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1.  Pain is Associated with Physical Activity and Health-Related Quality of Life in Overweight and Obese Children 
This study examined associations between pain, physical activity, physical fitness, and health-related quality of life (HRQOL) in overweight and obese children. Participants were 270 overweight and obese children 8–12 years of age and their parents. Children were separated into No Pain Frequency, Low Pain Frequency, and High Pain Frequency groups. Children in the Low Pain Frequency group spent less time in moderately intense physical activities compared to the No Pain Frequency group. Children in the High Pain Frequency group reported significantly lower HRQOL in most domains of functioning compared to children in the No Pain and Low Pain Frequency groups. Pain in overweight and obese children may negatively impact physical activity and HRQOL and should be assessed and treated in research and clinical work.
doi:10.1080/02739615.2013.837825
PMCID: PMC4254736  PMID: 25484483
2.  Anthropometrics to Identify Overweight Children at Most Risk for the Development of Cardiometabolic Disease 
Background
Sagittal abdominal diameter (SAD) is a novel anthropometric that correlates more strongly with visceral adipose tissue (VAT) and cardiometabolic disease risk in adults compared with body mass index (BMI). However, little research has evaluated this measurement in children.
Objective
To evaluate SAD as a measure of cardiometabolic risk compared with other anthropometrics in overweight/obese children.
Methods
This study was a cross-sectional subset analysis of 8- to 12-year-old overweight/ obese children. SAD was compared to BMI, waist circumference (WC), BMI z-score, and percent body fat to determine which measurement was most closely associated with cardiometabolic risk factors. A total cardiometabolic risk score comprising all biochemical markers and blood pressure was also compared to these same anthropometrics.
Results
Overweight/obese children (n = 145, mean age 10 ± 1.4 years, mean BMI percentile 97.9 ± 0.02) were included in the analysis. SAD correlated with the greatest number of biochemical markers/blood pressure values including triglycerides (r = .18, P = .03), HgbA1c (r = .21, P = .01), and systolic blood pressure (r = .38, P < .0001). SAD was more strongly correlated to total risk score (r = .25, P = .002) than WC (r = .22, P = .006), BMI (r = .17, P = .04), BMI-z (r = .18, P = .03), and percent body fat (r = .18, P = .03).
Conclusion
This is the first study to evaluate SAD in overweight/obese American children as a marker of cardiometabolic disease risk. The results suggest a slightly stronger correlation between SAD and cardiometabolic risk factors in overweight/obese children; however, all correlations were weak. As this was a pilot study, additional research is needed prior to recommending the use of this measurement in clinical practice.
doi:10.1177/1941406413501379
PMCID: PMC4254738  PMID: 25485038
sagittal abdominal diameter; children; adolescents; overweight and obesity; cardiometabolic disease
3.  The Community-based Healthy-lifestyle Intervention for Rural Preschools (CHIRP) Study: Design and Methods 
Contemporary clinical trials  2012;34(2):187-195.
The CHIRP Study is a two-arm, pilot randomized controlled trial assessing the effectiveness of a behavioral family weight management intervention in an important and at-risk population, overweight young children, 3 to 6 years of age, and their parents from underserved rural counties. Participants will include 96 parent-child dyads living in rural counties in north central Florida. Families will be randomized to one of two conditions: (a) Behavioral Family Based Intervention or (b) a Waitlist Control. Child and parent participants will be assessed at baseline (month 0), post-treatment (month 4), and follow-up (month 10). Assessments and intervention sessions will be held at the Cooperative Extension office in each participating rural county. The primary outcome measure is change in child body mass index (BMI) z-score. Additional key outcome measures include child dietary intake, physical activity, and parent BMI.
This study is unique because (1) it is one of the few randomized controlled trails examining a behavioral family intervention to address healthy habits and improved weight status in young overweight and obese children, (2) addresses health promotion in rural settings, (3) examines intervention delivery in real world community settings through the Cooperative Extension Service offices. If successful, this research has potential implications for medically underserved rural communities and preventative health services for young children and their families.
doi:10.1016/j.cct.2012.11.004
PMCID: PMC3594534  PMID: 23183252
Obesity; Young Children; Behavioral Intervention; Treatment; Randomized Controlled Trial
4.  Evaluating the Protective Role of Racial Identity in Children with Sickle Cell Disease 
Journal of Pediatric Psychology  2012;37(8):832-842.
Objective This study examined whether racial identity moderates the relation between pain and quality of life (QOL) in children with sickle cell disease (SCD). Methods 100 children 8–18 years of age with SCD participated during a regularly scheduled medical visit. Children completed questionnaires assessing pain, QOL, and regard racial identity, which evaluates racial judgments. Results Analyses revealed that regard racial identity trended toward significance in moderating the pain and physical QOL relation, (β = −0.159, t(93) = −1.821, p = 0.07), where children with low pain and high regard reported greater physical QOL than children with low pain and low regard. Regard racial identity did not moderate the relation between pain and other QOL dimensions. Pain significantly predicted all dimensions of QOL and regard racial identity significantly predicted social QOL. Conclusions Racial identity may be important to consider in future research examining QOL in children with SCD.
doi:10.1093/jpepsy/jss059
PMCID: PMC3437682  PMID: 22566667
children; pain; quality of life; racial identity; sickle cell disease
5.  Limited knowledge of chronic kidney disease among primary care patients – a cross-sectional survey 
BMC Nephrology  2012;13:54.
Background
Kidney disease is the 9th leading cause of death in Singapore. While preventive effects have focused on early detection and education, little is known about the knowledge level of chronic kidney disease (CKD) locally. We seek to evaluate the knowledge of CKD among primary care patients.
Methods
We conducted a cross-sectional survey of a convenience sample of 1520 patients from 3 primary care centers. Those with existing CKD or on dialysis were excluded. Knowledge was assessed based on 7 questions on CKD in the self-administered questionnaire. One point was given for each correct answer with a maximum of 7 points.
Results
1435 completed all 7 questions on CKD. Mean age was 48.9 ±15.0 (SD) years. 50.9% were male. 62.3% had a secondary and below education and 52.4% had a monthly household income of ≤ $2000. 43.7% had chronic diseases. Mean score was 3.44 ± 1.53 (out of a maximum of 7). Median score was 4. In multivariate logistic regression, being older {>60 years [Odds Ratio (OR) 0.50, 95% Confidence Interval (CI) 0.32-0.79]; 40–60 years (OR 0.62, 95% CI 0.43,0.89)}, less educated [up to primary education (OR 0.33, 95% CI 0.22-0.49)], having a lower monthly household income [
Conclusion
This suggests that CKD education should be targeted at older patients with lower education and lower socioeconomic status.
doi:10.1186/1471-2369-13-54
PMCID: PMC3411443  PMID: 22747853
Chronic kidney disease; General knowledge; Influencing factors; Primary care
Contemporary clinical trials  2010;32(1):50-58.
The Extension Family Lifestyle Intervention Project (E-FLIP for Kids) is a three-arm, randomized controlled trial assessing the effectiveness of two behavioral weight management interventions in an important and at-risk population, overweight and obese children and their parents in rural counties.
Participants will include 240 parent-child dyads from nine rural counties in north central Florida. Dyads will be randomized to one of three conditions: (a) a Family-Based Behavioral Group Intervention, (b) a Parent-Only Behavioral Group Intervention, and (c) an Education Control Condition. Child and parent participants will be assessed at baseline (month 0), post-treatment (month 12) and follow-up (month 24). Assessment and intervention sessions will be held at Cooperative Extension Service offices within each participating county. The primary outcome measure is change in child BMI z-score. Additional key outcome measures include child body fat, waist circumference, dietary intake, physical activity, blood lipids, blood glucose, blood pressure, physical fitness, quality of life, and program and participants costs. Parent BMI, dietary intake, and physical activity also will be assessed.
Randomized controlled trials testing the effectiveness of childhood obesity interventions in real-world community-based settings are extremely valuable, but much too rare. The E-FLIP for Kids trial will evaluate the impact of a community based intervention delivered to families in rural settings utilizing the existing Cooperative Extension Service network on long-term child behavior, weight status and biological markers of diabetes and early cardiovascular disease. If successful, a Parent-Only intervention program may provide a cost-effective and practical intervention for families in underserved rural communities.
doi:10.1016/j.cct.2010.08.002
PMCID: PMC3006088  PMID: 20708715
Obesity; Children; Behavioral Intervention; Treatment; Randomized Controlled Trial
Intravenous (IV) antibiotic therapy for pulmonary exacerbations (PE) has been shown to improve pulmonary functioning for patients with cystic fibrosis (CF); however, little is known about its effects on pediatric health-related quality of life (HRQOL). This prospective study assessed the impact of IV treatment of a PE on generic and CF-specific HRQOL for children and adolescents with CF. Participants included 52 children and adolescents with CF experiencing a PE (Mage = 13.6 years; 54% males; MFEV1% predicted = 58.8%). HRQOL, pulmonary functioning, and body mass index were assessed before and after IV antibiotic treatment. Results of this prospective, observational study indicated significant improvements on CFQ-R Respiratory (Mchange score = 11.7; 95% CI = 6.3–17.1; p < .0001) and Weight (Mchange score = 15.9; 95% CI = 7.9–23.8; p < .0001) scales. The CF-specific measure was more sensitive to changes in HRQOL than the generic instrument. These data suggest that CF-specific HRQOL improves with treatment for a PE with IV antibiotics. The noted statistically and clinically significant changes in the CFQ-respiratory scale indicate that the measure may be beneficial to pulmonary health care teams.
doi:10.1007/s10880-009-9179-2
PMCID: PMC2847844  PMID: 20157799
Patient-reported outcomes; Intravenous antibiotics; Disease-specific; Minimal clinically important difference
Journal of Pediatric Psychology  2007;33(9):939-955.
Objective To conduct an evidence-based review of pediatric pain measures. Methods Seventeen measures were examined, spanning pain intensity self-report, questionnaires and diaries, and behavioral observations. Measures were classified as “Well-established,” “Approaching well-established,” or “Promising” according to established criteria. Information was highlighted to help professionals evaluate the instruments for particular purposes (e.g., research, clinical work). Results Eleven measures met criteria for “Well-established,” six “Approaching well-established,” and zero were classified as “Promising.” Conclusions There are a number of strong measures for assessing children's pain, which allows professionals options to meet their particular needs. Future directions in pain assessment are identified, such as highlighting culture and the impact of pain on functioning. This review examines the research and characteristics of some of the commonly used pain tools in hopes that the reader will be able to use this evidence-based approach and the information in future selection of assessment devices for pediatric pain.
doi:10.1093/jpepsy/jsm103
PMCID: PMC2639489  PMID: 18024983
assessment; interviews; observational; pain; pediatrics; self-report

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