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1.
Prev Med ; 116: 81-86, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30218722

RESUMEN

Adverse family experiences (AFEs) are associated with childhood obesity. We evaluated whether certain positive contextual factors reduce the risk of obesity and overweight among children exposed to AFEs in a nationally representative sample. Using data derived from the National Survey of Children's Health 2011-12 (N = 43,864), we calculated the distribution of positive contextual factors (very good/excellent maternal mental health, neighborhood and school safety, and child resilience) and AFEs across weight status. The AFEs composite score was modeled as a categorical measure (0 or ≥1 AFEs). Positive contextual factors, AFEs and their interactions were evaluated in weighted, adjusted, multinomial logistic regression models predicting the odds of overweight and obesity. Children exposed to lack of very good/excellent maternal mental health and at least one AFE were at risk for overweight (OR = 1.43; 95% CI: 1.16, 1.76) and obesity (OR = 1.53; 95% CI: 1.22, 1.93). Unsafe school or neighborhood environment and exposure to 1 or more AFEs was. associated with overweight (OR = 1.32; 95% CI: 1.08, 1.61) and obesity (OR = 1.66; 95% CI: 1.34, 2.05). Lack of child resilience and exposure to 1 or more AFEs was associated with an increased risk of obesity (OR = 1.45; 95% CI: 1.17, 1.90) and overweight (OR = 1.29; 95% CI: 1.06, 1.57). These odds of obesity and overweight all decreased when positive contextual factors were present. Among children exposed to AFEs, overweight and obesity risk is reduced with positive contextual factors. Optimizing the early childhood environment can impact obesity risk.


Asunto(s)
Experiencias Adversas de la Infancia/estadística & datos numéricos , Familia/psicología , Obesidad Infantil , Características de la Residencia , Adolescente , Factores de Edad , Niño , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Obesidad Infantil/etnología , Resiliencia Psicológica , Factores de Riesgo , Factores Sexuales , Factores Socioeconómicos
2.
Fam Community Health ; 40(3): 192-197, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28525438

RESUMEN

This project examines the Northeast Iowa Food and Fitness Initiative, a policy-, community-, and school-based effort to slow children's body mass index (BMI) growth over 6 years. Kindergarteners (K) to fifth graders (5) from 10 different school districts participated (N = 4101). Students with 0 to 1 years of initiative exposure showed greater growth in BMI compared with children who had 2 to 6 years of exposure, resulting in K-5 BMI savings of 1.5 points (6 lb) for median-height boys and girls. Results suggest that changes to policies, communities, and schools may provide effective obesity reduction in children.


Asunto(s)
Índice de Masa Corporal , Obesidad/prevención & control , Obesidad/terapia , Niño , Preescolar , Femenino , Humanos , Iowa , Masculino , Instituciones Académicas
3.
Prev Med ; 90: 148-54, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-27377335

RESUMEN

While exposure to adverse family experiences (AFEs), subset of adverse childhood experiences (ACEs), has been associated with childhood obesity, less is known about the impact of exposures to each type of AFE. Using 2011-2012 National Survey of Children's Health data, we evaluated associations between exposure to individual AFEs and overweight/obesity status in children 10years or older, adjusting for socio-demographic factors. Caregivers reported their child's height, weight, and exposure to nine AFEs; body mass index (BMI) was classified by Center for Disease Control and Prevention's (CDC) guidelines. At Mayo Clinic, we calculated frequencies and weighted estimates of socio-demographic factors and AFEs. Unadjusted and adjusted weighted multinomial logistic regression models were employed to assess the independent associations of each AFE and the different AFE composite scores with BMI category. Exposure to two or more AFEs was independently associated with increased odds of overweight (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.13, 1.56) and obese (OR, 1.45; 95% CI, 1.21, 1.73) status after adjustment for age, household income, parents' education-level, race and sex. Death of parent (OR, 1.59; 95% CI, 1.18, 2.15) and hardship due to family income (OR, 1.26; 95% CI, 1.06, 1.50) were independently associated with obesity status with adjustment for other AFEs and socio-demographic factors. Our results suggest that, in addition to cumulative exposure to AFEs, exposure to certain childhood experiences are more strongly associated with childhood obesity than others. Death of parent and hardship due to family income are individual AFEs, which are strongly predictive of obesity.


Asunto(s)
Maltrato a los Niños/psicología , Conflicto Familiar/psicología , Relaciones Padres-Hijo , Obesidad Infantil/epidemiología , Adolescente , Índice de Masa Corporal , Niño , Femenino , Humanos , Renta/estadística & datos numéricos , Masculino , Encuestas y Cuestionarios , Estados Unidos/epidemiología
4.
Early Hum Dev ; 192: 105991, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38552329

RESUMEN

OBJECTIVE: To investigate early childhood development (ECD) outcomes in different subgroups before and during the COVID-19 pandemic. STUDY DESIGN: A retrospective cohort study of children 3-58 months of age whose caregivers completed a Survey of Well-being of Young Children (SWYC) as part of a well child visit (WCC). The data were divided into two phases: pre-pandemic (September 2018 - February 2020), and during pandemic (September 2020 - February 2022). The difference in the proportion of forms with Meets Expectations interpreted scores on the SWYC Developmental Milestones pre-pandemic versus during the pandemic timeframe overall and among subgroups were reported. Hypotheses were tested using logistic regression with repeated measures. RESULTS: 14,550 patients were included in the sample for analysis with 52,558 SWYC form observations. There was no difference in the odds of a Meets Expectations interpreted score before and after the pandemic for the entire sample, OR 0.99 (95 % CI: 0.94-1.04). There was evidence of decreased odds of an interpreted score of Meets Expectations for the following subgroups: male, Hispanic/Latino ethnicity, ages of 24, 30 or 36 months at WCC, Medicaid insurance, 2nd HOUSES Quartile, requiring interpreter, single parent household, young maternal age, maternal substance abuse, and race identified as Native Hawaiian/Pacific Islander, American Indian/Native Alaskan or Other. CONCLUSION: Decreased odds of meeting developmental milestones during the pandemic were evident in certain high risk sub-groups revealing unequal distribution of suboptimal developmental outcomes within our population during the pandemic that may be exacerbating existing inequities impacting development in children.


Asunto(s)
COVID-19 , Desarrollo Infantil , Humanos , COVID-19/epidemiología , Masculino , Femenino , Lactante , Preescolar , Estudios Retrospectivos
5.
Child Obes ; 20(3): 169-177, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-37010378

RESUMEN

Background: Early childhood weight trajectory is associated with future risk for obesity. However, little is known about the association of birth weight and weight trajectories before age 5.5 years with severe adult obesity. Methods: This study used a nested case-control design of 785 matched sets of cases and controls matched 1:1 on age and gender from a 1976 to 1982 birth cohort in Olmsted County, Minnesota. Cases with severe adult obesity were defined as individuals with a BMI ≥40 kg/m2 after 18 years of age. There were 737 matched sets of cases and controls for the trajectory analysis. Weight and height data from birth through 5.5 years were abstracted from the medical records, and weight-for-age percentiles were obtained from the CDC growth charts. Results: A two-cluster weight-for-age trajectory solution was identified as optimal, with cluster 1 having higher weight-for-age before age 5.5 years. While there was no association between birth weight and severe adult obesity, the odds of being in cluster 1, which includes children with higher weight-for-age percentiles, was significantly increased for cases compared with controls [odds ratio (OR) 1.99, 95% confidence interval (CI) 1.60-2.47]. The association between cluster membership and case-control status persisted after adjusting for maternal age and education (adjusted OR 2.08, 95% CI 1.66-2.61). Conclusions: Our data suggest that early childhood weight-for-age trajectories are associated with severe obesity status in adult life. Our results add to growing evidence that it is critical to prevent excess early childhood weight gain.


Asunto(s)
Trayectoria del Peso Corporal , Obesidad Mórbida , Obesidad Infantil , Niño , Adulto , Preescolar , Humanos , Obesidad Mórbida/complicaciones , Obesidad Mórbida/epidemiología , Peso al Nacer , Estudios de Casos y Controles , Obesidad Infantil/epidemiología , Factores de Riesgo , Índice de Masa Corporal , Aumento de Peso
6.
J Prim Care Community Health ; 14: 21501319231204438, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37795858

RESUMEN

INTRODUCTION/OBJECTIVES: Elevated blood lead levels can cause impaired cognition and behavioral problems in children. Screening is important for identifying children with elevated blood lead levels, but many children who qualify for screening do not get tested. We aimed to see if the addition of prompts in the electronic health record (EHR) would lead to differences in blood lead tests ordered for children with government insurance. METHODS: In May 2018, a prompt was added to our institutional EHR that reminded primary care practitioners to recommend lead testing for patients with government insurance. For this retrospective observational pre-post comparative study, we reviewed the rate of blood lead test orders and completed collection before and after the prompt was introduced. RESULTS: The number of blood lead tests ordered did not increase after prompts were introduced in the EHR; rather, the lead screening rates at 12-month well-child visits decreased from 63.6% to 53.8% (P = .008). The 24-month visit data did not change significantly for the number of lead tests ordered before and after the prompt was introduced in the EHR. The number of lead tests completed showed a significant decrease after the prompt was introduced for the 12-month visit (P < .001) but no significant change for the 24-month visit (P = .70). CONCLUSIONS: This study showed that the addition of prompts in the EHR was not associated with an increase in the number of blood lead level tests ordered. Further research is needed to determine factors that could affect lead screening rates.


Asunto(s)
Registros Electrónicos de Salud , Plomo , Humanos , Estudios Retrospectivos
7.
J Child Adolesc Trauma ; : 1-9, 2023 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-37359460

RESUMEN

The purpose of the present study was to examine intergenerational transmission of adverse childhood experiences (ACEs) from parents to children and examine the buffering influence of forgiveness of oneself and others. Participants were 150 parents and children enrolled in Head Start in an upper midwestern, rural state who volunteered to complete questionnaires measuring ACEs and levels of forgiveness of oneself and others. Multiple correlation and regression were used to examine the associations between parent-reported parent and child ACEs and self-forgiveness and forgiveness of others. Analyses revealed that parental ACEs and child ACEs were positively correlated. Parents with low and medium levels of self-forgiveness and forgiveness of others had a stronger positive correlation between their own experience of ACEs and their child's, whereas, for parents with high levels of self-forgiveness and forgiveness of others, the correlation between parent and child ACEs was reduced statistically to zero. The cycle of intergenerational transmission of ACEs may be interrupted, or at very least notably buffered, by forgiving oneself and others.

8.
Paediatr Neonatal Pain ; 5(3): 66-75, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37744282

RESUMEN

This study evaluated the effect of the Certified Child Life Specialist (CCLS) on pediatric pain and pain management during routine immunization administration in the pediatric primary care clinic. Children 4-12 years of age (n = 125) presenting for a well child physical examination at a rural primary care clinic were selected to receive standard nursing care or standard nursing care plus CCLS support during routine immunization administration. Patient reported pain was measured using the Faces Pain Scale-Revised (FPS-R), and patient behavioral responses were measured during immunization administration using the Children's Emotional Manifestation Scale (CEMS). The performance of psychosocial interventions and administration of topical pain-relieving interventions were measured between both groups. CCLS support was associated with fewer negative emotional behaviors during immunization administration among 7- to 12-year-old children and a significantly higher provision of psychosocial interventions and topical pain-relieving interventions among all ages. This study demonstrates that the presence of a CCLS can increase the provision of psychosocial and pain-relieving interventions and reduce distress during immunization administration in a busy pediatric primary care clinic.

9.
Transl Behav Med ; 13(9): 700-709, 2023 09 12.
Artículo en Inglés | MEDLINE | ID: mdl-37053109

RESUMEN

Interventions for adolescent weight management that are ready to use in clinical settings are needed to address the obesity epidemic and improve the health and wellbeing of affected adolescents. This report describes the systematic process our team followed to adapt an evidence-based intervention (EBI) for adolescent weight management from its randomized control trial protocol to a package for delivery in a group-based telehealth format within a medical center. The EBI adaptation was clinician initiated, prompted by identified practice needs, and involved collaboration of the clinical team with the EBI developer. The process was guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and followed key steps for adapting EBIs to new contexts. RE-AIM-aligned adaptations included telehealth delivery and broader inclusion criteria, separate clinical and research evaluation batteries, adaptations to fit the clinical practice, practical fidelity checklists to guide and record session delivery, and continuous quality improvement processes aimed to facilitate program longevity and family engagement. The process culminated in a package of adapted intervention materials deemed by stakeholders as appropriate to the practice and congruent with the EBI model. This report provides a much-needed practical demonstration of the translation of an EBI for adolescent weight management from research protocol to group telehealth delivery in a medical center. Key lessons include the value of clinician-researcher collaboration, the breadth of resources needed to adapt EBIs for real-world delivery, and the importance of considering delivery context in implementation and evaluation decisions, including defining inclusion criteria, staffing, and outcomes assessments.


Approximately one in five adolescents in the USA have or are at significant risk for health problems associated with higher weight, such as type 2 diabetes and high cholesterol. Health behavior scientists have developed promising programs to support adolescents in establishing and maintaining eating and activity habits for healthy weight management. However, such programs are not widely available. To increase access to effective interventions, science-developed programs for this age group need to be translated to ready-to-use packages suitable to real-world settings such as health care centers. This paper describes the systematic process our team followed to translate an adolescent weight management program from its research study form to an intervention package for delivery in a group-based telehealth format within a medical center. We describe the changes made to the intervention resulting from this process. We also present our plans for evaluating the performance of the adapted intervention. Key lessons from this work include the value of clinician-researcher collaboration, the breadth of resources needed to adapt science-developed interventions for real-world delivery, and the importance of considering delivery context when planning how to run and evaluate the program, including defining inclusion criteria, staffing, and outcomes assessments.


Asunto(s)
Obesidad Infantil , Humanos , Adolescente , Obesidad Infantil/prevención & control , Terapia Conductista
10.
J Asthma ; 49(1): 23-8, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22149172

RESUMEN

OBJECTIVE: To evaluate the effect of the timeliness of asthma diagnosis on chest X-ray (CXR) and antibiotic utilization in children. PATIENTS AND METHODS: This was a retrospective cohort study of 276 asthmatic children aged 5-12 years from Rochester, Minnesota. From the time when children met our predetermined asthma criteria, the frequency of CXR and antibiotic utilizations for respiratory illnesses were collected from medical records until age 18 years. Using a Poisson regression model, the frequency of CXR and antibiotic utilizations were compared in children with timely, delayed, or no clinician diagnosis of asthma. RESULTS: Of the 276 asthmatic patients, 97 (35%) had a timely diagnosis, 122 (44%) had a delayed diagnosis, while 57 patients (21%) had no clinician diagnosis of asthma. There was no significant difference in CXR or antibiotic utilization for respiratory illness between these groups. In addition, this was true for the comparison between the timely diagnosed group and the delayed diagnosed group combining both the group with a delay in asthma diagnosis and the group who never had asthma diagnosis. CONCLUSIONS: A delay in the diagnosis of asthma in children is common and overall it may not influence antibiotic and CXR utilization for respiratory symptoms by clinicians. However, its impact on access to asthma-related therapies and other healthcare utilizations could be possible and was not assessed in this study. Given the limitations of our study, a larger prospective study needs to be considered.


Asunto(s)
Antibacterianos/administración & dosificación , Asma/diagnóstico por imagen , Asma/tratamiento farmacológico , Radiografía Torácica/estadística & datos numéricos , Adolescente , Asma/diagnóstico , Niño , Preescolar , Estudios de Cohortes , Diagnóstico Tardío , Progresión de la Enfermedad , Utilización de Medicamentos/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Minnesota , Distribución de Poisson , Radiografía Torácica/métodos , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
11.
J Prim Care Community Health ; 13: 21501319221084165, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35289215

RESUMEN

Adverse childhood experiences (ACEs) are potentially traumatic events that can cause lifelong suffering, with 1 out of 2 children in the United States experiencing at least 1 ACEs. The intergenerational effect of ACEs has been described, but there's still paucity of knowledge of its impact on child development and behavior in children enrolled in Early Head Start (EHS) home visiting programs. A retrospective observational study was performed with 71 parents and 92 children participating in the EHS Home Visiting Program in Olmsted County from 2014 to 2019. Parents reported their own ACEs using a 10-item questionnaire. Children's social-emotional status was evaluated with Devereux Early Childhood Assessment Second Edition (DECA) and development was evaluated using the Brigance Early Childhood Screens III. Referrals of children by EHS staff to community agencies were recorded. The association between parental ACEs score, developmental outcomes and referrals was analyzed. Parental ACEs score of 4 or more was associated with failing at least 1 domain on the Brigance screen (P = .02) especially adaptive/cognitive domain (P = .05), and increased risk of referral to community resources (P < .001). However, there was no association between ACEs scores and failing DECA screens. We identified an intergenerational association between parental exposure to ACEs and risk for childhood developmental delay and referrals to community services. Parental adverse childhood experiences (ACEs) have intergenerational effects on offspring. In our study, parental ACEs are associated with offspring developmental delays and referral to community resources. Screening for parental adverse childhood experiences, a key social determinant of health, is imperative and should be incorporated into primary care and early childhood settings to identify children at risk for developmental delay.


Asunto(s)
Experiencias Adversas de la Infancia , Niño , Desarrollo Infantil , Preescolar , Humanos , Padres/psicología , Estudios Retrospectivos , Encuestas y Cuestionarios , Estados Unidos
12.
Brain Sci ; 12(3)2022 Feb 27.
Artículo en Inglés | MEDLINE | ID: mdl-35326277

RESUMEN

This study examined the prospective relationships between preschoolers' body mass index (BMI) and cognitive development. BMI, cognitive (i.e., Brigance), sex, and age data were collected from seven cohorts of children attending Head Start from 2012 to 2018. Children (N = 324) with two years of complete data were included. After controlling for the first year cognitive development scores, age, gender, and the cohort, the BMI was predictive of lower cognitive development scores in year two (B = -0.06, ß = -0.14, t = -3.19, p = 0.002). Female sex (B = 2.69, ß = 0.10, t = 2.30, p = 0.022) and older age (B = 0.02, ß = 0.15, t = 3.20, p ≤ 0.001) were also shown to be statistically significant predictors of improved year two cognitive scores. The initial BMI scores were associated with poorer one year cognitive development scores in this sample of preschool children. Excessive body mass may contribute to numerous biological, psychological, and social factors that inhibit children with obesity from reaching their full cognitive potential, during a time in which brain development and cognitive skills development are at critical points of growth. Early childhood obesity interventions may have positive consequences for cognitive development, but additional prospective studies are needed to confirm these results.

13.
J Prim Care Community Health ; 13: 21501327211058982, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35249418

RESUMEN

BACKGROUND: Perinatal factors including gestational age, birthweight, size for gestational age, delivery route, maternal parity, maternal age, maternal education, socioeconomic status, race, and sex, are associated with the future risk of obesity and co-morbid conditions. This study evaluated the relationship of birthweight for gestational age and perinatal factors with severe obesity and dyslipidemia in adulthood. METHODS: We conducted a population-based, retrospective birth cohort study of infants born to residents of Olmsted County, MN between 1976 and 1982. Outcomes were assessed after age 18 years until October 2020, including severe obesity (BMI ≥ 40 kg/m2) and dyslipidemia (total cholesterol ≥200 mg/dL, non-high density lipoprotein [non-HDL] cholesterol ≥145 mg/dL or HDL cholesterol <40 mg/dL). We obtained mother's age, education level, and parity as well as newborn sex, race, type of delivery, single/multiple birth, gestational age, and birthweight from birth certificate data. Individual-level socioeconomic status (SES) of the household at birth was determined with the HOUSES index. RESULTS: Of 10 938 birth cohort subjects, 7394 had clinic visits after age 18 years and were included, with 2630 having severe obesity (n = 798) or dyslipidemia (n = 2357) as adults. In multivariable models, female sex, singleton birth, less maternal education, and lower SES defined by HOUSES were independently associated with an increased risk of severe obesity in adulthood. Non-white race, singleton birth, and lower birthweight were independently associated with adult dyslipidemia. Birthweight for gestational age was not associated with severe obesity or dyslipidemia. CONCLUSION: Perinatal factors were associated with both severe obesity and dyslipidemia in adulthood. Lower SES at birth was predictive of severe obesity in adulthood, highlighting the opportunity to investigate modifiable perinatal social determinants to reduce the risk of severe obesity.


Asunto(s)
Dislipidemias , Obesidad Mórbida , Adolescente , Adulto , Peso al Nacer , Estudios de Cohortes , Dislipidemias/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Obesidad Mórbida/epidemiología , Embarazo , Estudios Retrospectivos , Factores de Riesgo
14.
Prog Community Health Partnersh ; 15(4): 431-438, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34975025

RESUMEN

BACKGROUND: There is a need for community-based parent education programs that strengthen the parent-child relationship and mitigate the negative impact of parental adverse childhood experiences (ACEs) on child social-emotional development. OBJECTIVE: To examine whether a community-based parent education program can improve children's social-emotional development. METHODS: This was a prospective observational study of a series of community education parenting classes in Rochester, Minnesota. Group classes were delivered weekly for three months. Classes used Dr. Becky Bailey's Conscious Discipline Program. Parents of children ages 2 to 5 years and identified as at risk of poor social-emotional outcomes based on the Ages and Stages Questionnaire: Social-Emotional 2 (ASQ:SE2) score were eligible to participate. RESULTS: There were 39 child-parent dyads who enrolled. Parental ACEs scores ranged from 0 to 6 with a median of 1.5 (interquartile range, 0-3, N = 34). In the 33 children with both before and after ASQ:SE2 tests available, there was a significant decrease in the post-ASQ:SE2 score compared with the pre-ASQ:SE2 score (mean difference, -30.3; 95% confidence interval, CI -42.2 to -18.4; p < 0.001) where lower scores are associated with less social-emotional impairment. There was no significant association in the change of pre-post ASQ:SE2 scores as parents' ACEs scores increased (estimated slope, 3.1; 95% CI -3.7 to 9.9; p = 0.36). CONCLUSIONS: Community-based, parent education interventions can improve child social-emotional development. This program using Dr. Becky Bailey's Conscious Discipline Program improved ASQ-SE scores, regardless of parental ACEs exposure.


Asunto(s)
Experiencias Adversas de la Infancia , Niño , Conducta Infantil , Preescolar , Investigación Participativa Basada en la Comunidad , Humanos , Relaciones Padres-Hijo , Padres
15.
Artículo en Inglés | MEDLINE | ID: mdl-34115451

RESUMEN

Objective: To compare outcomes among newborns of opioid-using and nonopioid drug-using mothers with those of control mothers who did not report substance use.Methods: Using the Rochester Epidemiology Project, newborns diagnosed with drug withdrawal syndrome (per ICD-9 or ICD-10 codes) from January 2010 through June 2017 were identified. For mothers, data collected included age, race, drug use, number of prenatal visits, and results of the urinary drug abuse survey, meconium test, and self-report survey. Demographic and perinatal data collected for newborns included birth date; sex; Apgar scores at 1, 5, and 10 minutes; neonatal intensive care stay; and vital status. Controls (n = 771) were similarly selected in regard to sex, birth date, and county.Results: Of 328 infants identified, 168 were born with opioid neonatal abstinence syndrome and 160 with a nonopioid withdrawal syndrome. Control mothers had more prenatal visits than mothers in the nonopioid and opioid groups. Newborns of control mothers had higher Apgar scores at 1 and 5 minutes than both substance-using groups. Opioid-using mothers were almost twice as likely to have newborns requiring intensive care and 3 times as likely to use benzodiazepines compared to the other substance-using mothers. Substance-using mothers had more premature babies than controls.Conclusions: Prenatal opioid use is a substantial risk factor for prematurity. Newborns diagnosed with neonatal abstinence syndrome are at risk of perinatal complications. Mothers using opioids during pregnancy also tend to use other substances. Longitudinal research should clarify how prenatal substance use interacts with other risk factors during a child's first years.


Asunto(s)
Síndrome de Abstinencia Neonatal , Trastornos Relacionados con Opioides , Complicaciones del Embarazo , Síndrome de Abstinencia a Sustancias , Analgésicos Opioides/efectos adversos , Femenino , Humanos , Recién Nacido , Madres , Síndrome de Abstinencia Neonatal/tratamiento farmacológico , Síndrome de Abstinencia Neonatal/epidemiología , Síndrome de Abstinencia Neonatal/etiología , Trastornos Relacionados con Opioides/epidemiología , Embarazo , Complicaciones del Embarazo/epidemiología
16.
Allergy Asthma Proc ; 31(4): e48-e52, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20819315

RESUMEN

Delays in diagnosing asthma in children are common and are known to delay asthma-specific treatment. Few studies have investigated whether a delay in asthma diagnosis impacts the use of health care services. This study was designed to assess whether a delay in diagnosis of asthma influences the use of health care services. This was a retrospective cohort study with subjects elicited from a convenience sample of 839 healthy children. The criteria for asthma was met in 276 (33%) subjects; of these subjects 179 (65%) had a delay in the diagnosis of asthma and 97 (35%) had a timely diagnosis. Data on health care services (e.g., flu shot, availability of a peak flow meter, hospitalizations, and urgent care or emergency department visits) and the frequency of systemic steroid treatments were collected from medical records during the first 18 years of life. The frequencies of health service and use of systemic steroids were compared using Poisson and logistic regression models in asthmatic children with and without a delay in asthma diagnosis. Children with a delay in asthma diagnosis were more likely to visit urgent care centers at least once (40.8% versus 21.6%; p < 0.001), compared with those with a timely diagnosis. There were no significant differences in other health care service or systemic steroid use. A delay in the diagnosis of asthma was associated with an increase in urgent care visits suggesting suboptimal care. Clinicians should be aware that a delay in the diagnosis of asthma in children may result in the use of suboptimal health care services.


Asunto(s)
Asma/diagnóstico , Asma/epidemiología , Servicios Médicos de Urgencia/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Asma/tratamiento farmacológico , Niño , Preescolar , Diagnóstico Precoz , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Retrospectivos , Estados Unidos
17.
J Prim Care Community Health ; 11: 2150132720926279, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32501125

RESUMEN

The prevalence of childhood obesity continues to rise despite decades of clinical and public health efforts. Early identification of children at risk of developing obesity is essential using newer electronic health systems, which move beyond traditional growth charts to provide a wealth of information about body mass index and other relevant parameters such as social determinants of health and comorbid conditions. For children who already have obesity, there are several evidence-based strategies health care providers can use as they work with patients and families to mitigate the effects. First and foremost, providers should address the issue; unfortunately, weight is often not discussed in clinical practice. In addressing the issue, providers should support families through effective, positive relationships. Providers must be aware of their biases; their language should be appropriate and nonstigmatizing. Helpful interventions should focus on behavior, not weight, health, or appearance. Motivational interviewing may be used to promote healthful behaviors: supportive parenting, regular exercise, healthful food choices, minimal screen time, and optimal sleep. There is limited evidence for the efficacy of specific weight loss diets. Both medication and bariatric surgery are indicated for select adolescents who have severe disease unresponsive to behavioral management.


Asunto(s)
Obesidad Infantil , Adolescente , Índice de Masa Corporal , Peso Corporal , Niño , Ejercicio Físico , Humanos , Responsabilidad Parental , Obesidad Infantil/prevención & control
18.
J Prim Care Community Health ; 11: 2150132720962866, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32996367

RESUMEN

BACKGROUND: Childhood obesity represents a public health crisis in the United States. Thus, focusing on early childhood is crucial to modify the consequences associated with obesity. The Food and Fitness Initiative (FFI) is a community-based wellness program implemented in Northeast Iowa since 2009. FFI focuses on healthy eating and physical activity. Our aim is to describe the impact on body mass index (BMI) after implementing FFI in a Northeast Iowa Community Action Head Start (HS) population. METHODS: Retrospective BMI data was collected from all children attending 14 HS sites from 2012 to 2018. Children with BMI measurements during July to December of the first year in HS were included in the study. Follow-up data the second year in HS was obtained. Overweight and obesity prevalence, as well as, BMI changes between year 1 and 2 in HS were analyzed. RESULTS: Data from 1013 children were collected, 850 (84%) had qualifying BMI measurements during their first year in HS and 352 of those children (41%) had follow-up data in their second year. There was a decrease in BMI between years 1 and 2 in HS that approached statistical significance (t = 1.83, P = .07, d = .10). There were no statistically significant changes in the percent of overweight (Wald χ2 = .50, P = .48) or obese (Wald χ2 = 1.71, P = .19) children between the first and second year. CONCLUSION: The FFI wellness program can be feasibly integrated into the HS curriculum and shows promising short-term results in improving BMI, but not to a statistically significant level when evaluated over 1 year.


Asunto(s)
Sobrepeso , Obesidad Infantil , Índice de Masa Corporal , Niño , Preescolar , Estilo de Vida Saludable , Humanos , Iowa/epidemiología , Sobrepeso/epidemiología , Obesidad Infantil/epidemiología , Obesidad Infantil/prevención & control , Estudios Retrospectivos
19.
Children (Basel) ; 7(7)2020 Jun 27.
Artículo en Inglés | MEDLINE | ID: mdl-32605041

RESUMEN

BACKGROUND: Childhood obesity is associated with dyslipidemia, fatty liver disease, and type 2 diabetes. Expert guidelines recommend screening for these conditions in children with obesity. AIMS AND OBJECTIVES: The objective of the study was to compare rates of laboratory screening for dyslipidemia, fatty liver disease, and type 2 diabetes in children with obesity prior to and following implementation of a point-of-care decision support tool. METHODS: We performed a retrospective record review of children with body mass index (BMI) ≥95th percentile for age and gender (age 7-18 years) undergoing well-child/sports examination visits. Multivariable logistic regression models were used to adjust for patient and provider confounders. RESULTS: There was no increase in the rates of screening following implementation of the point-of-care decision support tool. Tests were more likely to be recommended in children with severe obesity and in females. CONCLUSIONS: The implementation of a point-of-care decision support tool was not associated with improvement in screening rates for dyslipidemia, fatty liver disease, and type 2 diabetes for children with obesity. Further strategies are needed to improve rates of screening for obesity-related comorbid conditions in children with obesity.

20.
J Prim Care Community Health ; 10: 2150132719874252, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31509061

RESUMEN

Objectives: This systematic review evaluated the accuracy of triaxial and omnidirectional accelerometers for measuring physical activity and sedentary behavior in children. Design: Systematic review of the literature. Methods: We comprehensively searched several databases for studies published from January 1996 through June 2018 that reported diagnostic accuracy measures in children and adolescents (age 3-18 years) and compared accelerometers with energy expenditure using indirect calorimetry. Results: We included 11 studies that enrolled 570 participants. All studies used indirect calorimetry as the reference standard. Across the studies, median sensitivity ranged from 46% to 96% and median specificity ranged from 71% to 96%. Median area under the curve ranged from 69% to 98%. Conclusions: Accuracy measures were greatest when detecting sedentary behavior and lowest when detecting light physical activity. Accuracy was higher when the accelerometer was placed on the hip compared with the wrist. The current evidence suggests that triaxial and omnidirectional accelerometers are accurate in measuring sedentary behavior and physical activity levels in children.


Asunto(s)
Acelerometría/métodos , Ejercicio Físico , Conducta Sedentaria , Adolescente , Niño , Humanos
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