School-based health center-based treatment for obese adolescents: feasibility and body mass index effects.

BACKGROUND: School-based health centers (SBHCs) may be an ideal setting to address obesity in adolescents because they provide increased access to a traditionally difficult-to-reach population. The study evaluated the feasibility of adding a health educator (HE) to SBHC teams to provide support and increase the delivery of preventive services for overweight or obese adolescents. METHODS: Adolescents with BMI ≥85% recruited from two SBHCs were randomized to a control group (CG) or an intervention group (IG). Both groups received preventive services, including physical examinations and laboratory screening in the SBHC. The educator met with the IG during the academic year, utilizing motivational interviewing techniques to set lifestyle goals. Text messaging was used to reinforce goals between visits. RESULTS: Eighty-two students (15.7±1.5 years of age; BMI, 31.9±6.2 kg/m(2)) were enrolled in the IG and 83 in the control group (16.0±1.5 years of age; BMI, 31.6±6.5 kg/m(2)). Retention was 94% in the IG and 87% in the CG. A total of 54.5% of the IG and 72.2% of the CG decreased or maintained BMI z-score (less than 0.05 increase; p=0.025). Sports participation was higher in the CG (47% vs. 28% in the IG; p=0.02). Mean BMI z-score change was -0.05±0.2 for students participating in sports vs. 0.01±0.2 for those not (p=0.09). CONCLUSIONS: This SBHC intervention showed successful recruitment and retention of participants and delivery of preventive services in both groups. Meeting with an HE did not improve BMI outcomes in the IG. Confounding factors, including sports participation and SBHC utilization, likely contributed to BMI outcomes.

State strategies to reduce the number of uninsured children.

We present a local and state phased approach for expanding coverage and improving the health care system for children. During the first phase, state regulatory reforms can be instituted to enhance the ability of Medicaid and State Child Health Insurance Plan (SCHIP) programs to provide measurable, high-quality clinical care that is patient-centered, safe, effective, timely, and efficient. The second phase can implement regulatory and legislative reforms that build program awareness in the community and streamline the enrollment process to maximize the enrollment of eligible uninsured children into a state's Medicaid/SCHIP program. The third phase involves a legislative expansion of income eligibility for SCHIP together with state-financed programs for legal immigrant children and foreign national children. The fourth phase considers legislative reforms to make family coverage more affordable to slow the erosion of employer-sponsored family insurance coverage, especially in small businesses.

A successful international child health elective: the University of Colorado Department of Pediatrics' experience.

OBJECTIVES: To describe the organizational features of an international child health elective (ICHE) and to document the diversity of diagnoses observed by residents. DESIGN: Faculty from the Department of Pediatrics, University of Colorado Health Sciences Center, Denver, created a steering committee in 1999 to develop and direct an ICHE, including selecting residents, selecting and organizing sites, and creating objectives and a year-long preparatory curriculum. The elective was piloted in 2000 and repeated in 2002 and 2004. SETTING AND PARTICIPANTS: Residents chose from 4 ICHE sites in Peru and Guatemala, where they observed clinical care in various clinical settings during a 4-week elective. MAIN OUTCOME MEASURES: The ICHE was evaluated via written evaluations by faculty and residents as well as written and oral reports by participating residents. RESULTS: During the 2000 and 2004 electives, residents recorded clinical cases in a data-entry log. Of the patients logged, 18% had illnesses never seen before by the residents and 5.6% had illnesses in advanced stages not previously seen by the residents. Strong reciprocal relationships were created between the department and participating international institutions. Residents reported uniformly that the elective was a valuable element of their training. CONCLUSIONS: Planning and faculty involvement in ICHEs helps to ensure achievement of elective objectives. Well-organized ICHEs have the potential to augment resident education. The experience at our institution demonstrates that ICHEs can provide experience with a variety of medical systems, exposure to diverse pathophysiologic conditions, and opportunities for collaboration with international colleagues.