Low Fitness and Obesity among Migrant Children - Essay Example

Literature Critique Name Institution Date The study and the Questions The study asked a question that was clearly focused. The theme or purpose of the study is to determine the influence of intervention of multidimensional lifestyle on adiposity and aerobic fitness in preschool children that are predominantly migrant. It has been generally stated that low fitness and obesity are disproportionally widespread among migrant children. The aim of the study was to establish the truth behind such hypotheses, and the study question revolved on the subject matter of the study. It has also been noted that prevention programmes for the prevailing problem are scarce in this multicultural population. Programs that are present are ineffective or non-existing for preschool children (Silman & Macfarlane, 2002). The study demonstrated the essence of intervention program to deal with the crisis in environments such as in preschool children. The intervention was tailored towards a multidimensional culture lifestyle which included lessons on nutrition, activity programme, use of media (computers and TV), and sleep. There was also adapting to the built setting of the preschool class. Experts involved in the development of the intervention included preschool teachers, physiologists, dietitians, pediatricians, psychologists, and other stakeholders that included migrant families’ experts. The intervention was in place for a period of one year. The study was tailored towards intervening at the individual and environmental levels. The intervention narrowed down on changes in attitudes, behavior, education, and provision of social support. The outcomes measures primarily considered in this study were body mass index (BMI), and aerobic fitness. Secondary outcomes considered included balance, motor agility, waist circumference, percentage body fat, eating habits, physical activity, sleep, media use, cognitive abilities, and psychological health. All secondary and primary outcomes were assessed less a fortnight apart and are considered at the individual child level. Outcomes of physical outcomes were successfully assessed in the gym whereas cognitive abilities and adiposity outcomes were assessed in another room close to the classroom. Primary outcomes, which are aerobic fitness and body mass index, were measured. Standardized procedure was used to measure weight and height. 20 m shuttle run test was used to measure aerobic fitness whereby children run for 20m back and forth with a starting speed of 8km/h and increase of 0.5km/h each minute. Randomized controlled trial (RCT) and its Appropriateness This was a randomized controlled trial. A randomized clinical trial is a kind of study in which the participants are assigned through chance to separate groups which compare various treatment; neither participants nor researchers can select which group. Using chance in assigning people to groups translates to groups being similar and therefore, received treatment can be objectively compared. Participants are chosen at random and receive one of several interventions. One of the interventions is as a standard for control or comparison (Ranjith, 2005). This study was carried out as a randomized controlled trial. Randomization of classes was done separately the French and German speaking areas. Randomization of was done using envelopes that were opaque. For practical reasons and minimization of contamination, classes in preschool which were affiliated to the same school were effectively randomized into the same group. Recruitment was carried out between January 2008 and November 2007. Randomization and selection took place between March and February 2008 and were conducted by personnel from the school health services who did not take part in the study. Forty classes were affiliated to thirty schools, but school did not get involved in the intervention because all activities happened at the class level. Children, parents, and teachers were informed that the aim of the intervention was promotion of health of children but they were not aware of the study’s objectives. Trained researchers measured the, but were not aware of the study’s objective. Organizers and contact persons were not blinded and never took part in outcomes measurement. There is no financial incentive which was provided. This was a randomized controlled trial which was appropriately so (Owen, 2006). This was the right research approach for the study questions since it involved comparison of different groups in order to tell the effect of the intervention. Allocation of Participants & an Intervention and Control group The participants were allocated appropriately to the control and intervention group. Preschool classes were used as unit for intervention and randomization. Eligibility criteria used for preschool classes was a prevalence of above 40 percent of migrant children. The migrant children were defined with at least having one parent who was born outside Switzerland. The inclusion criteria required that participants should not be taking place in other alternative prevention project. The control group was not given any form of intervention and continued in their normal school curriculum. Forty five minute lesson of physical activity was maintained very week in the gym. In region with French speaking people, one additional rhythmic lesson of forty five minute was included in their regular curriculum. The study, which was a cluster randomized controlled trial was carried out in forty public preschool classes that were randomly selected in regions with high migrant population from two varying linguistic and socio-cultural regions in Switzerland. The French speaking region had close fifty thousand inhabitants while German speaking region had seventy thousands inhabitants. All children found in Switzer land attend preschool and, therefore, it was easy for any child to be randomly selected for the experiment. Trained health promoters carried out the intervention on the level of teachers (through visits with hands on training, workshops, the built environment adaptation), parents (events in collaborating with teachers), and children through physical lessons. Teachers took part in a two workshops prior to intervention in order to learn about practical and content aspect being targeted by the intervention. Use of highly trained health service specialists made sure that the intervention process took place perfectly. The process of allocation to either the control or intervention group was truly random. There was no predetermination concerning who should belong to which group. The random allocation was in the ration of 1:1 in French and German regions in Switzerland. A randomization was achieved through the method of allocation. Migrant status of the parent was determined by his or her country of birth. Children were also categorized into two groups according to the language they mostly spoke at home (Fletcher, 2005). Consequently there was some stratification during randomization. The groups in the study were well balanced and there was little difference between them. The design involved cluster randomized and controlled single blinded trail over a period of one year. Randomization was done after stratification in the linguistic region. A total of 727 children entered the study and were assigned randomly to group. There were twenty children in each group and this was done after stratification for linguistic and socio-cultural region. Were participants, staff and study personnel ‘blind’ to participants’ study group? The participants, study personnel, and staff were to a large extent blind to the participants’ study group. Blinding in study experiments is not easy to achieve but in this study there was success. Parents, children and teachers were told that the intervention was being used in promotion of children health but were kept in the dark in regard to the main objectives of the prevailing study. The trained researchers who measured the outcomes were also blinded to allocation of groups. The participants did not know the main objective of the study (Schulz, Chalmers & Atman, 2002). They were told it was a health promotion study for children. All these people did not know the real reason for the study. The study personnel, participants, and staff were not aware of the study group and they only carried out their function as directed. There was the German group and the French group in this study. Despite the teachers, parents, and children knowing that the study was a health promotion exercise, they did not realize that it was the migrant group being targeted. The main objective of the study was not revealed to them. A lot of effort was invested in this study in order to achieve blinding. The researchers tried as much as possible to make sure participants, teacher, study personnel, and parents are unaware of the main reason of the experiment or study. Blinding in very significant in this study since without it less accurate results could be achieved. The purpose of the study was to determine the effect of a multidimensional intervention in lifestyle on adiposity and aerobic fitness in preschool children who are predominately migrant. If the real objective of the study was known to the participants, there would be behavior modification to try and look the best of achieve the best outcomes. The real picture or scenario would not have been captured without blinding. Blinding helps in the elimination of the bias of the participants (Stolberg, Norman, & Trop, 2004). If the participants know what is exactly being measured, they will alter their behavior to suit their anticipation of the expected results. To maintain accuracy of results, it is important for the participants to be blind to the purpose or objective of the study. The participants who entered the trial and the conclusion Participants that took part in this study were 652 out of the possible 727 preschool children from regions having high migrant population in French and German speaking areas in Switzerland. Forty preschools were included in this study. Eighteen children in the control group and nine children in the intervention group moved away after the baseline testing. Informed consent was received from 655 children. This represented close to 90% of the total participation. 652 children were consequently examined at the baseline. A sample of close to 342 children got the intervention. There no school in the forty preschool that abandoned the research while it was ongoing. Eighteen children in the control group eight children in the intervention moved away before the year ended. In the course of the study feedback was obtained on the intervention from twenty out of twenty teachers. The feedback from the parents was 297 out of the possible 342. Majority of teachers attended informal meeting and workshops. Nutrition lessons and physical activity were implemented as previously planned. All analysis of data was done using Stata version 11.0. Averagely in a class of eighteen, it was assumed that thirteen children per class would take part in both shuttle run tests. Non-participation was due to moving, sickness, or attrition on the testing day. Analysis were carried out on an intention of treating bias through using data from individual children while adjusting for outcome clustering in preschool classes. Effects of intervention were estimated with logistic regression and linear mixed models with adjustments for sex, age, and linguistic and socio-cultural region. The intervention-group participants did not have a control group action. There was no way that a control group participant could cross over and take part in the intervention group. In this study, all participants were followed up save for those who left the groups after the baseline stage. Eighteen children of the control group and 8 of the intervention group left before the year of the study was over (Strite & Stuart, 2010). All participants’ outcomes analysis was done following the group in which they originally belonged. There was no switching of sides from the control to the intervention group in the course of the study. Whether the participants in all groups were followed up and data collected in the same way Parents took part in three interactive discussion and information evenings concerning limitation of TV use, promotion of healthy food, physical activity, and significance of enough sleep. This was conducted by health promoters in liaising with respective teacher in the preschool. Support was further provided through use of brochures, nutrition activity or physical activity cards, and worksheets brought home by children. Participants in all groups were followed up but data was not collected in exactly the same manner in each group (Friis & Sellers, 2009). The control and the intervention group data was analyzed in the same way using the same table even in the posting of results. Participants who withdrew themselves from the study were accounted for, but the rest of the analysis of data was data was done exhaustively. Did the study have enough participants to minimize the play of chance? The study had enough participants to minimize the influence of chance. The total number of preschool children with high migrant population in Switzerland is 727 children. Out of the 727 children, 652 accepted to take part in the study while the rest were denied permission by their parents. The participants who took part in the experiment are 90% of the whole targeted population. This is a fair representation that can give an accurate result. Eight students from the intervention group left after baseline testing while eighteen students from the control group left at the same time. The exiting of these preschool children may not significantly alter the result or outcome of the study so long as the initially bearing or direction is established. After the exit of the twenty six children the remaining were 626. This number to percentage to the total population is 86%. Looking at this number, it is fairly high and can give an accurate result of the situation at hand. A sample of 342 children was included in the intervention while 310 preschool children were placed in the control group (Trudy, 1997). It is right to say that the sample size used in the study was enough to give reliable results that can be used in making important health promotion decisions. How the results are presented and the main result The main result indicate that a multidimensional culturally tailored directed program of lifestyle intervention improved body fat and fitness, but did not influence body mass index (BMI) in young children who are predominantly migrant (Kaptchuk, 1998). The results are represented in vertical tables. The first table indicates the result of physical fitness during baseline testing, after intervention, and the total estimate of the effect. Both primary and secondary outcomes are represented in the table. Adiposity and physical fitness were the major aspects being affected in the experiment. The mean of result achieved are represented in the tables. The other tables go on to show the other results using same format of tables. Accuracy of the Results The results represented in the study are precise since they summary the objective of the study. It is noted that multidimensional cultural tailored behaviors program of intervention improved body fat and fitness, but not body mass index, in predominantly migrant children who are young. The results indicate there is higher increase significantly higher in aerobic fitness in the intervention group as compared to the control group. The adjusted mean difference against the control group represented to eleven percent of the mean baseline values in the 20 m shuttle run test or to an absolute increase in running distance of fifty six meters. The effect estimates for variables quantitative outcome outline the difference between the mean change in the group of intervention and the control group means change. The effect estimates for variables of binary outcomes were achieved from models of logistic regression and are represented as odds ratio using a 95% confidence interval (Gordis, 2009). The confidence level was 95% in this study. Important outcomes and whether they could be considered Important outcomes were considered and applied. The purpose of the study was to determine the effect an intervention in multidimensional lifestyle on adiposity and aerobic fitness in preschool that are predominantly migrant. Aerobic fitness predicts reduced mortality and morbidity in adults and it is linked to a cardiovascular risk profile that is more beneficial in children. Aerobic fitness in case of children dictates physical activity in future it may assist in sustaining intervention effects that are have been achieved. Consequently in the perspective of a substantial drop in fitness of children for the past 20 years, the improvement in aerobic fitness by a rate of eleven percent in fever of the intervention group that took part in the study is relevant. The prevalence of non-communicable diseases poses a crisis globally, and it affects mostly people who are poor, which boost the already existing inequalities. To overcome this, a strong focusing on primary prevention has been viewed as a priority of health priority. This was clearly demonstrated in the study. Prevalence of overweight especially in the control group started to rise at the end of the period of study. The study was carried out in two linguistically and socio-culturally areas in Switzerland, which showed a clear reflection of the situation in Europe. This indicates that intervention would be more applicable in Europe (Oleckno, 2008). Using preschool intervention that are successful and additional approaches to enhance collaboration by the parents like combining interventions that are school based with interventions in the health context and actions from the community and supporting such programs with broader policy and environmental intervention have to be further investigated in future studies. From the experiment approaches targeting a population that is multicultural of preschool children was unable to change BMI but occasioned improving of body fat and aerobic fitness, which are important determinants of health. Presently Cantonal Health promotion programmes are applying numerous modules of the Ballabeina intervention. Dissemination of the program further can decrease some aspects of chronic diseases and health inequalities that can come up as a result of social inequalities (Strite & Stuart, 2010). References Gordis, L. (2009). Epidemiology (4th ed.). Philadelphia: WB Saunders. Friis R.H., & Sellers, T. A. (2009). Epidemiology for Public Health Practice (4th ed.). Gaithersburg: Jones & Bartlett Publishers. Oleckno, W. A. (2008). Epidemiology – Concepts and Methods. Illinois: Waveland Press Inc Owen, JM.(2006).Program Evaluation: Forms and Approaches. Melbourne; Allen & Unwin. Silman, A. J., & Macfarlane, G. J. (2002). Epidemiological Studies (2nd ed.). Cambridge University Press. Kaptchuk, T.J. (1998). Intentional ignorance: a history of blind assessment and placebo controls in medicine. Bull Hist Med, 72; 389-433. Schulz, KF, Chalmers, I & Atman, DG. (2002). The landscape and lexicon of blinding in randomized trials. JAMA, 285; 2000-2003. Ranjith G (2005). Interferon-α-induced depression: when a randomized trial is not a randomized controlled trial. Psychother Psychosom 74 (6): 387 Trudy D. (1997). Deception, Efficiency, and Random Groups: Psychology and the Gradual Origination of the Random Group Design. Isis 88 (4): 653–673. Stolberg HO, Norman G, & Trop I (2004). Randomized controlled trials. Am J Roentgenol; 183 (6)1539–44. Fletcher, R. H. (2005). Clinical epidemiology: The essentials (4th ed.), Lippincott Williams & Wilkins. Strite SA,& Stuart ME. (2010). Importance of blinding in randomized trials. JAMA, 304(19):2127-8 Read More