Fighting Obesity in the Public Schools

Provides suggestions for addressing childhood obesity through changes in school-based policies and programs. Offers strategies for improving the nutritional content of foods served in schools and increasing physical activity among students

Validity of neonatal POC glucose testing

Background: Glucose monitoring a common invasive intervention in newborn period •most commonly obtained laboratory value Appropriate identification of hypoglycemia is critical: •Severe hypoglycemia can lead to neurologic insult •Cerebral palsy, developmental delay, seizures, deat

What’s Happening to our Patients in their Final Year of Life?

We want to “die well” which includes: • Effective symptom management • Receiving care consistent with wishes Who achieves this, and how? • Primary care physicians (PCPs) – Insufficient time and training • Palliative care physicians – Better quality care and decreased health care cost in last years of life • “Surprise Question” – “Would you be surprised if this patient dies in the next year?” • To recognize our sickest patients and discuss goals of care and consult palliative care, if appropriate • “Advance care planning tab” – To record code status, advance directive, POLST forms, medical power of attorne

Did racial representation change at our outpatient sports medicine clinic during the COVID-19 Pandemic?

Introduction/Objective • COVID-19 pandemic has disproportionately affected Black, Indigenous, and People of Color (BIPOC) • Increased infection, hospitalization, and death rates1,2 • Black Americans unequal access to outpatient care vs. White Americans 3 • Inequity worsened during the COVID-19 Pandemic 4 • Maine population: 94.25% “White;” 1.42% “Black” 5 • July 2020 COVID cases: 66.8% “White;” 22% “Black” 6 • Did this disparity reflect in in our sports medicine clinic?https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1006/thumbnail.jp

Obstetric Outcomes Assessment for New Mainers

Introduction • 13% of Portland’s population in 2019 was recent immigrants • Numbers have increased, with \u3e350 asylum-seeking families (1500 individuals) in 2022 in Portland alone • Maine Medical Center (MMC) provides obstetrical care for more newly arrived, non-English speaking patients • Total deliveries in 2020, 2021 (6192) broke records at MMC • New Mainers at Increased risk for health disparities due to: language barriers, low socioeconomic status and stressors from a history of traumahttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2023/1025/thumbnail.jp

Missed Opportunities: Documentation and Referral Rates Among Children and Adults with Obesity

Introduction: Our study reports rates of obesity documentation on the problem list (PL) and numbers of referrals to obesity medicine specialists and dietitians among pediatric and adult patients with obesity. Methods: All pediatric and adult patients with obesity seen at 14 primary care clinics between 7/1/2017 and 6/30/2019 were evaluated for inclusion of obesity on the PL and referrals to obesity medicine specialists or dietitians. Results: For children with BMI \u3e95% for age, obesity was documented in 31.2%, and 12.5% received a referral. For adults with BMI \u3e30, obesity was documented in 54.2%, and 8.4% received a referral. Significantly more subjects received referrals when obesity was on the PL (both age-groups) compared to those without (children: 20.2% vs 9.0%; adults: 12.12% vs 3.9%, p values \u3c 0.0001). Higher BMI and more comorbidities were also associated with higher referral rates (children: 26.6% vs 8.6% for those with a BMI ≥ 99 percentile; adults: 19.9% vs 5.8% for those with a BMI ≥ 40; children: 20.2% vs 10.7% for ≥ 1 comorbidity vs 1 or fewer; adults: 22.7% vs 5.1% with ≥ 3 comorbidities compared to 0 comorbidities). Discussion: The low rates of documentation of obesity and low rates of referral raise concern that providers may be missing opportunities to identify and manage their patients affected by obesity. Conclusions: Children and adults with obesity are more likely to be referred to a dietitian or obesity medicine specialist if obesity is on the PL, they have a higher BMI, and they have more medical comorbidities

Referral Patterns for Pediatric Sports-Related Concussion in One New England Health Care System

Introduction: Patients with concussion may benefit from care provided by professionals from multiple disciplines based on the constellation of symptoms being reported. This study analyzed referral patterns from primary care and sports medicine clinicians for pediatric patients with sports-related concussion in one health care system. Methods: A retrospective chart review identified referrals placed to physical therapy, occupational therapy, speech pathology, optometry, psychology, neuropsychology, audiology, neurology, ophthalmology, otolaryngology, psychiatry, and sports medicine for pediatric patients with sports-related concussion. These patients were evaluated at MaineHealth family medicine, internal medicine/pediatrics, pediatrics, and sports medicine clinics in southern Maine between February 2019 and June 2022. Results: We identified 375 patients with concussions. These patients were most often evaluated by pediatrics (199; 53.1%) and sports medicine (160; 42.7%), with fewer evaluated by family medicine (28; 7.5%), internal medicine/pediatrics (8 patients; 2.1%), or internal medicine (6; 1.6%). The most common referrals were to physical therapy (40; 10.7%), sports medicine (21; 5.6%), psychology (11; 2.9%), and neurology (9; 2.4%). Sports medicine placed a significantly higher number of referrals (P \u3c .0001) than non-sports medicine disciplines. Discussion: Compared to prior research, fewer referrals were placed in this cohort of patients with concussion. Possible explanations include a larger population of uncomplicated concussions, the more rural setting in which this study occurred, or a lack of awareness of resources for further concussion care. Conclusions: Further investigation should be done to evaluate the causes of the reduced referrals and their impact on the recovery of pediatric athletes with concussion

Puzzling It Out: The Current State of Scientific Knowledge on Pre-Kindergarten Effects - A Consensus Statement

Scientific research has established that if all children are to achieve their developmental potential, it is important to lay the foundation during the earliest years for lifelong health, learning, and positive behavior. A central question is how well our public pre-kindergarten (pre-K) programs are doing to build this foundation.Forty-two states and the District of Columbia, through 57 pre-K programs, have introduced substantial innovations in their early education systems by developing the infrastructure, program sites, and workforce required to accommodate pre-K education. These programs now serve nearly 30 percent of the nation's 4-year-olds and 5 percent of 3-year-olds

Physician Gender Impact on Obesity Care in the Academic Ambulatory Setting

BACKGROUND & OBJECTIVE: The purpose of this study was to assess a nationally representative sample of academic family physicians to determine whether personal physician characteristics are associated with attitudes towards and care of overweight and/or obese patients. METHODS: Questions pertaining to physician’s interactions with overweight and obese patients was administered as the 2012 Council of Academic Family Medicine Educational Research Alliance (CERA) survey to academic family physicians. We analyzed self-reported demographic responses physicians gave with the main outcome the association between self-reported likelihood of engaging in weight loss discussions with overweight or obese patients and physicians’ personal characteristics (gender and physician BMI). RESULTS: 36% of the 1099 physicians surveyed were overweight and 14% were obese (Table 1). We found no differences in the self-reported likelihood of discussing weight loss strategies with either their overweight patients or obese patients by physician BMI category. 77% female vs. 64% male physicians reported being very/extremely likely to discuss weight loss with their obese patients at their most recent visit (p=0.002). Female physicians reported discussing weight loss strategies often or at every visit more than males (females 79%, males 69%; p=0.02). Finally, female physicians self-reported more minutes spent counseling overweight and obese patients (p = 0.0001) (Table 3). CONCLUSION: Female family medicine physicians are more likely than male counterparts to discuss weight loss strategies with obese patients and they report spending more time discussing weight loss strategies with their patients. However, self-reported physician BMI was not associated with these behaviors