The Weight of a Healthy Home: Early Screening for Childhood Obesity Risk

Purpose Despite the Healthy People 2020 target of 14.5%, the California obesity prevalence among low-income children ages 2 to 19 was 21% in 2010. An obesogenic home environment is a major contributor to overeating and sedentariness during this phase of development as children have less autonomy and are influenced by family environmental cues. The purpose of this evidence-based project was to implement a screening tool at a low socioeconomic elementary school clinic to identify children at risk of developing obesity and provide standardization for practitioners on educating parents regarding child obesity risk factors. The Family Nutrition and Physical Activity (FNPA) screening tool was completed by parents at all visits of school aged children 4 to 11 years old. The nurse practitioner (NP) provided parents with education regarding healthy home practices based on American Academy of Pediatrics (AAP) recommendations. Conclusion Instituting the practice change helped to identify children at risk of becoming overweight or obese, and allowed for anticipatory guidance by the NP to increase awareness of parental influence as role models for healthy lifestyle behaviors. Parents who receive education on healthy home environmental strategies showed improvement in modifying home behaviors to reflect recommendations by the AAP. Practice Implications Implementation of the FNPA tool at a school based clinic is a feasible opportunity to identify children at risk for obesity. Continuing to educate parents about home risk factors is key in the primary and secondary prevention efforts against obesity

Increasing Follow-up in College Students with Latent Tuberculosis Infection

Around 13 million people in the United States have latent tuberculosis infection (LTBI) with a 5-10% chance of developing active tuberculosis (TB) in their lifetime if not treated (Center for Disease Control, 2015). At a University Student Health Center (SHC), there is a matriculation requirement for TB testing for students that screen as high risk. Many students have these testing requirements performed at outside clinics, including foreign clinics, and follow-up regarding education about LTBI and treatment recommendations was often missing. The purpose of this evidence-based practice (EBP) project was to increase follow-up, education, and treatment options after diagnosis of LTBI. Students presenting with LTBI to the SHC received a standardized message through the secure patient-portal regarding their diagnosis, treatment options and education about LTBI. It asked them to follow-up with a message, telephone call or in-person appointment. Prior to the intervention, most students with LTBI received no follow-up, and after the intervention 100% of new cases received follow-up. A total of 42 students were sent a secure message, 31 read the secure message and 13 of those students contacted the health center or an outside provider for further follow-up. Out of those 13 students, 7 started treatment for LTBI. The goals of this study were to increase follow-up and education around LTBI, and increase the number of students choosing treatment, all of these outcomes were met. The secure message system was a reliable way to contact students regarding their diagnosis and education around LTBI. Keywords: Latent tuberculosis, interferon-gamma release assay, tuberculin skin test, mycobacterium tuberculosi