Patterns of use of malnutrition risk screening in pediatric populations: A survey of current practice among pediatric hospitals in North America.

Information on the use of validated malnutrition risk screening tools in pediatric facilities to guide malnutrition identification, diagnosis, and treatment is scarce. Therefore, a survey of pediatric healthcare facilities and practitioners to ascertain malnutrition risk screening practices in North America was conducted. A pediatric nutrition screening practices survey was developed and sent to members of the American Society for Parenteral and Enteral Nutrition, the Council for Pediatric Nutrition Professionals and the Academy of Nutrition and Dietetics Pediatric Nutrition Practice Group. Respondents represented 113 pediatric hospitals in the United States and six in Canada, of which 94 were inpatient and 59 were outpatient. Nutrition risk screening was completed in 90% inpatient settings, and 63% used a validated screening tool. Nurses performed most malnutrition risk screens in the inpatient setting. Nutrition risk screening was reported in 51% of outpatient settings, with a validated screening tool being used in 53%. Measured anthropometrics were used in 78% of inpatient settings, whereas 45% used verbally reported anthropometrics. Measured anthropometrics were used in 97% outpatient settings. Nutrition risk screening was completed in the electronic health record in 80% inpatient settings and 81% outpatient settings. Electronic health record positive screen generated an automatic referral in 80% of inpatient and 45% of outpatient settings. In this sample of pediatric healthcare organizations, the results demonstrate variation in pediatric malnutrition risk screening in North America. These inconsistencies justify the need to standardize pediatric malnutrition risk screening using validated pediatric tools and allocate resources to perform screening.

Comparing and Predicting Rape Acknowledgment Between Sexual Orientation and Gender Identity Categories.

It is well known that sexual violence is a prevalent social problem that often results in numerous deleterious outcomes for victims and these outcomes are often influenced by rape acknowledgment (i.e., whether the rape victim acknowledges their experience as rape). Most research on rape acknowledgment examines acknowledgment as a dichotomous variable and comprises heterosexual cisgender women, revealing two gaps in the literature. To fill these gaps, this study used quantitative data that oversampled LGBTQ+ populations to examine three categories of rape acknowledgment (yes, no, uncertain) among a gender and sexually diverse sample (N = 817). Results indicate that 20% of the sample were uncertain as to whether they had been raped, 33% were unacknowledged victims, and 44% acknowledged their rape. Sexual minority transgender/nonbinary people had the highest prevalence of rape acknowledgment (56%), compared with four other groupings: heterosexual cis men and women as well as sexual minority cis men and women (28%-49%). Multivariate analysis revealed that when controlling for other factors, gender identity, but not sexual orientation, significantly predicts rape acknowledgment. Namely, sexual minority transgender/nonbinary people and cis women were more likely than cis men to acknowledge their rape. This study offers evidence to suggest that acknowledgment differs significantly by gender identity and is worth further inquiry. Limitations and suggestions for future research are discussed.

Measurement of mid-upper arm circumference to screen for childhood malnutrition: General applicability and use in special populations.

Since the development of consensus-recommended indicators for pediatric malnutrition in 2014, screening and diagnosis of pediatric malnutrition have improved, but the indicators are not always used; malnutrition continues to be underdiagnosed in some community and healthcare settings. In particular, mid-upper arm circumference (MUAC) is underused as a screening indicator for pediatric malnutrition, despite its unique advantages and usefulness in several clinical situations. In December 2022, a scientific roundtable was held to bring together several experts in pediatric malnutrition. One of the goals of the scientific roundtable was to discuss the clinical use of anthropometric measures as screening tools for pediatric malnutrition status, with a focus on the use of MUAC. This article arose from that event and is intended as an educational tool to aid clinicians in implementing MUAC measurements. In addition to describing the use of MUAC as a screening tool, the article discusses several clinical situations in which MUAC is especially useful. Additionally, the article reviews practical aspects of measuring and interpreting MUAC values, provides links to additional educational resources, and briefly reviews areas in which further research is needed regarding the use of MUAC for screening of nutrition status in children.

What is the influence of maternal weight gain in different gestational clinical conditions on the prole weight in pre-school age?

The aim of the current study was to assess the influence of maternal weight gain in different clinical gestational conditions on the child's weight at pre-school age. This was a longitudinal observational study of a prospective and controlled multiple cohort of 372 mother-child pairs with four causal groups of different adverse intrauterine environments (smoking, diabetic, hypertensive and intrauterine growth-restricted pregnant women) and a control group, in the period of, from 2011 to 2016 in three hospitals in Porto Alegre (Brazil). Sociodemographic, prenatal and perinatal data were analysed. Gestational weight gain (GWG) was categorised as 'insufficient', 'adequate' and 'excessive'. The generalised estimation equations (GEE) model was used to assess changes in the z-score of the child's body mass index from birth to pre-school age according to the GWG and gestational group. The child's GWG and weight gain were adjusted for maternal age and education, marital status, family income, pregnancy planning, number of children, prepregnancy BMI, prenatal consultations and type of delivery. A triple interaction effect was observed involving the gestational group, weight gain and study time (p = 0.020) through an adjusted model. Maternal weight gain above the recommended is associated with a significant increase in the child's z - BMI score over time, except for children from pregnant smokers. Children from diabetic mothers , hypertensive mothers and the control group who had a weight gain above that recommended during pregnancy changed their nutritional status from eutrophic to overweight, becoming obese in the DM and hypertension groups and overweight in control. Monitoring of the GWG, especially in the presence of hypertensive diseases and DM, should be effective to prevent children from developing overweight or obesity in pre-school age with an important impact on health conditions in the future.

Pathways to Resistance: Theorizing Trauma and Women's Use of Force in Intimate Relationships.

Using a feminist pathways general strain perspective, we explore the victim-offender continuum for women who perpetrated intimate partner violence/abuse (IPV/A). We use data from 86 women court-mandated to "female offender" domestic violence treatment programs, located in an American East Coast state, who were surveyed about their adverse childhood experiences and mental health/well-being as adults. Findings from bivariate linear regressions indicate childhood trauma negatively affects adult mental health/well-being, exacerbated for Black Indigenous People of Color women, suggesting a victim rather than an offender categorization for women using force against their abusive partner. Results imply the need to consider women's traumatic histories and IPV/A victimization, given an incident-driven system that criminalizes victimization over the life course.

Gerenciando paradoxos da estratégia aberta no setor público / Gestión de las paradojas de la estrategia abierta en el sector público / Managing open strategy paradoxes in the public sector

Resumo A chamada "estratégia aberta" preconiza a inclusão de colaboradores de diferentes níveis, bem como de agentes externos e parceiros, no processo de construção da estratégia. Esse movimento de abertura e inclusão também tem avançado no setor público por meio da governança colaborativa, como consequência das mudanças do entendimento do papel do Estado numa forma de gestão que promove a interação entre os atores públicos e privados. O argumento central deste ensaio é que há paradoxos inerentes à estratégia aberta no setor público que precisam ser gerenciados para evitar ou minimizar tensões prejudiciais entre os envolvidos. O artigo adota uma abordagem reflexiva e indutiva, baseada nas perspectivas teóricas tanto da estratégia aberta quanto da governança colaborativa. Como resultado, contribui para o campo de estudos em gestão pública e apresenta proposições teóricas e práticas que indicam caminhos para gerenciamento da estratégia aberta.

Resumen La denominada estrategia abierta aboga por la inclusión de empleados de diferentes niveles, y de agentes y socios externos, en el proceso de construcción de la estrategia. Este movimiento hacia la apertura y la inclusión también ha avanzado en el sector público a través de la gobernanza colaborativa, como consecuencia de cambios en la comprensión del papel del Estado en una forma de gestión que promueve la interacción entre actores públicos y privados. El argumento central de este ensayo es que existen paradojas inherentes al uso de la estrategia abierta en el sector público que deben gestionarse para evitar o minimizar tensiones dañinas entre los involucrados. El ensayo adopta un enfoque reflexivo e inductivo, basado en las perspectivas teóricas tanto de la estrategia abierta como de la gobernanza colaborativa. Como resultado, contribuye al campo de los estudios en gestión pública y presenta propuestas teóricas y prácticas que indican caminos para la gestión de estrategias abiertas.

Abstract The open strategy approach advocates the inclusion of external agents, partners, and employees working at different levels in the strategy construction process. This movement toward openness and inclusion has also advanced in the public sector through collaborative governance. This development is due to changes in understanding the state's role as a promoter of interaction between public and private actors. The central argument of this essay is that there are paradoxes inherent in the use of open strategy in the public sector that need to be managed in order to avoid or minimize damaging tensions between those involved. The essay adopts a reflexive and inductive approach based on the theoretical perspectives of both open strategy and collaborative governance. As a result, it contributes to the field of public management studies and presents theoretical and practical propositions that indicate ways of managing open strategy.

Current nutrition assessment practice: A 2022 survey.

BACKGROUND: Malnutrition remains a significant problem in patients with acute or chronic illnesses. Nutrition assessment is an important component in detecting malnutrition; but not always performed using a standardized tool. This survey on nutrition assessment evaluates current clinical practices on the assessment, diagnosis, and treatment of malnutrition. METHODS: This 2022 survey of US-based nutrition clinicians collected data on assessment parameters used in hospitals, long-term care facilities, and the home care setting. RESULTS: A total of 686 surveys were available for analysis. Ninety-seven percent of adult and 91% of pediatric responding clinicians indicated that a dietitian completed the assessment. Parameters used most frequently among adult clinician respondents included nutrient intake, current weight, and weight history, those used by pediatric clinician respondents included nutrient intake, weight-for-age z score, and weight-for-length/height z score. Eighty-nine percent of adult clinicians in all care settings and 85% of pediatric clinicians use the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Indicators of Malnutrition (AAIM). Respondents reported malnutrition rates of 32%-40% for adults and 4%-30% for pediatric patients, depending on the setting. Appropriate interventions for those with malnutrition (as perceived by the survey respondents) were ordered 70% of the time. CONCLUSION: This survey demonstrated significant use of the AAIM by both adult and pediatric clinicians across care settings. Reported malnutrition rates are consistent with others published in the literature. The authors suggest that quality improvement efforts should focus on the 30% of patients with malnutrition but without a reported appropriate nutrition intervention.

Does early fruit juice introduction influence anthropometric outcomes and food consumption at preschool age? / A introdução precoce de sucos pode influenciar desfechos antropométricos e consumo alimentar em idade pré-escolar?

The aim of this study was to evaluate the impact of fruit juice consumption before 6 months of age on Body Mass Index-for-age (BMI-for-age) and food consumption in preschoolers. We conducted a longitudinal study with mothers and their children (n=103) at 6 months and 3-6 years. Weight and height were measured and converted into BMI-for-age z-scores. Food consumption was analyzed using the Food Frequency Questionnaire for Children. Groups were compared using the chi-squared and Student's t-tests. No differences in anthropometric measurements were found at preschool age between children who had been given fruit juice before 6 months and those who had not. Consumption of artificial juice (≥once/day) and sandwich cookies at preschool age was higher in children with early introduction of fruit juice (≤150 days of life) (63.8% versus 35.7%; p=0.028 and 21.3% versus 14.3%; p=0.001, respectively). The prevalence of the consumption of soda (1 to 4 times/week) and chocolate milk (at least once/day) was higher in children who had been given artificial juice before 6 months (69.2% versus 27.4%; p=0.014 and 38.5% versus 69.4%; p=0.027, respectively). It can be concluded that the consumption of sweet foods and sugary beverages was higher in children with early introduction of fruit juice.

Objetivou-se avaliar o impacto do consumo de sucos antes dos 6 meses de idade no Índice de Massa Corporal para Idade (IMC/I) e no consumo alimentar em pré-escolares. Estudo longitudinal com amostra composta por mães e seus filhos (n=103) entre 6 meses e 3 a 6 anos. Peso e estatura foram aferidos e convertidos para o escore z de IMC/I. Para avaliar o consumo alimentar, foi utilizado o Questionário de Frequência Alimentar Infantil. Testes de Qui-Quadrado e t de Student foram utilizados para comparação entre os grupos. Não houve diferença nos parâmetros antropométricos entre pré-escolares que receberam ou não suco antes dos seis meses. Aquelas que tiveram introdução de suco mais precoce (≤150 dias de vida) apresentaram consumo mais frequente (≥1x/dia) de suco artificial (63,8% versus 35,7%; p=0,028) e biscoito recheado (21,3% versus 14,3%; p=0,001) na idade pré-escolar. Crianças que receberam suco do tipo artificial antes dos 6 meses tiveram maior prevalência de consumo de refrigerante entre 1 e 4x/semana (69,2% versus 27,4%; p=0,014) e menor prevalência de consumo de achocolatado pelo menos 1x/dia (38,5% versus 69,4%; p=0,027). Sendo assim, crianças com introdução precoce de suco apresentaram maior consumo de alimentos doces e bebidas açucaradas em fase pré-escolar.

A introdução precoce de sucos pode influenciar desfechos antropométricos e consumo alimentar em idade pré-escolar? / Does early fruit juice introduction influence anthropometric outcomes and food consumption at preschool age?

Resumo Objetivou-se avaliar o impacto do consumo de sucos antes dos 6 meses de idade no Índice de Massa Corporal para Idade (IMC/I) e no consumo alimentar em pré-escolares. Estudo longitudinal com amostra composta por mães e seus filhos (n=103) entre 6 meses e 3 a 6 anos. Peso e estatura foram aferidos e convertidos para o escore z de IMC/I. Para avaliar o consumo alimentar, foi utilizado o Questionário de Frequência Alimentar Infantil. Testes de Qui-Quadrado e t de Student foram utilizados para comparação entre os grupos. Não houve diferença nos parâmetros antropométricos entre pré-escolares que receberam ou não suco antes dos seis meses. Aquelas que tiveram introdução de suco mais precoce (≤150 dias de vida) apresentaram consumo mais frequente (≥1x/dia) de suco artificial (63,8% versus 35,7%; p=0,028) e biscoito recheado (21,3% versus 14,3%; p=0,001) na idade pré-escolar. Crianças que receberam suco do tipo artificial antes dos 6 meses tiveram maior prevalência de consumo de refrigerante entre 1 e 4x/semana (69,2% versus 27,4%; p=0,014) e menor prevalência de consumo de achocolatado pelo menos 1x/dia (38,5% versus 69,4%; p=0,027). Sendo assim, crianças com introdução precoce de suco apresentaram maior consumo de alimentos doces e bebidas açucaradas em fase pré-escolar.

Abstract The aim of this study was to evaluate the impact of fruit juice consumption before 6 months of age on Body Mass Index-for-age (BMI-for-age) and food consumption in preschoolers. We conducted a longitudinal study with mothers and their children (n=103) at 6 months and 3-6 years. Weight and height were measured and converted into BMI-for-age z-scores. Food consumption was analyzed using the Food Frequency Questionnaire for Children. Groups were compared using the chi-squared and Student's t-tests. No differences in anthropometric measurements were found at preschool age between children who had been given fruit juice before 6 months and those who had not. Consumption of artificial juice (≥once/day) and sandwich cookies at preschool age was higher in children with early introduction of fruit juice (≤150 days of life) (63.8% versus 35.7%; p=0.028 and 21.3% versus 14.3%; p=0.001, respectively). The prevalence of the consumption of soda (1 to 4 times/week) and chocolate milk (at least once/day) was higher in children who had been given artificial juice before 6 months (69.2% versus 27.4%; p=0.014 and 38.5% versus 69.4%; p=0.027, respectively). It can be concluded that the consumption of sweet foods and sugary beverages was higher in children with early introduction of fruit juice.

Malnutrition among Hospitalized Children in the United States: A 2012-2019 Update of Annual Trends.

BACKGROUND: Malnutrition is associated with adverse clinical outcomes and increased health care utilization for hospitalized children. Yet pediatric malnutrition often goes undiagnosed and national prevalence research in this population is scarce. OBJECTIVE: The aim was to assess change in the coded diagnosis of malnutrition (CDM) among US hospitalized children given increased awareness of the need for improved recognition and standardized diagnosis. DESIGN: Retrospective, cross-sectional analysis using nationally representative data from the Nationwide Inpatient Sample. PARTICIPANTS/SETTING: Our sample was 13.2 million hospitalizations from 2012 to 2019 among pediatric patients between age 1 month and 17 years. MAIN OUTCOME MEASURE: CDM using International Classification of Diseases Ninth and 10th Revision-Clinical Modification diagnosis codes. STATISTICAL ANALYSES: Descriptive statistics and sampling weights were used to estimate the national frequency and prevalence of CDM. Temporal trends in CDM overall and stratified by age, race/ethnicity, and hospital type were analyzed using joinpoint regression. RESULTS: CDM prevalence increased from 3.9% in 2012 to 6.4% in 2019. During this period, failure to thrive decreased from 40.6% to 23.3% of all cases with concomitant increases in the diagnosis of protein-calorie malnutrition and children identified with more than one malnutrition subtype. Differences in CDM diagnoses are evident by hospital type, race/ethnicity, and age of the patient. CONCLUSIONS: Although pediatric malnutrition continues to be underdiagnosed in hospital settings, this study demonstrates improvement over time. There continues to be a need for continued professional education regarding best practices for diagnosis to improve health care provider knowledge and self-efficacy on this topic, especially in nonteaching hospitals.

Applying the recommended indicators for the diagnosis of preterm and neonatal malnutrition: Answers to frequently asked questions.

In 2018, a committee of expert preterm/neonatal registered dietitian nutritionists published recommended indicators for the diagnosis of malnutrition in preterm infants and neonates. This was in response to a need for indicators appropriate to the preterm/neonatal population, given the emphasis on diagnosing malnutrition in the pediatric and adult population. Since the publication, the authors have received numerous questions regarding the application and use of the indicators. This paper answers questions regarding the three categories of indicators and billing and reimbursement. The goal is to develop uniformity in the application of the malnutrition indicators for quality improvement and research efforts.

Pediatric malnutrition screening and assessment tools: Analyzing the gaps.

Pediatric healthcare professionals know that children who are malnourished have worse clinical outcomes than do their well-nourished peers. The body of evidence in the literature on the topic of pediatric malnutrition (PMN) is growing and supports this conclusion. The goal of this article is to present the current state of practice related to PMN screening, the use of malnutrition risk screening (MNRS) tools, malnutrition assessment, and the use of malnutrition assessment tools. The purpose is also to discuss best practice for MNRS and assessment and to consider the gaps in practice where additional work is needed.

Implementing a Culture of Health Among Probationers.

Justice-involved individuals struggle with a multitude of health issues, and addressing the needs of these individuals requires the efforts of multiple agencies working across traditionally siloed systems. This study provides evidence on the implementation of a one-stop health services delivery model, Culture of Health, piloted in an urban probation office. This model uses a change team approach to focus the efforts of multiple agencies toward improving the alignment, collaboration, and synergy of health and other social service delivery to this underserved population. This article reports on the development and application issues involved in instituting such a novel design. The study demonstrates that the health culture within probation, buy-in from probation officers, and dwindling support from change team members all posed noteworthy issues for program implementation.

Food Insecurity and Pediatric Malnutrition Related to Under- and Overweight in the United States: An Evidence Analysis Center Systematic Review.

Both food insecurity and malnutrition are associated with adverse health outcomes in the pediatric population. However, the research on the relationship between these factors has been inconsistent, leading to uncertainty regarding whether or how evaluation of food insecurity should be incorporated into nutrition screening or the nutrition care process. The objective of this systematic review was to determine the association between food insecurity and malnutrition related to undernutrition or overnutrition (defined by anthropometrics) in the pediatric population in the United States. A literature search was conducted using Medline, Embase, and CINAHL databases for studies published from January 2002 through November 2017. A total of 23 studies (19 cross-sectional and 4 prospective cohort studies) met inclusion criteria and were included in qualitative analysis. In 6 studies, there was no overall relationship between food insecurity and underweight. All included studies examined the relationship between food insecurity status and overweight/obesity and results were mixed, with large cross-sectional studies demonstrating a positive relationship between food insecurity and overweight/obesity. There were no clear patterns according to subpopulation. Evidence quality was graded as fair due to heterogeneity in how food insecurity was measured and populations included as well as inconsistency in results. Use of a 2-item food insecurity screening tool may allow for efficient, effective screening of food insecurity in order to identify potential contributors overweight and obesity.

Are We Comparing Apples and Oranges? Exploring Trauma Experienced by Victims of Interpersonal Violence and Abuse and by Court-Involved Women Who Have Used Force in Relationships.

Due to the enactment of mandatory and proarrest policies, there has been a sharp increase in the number of women arrested for use of force against an intimate partner. Many of these arrested women are also victims of intimate partner violence (IPV) and experience high levels of trauma and post-traumatic stress disorder (PTSD). Our study explores experiences of two groups: 80 women who self-refer into survivor groups or individual counseling sessions facilitated by a trained counselor and 86 court-involved women who have been arrested on an IPV/abuse (IPV/A)-related charge and (in lieu of more substantial punishment) participate in an intervention/treatment program. The current research asks, "What do trauma measures tell us about women who voluntarily seek IPV/A victim support groups and about women court-mandated to a treatment program?" Using measures of adverse childhood experiences (ACEs), post-trauma distress, and danger assessments, we explore these two groups. Our findings demonstrate that within the three measures used, women who voluntarily sought victim counseling services had a higher mean compared with women arrested for use of force against an intimate partner. Yet, both groups are significantly different from the general population in terms of having experienced significant trauma. Both groups of women report significantly higher levels of ACEs, post-trauma distress, and danger assessments compared with the general population, indicating that women who experience IPV/A or women who use force in relationships may share more similarities than differences. In addition, we explore the ways in which different relationship characteristics and treatment trajectories might help explain the differences present between these two groups of women. We conclude with a discussion of policy and treatment implications.

Can the pregnant womans food intake be influenced by her clinical condition during pregnancy? / O consumo alimentar da gestante pode sofrer influência de sua condição clínica durante a gestação?

Abstract Objectives: to evaluate the association between dietary intake during pregnancy and different gestational clinical conditions (hypertensive, diabetics, smokers, having intrauterine growth restriction and a control group) and associated factors. Methods: cross-sectional study nested in a cohort study from 2011 to 2016 that occurred in three hospitals in Porto Alegre (Brazil). Sociodemographic conditions and prenatal were investigated and maternal feeding practices were analyzed by the Food Frequency Questionnaire. To calculate the caloric percentage from food groups, food items were categorized into:unprocessed or minimally processed, processed and ultra-processed foods. The Kruskal-Wallis test with Dunn's post-hoc compared food consumption between the groups and the Poisson regression evaluated the association between the variables. Results: there was no statistical difference in food intake among 303 mothers of different gestational clinical conditions, but diabetic pregnant women had lower caloric contribution value of ultra-processed foods. In addition, pregnant women from all groups showed adequate consumption in relation to the percentage of caloric contribution of macronutrients in the total energy value. Conclusions: there was no difference in energy consumption according to different gestational clinical conditions.In diabetic, smokers and hypertensive pregnant women, associations between total energy intake and different sociodemographic factors were observed between the groups.

Resumo Objetivos: avaliar a associação entre o consumo alimentar gestacional com diferentes condições clínicas das gestantes (hipertensão, diabete, tabagismo, restrição de crescimento intrauterino e um grupo controle) e os demais fatores associados. Métodos: pesquisa transversal aninhada em estudo de coorte realizado de 2011 a2016 em três hospitais de Porto Alegre (Brasil). Foram analisadas, por um questionário estruturado, as condições sociodemográficas e o pré-natal; e práticas alimentares gestacionais pelo Questionário de Frequência Alimentar (QFA). Para o cálculo do percentual calórico referente ao processamento, os itens alimentares foram categorizados em: in natura ou minimamente processados, processados e ultraprocessados. O teste de Kruskal-Wallis com post-hoc de Dunn comparou o consumo alimentar entre os grupos e a regressão de Poisson, a associação entre as variáveis. Resultados: não houve diferença de consumo calórico entre as 303 mães dos diferentes grupos pesquisados, porém as gestantes diabéticas apresentaram menor valor de contribuição vinda dos alimentos ultraprocessados. Além disso, as gestantes de todos os grupos apresentaram consumo adequado em relação ao percentual de contribuição calórica de macronutrientes no valor energético total. Conclusões: não foi encontrada associação entre consumo alimentar e diferentes condições clínicas gestacionais. Nas gestantes diabéticas, tabagistas e hipertensas foram observadas associações da ingestão energética total com diferentes fatores sociodemográficos entre os grupos.

Current Practices Using Pediatric Malnutrition Indicators: A Survey of Dietitians Working in Pediatrics.

BACKGROUND: In 2014, the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition recommended indicators to identify malnutrition in children aged 1 month to 18 years. The purpose of this study was to evaluate current practices and the effectiveness of the consensus statement-recommended pediatric malnutrition indicators. METHODS: A cross-sectional electronic survey link was posted in the Pediatric Nutrition Practice Group (subscribers = 3160) and Clinical Nutrition Management Practice Group's Pediatric Subunit (subscribers = 177) community discussion boards. Additionally, flyers with the survey link were distributed to registered dietitian nutritionists (RDNs) currently working in pediatrics at the 2018 Food & Nutrition Conference & Expo. Frequencies described participant characteristics, awareness of indicators, and use of indicators. Researchers used the Fisher exact test to determine associations between categorical variables. RESULTS: Two hundred eighty-one surveys were included in data analysis. A majority of RDNs (88.6%) reported they knew the indicators existed and considered themselves knowledgeable about the indicators. Weight loss was the most frequently used indicator, with 224 RDNs (80%) reporting use as often or always. Mid-upper arm circumference (MUAC) was the least used indicator with only 68 RDNs (25%) using it often or always. Most RDNs (71.5%) reported that their facility used International Classification of Disease, Tenth Revision codes to document malnutrition. CONCLUSION: RDNs working with pediatric populations consistently use the recommended malnutrition indicators; however, further education is needed on the appropriate use of MUAC and length/height per age as malnutrition indicators.

Linking individuals on probation to health care: a pilot randomized trial.

BACKGROUND: Probation offices represent a location where at-risk individuals in need of health care appear on a known and regular basis. We sought to study how providing linkages to health care could improve the proportion of underserved, justice-involved individuals accessing the health care system. This study tested a linkage and referral to health care intervention for individuals on probation designed by a local change team that brought together actors from multiple agencies and tasked them with increasing general practitioner physician access for probationers. The pilot trial randomized 400 individuals on probation in Delaware during 2016-2018 to determine the effectiveness of placing a health navigator in an urban probation office to refer people to an appointment with a primary care physician. The project also tested the impact of offering an incentive to probationers for attending a doctor's appointment. RESULTS: Referral by a health navigator to a primary care physician was associated with a modest but significant increase in the proportion of individuals accessing care through a general practitioner physician. Offering an incentive had no significant impact on keeping the medical appointment above the effect of referral by the health navigator. CONCLUSIONS: Probation offices represent a location where at-risk individuals in need of health care appear on a known and regular basis. This study highlights how providing linkages to health care can improve the proportion of underserved individuals accessing the health care system.

Validity and Reliability of Pediatric Nutrition Screening Tools for Hospital, Outpatient, and Community Settings: A 2018 Evidence Analysis Center Systematic Review.

BACKGROUND: Nutrition screening tools are used to identify risk of malnutrition or change in risk of malnutrition. However, it is unclear which tools have demonstrated high validity, reliability, and agreement. OBJECTIVE: Our aim was to conduct a systematic review of valid and reliable pediatric nutrition screening tools for identifying malnutrition risk (under- or overnutrition), and to determine whether there are differences in validity and reliability according to users of the tools. METHODS: A literature search using Medline, Embase, and CINAHL databases was conducted to identify relevant research published between 1995 and May 2017 examining validity and reliability of nutrition screening tools in the pediatric population. A multidisciplinary workgroup developed eligibility criteria, data were extracted and summarized, risk of bias was assessed, and evidence strength was graded, according to a standard process. RESULTS: Twenty-nine studies met inclusion criteria. Thirteen pediatric nutrition screening tools designed for various settings were included in the review (seven inpatient/hospital, three outpatient or specialty setting, and three community). The most frequently examined tools were the Screening Tool for the Assessment of Malnutrition in Pediatrics, Screening Tool for Risk on Nutritional Status and Growth (13 studies each), and Paediatric Yorkhill Malnutrition Score (nine studies). No tools demonstrated high validity. Reliability and agreement were reported infrequently. CONCLUSIONS: Nutrition screening tools with good/strong or fair evidence and moderate validity included the Screening Tool for the Assessment of Malnutrition in Pediatrics, Screening Tool for Risk on Nutritional Status and Growth, and Paediatric Yorkhill Malnutrition Score in the inpatient setting and Nutrition Risk Screening Tool for Children and Adolescents with Cystic Fibrosis in the specialty setting. No tools in the community setting met these criteria. While differences in validity and reliability measures among tool users were found, the significance of these findings is unclear. Limitations included few studies examining each tool, heterogeneity between studies examining a common tool, and lack of tools that included currently recommended indicators to identify pediatric malnutrition.