Change that Matters: A Health Behavior Change and Behavioral Health Curriculum for Primary Care.

Although primary care is an ideal setting in which to address behavioral influences on health, clinicians spend little time discussing preventive care, including lifestyle counseling. There is a dearth of comprehensive training and evidence-based resources to educate clinicians in how to effectively engage with patients about these topics. This study describes and evaluates the acceptability of Change that Matters: Promoting Healthy Behaviors, a ten-module curriculum to train clinicians in brief, evidence-based interventions. Each module includes three parts: interactive patient handouts, didactic training, and electronic health record templates to guide the discussion and after visit summary. A two-part, mixed-methods pilot study was used to evaluate the acceptability of the curriculum in a family medicine residency clinic. In Study 1, external family medicine faculty experts (N = 11) provided written feedback on the patient handouts. In Study 2, 20 residents and 20 patients completed qualitative interviews regarding their experience with curricular materials. Content analysis was used to extract qualitative themes. Experts rated the patient handouts as highly understandable and actionable. Resident themes indicated that the curriculum provided concrete tools to address health behavior change, helped structure patient discussions, and increased confidence. Patients felt empowered to make behavior changes. This new curriculum addresses a gap in existing resources, and is available for free download online which can facilitate dissemination ( https://changethatmatters.umn.edu/ ). Research has found the curriculum to be acceptable to experts, residents, and patients. Future studies need to explore its impact on the behavior of both clinicians and patients.

First, Do No Harm: Understanding Primary Care Providers' Perception of Risks Associated With Discussing Weight With Pediatric Patients.

Many health care providers struggle with if- and how-to discuss weight with their pediatric patients. This study used one-on-one interviews with primary care providers (n = 20) to better understand their: (1) perception of risks associated with talking about weight with pediatric patients, (2) commitment to adhering to best practices of pediatric weight management, and (3) approaches to mitigate perceived risks. Providers felt concerned that discussing weight with children during clinic visits may have unintended negative impacts. Despite perceived risks, providers continued regular BMI screening and weight-focused conversations, but took care with regard to language and approach with the goal of mitigating perceived risks. Findings suggest that pediatric primary care providers perceive that engaging in weight-related discussions with their patients has the potential to lead to negative, unintended consequences. Future research is needed to understand if weight-focused conversations should be avoided altogether or if there are approaches that can effectively mitigate risks.

Primary care providers' perspectives on initiating childhood obesity conversations: a qualitative study.

BACKGROUND: Primary care physicians (PCPs) are in a critical position for identifying, preventing and treating childhood obesity. However, a one-size-fits-all approach does not exist for having conversations about weight with families. A better understanding of how PCPs can address paediatric patients' weight concerns is needed in order to develop effective guidelines and trainings. OBJECTIVE: To describe PCPs preferences and behaviours regarding weight-related conversations with paediatric patients' and their families. METHODS: Twenty PCPs affiliated with the University of Minnesota, USA, were recruited to participate in semi-structured interviews. Transcripts were analysed using inductive thematic analysis. RESULTS: PCP's identified well-child visits as the most appropriate time for weight-related discussions with families. Physicians described what approaches/elements they perceived to work best during conversations: collaboration, empathy, health-focused and objective measures. CONCLUSIONS: Overall, PCPs were more comfortable with weight-related discussions during annual well-child visits and rarely initiated them during an acute visit or the first encounter with a patient. Objective measures, such as growth charts, were often utilized to start discussions. Considering a large proportion of well-child visits are missed, alternative opportunities to have discussions about healthy lifestyle behaviours should be explored. The integral role PCPs play in paediatric obesity warrants further research.

The intergenerational transmission of family meal practices: a mixed-methods study of parents of young children.

OBJECTIVE: The current mixed-methods study explored qualitative accounts of prior childhood experiences and current contextual factors around family meals across three quantitatively informed categories of family meal frequency patterns from adolescence to parenthood: (i) 'maintainers' of family meals across generations; (ii) 'starters' of family meals in the next generation; and (iii) 'inconsistent' family meal patterns across generations. DESIGN: Quantitative survey data collected as part of the first (1998-1999) and fourth (2015-2016) waves of the longitudinal Project EAT (Eating and Activity in Adolescents and Young Adults) study and qualitative interviews conducted with a subset (n 40) of Project EAT parent participants in 2016-2017. SETTING: Surveys were completed in school (Wave 1) and online (Wave 4); qualitative interviews were completed in-person or over the telephone.ParticipantsParents of children of pre-school age (n 40) who had also completed Project EAT surveys at Wave 1 and Wave 4. RESULTS: Findings revealed salient variation within each overarching theme around family meal influences ('early childhood experiences', 'influence of partner', 'household skills' and 'family priorities') across the three intergenerational family meal patterns, in which 'maintainers' had numerous influences that supported the practice of family meals; 'starters' experienced some supports and some challenges; and 'inconsistents' experienced many barriers to making family meals a regular practice. CONCLUSIONS: Family meal interventions should address differences in cooking and planning skills, aim to reach all adults in the home, and seek to help parents who did not eat family meals as a child develop an understanding of how and why they might start this tradition with their family.

How Should We Approach and Discuss Children's Weight With Parents? A Qualitative Analysis of Recommendations From Parents of Preschool-Aged Children to Physicians.

The primary objective of this study was to describe parents' preference for how physicians should approach diet and weight-related advice for their child. Semi-structured interviews were conducted with parents (n = 40) of preschoolers, transcribed verbatim, and double-coded using an inductive thematic analysis approach. Parents identified recommendations for how physicians should approach conversations about weight. Themes included (1) Tone and Approach are Important, (2) Avoid Judgment, (3) Have Regard for Parental Expertise, (4) Consider the Timing of the Discussion with Parents, and (5) Equip Parents with Concrete and Individualized Recommendations. Future research should focus on developing brief, effective communication tools to guide discussions with parents about child nutrition and weight. Opportunities to learn about and practice the use of these brief interventions should be incorporated into medical education with the goal of providing clinicians the learning opportunities, skills/tools, and resources needed to adequately and respectfully discuss weight and diet with parents and children.

A qualitative exploration into momentary impacts on food parenting practices among parents of pre-school aged children.

Food parenting practices have been identified as a potentially significant correlate of weight status and weight-related behaviors in children. The extent to which food parenting practices fluctuate across time and context is not well known. In particular, situational factors are thought to shape the types of food parenting practices used in the moment, but the nature of those factors remain unclear. In this paper data from interviews with parents (n = 40) of preschoolers was used to: 1) describe parents' day-to-day lived experiences of food parenting within the broad theoretical domains of coercive control, structure and autonomy support; 2) identify salient momentary factors that influence use of these food parenting practices; and 3) understand how these momentary factors impact the use of different types of food parenting practices. The feeding practices described by parents align well with the three overarching themes described within the literature: coercive control, autonomy support, and structure. Parents described using a combination of practices from within each of these domains; they also indicated that their feeding practices were easily influenced by momentary factors that impacted their food parenting within and across eating occasions. For the most part, parents described momentary factors (e.g. schedule changes, parental stress, child behavior) that shifted them away from structure and autonomy support feeding practices, towards indulgent and coercive feeding practices. Researchers should be aware of the likely interplay between different types of feeding practices as well as the potential that momentary factors may shift parents from one type of practice towards another. The use of novel data collection methods, such as ecological momentary assessment, that allow for exploration of food parenting practices as dynamic, rather than static, behaviors should be explored.

Potential treatment of cerebral global ischemia with Oct-4+ umbilical cord matrix cells.

Potential therapeutic effects of Oct-4-positive rat umbilical cord matrix (RUCM) cells in treating cerebral global ischemia were evaluated using a reproducible model of cardiac arrest (CA) and resuscitation in rats. Animals were randomly assigned to four groups: A, sham-operated; B, 8-minute CA without pretreatment; C, 8-minute CA pretreated with defined media; and D, 8-minute CA pretreated with Oct-4(+) RUCM cells. Pretreatment was done 3 days before CA by 2.5-microl microinjection of defined media or approximately 10(4) Oct-4(+) RUCM cells in left thalamic nucleus, hippocampus, corpus callosum, and cortex. Damage was assessed histologically 7 days after CA and was quantified by the percentage of injured neurons in hippocampal CA1 regions. Little damage (approximately 3%-4%) was found in the sham group, whereas 50%-68% CA1 pyramidal neurons were injured in groups B and C. Pretreatment with Oct-4(+) RUCM cells significantly (p < .001) reduced neuronal loss to 25%-32%. Although the transplanted cells were found to have survived in the brain with significant migration, few were found directly in CA1. Therefore, transdifferentiation and fusion with host cells cannot be the predominant mechanisms for the observed protection. The Oct-4(+) RUCM cells might repair nonfocal tissue damage by an extracellular signaling mechanism. Treating cerebral global ischemia with umbilical cord matrix cells seems promising and worthy of further investigation.