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1.
J Cardiovasc Magn Reson ; 19(1): 86, 2017 Nov 09.
Artículo en Inglés | MEDLINE | ID: mdl-29117866

RESUMEN

BACKGROUND: Children with obesity have hypertrophic cardiac remodeling. Hypertension is common in pediatric obesity, and may independently contribute to hypertrophy. We hypothesized that both the degree of obesity and ambulatory blood pressure (ABP) would independently associate with measures of hypertrophic cardiac remodeling in children. METHODS: Children, aged 8-17 years, prospectively underwent cardiovascular magnetic resonance (CMR) and ABP monitoring. Left ventricular (LV) mass indexed to height2.7 (LVMI), myocardial thickness and end-diastolic volume were quantified from a 3D LV model reconstructed from cine balanced steady state free precession images. Categories of remodeling were determined based on cutoff values for LVMI and mass/volume. Principal component analysis was used to define a "hypertrophy score" to study the continuous relationship between concentric hypertrophy and ABP. RESULTS: Seventy-two children were recruited, and 68 of those (37 healthy weight and 31 obese/overweight) completed both CMR and ABP monitoring. Obese/overweight children had increased LVMI (27 ± 4 vs 22 ± 3 g/m2.7, p < 0.001), myocardial thickness (5.6 ± 0.9 vs 4.9 ± 0.7 mm, p < 0.001), mass/volume (0.69 ± 0.1 vs 0.61 ± 0.06, p < 0.001), and hypertrophy score (1.1 ± 2.2 vs -0.96 ± 1.1, p < 0.001). Thirty-five percent of obese/overweight children had concentric hypertrophy. Ambulatory hypertension was observed in 26% of the obese/overweight children and none of the controls while masked hypertension was observed in 32% of the obese/overweight children and 16% of the controls. Univariate linear regression showed that BMI z-score, systolic BP (24 h, day and night), and systolic load correlated with LVMI, thickness, mass/volume and hypertrophy score, while 24 h and nighttime diastolic BP and load also correlated with thickness and mass/volume. Multivariate analysis showed body mass index z-score and systolic blood pressure were both independently associated with left ventricular mass index (ß=0.54 [p < 0.001] and 0.22 [p = 0.03]), thickness (ß=0.34 [p < 0.001] and 0.26 [p = 0.001]) and hypertrophy score (ß=0.47 and 0.36, both p < 0.001). CONCLUSIONS: In children, both the degree of obesity and ambulatory blood pressures are independently associated with measures of cardiac hypertrophic remodeling, however the correlations were generally stronger for the degree of obesity. This suggests that interventions targeted at weight loss or obesity-associated co-morbidities including hypertension may be effective in reversing or preventing cardiac remodeling in obese children.


Asunto(s)
Presión Sanguínea , Hipertensión/etiología , Hipertrofia Ventricular Izquierda/etiología , Obesidad Infantil/complicaciones , Función Ventricular Izquierda , Remodelación Ventricular , Adolescente , Factores de Edad , Monitoreo Ambulatorio de la Presión Arterial , Índice de Masa Corporal , Distribución de Chi-Cuadrado , Niño , Estudios Transversales , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/fisiopatología , Modelos Lineales , Imagen por Resonancia Cinemagnética , Masculino , Análisis Multivariante , Obesidad Infantil/diagnóstico , Obesidad Infantil/fisiopatología , Análisis de Componente Principal , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad
2.
J Pediatr Psychol ; 38(9): 978-86, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23750019

RESUMEN

Lifestyle modification programs (LMP) for weight loss in adolescents with obesity are effective but not available. Primary care may be a setting for reaching more adolescents. Two models of LMP for use in primary care were examined. Adolescents and caregivers enrolled in a 1-year randomized trial comparing Group LMP with Self-Guided LMP. All participants (N = 169) received the same treatment recommendations and met with a health coach six times in clinic. Group LMP participants had an additional 17 group sessions; those in Self-Guided LMP followed the remainder of the program at home with parental support. The primary outcome was percentage change in initial body mass index. The mean (SE) 1.31% (0.95%) reduction in Group LMP did not differ significantly from the 1.17% (0.99%) decrease in the Self-Guided LMP (p = 0.92). Both treatments were significantly effective in reducing body mass index. Given its brevity, the Self-Guided LMP offers an innovative approach for primary care.


Asunto(s)
Obesidad/terapia , Atención Primaria de Salud/métodos , Psicoterapia de Grupo/métodos , Conducta de Reducción del Riesgo , Programas de Reducción de Peso/métodos , Adolescente , Niño , Femenino , Humanos , Masculino , Autocuidado/métodos
3.
Front Pediatr ; 10: 892947, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36330368

RESUMEN

Patient reported outcome measures (PROM) can engage patients and clinicians to improve health outcomes. Their population health impact may be limited by systematic barriers inhibiting access to completion. In this analysis we evaluated the association between individual parent/child characteristics and clinic factors with parental completion of a locally developed PROM, the Early Healthy Lifestyles (EHL) questionnaire. Participants included parent-child dyads who presented at 14 pediatric clinics for regularly scheduled well-child visits (WCV) prior to age 26 months. EHL items include feeding practices, diet, play time, screen exposure, and sleep. Completion was categorized at patient- (i.e., parent-child dyad) and clinic-levels. Parents completed the 15-item EHL in the patient portal before arrival or in the clinic; ninety-three percent of EHL questionnaires were completed in the clinic vs. 7% in the patient portal. High-completers completed EHL for half of WCVs; low-completers completed at least once; and non-completers never completed. Clinics were classified by EHL adoption level (% high completion): High-adoption: >50%; Moderate-adoption: 10%-50%; and Low-adoption: <10%. Individual-level factors had negligible impact on EHL completion within moderate/low EHL adoption sites; high-adoption sites were used to evaluate infant and maternal factors in association with EHL completion using hierarchical logistic regression. Noncompletion of EHL was significantly associated (p < 0.05) with infant use of public insurance (OR = 1.92 [1.42, 2.59]), >1 clinic site for WCV (OR = 1.83 [1.34, 2.50]), non-White birth mother (OR = 1.78 [1.28, 2.47]), and body weight <2,500 grams or gestational age <34 weeks (OR = 1.74 [1.05, 2.90]). The number of WCVs, a proxy for clinic size, was evaluated but was not associated with completion. Findings indicate potential disparities between populations exposed to, completing, and benefitting from these tools.

4.
Pediatrics ; 144(5)2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31659005

RESUMEN

The prevalence of nonnutritive sweeteners (NNSs) in the food supply has increased over time. Not only are more children and adolescents consuming NNSs, but they are also consuming a larger quantity of NNSs in the absence of strong scientific evidence to refute or support the safety of these agents. This policy statement from the American Academy of Pediatrics is intended to provide the pediatric provider with a review of (1) previous steps taken for approved use of NNSs, (2) existing data regarding the safety of NNS use in the general pediatric population, (3) what is known regarding the potential benefits and/or adverse effects of NNS use in children and adolescents, (4) identified gaps in existing knowledge and potential areas of future research, and (5) suggested talking points that pediatricians may use when discussing NNS use with families.


Asunto(s)
Edulcorantes no Nutritivos , Adolescente , Animales , Niño , Dieta , Aprobación de Drogas/historia , Ingestión de Energía , Historia del Siglo XX , Humanos , Legislación de Medicamentos/historia , Edulcorantes no Nutritivos/efectos adversos , Edulcorantes no Nutritivos/historia , Edulcorantes no Nutritivos/uso terapéutico , Política Organizacional , Sociedades Médicas , Estados Unidos , United States Food and Drug Administration
5.
Transl Behav Med ; 8(6): 944-952, 2018 11 21.
Artículo en Inglés | MEDLINE | ID: mdl-29370433

RESUMEN

New care delivery models call for integrating health services to coordinate care and improve patient-centeredness. Such models have been embraced to coordinate care with evidence-based strategies to prevent obesity. Both the Special Supplemental Program for Women, Infants and Children (WIC) Program and pediatricians are considered credible sources of preventive guidance, and coordinating these independent siloes would benefit a vulnerable population. Using semistructured focus groups and interviews, we evaluated practices, messaging, and the prospect of integrating and coordinating care. Across Pennsylvania, WIC nutritionists (n = 35), pediatricians (n = 15), and parents (N = 28) of an infant or toddler participated in 2016. Three themes were identified: health assessment data sharing (e.g., iron, growth measures), benefits and barriers to integrated health services, and coordinating care to reduce conflicting educational messages (e.g., breastfeeding, juice, introduction of solids). Stakeholders supported sharing health assessment data and integrating health services as strategies to enhance the quality of care, but were concerned about security and confidentiality. Overall, integrated, coordinated care was perceived to be an acceptable strategy to facilitate consistent, preventive education and improve patient-centeredness.


Asunto(s)
Prestación Integrada de Atención de Salud/normas , Servicios de Salud Materno-Infantil/normas , Madres , Nutricionistas , Atención Dirigida al Paciente/normas , Obesidad Infantil/prevención & control , Pediatras , Prevención Primaria/normas , Calidad de la Atención de Salud/normas , Adulto , Preescolar , Femenino , Humanos , Lactante , Masculino , Pennsylvania , Prevención Primaria/métodos , Investigación Cualitativa
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