RESUMO
OBJECTIVE: To identify the medical, demographic, and behavioral factors associated with a reduction of body mass index percent of the 95th percentile (BMIp95) after 1 year for patients receiving care at a tertiary care obesity management clinic. STUDY DESIGN: A retrospective review of data from first and 12 ± 3-month follow-up visits of subjects aged 8-17 years with obesity. Data included anthropometrics, demographics, medical/psychological history, reported diet patterns, and participation in moderate/vigorous physical activity. After analyzing factors associated with 1-year follow-up, we used a forward conditional logistic regression model, controlling for subject's sex, to examine associations with a BMIp95 ≥5-point decrease at 1 year. RESULTS: Of 769 subjects, 184 (23.9%) had 1-year follow-up. Boys more often had follow-up (28.4% vs girls, 19.1%; P = .003). The follow-up sample was 62.0% male, 65.8% Hispanic, and 77.7% with public insurance; 33.2% achieved a ≥5-point decrease in BMIp95. In regression results, the ≥5-point decrease group was more likely to have completed an initial visit in April-September (OR 2.0, 95% CI 1.1-3.9); have increased physical activity by 1-2 d/wk (OR 3.4, 95% CI 1.4-7.8) or increased physical activity by ≥ 3 d/wk at 1 year (OR 2.7, 95% CI 1.1-6.3); and less likely to have been depressed at presentation (OR 0.4, 95% CI 0.2-0.9). Demographic and dietary factors were not significantly associated with BMIp95 group status. CONCLUSIONS: Strategies improving follow-up rates, addressing mental health concerns, and promoting year-round physical activity are needed to increase the effectiveness of obesity management clinics.
Assuntos
Exercício Físico , Obesidade Infantil/terapia , Redução de Peso , Adiposidade , Adolescente , Índice de Massa Corporal , Criança , Depressão/complicações , Comportamento Alimentar , Feminino , Humanos , Masculino , Obesidade Infantil/complicações , Obesidade Infantil/psicologia , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To assess the prevalence of elevated blood pressure (BP) and its identification among outpatients at a pediatric tertiary care hospital and to assess clinician attitudes towards BP management. STUDY DESIGN: A retrospective review was undertaken of electronic medical record data of visits over the course of 1 year to 10 subspecialty divisions and 3 primary care services at an urban tertiary care hospital. Interviews of division/service representatives and a clinician survey on perceived role on BP care, practices, and protocols related to BP management were conducted. Elevated BP was defined as ≥90th percentile (using US references); identification of elevated BP was defined as the presence of appropriate codes in the problem list or visit diagnoses. RESULTS: Among 29,000 patients (ages 2-17 years), 70% (those with ≥1 BP measurement) were analyzed. Patients were as follows: 50% male; 42% white, 31% Hispanic, 16% black, 5% Asian, and 5% other/missing; 52% had Medicaid insurance. A total of 64% had normal BPs, 33% had 1-2 elevated BP measurements, and 3% had ≥3 elevated BP measurements. Among those with ≥3 elevated BP measurements, the median frequency of identification by division/service was 17%; the greatest identification was for Kidney Diseases (67%), Wellness & Weight Management (60%), and Cardiology (33%). Among patients with ≥3 elevated BP measurements, 21% were identified vs 7% identified among those with 1-2 increased measurements (P<.001). All clinician survey respondents perceived self-responsibility for identification of elevated BP, but opinions varied for their role in the management of elevated BP. CONCLUSIONS: The identification of patients with elevated BP measurements was low. Strategies to increase the identification of elevated BPs in outpatient tertiary care settings are needed.
Assuntos
Assistência Ambulatorial/organização & administração , Hipertensão/diagnóstico , Pediatria/organização & administração , Atenção Terciária à Saúde/organização & administração , Adolescente , Atitude do Pessoal de Saúde , Pressão Sanguínea , Criança , Pré-Escolar , Registros Eletrônicos de Saúde , Feminino , Humanos , Modelos Logísticos , Masculino , Sistemas Computadorizados de Registros Médicos , Análise Multivariada , Pacientes Ambulatoriais , Estudos RetrospectivosRESUMO
We evaluated pediatric obesity clinics for internal referrals developed at 5 primary care offices. Clinics developed site-specific strategies: 1 group approach and 4 clinics providing individualized care only. Clinicians reported patient/family motivation as an important referral consideration and compliance as the greatest challenge and perceive clinics to have provided some help.
Assuntos
Obesidade/terapia , Padrões de Prática Médica , Atenção Primária à Saúde , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , MasculinoRESUMO
OBJECTIVES: To assess the frequency and recognition of abnormal nutritional status and elevated admitting blood pressure (BP) in hospitalized children. STUDY DESIGN: From children aged 3 to 18 years who were hospitalized during 4 months of 2005 (n = 1143), a stratified sample of paper-based medical records were reviewed for demographics, anthropometric and BP measurements and interpretations, care related to nutrition and BP, and discharge diagnoses. Records of 317 of 337 (94%) selected patients were reviewed, and data from 277 of these patients (records with weight and height documented) were analyzed. US references were applied to assign body mass index and BP percentiles. Data were weighted to account for sampling. RESULTS: A total of 51% of subjects were Medicaid/self-pay, with a median age of 9.1 years; and 20% of subjects were obese (14% overweight, 58% healthy weight, 8% underweight). Body mass index was plotted/calculated for 35% of subjects. Six percent of subjects had BP >99th percentile + 5 mm Hg (18% BP 95th to < or =99th percentile + 5 mm Hg). A nutrition referral was documented for 61% of subjects who were underweight and 39% of subjects who were obese. BP concerns were documented for 26% of subjects with BP >99th percentile + 5 mm Hg. CONCLUSIONS: Many pediatric inpatients had abnormal nutritional status or elevated BP. Systems to improve interpretation of these measures, which are commonly obtained in pediatric hospital settings, are needed.
Assuntos
Pressão Sanguínea , Documentação , Hospitalização , Hipertensão/epidemiologia , Estado Nutricional , Adolescente , Distribuição por Idade , Índice de Massa Corporal , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Medicaid/estatística & dados numéricos , Auditoria Médica , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Obesidade/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Distribuição por Sexo , Magreza/epidemiologia , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To pilot a practice-directed intervention to promote growth interpretation and lifestyle counseling during child health supervision visits. STUDY DESIGN: The intervention at 4 diverse primary care practices included education, facilitation by a practice-change leadership team, tools, and guidance from the study team. Preintervention and postintervention evaluations used were clinician interviews, in-office surveys of parents, 1-month post-visit telephone survey, visit observations, and medical record reviews. Outcomes evaluated growth interpretation documentation, clinician recognition of overweight, topic discussed at health supervision visit, and parental visit content recall and health behavior changes. RESULTS: The intervention was well accepted, and tools provided were deemed helpful. Documentation of growth interpretation was higher after intervention (pre versus post: 32% vs 87%; P< .001). Parent reports of topics discussed were similar between evaluation periods (pre versus post: growth 96% vs 99%; diet 90% vs 93%; physical activity 81% vs 85%). Observed topics at health supervision visits were similarly high and were unchanged between periods. Parental recall of topics at 1 month was also high and similar between periods. Parental report of adoption of a healthier behavior for themselves or their child at 1 month did not significantly change. CONCLUSIONS: The Systematic Nutritional Assessment in Pediatric Practice intervention provides a promising model to increase interpretation and documentation of growth.
Assuntos
Antropometria/métodos , Promoção da Saúde , Estilo de Vida , Obesidade/prevenção & controle , Padrões de Prática Médica , Adolescente , Índice de Massa Corporal , Chicago , Criança , Pré-Escolar , Crescimento , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Recém-Nascido , Pais , Projetos Piloto , Medição de RiscoRESUMO
OBJECTIVE: To describe content and time devoted to 5 preventive health topics during health supervision visits (HSVs). STUDY DESIGN: New software (Pediatric Health Supervision Timer Software, PHSTS) run in handheld computers was developed to record time and content while observing HSVs. 185 visits of children ages 2 to 10 years (58% Medicaid/self-pay) to 28 clinicians were observed at 6 practices. Parents were surveyed on demographics. Data on times and actions related to assessments and counseling of growth, diet, physical activity, safety, and tobacco were collected using PHSTS. RESULTS: The PHSTS method was well accepted (89% participation rate). Most visits included assessment/counseling for diet (95%), growth (84%), and safety (71%) and less often physical activity (52%) and tobacco (43%). Discussions occurring were short (median time [25th to 75th percentiles]: diet, 42 seconds [21 to 85 seconds]; safety, 24 seconds [11 to 61 seconds]; growth, 15 seconds [7 to 31 seconds]; physical activity, 12 seconds [5 to 22 seconds]; and tobacco, 3 seconds [2 to 6 seconds]). Clinicians expressed concerns about child weight during 18 of 33 visits (55%) that included an obese child and provided tobacco-related counseling at 6 of 30 visits (20%) that included a child living with a smoker. CONCLUSIONS: The PHSTS method was successfully used. Our observations found that limited time was devoted to assessment and counseling on key health topics during HSVs.
Assuntos
Educação em Saúde/métodos , Pediatria/métodos , Serviços Preventivos de Saúde/métodos , Medicina Preventiva/métodos , Criança , Pré-Escolar , Computadores de Mão , Dieta , Feminino , Humanos , Lactente , Masculino , Avaliação de Programas e Projetos de Saúde , Segurança , SoftwareRESUMO
The objective of this study was to determine the prevalence of and possible risk factors for overweight in a sample of 5- to 6-year-old Hispanic (predominantly Mexican American) children in Chicago, Illinois, to see if overweight is more common in more highly acculturated immigrant families. There were 250 kindergarten students (92% of those eligible) attending two public elementary schools serving primarily Mexican American neighborhoods measured for height and weight. Consenting mothers were interviewed (n = 80) and measured (n = 38). The interview tool covered demography, acculturation, infant and toddler feeding practices, current eating patterns and food preparation habits, physical activity, and psychosocial family characteristics. Overweight was conservatively defined as weight-for-height at or above the National Center for Health Statistics 95th percentile. The data were used to describe the prevalence of overweight. Overweight and nonoverweight children were compared on all survey variables using appropriate statistical tests, with significance set at.05. There were 23% of the total sample of children (n = 250) and 26% of the subsample of children (those whose mothers were interviewed) who were overweight. Analysis limited to children in the subsample explored risk factors. The median score on the Acculturation Scale was 4.0 (range 2.4 - 10.4) on a scale of 2.4 (entirely not acculturated) to 12 (fully acculturated). There was no significant association between overweight and Acculturation Scale score. Overweight children were more likely than those not overweight to watch television for more than 3 hours during weekend days (48% vs. 22%, P =.03). Overweight children were also more likely to consume sweetened beverages (powdered drinks, soda pop, atole) daily (67% vs. 39%, P =.03). There was a trend indicating that free access to food at home increased the risk of overweight (P = 0.06). No other family- or child-level variables were related to overweight. Only 40% of mothers with an overweight child correctly assessed these children as overweight. Approximately one quarter of the children in the study were overweight. Our hypothesis that their obesity was linked to acculturation was not confirmed. Longer hours of child television viewing on weekends and higher levels of sweetened beverage consumption were important behaviors associated with the occurrence of overweight. These data should be considered when designing future studies in this population.
Assuntos
Aculturação , Inquéritos Epidemiológicos , Hispânico ou Latino/estatística & dados numéricos , Obesidade/etnologia , Análise de Variância , Chicago/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Emigração e Imigração , Comportamento Alimentar/etnologia , Feminino , Guatemala/etnologia , Humanos , Entrevistas como Assunto , Masculino , México/etnologia , Mães , Obesidade/epidemiologia , Projetos Piloto , Prevalência , Porto Rico/etnologia , Fatores de Risco , Instituições AcadêmicasRESUMO
OBJECTIVES: To assess changes in hospitalization rates for invasive group A streptococcal (IGAS) and varicella-associated IGAS (VA-IGAS) infections at a pediatric hospital over a period of 9 years, to characterize clinical features of patients with IGAS infections, and to assess frequency of macrolide-resistant IGAS isolates. Study design Medical records of all hospitalized patients with group A streptococcus isolated from a normally sterile site from 1993 to 2001 were reviewed. Data collected included demographics, clinical course, microbiologic features, outcome, and presence of streptococcal toxic shock syndrome (STSS) or necrotizing fasciitis (NF). Annual hospitalization rates for IGAS were determined. RESULTS: There were 144 patients with IGAS infections, including 11 (8%) with STSS or NF. Overall mortality rate was 2% (3/144) but 18% (2/11) among patients with STSS or NF. Preexisting varicella was present in 16% (23/144); 4 of 23 VA-IGAS cases had STSS or NF. Although there was no change in annual hospitalization rates for IGAS infections during the study period, the percentage of VA-IGAS hospitalizations decreased from 27% in the prevaccine era (1993 to 1995), to 16% during vaccine implementation (1996 to 1998) and 2% during widespread vaccine use (1999 to 2001) (linear-by-linear association, P=.001). Macrolide resistance was low in 1993 to 1995 (5%, 1/19) and 1996 to 1998 (0%, 0/42) among tested IGAS isolates and increased significantly in 1999 to 2001 (13%, 5/38) (Fisher exact, P=.035). CONCLUSIONS: A decline in pediatric varicella-related IGAS hospitalizations was temporally associated with utilization of varicella vaccine. These data reinforce the importance of universal varicella vaccination for children. Increasing macrolide resistance among IGAS isolates indicates a need for continued surveillance.