Healthcare Professionals’ Perceptions of Childhood Obesity in Iquitos, Peru: A Qualitative Study

Background: Childhood obesity is an urgent worldwide concern associated with increased morbidity in adulthood. Healthcare professionals (HCPs) are well placed to influence childhood obesity trends and implement interventions. English-language studies regarding HCPs’ perceptions of childhood obesity are limited to high-income countries. Peru is an upper-middle-income country with regional disparities in childhood obesity prevalence. This qualitative study aims to explore HCPs’ perceptions of childhood obesity in Iquitos, Peru, where prevalence is relatively low.Methods: Twenty-one HCPs with child healthcare experience were purposively recruited from two primary healthcare centres. Semi-structured, individual interviews were conducted with a translator and audio recorded. Transcribed data were analysed using thematic analysis.Results: Eight themes were identified and divided into four categories: (1) HCPs’ perceptions and attitudes towards childhood obesity (level of concern regarding childhood obesity, perceived consequences of childhood obesity); (2) Factors which HCPs perceive to be important in the development of childhood obesity (parental factors, contextual factors); (3) HCPs’ perceptions of their role in childhood obesity prevention and management (educating parents about childhood obesity, regular monitoring of child growth); and (4) Barriers and facilitators in childhood obesity prevention and management (in healthcare, in schools). Conclusions: HCPs had a low level of concern regarding childhood obesity in Iquitos and prioritised undernutrition. Parental factors were perceived to be the most influential in the development of childhood obesity. HCPs perceived themselves to have minimal influence due to prevailing positive views of excess weight and difficulties engaging parents. Educating parents about childhood obesity was felt to be essential to prevention and management although regular monitoring of child growth and home healthcare visits were viewed as useful additional measures. This study can help to inform the development of targeted public health strategies which are sensitive to local contexts and could prevent the upward childhood obesity trends evident elsewhere in Peru.

Subchondral bone microenvironment in osteoarthritis and pain

Osteoarthritis comprises several joint disorders characterized by articular cartilage degeneration and persistent pain, causing disability and economic burden. The incidence of osteoarthritis is rapidly increasing worldwide due to aging and obesity trends. Basic and clinical research on osteoarthritis has been carried out for decades, but many questions remain unanswered. The exact role of subchondral bone during the initiation and progression osteoarthritis remains unclear. Accumulating evidence shows that subchondral bone lesions, including bone marrow edema and angiogenesis, develop earlier than cartilage degeneration. Clinical interventions targeting subchondral bone have shown therapeutic potential, while others targeting cartilage have yielded disappointing results. Abnormal subchondral bone remodeling, angiogenesis and sensory nerve innervation contribute directly or indirectly to cartilage destruction and pain. This review is about bone-cartilage crosstalk, the subchondral microenvironment and the critical role of both in osteoarthritis progression. It also provides an update on the pathogenesis of and interventions for osteoarthritis and future research targeting subchondral bone.

A COVID-19 Crisis in Child Physical Fitness: Creating a Barometric Tool of Public Health Engagement for the Republic of Slovenia

The Republic of Slovenia implements the largest longitudinal database of child physical fitness in the world–SLOfit. Slovenia has some of the most physically active children globally, and it has responded rapidly to incorporate national physical activity (PA) interventions throughout the COVID-19 pandemic. Despite aggressive campaigns to maintain PA at home, the country has seen a tremendous decrease in child physical fitness over the past several months as self-isolation measures have been mandated by national authorities. These trends prompted researchers to create a method of tracking and communicating government decisions which have a direct impact on child physical activity, fitness and overall health (i.e., the SLOfit Barometer). The research team assembled experts for consultation on creation of the SLOfit Barometer after processing preliminary data on 20,000 schoolchildren which found the greatest decline in child physical fitness since systematic testing began more than 30 years ago. Only 2 months of self-isolation erased over 10 years of hard-fought health gains acquired from national public health policies and PA interventions. This crisis in child fitness requires integrated community participation and a robust public health policy response, and with the SLOfit Barometer acting as a national bellwether system, it is envisioned that policy makers and the public will advocate for bold, progressive actions to combat this national health emergency. This surveillance tool tracks government action to combat the increasing child physical inactivity and obesity trends brought on as a direct result of COVID-19 isolation regulations.

Trends in Obesity and Medical Expenditure among Women with Diabetes, 2008-2016: Differences by Race/Ethnicity

Objectives: Diabetes results in $327 billion in medical expenditures annually, while obesity, a risk factor for type 2 diabetes, leads to more than $147 billion in expendi­ture annually. The aims of this study were: 1) to evaluate racial/ethnic trends in obesity and medical expenditures; and 2) to assess incremental medical expenditures among a nationally representative sample of women with diabetes.Methods: Nine years of data (2008–2016) from the Medical Expenditure Panel Survey Full Year Consolidated File (unweighted = 11,755; weighted = 10,685,090) were used. The outcome variable was medical expenditure. The primary independent variable was race/ethnicity defined as non-Hispanic Black (NHB), Hispanic, or non-Hispanic White (NHW). Covariates included age, education, marital status, income, insurance, employment, region, comorbidity, and year. Cochran-Armitage tests determined statistical significance of trends in obesity and mean expenditure. Two-part modeling using Probit and gamma distribution was used to assess incremental medical expenditure. Data were clustered to 2008-2010, 2011-2013, 2014-2016.Results: Trends in medical expenditures dif­fered significantly between NHB and NHW women between 2008-2016 (P<.001). His­panic women paid $1,291 less compared with NHW women, after adjusting for rel­evant covariates. There were no significant differences in obesity trends from 2008- 2016 between NHB (P=.989) or Hispanic women with diabetes (P=.938) compared with NHW women with diabetes.Conclusions: These findings suggest the need to further understand the factors asso­ciated with differences in trends for medical expenditures between NHB and NHW women with diabetes and incremental med­ical expenditures in Hispanic women with diabetes compared with NHW women with diabetes.Ethn Dis. 2020;30(4);621-628; doi:10.18865/ed.30.4.621