 35% to 63%) said that their life was better currently than it was before they contracted HIV infection; only 29% said that life was currently worse. The mean (+/- SD) time-tradeoff score was 0.95 +/- 0.10, indicating that, on average, patients would give up no more than 5% of their remaining life expectancy in their current state of health in exchange for a shorter but healthy life. The average health rating score was 71.0 +/- 18.7 on a scale of 0 to 100, and the average standard-gamble score was 0.80 +/- 0.27. Factors contributing to life satisfaction and time-tradeoff scores included spirituality and having children. CONCLUSION: Many patients with HIV have a strong will to live, and many feel that life with HIV is better than it was before they became infected.

Hepatitis B prevention: practices and attitudes of physicians and dentists.

A survey of community-based physicians and dentists from the Washington, D.C., metropolitan area was conducted to assess the practices and attitudes of these health professionals relative to hepatitis B prevention. Mail questionnaires were sent to 200 physicians and 200 dentists. An overall response rate of 50 percent was obtained with one follow-up to all nonrespondents. The preventive practices adopted by the physicians were found to differ significantly from those of the dentists, including risk factors, history taking, using gloves and/or masks, and routinely screening for serologic markers. The physicians were significantly more likely than the dentists to be unwilling to take a safe, effective, hepatitis vaccine (p less than .01). Concerns about long-term safety and side effects were the most frequently mentioned reasons for this attitude. Though most survey respondents believed that if they were to become a hepatitis B chronic carrier, it would be better to know about it. Twenty six percent of the physicians and 14 percent of the dentists believed that not knowing about being a chronic carrier would be protective in a legal action against them. A majority of all of the health professionals surveyed felt that knowing their carrier status could jeopardize their career.