Factors associated with development of excessive fatness in children and adolescents: a review of prospective studies

The purpose of this review was to examine the factors that predict the development of excessive fatness in children and adolescents. Medline, Web of Science and PubMed were searched to identify prospective cohort studies that evaluated the association between several variables (e.g. physical activity, sedentary behaviour, dietary intake and genetic, physiological, social cognitive, family and peer, school and community factors) and the development of excessive fatness in children and adolescents (5-18 years). Sixty-one studies met the eligibility criteria and were included. There is evidence to support the association between genetic factors and low physical activity with excessive fatness in children and adolescents. Current studies yielded mixed evidence for the contribution of sedentary behaviour, dietary intake, physiological biomarkers, family factors and the community physical activity environment. No conclusions could be drawn about social cognitive factors, peer factors, school nutrition and physical activity environments, and the community nutrition environment. There is a dearth of longitudinal evidence that examines specific factors contributing to the development of excessive fatness in childhood and adolescence. Given that childhood obesity is a worldwide public health concern, the field can benefit from large-scale, long-term prospective studies that use state-of-the-art measures in a diverse sample of children and adolescents.

After-school setting, physical activity, and sedentary behavior in 5th grade boys and girls

After-school hours are considered critical for children's physical activity (PA) and sedentary behaviors (SB); however, whether the after-school setting influences children's activity patterns is unknown. This study examined the influence of after-school setting (i.e., parent report of the child's usual after-school setting) on 5th grade children's PA and SB, and differences by race/ethnicity. Boys whose parents reported they usually attended an after-school program had higher PA than boys who usually went home after school. A significant interaction between race/ethnicity and after-school setting showed that minority girls whose parents reported they usually attended an after-school program had higher PA and engaged in less SB compared with those who usually went home, whereas the activity patterns of white girls did not differ by after-school setting. Children's usual after-school setting affects their activity patterns; after-school programs may potentially increase PA in boys and minority girls.

Spatial accessibility and availability measures and statistical properties in the food environment

Spatial accessibility is of increasing interest in the health sciences. This paper addresses the statistical use of spatial accessibility and availability indices. These measures are evaluated via an extensive simulation based on cluster models for local food outlet density. We derived Monte Carlo critical values for several statistical tests based on the indices. In particular we are interested in the ability to make inferential comparisons between different study areas where indices of accessibility and availability are to be calculated. We derive tests of mean difference as well as tests for differences in Moran's I for spatial correlation for each of the accessibility and availability indices. We also apply these new statistical tests to a data example based on two counties in South Carolina for various accessibility and availability measures calculated for food outlets, stores, and restaurants.

Referral of breast cancer patients to medical oncologists after initial surgical management

BACKGROUND

Decisions to refer patients to other physicians for care or consultation are an important component of the provision of appropriate care for cancer patients. However, little is known about the referral process between specialists.

OBJECTIVES

To examine the referral patterns of specialists to specialists and to understand why only some breast cancer patients receive a consultation with a medical oncologist.

RESEARCH DESIGN

This study was conducted in a large metropolitan region from 1993 to 1995 using a 2-staged population-based sampling strategy. One hundred seven physicians discussed 244 patient cases and their own knowledge, attitudes, and practices toward treatment and referral.

RESULTS

Of the 244 patients, 87.7% were referred to an oncologist, and 10.2% were actually prescribed tamoxifen by their surgeons before they saw the oncologist. Surgeons who were less involved in making decisions about the type of adjuvant therapy the patients were to receive and who preferred the use of chemotherapy were significantly more likely to refer patients to oncologists. Patients who were older, unemployed, node negative, and had a better prognosis or preferred not to see an oncologist were significantly less likely to be referred. These 7 factors explained a total of 55% of the variation in surgeons' decisions to refer patients to an oncologist.

CONCLUSIONS

Extramedical factors, such as surgeon and patient preferences and communication factors, play a strong role in the referral process. In this sample, most patients were referred to an oncologist. However, older, unemployed patients and patients whose medical features indicated a better long-term prognosis were most likely to be among the nonreferred group.

Factors that predict the referral of breast cancer patients onto clinical trials by their surgeons and medical oncologists

PURPOSE

To improve understanding of physicians' reluctance to refer patients to clinical trials.

METHODS

This study was conducted in a large metropolitan region from 1993 to 1995 using a two-staged population-based sampling strategy. A total of 147 physicians discussed 245 patient cases and their own knowledge, attitudes, and practices toward clinical trials.

RESULTS

Ninety-three patients (38. 0%) were offered a trial, and 49 (52.7%) of them agreed to participate. Forty-five patients (18.4%) actually received their adjuvant therapy on trial. Older patients and those with a poorer prognosis were less likely to be referred. Patients who delayed their decision were more than three times as likely to participate in a trial and more than eight times as likely to participate when they were reported to be actively involved in making the decision. Generally, physicians in university settings and who had formal support from a cooperative group were more likely to refer patients to trials. More specifically, surgeons referred more patients to trials when they felt comfortable explaining trials or believed that treatment should not stray from protocol. Oncologists were less likely to make referrals if they perceived the paperwork to be onerous or entry requirements to be too stringent. Surgeons' participation in recommending adjuvant therapy to patients resulted in more trial referrals unless they treated their patients with tamoxifen.

CONCLUSION

(1) Physicians still need to overcome attitudinal and practical barriers to trial participation, (2) more support for physicians is needed, (3) surgeons may play a pivotal role in the recruitment of patients to adjuvant therapy trials, and (4) garnering patient enthusiasm for trial participation and involving them in the choice of adjuvant therapy may be key components to increasing trial enrollment.