Background The World Health Organization estimates that 19 million deaths worldwide are attributable to physical inactivity Chronic diseases associated with physical inactivity include cancer, diabetes and coronary heart disease Objectives The purpose of this systematic review is to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents Search strategy The search strategy included searching several databases In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews Primary authors of included studies were contacted as needed for additional information Selection criteria To be included, the intervention had to be relevant to public health practice, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, report on outcomes for children and adolescents (aged 6 to 18 years), and use a prospective design with a control group Data collection and analysis Standardized tools were used by two independent reviewers to rate each studyﾒs methodological quality and for data extraction Where discrepancies existed discussion occurred until consensus was reached The results were summarized narratively due to wide variations in the populations, interventions evaluated and outcomes measured Main results 13,841 titles were identified and screened and 482 articles were retrieved Multiple publications on the same project were combined and counted as one project, resulting in 395 distinct project accounts (studies) Of the 395 studies 104 were deemed relevant and of those, four were assessed as having strong methodological quality, 22 were of moderate quality and 78 were considered weak In total 26 studies were included in the review There is good evidence that school-based physical activity interventions have a positive impact on four of the nine outcome measures Specifically positive effects were observed for duration of physical activity, television viewing, VO2 max, and blood cholesterol Generally school-based interventions had no effect on leisure time physical activity rates, systolic and diastolic blood pressure, body mass index, and pulse rate At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity result in positive effects Authors' conclusions Given that there are no harmful effects and that there is some evidence of positive effects on lifestyle behaviours and physical health status measures, ongoing physical activity promotion in schools is recommended at this time

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School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6-18.

Background: Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and longterm health consequences This is an update of a Cochrane Review published first in 2003, and updated previously in 2009 However, the update has now been split into six reviews addressing different childhood obesity treatments at different ages Objectives: To assess the effects of diet, physical activity and behavioural interventions (behaviour-changing interventions) for the treatment of overweight or obese children aged 6 to 11 years Search methods: We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as trial registers ClinicalTrialsgov and RsdI1401 Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from th 2 / 499 ICTRP Search Portal We checked references of studies and systematic reviews We did not apply any language restrictions The date of the last search was July 2016 for all databases Selection criteria: We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions (behaviour-changing interventions) for treating overweight or obese children aged 6 to 11 years, with a minimum of six months' follow-up We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity Data collection and analysis Two review authors independently screened references, extracted data, assessed risk of bias, and evaluated the quality of the evidence using the GRADE instrument We contacted study authors for additional information We carried out metaanalyses according to the statistical guidelines in the Cochrane Handbook for Systematic Reviews of Interventions Main results: We included 70 RCTs with a total of 8461 participants randomised to either the intervention or control groups The number of participants per trial ranged from 16 to 686 Fifty-five trials compared a behaviour-changing intervention with no treatment/usual care control and 15 evaluated the effectiveness of adding an additional component to a behaviour-changing intervention Sixty-four trials were parallel RCTs, and four were cluster RCTs Sixty-four trials were multicomponent, two were diet only and four were physical activity only interventions Ten trials had more than two arms The overall quality of the evidence was low or very low and 62 trials had a high risk of bias for at least one criterion Total duration of trials ranged from six months to three years The median age of participants was 10 years old and the median BMI z score was 22 Primary analyses demonstrated that behaviour-changing interventions compared to no treatment/usual care control at longest follow-up reduced BMI, BMI z score and weight Mean difference (MD) in BMI was -053 kg/m2 (95% confidence interval (CI) -082 to -024); P < 000001; 24 trials; 2785 participants; low-quality evidence MD in BMI z score was -006 units (95% CI -010 to -002); P = 0001; 37 trials; 4019 participants; low-quality evidence and MD in weight was -145 kg (95% CI -188 to -102); P < 000001; 17 trials; 1774 participants; low-quality evidence Thirty-one trials reported on serious adverse events, with 29 trials reporting zero occurrences RR 057 (95% CI 017 to 193); P = 037; 4/2105 participants in the behaviour-changing intervention groups compared with 7/1991 participants in the comparator groups) Few trials reported health-related quality of life or behaviour change outcomes, and none of the analyses demonstrated a substantial difference in these outcomes between intervention and control In two trials reporting on minutes per day of TV viewing, a small reduction of 66 minutes per day (95% CI -1288 to -031), P = 004; 2 trials; 55 participants) was found in favour of the intervention No trials reported on all-cause mortality, morbidity or socioeconomic effects, and few trials reported on participant views; none of which could be meta-analysed As the meta-analyses revealed substantial heterogeneity, we conducted subgroup analyses to examine the impact of type of comparator, type of intervention, risk of attrition bias, setting, duration of post-intervention follow-up period, parental involvement and baseline BMI z score No subgroup effects were shown for any of the subgroups on any of the outcomes Some data indicated that a reduction in BMI immediately post-intervention was no longer evident at follow-up at less than six months, which has to be investigated in further trials Authors' conclusions: Multi-component behaviour-changing interventions that incorporate diet, physical activity and behaviour change may be beneficial in achieving small, short-term reductions in BMI, BMI z score and weight in children aged 6 to 11 years The evidence suggests a very low occurrence of adverse events The quality of the evidence was low or very low The heterogeneity observed across all outcomes was not explained by subgrouping Further research is required of behaviourchanging interventions in lower income countries and in children from different ethnic groups; also on the impact of behaviour-changing interventions on health-related quality of life and comorbidities The sustainability of reduction in BMI/BMI z score and weight is a key consideration and there is a need for longer-term follow-up and further research on the most appropriate forms of post-intervention maintenance in order to ensure intervention benefits are sustained over the longer term

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Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years

OBJECTIVE. We sought to inform decision-making for children and families by describing what is known and remains unknown about the impact of childhood critical illness and injury on families. This report also was designed as a tool for research planning and design so that meaningful studies are performed and duplication is avoided. DESIGN. After a national scholarship competition and the identification of 3 medical student summer scholars, a literature search was conducted by using the National Library of Medicine and a PubMed keyword search system at the National Institutes of Health. RESULTS. A total of 115 reports were reviewed and assigned to the 5 following categories characterizing the impact of pediatric critical illness/injury on families: stressors, needs, specific domains (psychological, physical, social), coping, and interventions. The reports reviewed indicate that pediatric critical illness and injury is stressful for the entire family. The effects on parents, siblings, and marital cohesion were variably described. Needs of family members (eg, rest, nutrition, communication) were identified as being unmet in many studies. Permanent impact on siblings and marital relationships has been considered detrimental, but these conclusions are not adequately quantified in presently available studies. Reviewed reports minimally investigated cultural diversity, effects on fathers versus mothers, siblings, socioeconomic status, and financial burden. Studies were often anecdotal and included small sample sizes. Methodologic limitations were numerous and varied and seriously narrowed the significance of the studies we reviewed. The reports that we evaluated were largely limited to those of English-speaking families, white people, and married mothers. CONCLUSIONS. Future research should use more rigorous methods in the measurement of impact of childhood critical illness and injury on families. Families of critically ill and injured children would benefit from the practitioners of pediatric critical care acquiring enhanced knowledge and sensitivity about famliy communication and dynamics.

https://pediatrics.aappublications.org/content/pediatrics/118/Supplement_3/S203.full.pdf

Impact of pediatric critical illness and injury on families : A systematic literature review

86 Purpose: Transitions in caregiving, such as becoming a primary caregiver to grandchildren or having adult children and grandchildren move in or out, may affect the well-being of the grandmother. Design and Methods: This report describes caregiving patterns at 3 time points over 24 months in a sample of 485 Ohio grandmothers and examines the effects of stability and change in grandmother caregiving roles (raising a grandchild, living in a multigenerational home, or not caregiving to grandchildren). Drawing on the Resiliency Model of Family Stress, the study examined caregiving stress and reward, intrafamily strain, social support, resourcefulness, depressive symptoms, mental and physical health, and perceived family functioning. Caregiver group, time of measurement, switching between caregiver groups, and baseline age, race, education, work status, and marital status were considered as independent variables within the context of a one-way treatment structure in a mixed-model multivariate analysis. Results: There were significant caregiver group effects for all variables, except mental health and resourcefulness. Grandmothers raising grandchildren reported the most stress, intrafamily strain, and perceived problems in family functioning, the worst physical health and more depressive symptoms, and the least reward and subjective support. Across groups, there were significant time effects, with worsening physical health and increased stress over time. Switching to higher levels of caregiving was associated with worsening physical health and increases in stress, intrafamily strain, and perceived problems in family functioning. Implications: Recommendations

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Grandmothers and Caregiving to Grandchildren: Continuity, Change, and Outcomes Over 24 Months

This study used the resiliency model of family stress, adjustment, and adaptation as the framework to examine the main and moderating effects of social support and resourcefulness in the relationship between family life stresses and strain and depressive symptoms in grandmothers raising grandchildren, grandmothers in multigenerational homes, and noncaregivers to grandchildren. A sample of 486 Ohio grandmothers, recruited using random and supplemental convenience methods, completed mailed surveys. Analysis of variance was used to examine differences in family life stresses and strain, resourcefulness, support, and depressive symptoms across the three groups of grandmothers. Hierarchical multiple regression analyses were used to examine whether family stresses and strains affected the grandmother's depressive symptoms and whether social support and resourcefulness moderated the relationship between family stresses and strain and grandmothers' mental health. Grandmothers raising grandchildren reported more depressive symptoms, but in multiple regression analyses of the full sample that controlled for demo-graphics, primary caregiving status was not related to depressive symptoms. More strain and less subjective support and resourcefulness were associated with higher depressive symptoms for all grandmothers, with 33% to 54% explained variances of such symptoms for each caregiving group and the full sample. Subjective support moderated the effects of strain and instrumental support moderated the effects of family life stresses on depressive symptoms. Social support and resourcefulness may help protect grandmothers from the effects of family stresses and strain, and interventions to enhance these factors may assist grandmother caregivers to achieve better mental health.

Grandmother caregiving, family stress and strain, and depressive symptoms

Family stress, perceived social support and coping following the diagnosis of a child's congenital heart disease

Background.  Congenital heart disease (CHD) is now estimated to be the second most prevalent chronic illness. A child's chronic illness may have effects that have pervasive consequences for family life. Recently, attention has focused on resiliency variables, especially social support and coping strategy, regulating the impact of stress. In the resiliency model of family stress, adjustment and adaptation, social support is viewed as one of the primary moderators or mediators between stress and well-being.

Aims.  The purpose of this study was to explore the relationships of family stress, perceived social support, and coping and determine the resiliency factor associated with coping by families who have a child with chronic illness.

Design.  In a secondary analysis of a large longitudinal study, the sample consisted of 92 families who had a child under age 12 who was newly diagnosed with CHD within the last 3–4 months.

Findings.  Results from regression analysis revealed that perceived social support operated as a resiliency factor between family stress and both parental and family coping. Child and family characteristics appeared to be the important predictors of perceived social support and parental coping. Although perceived social support appeared to be an important predictor of parental and family coping, neither the moderating nor mediating model was supported in full but partial causal relations were confirmed.

Conclusions.  Findings provided evidence for the theoretical and empirical significance of perceived social support as a predictor of family coping. Further, these findings suggest that perceived social support is a factor influencing the resiliency of relatively high-risk groups of families who have a child with chronic illness.

Family stress, perceived social support and coping following the diagnosis of a child's congenital heart disease.

Purpose: This study was to investigate the prevalence of depressive symptoms and risk factors in elderly people (old vs oldest-old) with arthritis. Methods: The Korean Longitudinal Study of Aging (KLoSA) was used with a sample of 1,084 elderly people with arthritis aged 65 or above. Results: We found that the prevalence of depressive symptom was greater for oldest-old people (66.7%) compared to old people (56%). Significant differences between old people and oldest-old people were found for education, living with spouse, number of generation, regular exercise, body mass index (BMI), ADL limitation, self-rated health, and depression. Significant differences existed between depression and non-depression in terms of all variables except region and BMI among old people. But, among the oldest people, ADL limitation and self-rated health showed differences. The Logistic regression analysis revealed that religion, medical comorbidity, ADL limitation, self-rated health were significantly associated with depressive symptoms in old people. But, in oldest-old people, none of the variables were associated with depressive symptoms. Conclusion: The findings show that there are age differences in depression and related factors in elderly people with arthritis. Longitudinal studies, which covered depressive symptom severity and which are controlled for a large number of potential confounders, will need to complement the results of this study in the future.

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[Depressive symptoms and related risk factors in old and oldest-old elderly people with arthritis].

Purpose: The aim of this study was to evaluate the validity and reliability of the Korean version of the Person-centered Care Assessment Tool (P-CAT). Methods: The English P-CAT was translated into Korean with forward and backward translation. Survey data were collected from 458 staff in 17 long-term care facilities in Korea. Construct validity and criterion related validity were evaluated. Cronbach’s alpha was used to assess reliability. Results: The Korean version of P-CAT was shown to be valid homogeneously by factor, item and content analysis. Internal consistency reliability was satisfactory in which the values of factor 1, factor 2 and the total scale were .84, .77 and .86 respectively. Exploratory factor analysis supported the construct validity with a two-factor solution. Factor loadings of the 13 items ranged in .34~.80. Criterion validity to the Person-centered Climate Questionnaire-staff (PCQ-S) was .74(p<.001). Conclusion: The Korean version of the P-CAT was found to be an applicable instrument with satisfactory reliability and validity for further use in measuring successful person-centered care in long-term care facilities for older persons.

https://www.jkan.or.kr/Synapse/Data/PDFData/0006JKAN/jkan-45-412.pdf

[Validity and Reliability of the Person-centered Care Assessment Tool in Long-term Care Facilities in Korea].

Maternal attachment to promote role development in mothers of preterm infants is critical for babies’ optimal growth and development. However, few models specify how neonatal intensive care units (NICUs) and their environments work to foster postpartum attachment (PPA) after preterm birth. We investigated relationships of quality of family-centered care and NICU environmental stressors with maternal PPA, to determine whether these are mediated by mothers’ psycho-emotional response and whether pathways to PPA are moderated by developmental immaturity (gestation, birthweight). A cross-sectional study using structural equation modeling was conducted on 294 mothers of premature infants with experience in NICUs in over 49 tertiary hospitals in 12 cities or provinces of South Korea. Data were collected using Korean versions of instruments including the Quality of Family-centered Care, Parental Stressor Scale: NICU, and Maternal Postpartum Attachment Scale. Maternal self-representation was a key predictor of PPA (β = .68), accounting for 42.2% of variance. Multi-group analysis indicated that NICU environmental stressor sensitivity (β = .26) and maternal self-representation (β = .67) were predictive of PPA in mothers of moderately preterm and low birthweight (32–36 weeks’ gestation, 1500–2499 g birthweight) infants. Quality of family-centered developmental care (β = .11) and NICU environmental stressor sensitivity (β = − .16) had significant indirect effects on PPA through psycho-emotional responses. Healthcare professionals should be aware of the importance of family-centered interventions focusing on psychosocial support and family participation in baby care, based on their environmental role in promoting PPA.

Mothers’ Perceptions of Quality of Family-Centered Care and Environmental Stressors in Neonatal Intensive Care Units: Predictors of and Relationships with Psycho-emotional Outcomes and Postpartum Attachment

This study investigated the relationships among psychosocial factors that contribute to smartphone dependency among South Korean adolescents. This cross-sectional study involved the secondary data analysis of the 2016 Korean Children and Youth Panel Survey, a nationwide multistage cluster survey. Data were collected from 1,840 7th grade students in South Korea and analyzed with descriptive statistics, Pearson's correlation coefficients, and a path analysis using SPSS 21.0 and AMOS 23.0. The path analysis showed that self-esteem and aggressiveness directly influenced smartphone dependency, while affective parenting attitude, peer attachment, resilience, self-esteem, and depressive symptoms indirectly influenced it. The explanatory variables accounted for 18.3% of the total variance. In conclusion, parents' education on positive parenting and guidance concerning adolescents' smartphone use is necessary to reduce adolescents' smartphone dependency. It may also prove effective to promote adolescents' interpersonal skills and self-esteem to foster positive peer relationships and self-control concerning smartphone use.

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Young Ran Tak

Papers

Family stress, perceived social support and coping following the diagnosis of a child's congenital heart disease.

[Depressive symptoms and related risk factors in old and oldest-old elderly people with arthritis].

[Validity and Reliability of the Person-centered Care Assessment Tool in Long-term Care Facilities in Korea].

Mothers’ Perceptions of Quality of Family-Centered Care and Environmental Stressors in Neonatal Intensive Care Units: Predictors of and Relationships with Psycho-emotional Outcomes and Postpartum Attachment

Exploring psychosocial factors that influence smartphone dependency among Korean adolescents