Health care and lost productivity costs of overweight and obesity in New Zealand

Objective: To estimate the costs of health care and lost productivity attributable to overweight and obesity in New Zealand (NZ) in 2006.

Methods: A prevalence-based approach to costing was used in which costs were calculated for all cases of disease in the year 2006. Population attributable fractions (PAFs) were calculated based on the relative risks obtained from large cohort studies and the prevalence of overweight and obesity. For each disease, the PAF was multiplied by the total health care cost. The costs of lost productivity associated with premature mortality were estimated using both the Human Capital approach (HCA) and Friction Cost approach (FCA).

Results: Health care costs attributable to overweight and obesity were estimated to be NZ$686m or 4.5% of New Zealand's total health care expenditure in 2006. The costs of lost productivity using the FCA were estimated to be NZ$98m and NZ$225m using the HCA. The combined costs of health care and lost productivity using the FCA were $784m and $911m using the HCA.

Conclusion: The cost burden of overweight and obesity in NZ is considerable.

Implications: Policies and interventions are urgently needed to reduce the prevalence of obesity thereby decreasing these substantial costs.

Does the cognitive interview promote the coherence of narrative accounts in children with and without an intellectual disability?

We examined whether the cognitive interview (CI) procedure enhanced the coherence of narrative accounts provided by children with and without intellectual disabilities (ID), matched on chronological age. Children watched a videotaped magic show; one day later, they were interviewed using the CI or a structured interview (SI). Children interviewed using the CI reported more correct details than those interviewed using the SI. Additionally, children interviewed using the CI reported more contextual background details, more logically ordered sequences, more temporal markers, and fewer inconsistencies in their stories than those interviewed using the SI. However, the CI did not increase the number of story grammar elements compared with the SI. Overall children interviewed with the CI told better stories than those interviewed with the SI. This finding provided further support for the effectiveness of the CI with vulnerable witnesses, particularly children with ID.

Efficacy and adverse effects of venlafaxine in children and adolescents with ADHD : a systematic review of non-controlled and controlled trials

Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in children and adolescents. Stimulants are commonly prescribed for ADHD management. There is clinical trial evidence that some medications with noradrenergic properties such as atomoxetine are effective. It is of theoretical and practical importance if other agents with noradrenergic properties display a comparable pattern of efficacy.
This paper is a systematic review of the efficacy and safety of venlafaxine for treating children and adolescents with ADHD. MEDLINE, Google scholar, Scopus, and Web of science (ISI) databases were electronically searched in July 2012, updated on November 2012. Time and language of publication were not exclusion criteria. Efficacy outcomes were assessed by a valid and reliable parent- and/or teacher-reported instrument to evaluate clinical symptoms. Adverse effects were also evaluated.

There were three uncontrolled trials and only two double blind controlled clinical trials. Venlafaxine appeared effective for treating ADHD. The rates of some adverse effects of venlafaxine were less than those documented for methylphenidate.

While one of the two small controlled trials did not find difference between venlafaxine ad methylphenidate, the other trial reported lower efficacy for venlafaxine. Headache, insomnia, and nausea were among the most common adverse effects.

This systematic review provides preliminary support that venlafaxine may have short term utility in treating ADHD in children and adolescents. However, before recommending venlafaxine for treatment, more robust and larger clinical trials, in particular providing evidence of its long-term efficacy, safety and tolerability are required.

Is a change in mode of travel to school associated with a change in overall physical activity levels in children? Longitudinal results from the SPEEDY study

Background
Children who use active modes of travel (walking or cycling) to school are more physically active than those who use passive (motorised) modes. However, less is known on whether a change in mode of travel to school is associated with a change in children’s physical activity levels. The purpose of this analysis was to investigate the association between change in mode of travel to school and change in overall physical activity levels in children.

Methods
Data from 812 9–10 year old British children (59% girls) who participated in the SPEEDY study were analysed. During the summer terms of 2007 and 2008 participants completed a questionnaire and wore an accelerometer for at least three days. Two-level multiple linear regression models were used to explore the association between change in usual mode of travel to school and change in objectively measured time spent in MVPA.

Results
Compared to children whose reported mode of travel did not change, a change from a passive to an active mode of travel was associated with an increase in daily minutes spent in MVPA (boys: beta 11.59, 95% CI 0.94 to 22.24; girls: beta 11.92, 95% CI 5.00 to 18.84). This increase represented 12% of boys’ and 13% of girls’ total daily time spent in MVPA at follow-up.

Conclusion
This analysis provides further evidence that promoting active travel to school may have a role in contributing to increasing physical activity levels in children.

Body mass index and dental caries in children and adolescents : a systematic review of literature published 2004 to 2011

The objective
The authors undertook an updated systematic review of the relationship between body mass index and dental caries in children and adolescents.
Method
The authors searched Medline, ISI, Cochrane, Scopus, Global Health and CINAHL databases and conducted lateral searches from reference lists for papers published from 2004 to 2011, inclusive. All empirical papers that tested associations between body mass index and dental caries in child and adolescent populations (aged 0 to 18 years) were included.
Results
Dental caries is associated with both high and low body mass index.
Conclusion
A non-linear association between body mass index and dental caries may account for inconsistent findings in previous research. We recommend future research investigate the nature of the association between body mass index and dental caries in samples that include a full range of body mass index scores, and explore how factors such as socioeconomic status mediate the association between body mass index and dental caries.

Perceptions of engineering from female secondary college students in regional Victoria

Survey and focus group interviews with female students in regional Victoria resulted in identification of four perceived barriers that influence them to exclude engineering as a career choice. These barriers were identified as a lack of interest in the perceived image, a lack of knowledge, a traditionally maledominated industry, and limited recognisable role models. This paper reports on what Year 10 females are saying about the barriers and, consequently, how engineering can be promoted to overcome these barriers.

Morbid obesity in women on the rise : an observational, population-based study

Background The obesity epidemic is generally monitored by the proportion of the population whose body mass index (BMI) exceeds 30 kg/m2 but this masks the growing proportion of those who are morbidly obese. This issue is important as the adverse health risks amplify as the level of obesity increases. The aim of this study was to determine how the prevalence of morbid obesity (BMI >= 40.0 kg/m2) has changed over a decade among women living in south-eastern Australia.

Methods BMI was determined for women in the Geelong Osteoporosis study (GOS) during two time periods, a decade apart. Height and weight were measured for 1,494 women (aged 20--94 years) during 1993--7 and for 1,076 women (aged 20--93 years), 2004--8, and the BMI calculated as weight in kilograms divided by the square of the height in metres (kg/m2). Prevalence estimates were age-standardised to enable direct comparisons.

Results Mean BMI increased from 26.0 kg/m2 (95%CI 25.7-26.3) in 1993--7, to 27.1 kg/m2 (95%CI 26.8-27.4) in 2004--8. During this period, the prevalence of morbid obesity increased from 2.5% to 4.2% and the standardised morbidity ratio for morbid obesity was 1.69 (95%CI 1.26-2.27). Increases in mean BMI and prevalence of morbid obesity were observed for all ages and across the socioeconomic spectrum.

Conclusions These findings reveal that over a decade, there has been an increase in mean BMI among women residing in south-eastern Australia, resulting in a measurable increase in the prevalence of morbid obesity.

Oral baclofen in children with cerebral palsy : a double-blind cross-over pilot study

Aim: To assess the effectiveness of oral baclofen in reducing spasticity and improving function in children with cerebral palsy. Methods: A double-blind, randomised cross-over pilot study of oral baclofen versus placebo. Assessment tools included the Goal Attainment Scale, Pediatric Evaluation of Disability Inventory, Modified Tardieu Scale and parent questionnaire. Results: Fifteen children with mean age 7.4 years (SD = 2.7 years) and spastic or spastic/dystonic quadriplegia (Gross Motor Function Classification System Level IV or V) were enrolled. Children scored significantly better on the Goal Attainment Scale with baclofen compared with placebo (F(1,13) = 4.5, P = 0.05). There was no significant difference between baclofen and placebo for the Pediatric Evaluation of Disability Inventory or Modified Tardieu Scale. Parent questionnaire results are described. Conclusion: This pilot study demonstrates that oral baclofen has an effect beyond placebo in improving goal-oriented tasks, such as transfers, in children with spastic quadriplegic cerebral palsy.

The association between alcohol interventions and Dui incidents in Geelong, Victoria

Introduction and aims : Driving under the influence of alcohol is a major public health problem, every year affecting the lives of billions around the world - and not least in Australia. Since 2001, several Traffic Accident Commission (TAC), police, and community interventions have been implemented in Geelong, Australia to curb drink driving. The current paper aims to assess the impact of 13 alcohol interventions on drink-driving rates in the Geelong region of Australia. The interventions comprised seven TAC media campaigns, three Victoria Police operations, two community interventions targeting licensed premises, and the alcohol interlock program.

Method : This study examined two types of Victoria Police frequency data: Driving under the influence (DUI) offences, and roadside preliminary breath testing (PBT) rates. Multiple regressions were carried out to determine if any of the interventions were significantly associated with frequency fluctuations in the data.

Results : Of the 13 alcohol interventions examined, three TAC campaigns and one Victoria Police operation precipitated significant decreases in drink-driving rates, while another three TAC campaigns were associated with significant increases in drink-driving rates. Over one in five (22.5%) had recorded prior DUI offences.

Conclusions : The most promising approach to curbing DUI-rates in Geelong, appear to be through informative media campaigns which show people specific settings where they might become mildly intoxicated without being aware of it, such as TAC’s ‘Education 1’ campaign. However, there remains a worrying level of recidivist drink drivers in Geelong suggesting the need for tailored approaches.

Fictional inquiry : an alternative process to inspire creativity in children's co-design projects

Children's creativity is a valuable resource for architectural design, and attempts have been made throughout the world to involve children in the design process of their environments. Previous children's co-design projects often followed a problem solving process, however, this process has limitations in stimulating children's creativity. Research has found that children's creativity is different to adult's creativity: Instead of creative problem solving skills, children's creativity is most evident in their imagination and originality of thinking. Addressing this issue, an alternative process in children's co-design projects was experimented: Fictional Inquiry. In this paper, two case studies are used to illustrate how the fictional inquiry process is applied in children's co-design projects.* These two projects were both joint educational projects between Deakin University and schools in Geelong and Melbourne. Through several weeks' of workshops, children and university architecture students worked in small groups to develop architectural design solutions. It was observed that creative design outcomes have been achieved in these two projects, which suggested that Fictional Inquiry was an effective process to inspire children's creativity. Applying the Fictional Inquiry process, Deakin University is currently working with another school in the Geelong Region, with the aim of achieving creative architectural design outcomes.