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Epidemiology: Family Involvement And Parenting Skills

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Epidemiology: Family Involvement And Parenting Skills Question: Discuss about the Epidemiology for Family Involvement and Parenting Skills.   Answer: Introduction: The obesity among children has become prevalent over the last few years. Family involvement and parenting skills can be effective in management of obesity (Waters, E et al., 2014). In this assignment, the childhood obesity is addressed along with effective intervention. The article “Golley, R. K., Magarey, A. M., Baur, L. A., Steinbeck, K. S., & Daniels, L. A. (2007). Twelve-month effectiveness of a parent-led, family-focused weight-management program for prepubertal children: a randomized, controlled trial. Pediatrics, 119(3).” is critically analysed based on the evidences from other similar studies.  Intervention In the study, mainly two interventional groups were selected. One of the intervention groups was based on the skill training of the parents; the other intervention group was based on training of parenting skills as well as those who attended more than seven intensive care and support program. The third group included wait listed controls and they obtained the similar life style demonstrations as that of the first group (Golley et al., 2007).  Outcome The outcomes were evident from the Table 3 of the article. It was depicted from the given table that the baseline study population or the 12 months study group had no significant difference. It was illustrated from the table that there was a prominent decrease in the diastolic blood pressure at six months rather than at twelve months in comparison to the baseline study group.  Study Design The chosen study was based on a randomized, single blinded, controlled trial design. Child weight management interventions of parenting skills training with intensive lifestyle education and parenting skills training alone were estimated. A comparison was made between these two groups and both of the groups were compared with a third group of wait listed controls for a duration of 12 months. The parents and the control group, both were given a common life style pamphlet.  The study was made in two metropolitan hospitals. It had an approval from concerned ethics committee. The design, study conduct and reporting patterns were done in accordance to the outlined guidelines under the CONSORT standards.    Study Population The study involved 111 participants, 64% of them were female. The inclusion criteria the children of age between 6-9 years, overweight and having patents or caregivers willing to participate in the program, having ability to read and apprehend English language. The exclusion criteria involved children with body mass index < 3.5, detected with acute obesity due to medicine use affecting their body weight. Their physical or growth profiles, presence of anomalies or severe ailments were examined. Telephonic interviews were used to assess the eligibility of the participants to be included into the study design. The informed consent forms were obtained from the parents of the selected subjects as per the guidelines  Findings A prominent declination in BMI score was observed for all the groups over a period of 1 year. The training of the parenting skills along with a healthy family lifestyle might be impactful for management of weight in the prepubescent children (Golley et al., 2007). Observed association between the exposure and outcome (non-causal explanations) The association between the exposure and outcomes are not attributed to non-casual explanations. Non-causal relationship was not found between the interventions and health outcomes. In a non-casual relationship, the variables are associated with each other, but one variable is not directly affected by the other variable. This is evident from the study results. It was found that the impact of family involvement including the training of parenting skills was positive towards the management of obesity among children within the age group between six to nine years. A non-causal association occurs in two ways. The non-causal association may prevail in case a disease has caused the exposure and not the exposure that had caused the disease. The other way in which association can be said as non-causal, when the outcome or a disease and the exposure, both of them are associated with confounding factor. In this present study, no such third confounding factor had been found. A non-causal association can be determined by inspecting the parameters like selection or measurement practice, confounding factor and chance variation (Richmond et al., 2014).    Selection Or Measurement Bias  In this present study, the results were not found to be affected by selection/ or measurement bias. The selected study was based on a randomized trial design. The limitations like the selection or measurement bias were avoided. In a randomized trial, the randomization facilitates the selection of samples randomly and hence the bias of the selection is preliminarily reduced. A randomized control trial is the one, which is designed ethically and carefully. This trial design applies for accurate and sufficient controls through randomization processes. This kind of randomization designs is capable of answering precise study questions. The randomized controlled trials are mainly applied to such studies where the potential and efficacy of a new healthcare strategy is to be determined through a systemic study methodology (Bulpitt, 2012). The selected study also aimed at evaluating a new family oriented parenting skill developing strategy for obesity management among children. According to a study, parents and behavioural interference in management of weight in preschool obese children was found to be positive. It was a randomized controlled trial in which, 42 children within 2 to 5 years of age were involved.  Their body mass index was calculated to be greater than 95. The selections of the subjects were done randomly. They were assessed at baseline, for a period of 6 months and 1 year. It was found that parental and family involvement had prominent influence over the children in reducing the body mass index (Stark et al., 2014). Hence, it can be stated that random selection can be beneficial for such studies in which new approaches towards healthcare are accounted. Moreover, the selected study is devoid of any measurement bias as a skilled assessor who was blinded to the subject allocation made the measurements and hence, the measurements were done without any bias, maintaining the neutrality of the trial design (Golley et al., 2007). This kind of randomization ensures avoidance of bias in context to both measurement and selection.  Confounding            Confounding factors affecting the study results of the selected article can be illustrated well. A confounding factor is the one, which can affect the exposure or the outcome association. It may be positive or negative. The factors like sex, age, parent and child relationship, ethnicity, family organization, number of children present in the family and marital status might affect a study result. However, in this study, Australian Socioeconomic Index assessed the demographic as well as socioeconomic status of the family and children appropriately. Moreover, the weight status of the parents were also analysed in accordance with World Health Organization (Skelly, Dettori & Brodt, 2012). The probable confounding factors that might intervene and distort the study results were considered for conducting the study. The age group taken was narrow, yet age appropriate for determining the effectiveness of parental involvement and training skills for weight management of prepubertal children (Golley et al., 2007). A study was made to investigate the effectiveness of parental involvement in preventing the obesity among children. It was a parallel randomized controlled trial design. It involved 86 obese children and the selection were made randomly. The confounding factors like child characteristics, birth date, sex, parental employment and income status and weight were analysed appropriately. However, there were certain differences in baseline characteristics in the control and intervention groups (Gerards et al., 2015). In the selected study, there might be some negative effect sue to confounding factors. However, the factors were addressed well in the study, but the baseline differences of the randomly selected group might intervene the study results.    Chance Variation             The chance variation that might affect the results of the chosen study can be demonstrated well. Chance variation is also called random error, which is innate error of such statistical methodologies. A parameter like chance variation measures the differences in the anticipated value and the original value of statistical model. It generally occurs in a random fashion. They cannot be controlled in any of the studies irrespective of the accuracy of the model. Hence, presence of a random error does not imply that the model has reduced credibility. In the present study, there was an unpredicted error associated inherently. The BMI Z score reduction in the control population might produce the chances of type two errors (Golley et al., 2007). A study was conducted to determine the impact of behavioural patterns of the parents and family in weight management of the children. The study was based on a randomized controlled trial design. It was a community-based study in Australia. The study involved 570 subjects within the age group of 7 to 13 years. The random error that might have occurred in the study may attribute to its limitations. However, the error did not underestimate the relevance and credibility of the study design (Redfern et al., 2016). Another study was conducted to predict the effect of family and parent oriented treatment approaches in obesity management among children. The study includes 80 participants of age 10 years and parent’s age of 43 years. The measurements were calculated at baseline, 5 months and throughout a follow up period of 11 months. All the confounding factors and related errors were addressed well, still an intrinsic error in the treatment group was found that might have affected the study results. The error rate was detected to be 0.05 and accordingly measures were taken to reduce them by Hochberg’s adjustments (Boutelle, Cafri & Crow, 2012). Evidence Of A Causal Association Between The Exposure And The Outcome In the selected study, the causal association between exposure and outcome can be explained evidently. A causal relationship between two variables exists when there is a direct influence of one variable on the other. A causal relationship is assessed based on evaluations of temporal relationship, strength of association and dose-response relationship (Szklo & Nieto, 2012).  Temporal Relationship            In a temporal relationship, the intervention predates the outcome. It implies that the outcome is predominantly occurring due to the particular exposure. The strength of the relationship between exposure and result can be determined by adequate analysis of statistical models. It implies a causal association. Dose-Response Relationship  A dose-response relationship between outcomes and exposure also indicates a causal relationship. In this study, a causal association exists between the family led parenting skill training and obesity management in children. Internal Validity            The internal validity of a study implies the way the study has been made, it is determined that the confounding factors are avoided in the study. A study has higher internal validity when there is a less chance of confounding in the research study (Leow & Hama, 2013).  In the selected study, it was found that all the confounding factors like age, gender, socioeconomic status were considered and avoided accurately.  Hence, the study indicated a causal association between the exposure and outcome. It was evident from the findings that the BMI of the children were reduced with parenting skills along with good lifestyle pattern as well as skills training of the parents alone. However, there was a gender variation in the study; the results were found to be more consistent with the boys within the selected study group. Consistency  The results of a study are said to be consistent when it is found to be complying with other studies. Several other studies with different settings are to be reviewed for analysing the consistency of a study. The study also needs to be conducted to comprehend the different aspects of the issue; hence, participants of both the genders were to be considered in the studies.  However, the consistency of the results within the study itself is also significant in determining the validity of the study. Internal consistency in a research study is determined by assessing the correlation among various items based on the same criterion (Sabet, Azad & Taghizadeh, 2016).  In the present study, the overall growth and neural adiposity of the participants were measures. It was identified that the subject’s height increased within the period of baseline and 12 months, which indicated a consistent result with the control population. The reduction in the BMI reading occurred in all the groups, 9% in the parents skill along with intensive program group, 6% in the parents skill alone and a reduction of 5% in the control group was observed.            An increase in BMI score was observed in 45% of the control group as compared to 19% in parents and intensive support group and 24% in parenting skill group alone. It was found that there was significant decrease in the BMI score among the boys. A statistical sub analyses was not included in the measurement criterion of the study as the gender effect was not anticipated previously (Golley et al., 2007).  The results and statistics show that there was internal consistency of the results within the study. The internal validity is maintained within the study as it was conducted by applying standard protocols and a blinded assessor was involved for assessing the parameters and subjects in addition to eliminating the chances of site bias.    Consistency Of Findings With Other Evidence  The findings of the study were that the BMI Z score of the intervention groups and control group was reduced significantly over a period of 12 months. There was a gender effect prominent, which showed more decrease in the BMI Z score among boys in comparison to the girls of the selected study population.            According to a pilot study, a comparison was made regarding weight management of obese children with and without parental interventions. It was found that after the intervention, the children showed improvements in weight management, physical and mental wellbeing. Healthy food habits and intensive support by the patent increased the efficacy of the intervention and reduced the obesity among the children of the relevant population group (Davison et al., 2013).  According to a study, the parental involvement improved the weight management program intended for the obese children of age 9 to 12 years. Parenting skills and lifestyle changes were found to be impactful in weight management of the children. The parental involvement in child weight management was found to be effective for longer period of time (Kruk et al., 2013).  Another study was made to evaluate the family relationship and weight management in adolescents. The relationship was measured with the help of multiple linear regression model.  It was found that family involvement in the weight management of the obese adolescents was effective on case of both female and male subjects (Berge et al., 2013).  Hence, from the similar studies the findings of the selected article was found to be consistent. Therefore, the study findings accord with the other evidences. Plausibility  Plausibility of a study determines whether the association between exposure and outcome complies with the current biological or pathological basis. The results are plausible in terms of biological mechanism.  According to a study, the parental perception has a great impact on the weight management of children. It was found that genetic inheritance has a significant role in this context. The children with obese parents were more likely to be obese and it was found that the parents with obesity problems are less concerned regarding the eating habits (Musaad et al., 2013). External Validity /Generalisability  Generalisability is defined as the magnitude to which the study findings could be applicable to a different setup other than the selected study. The external validity of a study depends on the compliance with the other studies. The study was compliant with all the standards and might be applicable to other populations as well.  According to a study, the weight management of children were treatment specific and were analysed by a randomized in a trial. The study included female based on socio economic status and family involvement status. It was found that children with good family support were found with improved weight management. Hence, it is consistent with the selected study (Goldschmidt et al., 2014).   Another study was made to investigate the effectiveness of family and parental interventions as compared to a standard intervention in treating the obesity among the children. It was a randomized controlled trial study. The study involved 72 children who were overweight. The measurements were made anthropometrically at baseline, duration of 3 month and 6 months. It was found that as compared to standard approaches, the parenteral behavioural approach was more effective in treating the obese children as evident from the reduction in BMI Z score (Saelens, Lozano & Scholz, 2013).  According to another study, better weight management can be obtained in adult individuals and youths. The study involved 101 obese children within the age group of 7 to 12 years and obese parents. It was concluded that more adherence to the weight management and family support program increased the chances of better outcomes in terms of reduction on body mass index. Hence, it complies with the selected study (Theim et al., 2013).   References:  Berge, J. M., Wall, M., Larson, N., Loth, K. A., & Neumark-Sztainer, D. (2013). Family functioning: associations with weight status, eating behaviors, and physical activity in adolescents. Journal of adolescent health, 52(3). Boutelle, K. N., Cafri, G., & Crow, S. J. (2012). Parent predictors of child weight change in family based behavioral obesity treatment. Obesity, 20(7). Bulpitt, C. (2012). Randomised controlled clinical trials. Springer Science & Business Media. Davison, K. K., Jurkowski, J. M., Li, K., Kranz, S., & Lawson, H. A. (2013). A childhood obesity intervention developed by families for families: results from a pilot study. International Journal of Behavioral Nutrition and Physical Activity, 10(1). Gerards, S. M., Dagnelie, P. C., Gubbels, J. S., Van Buuren, S., Hamers, F. J., Jansen, M. W., ... & Kremers, S. P. (2015). The effectiveness of Lifestyle Triple P in the Netherlands: a randomized controlled trial. PloS one, 10(4). Goldschmidt, A. B., Best, J. R., Stein, R. I., Saelens, B. E., Epstein, L. H., & Wilfley, D. E. (2014). Predictors of child weight loss and maintenance among family-based treatment completers. Journal of consulting and clinical psychology, 82(6). Golley, R. K., Magarey, A. M., Baur, L. A., Steinbeck, K. S., & Daniels, L. A. (2007). Twelve-month effectiveness of a parent-led, family-focused weight-management program for prepubertal children: a randomized, controlled trial. Pediatrics, 119(3). Kruk, J. J., Kortekaas, F., Lucas, C., & Jager?Wittenaar, H. (2013). Obesity: A systematic review on parental involvement in long?term European childhood weight control interventions with a nutritional focus. obesity reviews, 14(9). Leow, R. P., & Hama, M. (2013). Implicit learning in SLA and the issue of internal validity. Studies in Second Language Acquisition, 35(03). Musaad, S., Paige, K. N., Teran-Garcia, M., Donovan, S. M., Fiese, B. H., & Strong Kids Research Team. (2013). Childhood overweight/obesity and pediatric asthma: the role of parental perception of child weight status.Nutrients, 5(9). Redfern, J., Enright, G., Raadsma, S., Allman-Farinelli, M., Innes-Hughes, C., Khanal, S., ... & Gyani, A. (2016). Effectiveness of a behavioral incentive scheme linked to goal achievement: study protocol for a randomized controlled trial. Trials, 17(1). Richmond, R. C., Al-Amin, A., Smith, G. D., & Relton, C. L. (2014). Approaches for drawing causal inferences from epidemiological birth cohorts: a review. Early human development, 90(11). Sabet, A., Azad, A., & Taghizadeh, G. (2016). Test-retest Reliability, Convergent Validity, and Internal Consistency of the Persian Version of Fullerton Advanced Balance Scale in Iranian Community-dwelling Older Adults. Iranian Journal of Ageing, 10(4). Saelens, B. E., Lozano, P., & Scholz, K. (2013). A randomized clinical trial comparing delivery of behavioral pediatric obesity treatment using standard and enhanced motivational approaches. Journal of pediatric psychology. Skelly, A. C., Dettori, J. R., & Brodt, E. D. (2012). Assessing bias: the importance of considering confounding. Evidence-based spine-care journal,3(01). Stark, L. J., Clifford, L. M., Towner, E. K., Filigno, S. S., Zion, C., Bolling, C., & Rausch, J. (2014). A pilot randomized controlled trial of a behavioral family-based intervention with and without home visits to decrease obesity in preschoolers. Journal of pediatric psychology, 39(9). Szklo, M., & Nieto, J. (2012). Epidemiology. Jones & Bartlett Publishers. Theim, K. R., Sinton, M. M., Goldschmidt, A. B., Van Buren, D. J., Doyle, A. C., Saelens, B. E., ... & Wilfley, D. E. (2013). Adherence to behavioral targets and treatment attendance during a pediatric weight control trial.Obesity, 21(2). Waters, E., Silva-Sanigorski, A. D., Burford, B. J., Brown, T., Campbell, K. J., Gao, Y., ... & Summerbell, C. D. (2014). Interventions for preventing obesity in children. Sao Paulo Medical Journal, 132(2).

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