Can Australain general practitioners tackle chidhood overweight/obesity? Methods and processes from the LEAP (live, eat, and play) randomized controlled trial

Background: General practitioners (GPs) could make an important contribution to management of childhood overweight. However, there are no efficacy data to support this, and the feasibility of this approach is unknown.

Objectives: To determine if GPs and families can be recruited to a randomized controlled trial (RCT), and if GPs can successfully deliver an intervention to families with overweight/obese 5- to 9-year-old children.

Methods: A convenience sample of 34 GPs from 29 family medical practices attended training sessions on management of childhood overweight. Practice staff trained in child anthropometry conducted a cross-sectional body mass index (BMI) survey of 5- to 9-year-old children attending these practices. The intervention focused on achievable goals in nutrition, physical activity and sedentary behaviour, and was delivered in four solution-focused behaviour change consultations over 12 weeks.

Results: General practitioners were recruited from across the sociodemographic spectrum. All attended at least two of the three education sessions and were retained throughout the trial. Practice staff weighed and measured 2112 children in the BMI survey, of whom 28% were overweight/obese (17.5% overweight, 10.5% obese), with children drawn from all sociodemographic quintiles. Of the eligible overweight/obese children, 163 (40%) were recruited and retained in the LEAP RCT; 96% of intervention families attended at least their first consultation.

Conclusions: Many families are willing to tackle childhood overweight with their GP. In addition, GPs and families can participate successfully in the careful trials that are needed to determine whether an individualized, family-based primary care approach is beneficial, harmful or ineffective.

Outcome data from the LEAP (Live, Eat and Play) trial: a randomized controlled trial of a primary care intervention for childhood overweight/mild obesity

OBJECTIVES: To reduce gain in body mass index (BMI) in overweight/mildly obese children in the primary care setting.
DESIGN: Randomized controlled trial (RCT) nested within a baseline cross-sectional BMI survey.
SETTING: Twenty nine general practices, Melbourne, Australia.
PARTICIPANTS: (1) BMI survey: 2112 children visiting their general practitioner (GP) April-December 2002; (2) RCT: individually randomized overweight/mildly obese (BMI z-score <3.0) children aged 5 years 0 months-9 years 11 months (82 intervention, 81 control).
INTERVENTION: Four standard GP consultations over 12 weeks, targeting change in nutrition, physical activity and sedentary behaviour, supported by purpose-designed family materials.
MAIN OUTCOME MEASURES: Primary: BMI at 9 and 15 months post-randomization. Secondary: Parent-reported child nutrition, physical activity and health status; child-reported health status, body satisfaction and appearance/self-worth.
RESULTS: Attrition was 10%. The adjusted mean difference (intervention-control) in BMI was -0.2 kg/m(2) (95% CI: -0.6 to 0.1; P=0.25) at 9 months and -0.0 kg/m(2) (95% CI: -0.5 to 0.5; P=1.00) at 15 months. There was a relative improvement in nutrition scores in the intervention arm at both 9 and 15 months. There was weak evidence of an increase in daily physical activity in the intervention arm. Health status and body image were similar in the trial arms.
CONCLUSIONS: This intervention did not result in a sustained BMI reduction, despite the improvement in parent-reported nutrition. Brief individualized solution-focused approaches may not be an effective approach to childhood overweight. Alternatively, this intervention may not have been intensive enough or the GP training may have been insufficient; however, increasing either would have significant cost and resource implications at a population level.

Economic Evaluation of a Primary Care Trial to Reduce Weight Gain in Overweight/Obese Children: The LEAP Trial

Background:- A common policy response to the childhood obesity epidemic is to recommend that primary care physicians screen for and offer counseling to the overweight/obese. As the literature suggests, this approach may be ineffective; it is important to document the opportunity costs incurred by brief primary care obesity interventions that ultimately may not alter body mass index (BMI) trajectory.

Methods:- Live, Eat and Play (LEAP) was a randomized controlled trial of a brief secondary prevention intervention delivered by family physicians in 2002-2003 that targeted overweight/ mildly obese children aged 5 to 9 years. Primary care utilization was prospectively audited via medical records, and parents reported family resource use by written questionnaire. Outcome measures were BMI (primary) and parent-reported physical activity and dietary habits (secondary) in intervention compared with control children.

Results:- The cost of LEAP per intervention family was AU $4094 greater than for control families, mainly due to increased family resources devoted to child physical activity. Total health sector costs were AU $873 per intervention family and AU $64 per control, a difference of AU $809 {P < .001). At 15 months, intervention children did not differ significantly in adjusted BMI or daily physical activity scores compared with the control group, but dietary habits had improved.

Conclusions:- This brief intervention resulted in higher costs to families and the health care sector, which could have been devoted to other uses that do create benefits to health and/or family well-being. This has implications for countries such as the United States, the United Kingdom, and Australia, whose current guidelines recommend routine surveillance and counseling for high child BMI in the primary care sector.

Outcomes and costs of primary care surveillance and intervention for overweight or obese children : the LEAP 2 randomised controlled trial

Objective To determine whether ascertainment of childhood obesity by surveillance followed by structured secondary prevention in primary care improved outcomes in overweight or mildly obese children.

Design Randomised controlled trial nested within a baseline cross sectional survey of body mass index (BMI). Randomisation and outcomes measurement, but not participants, were blinded to group assignment.

Setting 45 family practices (66 general practitioners) in Melbourne, Australia.

Participants 3958 children visiting their general practitioner in May 2005-July 2006 were surveyed for BMI. Of these, 258 children aged 5 years 0 months up to their 10th birthday who were overweight or obese by International Obesity Taskforce criteria were randomised to intervention (n=139) or control (n=119) groups. Children who were very obese (UK BMI z score 3.0) were excluded.

Intervention Four standard consultations over 12 weeks targeting change in nutrition, physical activity, and sedentary behaviour, supported by purpose designed family materials.

Main outcomes measures Primary measure was BMI at 6 and 12 months after randomisation. Secondary measures were mean activity count/min by 7-day accelerometry, nutrition score from 4-day abbreviated food frequency diary, and child health related quality of life. Differences were adjusted for socioeconomic status, age, sex, and baseline BMI.

Results Of 781 eligible children, 258 (33%) entered the trial; attrition was 3.1% at 6 months and 6.2% at 12 months. Adjusted mean differences (intervention – control) at 6 and 12 months were, for BMI, –0.12 (95% CI –0.40 to 0.15, P=0.4) and –0.11 (–0.45 to 0.22, P=0.5); for physical activity in counts/min, 24 (–4 to 52, P=0.09) and 11 (–26 to 49, P=0.6); and, for nutrition score, 0.2 (–0.03 to 0.4, P=0.1) and 0.1 (–0.1 to 0.4, P=0.2). There was no evidence of harm to the child. Costs to the healthcare system were significantly higher in the intervention arm.

Conclusions Primary care screening followed by brief counselling did not improve BMI, physical activity, or nutrition in overweight or mildly obese 5-10 year olds, and it would be very costly if universally implemented. These findings are at odds with national policies in countries including the US, UK, and Australia.

Law schools told to leap into social media learning

Law schools should use social media websites such as Twitter and Facebook, and blogs to strengthen ties with students and keep them more engaged with their studies, argues an Australian academic research paper.

Taking the LEAP with the Oculus HMD and CAD - plucking at thin air?

Achieving adequate visualisation of designs within CAD packages remains a challenge for designers with current methods of 3D CAD visualisation requiring either a high level of technical ability, or expensive hardware and software. The recent re-emergence of consumer VR has lowered the barrier for everyday developers wanting to visualise their designs in true 3D. This paper presents the CAD Interaction Lab (CIL) which employs the Oculus Rift Head Mounted Display (HMD) and Leap Motion Controller (LMC) to provide a low cost method enabling users to use their hands to dissect a mechanic model to manipulate and inspect individual components in realistic 3D. Qualitative observations of user interactions with the CIL show that users were able to intuitively manipulate the CAD model using natural hand movements with only minimal instruction.

Dance review: Australian ballet's Vitesse finds leap of faith falls just short

Dance review of The Australian Ballet

The square from inside out: Federation Square, Melbourne

This XXlst Annual Conference of SAHANZ offers a timely opportunity for celebrating and critically reflecting on Federation Square, Melbourne - a project that continually crosses the line between the purely experimental and the built form (A Benjamin, 2003) and offers an opportunity to identify and investigate the different, often competing, limits within the discipline of architecture. Here in this project, considered by the city of Melbourne to point to its future aspirations; and by the RAIA as demonstrating 'the strength of design and the leap into the unknown which is where good design always comes from' (I McDougall, 2003), different approaches to the possibilities of 'limit' as a contemporary concern can be fruitfully explored. Architectural masterpieces are daringly imaginative and each in their own way challenges architects, engineers, builders and technologists - those who are to realise the dream - and makes administrators, politicians and governments put their credibility on the line. So how does Federation Square contribute to contemporary architectural debate, specifically to Melbourne architecture? How has it dealt with thresholds? Where has It approached, crossed and/or exceeded boundaries? This paper will deal with design aesthetics in the realisation of the Lab architects 'vision' in the context of historical, urban and political realities. Analysis will provide insights into the limitations imposed upon this architectural project and the limitations it now, in turn, imposes on the city. Two aspects will be dealt with: understanding Lab's overall vision, and juxtaposing the vision with the reality of Federation Square. The author's interview with Don Bates, principal Lab architecture studio, forms the frame argument about Federation Square in this paper.

Understanding the factors contributing to inter-partner trust in joint ventures

Forming an international joint venture (IJV) with a local (Chinese) partner is one of the popular ways available for an overseas investor to enter into small and medium business sectors in China. A joint venture is commonly viewed as a cooperative, rather than a competitive, business relationship between two or more partners. Interpartner trust is widely acknowledged as a key prerequisite for genuine cooperation between joint venture partners. Although the importance of trust in the context of joint ventures is well recognized, the question of how interpartner trust is formed has received only scant attention in academic as well as professional literatures. Drawing from diverse academic literature bearing on the formation of trust between partner firms, this paper explores the factors that may contribute to inter-partner trust in the context of joint ventures. The primary argument in this paper is that trust between IJV partners is determined by observable and objective social, economic and structural factors. In other words, it is argued that interpartner trust is rational and it does not require a 'leap of faith'.

The importance of national ICT visions for information society in South East Asia

This paper addresses the question ‘How necessary is a national information and communications technology (ICT) strategy/vision for the development of an information society?’ For the purpose of this paper, ‘information society’ is reduced to two key dimensions: penetration of ICT, and access to government information on-line. In considering the question, the paper calls on data contained in the International Telecommunication Union’s (ITU) case studies of e-readiness in eight South East Asian (SEA) nations (Cambodia, Indonesia, Laos, Malaysia, Philippines, Singapore, Thailand and Vietnam). The background to the paper includes an overview of the SEA nations in terms of demographics and a discussion of the dilemma of government involvement in developing an information society in the light of the ‘small government mantra’ that has dominated in recent years. National ICT strategies visions of each nation are presented, followed by on overview of their information society policies and practices and their ICT penetration. The importance of the vision is then contrasted with other factors including level of development and national income. The conclusions draw attention to the importance of a vision irrespective of level of development and resource availability. In fact, for the least developed nations, poor infrastructure may be an opportunity to leap frog to the most advanced networks supporting an information society, if the vision is relevant, powerful and broadly held.