A systematic review of controlled trials of interventions to prevent childhood obesity and overweight: realistic synthesis of the evidence

Background: Preventing childhood overweight and obesity has become a major public health issue in developed and developing countries. Systematic reviews of this topic have not provided practice-relevant guidance because of the generally low quality of research and the heterogeneity of reported effectiveness. Aim: To present practice-relevant guidance on interventions to reduce at least one measure of adiposity in child populations that do or do not contain overweight or obese children. Design: Systematic review of eligible randomized, controlled trials or controlled trials using a novel approach to synthesizing the trial results through application of descriptive epidemiological and realistic evaluation concepts. Eligible trials involved at least 30 participants, lasted at least 12 weeks and involved non-clinical child populations. Results: Twenty-eight eligible trials were identified to 30 April 2006. Eleven trials were effective and 17 were ineffective in reducing adiposity. Blind to outcome, the main factor distinguishing effective from ineffective trials was the provision of moderate to vigorous aerobic physical activity in the former on a relatively 'compulsory' rather than 'voluntary' basis. Conclusions: By using a novel approach to synthesizing trials, a decisive role for the 'compulsory' provision of aerobic physical activity has been demonstrated. Further research is required to identify how such activity can be sustained and transformed into a personally chosen behaviour by children and over the life course. (C) 2007 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.

Configurations institutionnelles de la protection de l’enfance: regards croisés de l’Afrique, de l’Europe et de l’Amérique du Nord

Cet article porte sur l’analyse de trois configurations institutionnelles de la protection de l’enfance : celle en place au Burkina Faso, en Belgique et au Québec. Pour chaque configuration, le texte explore les transformations qui ont marqué le passage de la prise en charge exclusive de l’enfant par la famille vers la présence accrue de l’État et la manière dont la Convention internationale des droits de l’enfant de 1989 a influencé ce passage. Il montre, au travers d’une lecture historique, que l’implication de l’État dans la protection des enfants a connu des formes et des modalités variables selon le temps et l’espace. L’approche actuelle en matière de protection de l’enfance au Nord et au Sud, approche largement inspirée de la perspective des droits, représente un défi tant pour les intervenants que pour les familles, car son application dépend à fois des ressources disponibles pour aider les enfants et les familles en difficulté, de la capacité d’action des institutions publiques et de l’efficacité des interventions. This article deals with the analysis of three institutional configurations of child protection: those in Burkina Faso, in Belgium, and in Québec. With respect to each configuration, the text explores the changes from situations in which the family had sole control of the child to those where the State played a greater role, and the manner in which the 1989 International Convention on the Rights of the Child has affected such changes. It shows, through a reading of history, that the involvement of the State in child protection has gone through different forms and stages over time and space. The current strategies as regards child protection in the North and in the South—an approach that is largely subject to a legal perspective—represent a challenge both for intervenors and for families, since their application depends on the resources available for helping children and families in difficulty, on the ability of the public institutions to intervene, and on the efficiency of such interventions.

The effect of targeting tolerance of children's negative emotions among anxious parents of children with anxiety disorders: a pilot randomised controlled trial

Following cognitive behavioural therapy for child anxiety a significant minority of children fail to lose their diagnosis status. One potential barrier is high parental anxiety. We designed a pilot RCT to test claims that parental intolerance of the child’s negative emotions may impact treatment outcomes. Parents of 60 children with an anxiety disorder, who were themselves highly anxious, received either brief parent-delivered treatment for child anxiety or the same treatment with strategies specifically targeting parental tolerance of their child’s negative emotions. Consistent with predictions, parental tolerance of the child’s negative emotions significantly improved from pre- to post-treatment. However, there was no evidence to inform the direction of this association as improvements were substantial in both groups. Moreover, while there were significant improvements in child anxiety in both conditions, there was little evidence that this was associated with the improvement in parental tolerance. Nevertheless, findings provide important clinical insight, including that parent-led treatments are appropriate even when the parent is highly anxious and that it may not be necessary to adjust interventions for many families.