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Topic: Childhood Obesity

Please use the template to fill out the “synthesis of the literature” and “practice recommendation” sections. Only two pages needed. The previous sections with background information completed is in the other attachment. That other attachment must be read to understand the last two sections. 

University of Saint Augustine for Health Sciences

NUR7050: Evidence-Based Practice for Healthcare Professionals

NOTE: An abstract is not required

NOTE: This is a template and guide. Delete all highlighted materials.

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Synthesis of the Literature

Synthesize your final primary quantitative research studies and/or systematic reviews; do not include summary articles such as a review of the literature, a clinical article, or a clinical practice guidelines. This section is all about the scientific evidence rather than someone else’s opinion of the evidence. Refer the reader to your evidence table(s). See Table 1 and 2. Do not use secondary sources; you need to get the article, read it, and make your own decision about quality and applicability to your question even if you did find out about the study in a review of the literature. The studies that you cite in this section must relate directly to your PICOT question. This is a synthesis (Table 3) rather than a study-by-study review. Address the similarities, differences, and controversies in the body of evidence.

Practice Recommendations

So. . . using available best evidence, what is the answer to your question? This section is for you to summarize the strength of the body of evidence (quality, quantity, and consistency), make a synthesis statement, and, based on your conclusions drawn from your review of the body of evidence related to your clinical question, give a recommendation for practice change. This would logically be the intervention of your PICOT question. You might want to design an algorithm and include it in as a figure. Perhaps you found substantiation for usual practice, and you recommend reinforcement and education regarding this best practice. Using Johns Hopkins, identify whether this recommendation be graded A, B, or C based on the strength of the evidence.

References

Remember that this is a reference list rather than a bibliography. A bibliography is everything you read to prepare the paper but a reference list is only what you cited. If there is not a citation for a reference, it should not be here. PLEASE make sure that your references and your citations throughout the paper are in APA format. You can go from an A paper to a B paper on APA errors alone. Take the time to make sure that they are correct. We have already formatted the paper for you with this template.

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Table 1

Primary Quantitative Research Evidence (this table may be single space and 10-point font; ONLY primary quantitative research articles should be in this table) Example provided.

Source

Study design

JH Level of Evidence

Population/

Sample

Age
Race/ Ethnicity

Setting/
Location

% dropout

Intervention (IV)

Details

Action

Duration
Fidelity

Comparison/ Control (IV)

Details

Action

Duration

Fidelity

Outcome (DV) &Time

Intervention vs comparison

(statistical test, value, p value)



Grading of evidence

JH Quality Rating

Author’s conclusions

———–


Other outcomes of interest

Your Conclusions

Limitations

Fit/Useful

Abel, 2020

RCT

Level I

196 inter-city

Age 36.4 (8.9) [Range 24 – 49]

55% Male,

40% Black,

62% Latino

73% Medicaid, annual income <$25,000

Setting: Outpatient

Location: Boston, MA

Baseline pain score 6.4 avg on both groups

Dropout: 15/200, 7.5%

Weekly chiropractic adjustment

Assessed & tx

10 weeks

100% of visits over 10weeks

Average total 180 mins

Massage

Medical massage

50 min/wk

100% for 10 weeks

At 10 weeks,

avg pain score

Tx = 3.6

Control = 5.2

(X2 = 7.3; p<.05):

Latino males

Tx = 2.8

Control = 5.7

(X2 = 8.3; p<.001):

Latino women

Tx =6.0

C = 2.8

(X2 = 9.2; p<.001):

Quality A

Pain scores

30% lower w/ wkly chiro compared to 50 mins/wk medical massage

Tx more effective in Latino males

C more effective in Latino women

———

Massage would cost 30% more out of pocket

Tx. Better than control

Chiropractic adjustments effective in general and in Latino males but not in Latino women

Limitations =

-not equal time in tx

-not include high income

Yes/Yes but only if cost covered by Medicaid in my state

Legend: (all abbreviations and acronyms used in the table should be listed here such as: )

Table 2

Evidence Summaries (this table may be single space and 10 point font; ONLY systematic reviews should be in this table) (Example provided)

Source

Study design

JH Level of Evidence

Population/

Sample

Search strategy

Inclusion

Exclusion

N articles addressing your PICOT

Other descriptions

Intervention (IV)

Details

Action

Duration
Fidelity

Comparison/ Control (IV)

Details

Action

Duration

Fidelity

Outcome (DV)

& Time

Mean differences

Intervention vs comparison

Effect size

Heterogeneity

(statistical test, value, p value)

Grading of evidence

JH Quality Rating

Author’s conclusions

——


Other outcomes of interest

Your Conclusions

Limitations

Fit/Useful

Brown, 2018

Meta-analysis

Level I

Medline

OVID

CINAHL

2000-2017

RCTs, conducted in the US, high-quality (>21/25 points on CONSORT), comparing regular chiropractic adjustment vs regular medical massage for chronic pain measured using a 0-10 scale

10 RCTs of low back pain

Exclusions

Studies of phantom pain

Total participants N=867

Avg age 59 (6)

Avg baseline pain scores 3.2 (3.4)

Avg Dropout:

8% (4) Only completers included in this analysis

Chiropractic adjustment in office

Most weekly

(2/10 allowed 2x wk)

Fidelity

All > 80%

Massage

45-60 mins

Most weekly

(2/10 allowed 2x wk)

Fidelity

All >86%

At 8 weeks

N=4

Tx = 3.6

Control = 5.2

(RR for 2 point pain reduction= 1.6 (1.1-2.3); p=.04):

I2= 10%


At 12 weeks

N=6

Tx = 3.2

Control = 4.8

(RR for 2 point pain reduction= 1.7 (1.4-2.4); p=.04):

I2= 13%

Quality B due to no ITT

wkly chiropractic adjustment was more effective than weekly massage for reducing chronic pain based on the data from these studies

—none

Tx. Better than control

High dropout rate and not analyzed with ITT

Partially- my population is much younger on average

Partially- my population has a variety of pain sources

Useful- yes

Add more

Legend: (all abbreviations and acronyms used in the table should be listed here)

Table 3.

Synthesis Matrix (identify the trends; this table may be single space and 10 point font; ONLY primary quantitative research articles or systematic reviews should be in this table; use only the highest level and quality of evidence; if the evidence is of mixed level or mixed quality, sort the trends using the Johns Hopkins Appendix H; trends must be related to the outcome) (example provided regarding effective pain management which may or may not be within your scope of practice- make sure your PICOT is within your scope of practice.)

Main ideas

Albright (2020)

Reference 2

Reference 3

Reference 4

Reference 5

Add columns as necessary

Weekly chiropractic adjustment equally effective as weekly massage

Biweekly chiropractic adjustment associated with 30% lower pain scores compared to weekly massage in those with back pain

In those with a mean age under 50, weekly massage associated with 20% lower pain scores compare to chiropractic adjustments

Add more as needed

Figure 1

Results of Search for Research

Use

http://prisma.thetacollaborative.ca/

to generate a diagram describing the results of your search. Paste it here.


Obesity In Children

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Obesity in Children Comment by Shawna Butler: Bold this heading

An apple does not fall far from the tree. A saying that has been referenced in conversations involving children who have acquired specific traits from their parents. Among these traits is obesity, both genetic and lifestyle-related obesity. A child is classified as obese when his or her weight is well above the normal for their age and height (CDC, 2021). Comment by Shawna Butler: Use “their weight” instead of his/hers

One of the tools widely used to gauge obesity is the body mass index (BMI). The BMI needs to be compared against age and sex growth charts as children gain weight and muscle a different rate with age. Normal BMI for boy’s ranges from 13.8 to 16.8 at five years, 14.2 to 19.4 at ten years, and 16.5 to 23.4 at fifteen years. Normal BMI for girls ranges from 13.6 to 16.7 at five years, 14.0 to 19.5 at ten years and 163 to 24.0 at fifteen years (CDC, 2021). Discussed in this paper is the relation of parent health patterns and their probability of affecting their children’s weight.

Significance of the Practice Problem

BMI values that lie above the higher percentiles very likely indicate obesity. Obesity puts the child at a higher risk of chronic lifestyle diseases such as hypertension, diabetes, and cardiovascular diseases (Henderson, 2021). Not only does it affect their physical well-being, but it also exposes them to psychological issues including low self-esteem issues, bullying, eating disorders and depression (Angawi, & Gaissi, 2021). Comment by Shawna Butler: Add a little more detail here. Two sentences is probably not enough to lay the foundation for the significance of the problem for the entire premise of the question.

Address significance to family, health system, finances, society, etc.

Include the incidence and prevalence and any other relevance like disability issues, etc. Use the template as a guide. Include sources.

PICOT Question

In adolescent patients under the age of 12 who have obese parents (P) what is the effect of a dietitian and exercise program (I) compared to children who did not have a dietitian and exercise program (C) on preventing the adolescent from having a BMI over the 85th percentile range (O) within one year (T)? This is our main question of concern throughout this article. A child’s health and well-being are fostered by a home environment with engaged and skillful parenting that models, values, and encourages sensible eating habits and a physically active lifestyle. Parents can have a great influence on their children that is marked when they serve as role models who promote specific values and reinforce or punish certain behaviors. It is no surprise that sedentary behaviors and their resultant diseases tend to trail within families. Not to ignore that some of these risk factors rise from genetic components, but most are strongly influenced by behavioral aspects. The family is thus an appropriate and important target for interventions designed to prevent obesity in children through increasing physical activity levels and promoting healthful eating behaviors (Kraak, Liverman, & Koplan, 2005). Comment by Shawna Butler: Good question with detail that addresses each section Comment by Shawna Butler: This is the research question that will be addressed in this paper. Comment by Shawna Butler: Some of this paragraph can probably go above in the significance of the problem part where detail is missing elaborating on the importance of why this is an issue.

Population/Problem

The population of interest was mainly lower to middle class households where one or more of the parents is diagnosed as obese. The variables in this case were BMI values (to assess obesity), type of food eaten (fast food or home cooked meals), exercise patterns of the family members, education level of the parents and age of both the parents and children. By the end of the study, parents should be able to identify their role in encouraging healthy lifestyles in their children, combat childhood obesity, and understand the significance of teaching children healthy diet and exercise habits. Comment by Shawna Butler: Any sources you can cite here to support your chosen population?

Intervention

The above families were monitored for six weeks to assess their daily nutrition-exercise pattern. During the first meet-up of the parents and research assistants, the parents were given evaluator questionnaires to fill out to determine their household structure and lifestyle patterns. After the first six weeks elapsed, the families were provided with diet plans and exercise routines to follow through the next twelve weeks to help rate whether there would be a difference in the weight status of the family members, including the children. Following the 12 weeks, the familial progression was assessed. Each family met with the dietitian to review progress and measure the success of current goals. At the conclusion of this meeting, new goals were set for the next 34 weeks, and a final meeting at the one-year conclusion of the intervention was scheduled. Comment by Shawna Butler: Need to include sources in this section to support why you chose this intervention. What sources support this method?

Do not skip this space

Comparison

The level of adherence of parents and children in this program was compared to parents and children who did not have a dietitian and exercise program in place. A comparison was also done between the households that switched to the healthier meal and exercise options and those that chose to stick to their usual routine. Comment by Shawna Butler: This section needs more detail. See the template for more tips as to what should be included. Also include sources to support why this is your comparison group.

Outcome

The study outcome will mainly focus on weight changes in the obese children at the end of the year. It is anticipated that the parents will cooperate and stick to the plan of action during the study period. Both the parents’ and children’s weights and height will be measured at the beginning and BMI will be calculated to determine how obese they are. These same parameters will again be measured at the end of the study to determine whether there will be any significant changes. Comment by Shawna Butler: What is the measure you will use to determine it has changed? How much does it need to change to be positive correlated with “healthy behaviors”? Also need to include sources here in this section to back up why you chose this outcome.

Timing

The study is timed at fifty-two weeks or one year. The first six to assess the sample household lifestyles while the following forty-six will focus on replacing the unhealthy lifestyles with healthier choices and assess the results. A twelve-week check-in will be scheduled to make any necessary adjustments. Comment by Shawna Butler: This is good since it will take a longer time to see if any real change has occurred. Just be sure to also add sources.

Search Strategy and Results

The inclusion criteria included obese adults with children as well as non-obese adults with obese children. Parents working more than eight hours a day who leave their children under minimal supervision while they’re at work were also considered for the study. Parents with a higher level of education (those that completed their tertiary training) have greater adherence to providing healthier meal options to their families at least twice every day, compared to those that dropped out in high school. Previously obese members from households that embraced the healthier meal options and exercise plans showed a significant reduction in weight compared to those from the households that chose to stick to their routine unhealthy diet options and non-exercising lifestyle.

Do not skip this space

Conclusion

In summary, it is evident that parental diet and exercise habits are greatly reflected in their children’s weight gain patterns. Genetic obesity aside, adults who became obese because of their carefree lifestyle choices are highly likely to have obese children. As seen in the paper, they do not take the initiative to train their children through sensibly healthy eating habits and physical exercise since they themselves have not been through these choices.

References

Angawi, K., & Gaissi, A. (2021). Systematic Review of Setting-Based Interventions for

Preventing Childhood Obesity. BioMed Research International, 1–10. https://doi.org/10.1155/2021/4477534

Center for Disease Control and Prevention. (2021). Healthy Weight, Nutrition, and Physical

Activity. Retrieved from:

https://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html

Henderson, N. N. (2021). Childhood Obesity: Improving Outcomes Through Primary Care-

Based Interventions. Pediatric Nursing47(6), 267–300.

Kraak, V. A., Liverman, C. T., & Koplan, J. P. (Eds.). (2005). Preventing childhood obesity:

health in the balance.