Referrals and Management Strategies for Pediatric Obesity—DocStyles Survey 2017

Background: Childhood obesity care management options can be delivered in community-, clinic-, and hospital-settings. The referral practices of clinicians to these various settings have not previously been characterized beyond the local level. This study describes the management strategies and referral practices of clinicians caring for pediatric patients with obesity and associated clinician characteristics in a geographically diverse sample.Methods: This cross-sectional study used data from the DocStyles 2017 panel-based survey of 891 clinicians who see pediatric patients. We used multivariable logistic regression to estimate associations between the demographic and practice characteristics of clinicians and types of referrals for the purposes of pediatric weight management.Results: About half of surveyed clinicians (54%) referred <25% of their pediatric patients with obesity for the purposes of weight management. Only 15% referred most (≥75%) of their pediatric patients with obesity for weight management. Referral types included clinical referrals, behavioral referrals, and weight management program (WMP) referrals. Within these categories, the percentage referrals ranged from 19% for behavioral/mental health professionals to 72% for registered dieticians. Among the significant associations, female clinicians had higher odds of referral to community and clinical WMP; practices in the Northeast had higher odds of referral to subspecialists, dieticians, mental health professionals, and clinical WMP; and clinics having ≥15 well child visits per week were associated with higher odds of referral to subspecialists, mental health professionals, and health educators. Not having an affiliation with teaching hospitals and serving low-income patients were associated with lower odds of referral to mental health professionals, and community and clinical WMP. Compared to pediatricians, family practitioners, internists, and nurse practitioners had higher odds of providing referrals to mental health professionals and to health educators.Conclusion: This study helps characterize the current landscape of referral practices and management strategies of clinicians who care for pediatric patients with obesity. Our data provide insight into the clinician, clinical practice, and reported patient characteristics associated with childhood obesity referral types. Understanding referral patterns and management strategies may help improve care for children with obesity and their families

Height-for-age z scores increase despite increasing height deficits among children in 5 developing countries

Background: Growth failure remains a persistent challenge in many countries, and understanding child growth patterns is critical to the development of appropriate interventions and their evaluation. The interpretation of changes in mean height-for-age z scores (HAZs) over time to define catch-up growth has been a subject of debate. Most studies of child growth have been cross-sectional or have focused on children through age 5 y

非老年糖尿病患者接受眼科检查的合并症状况和医疗利用情况的差异

Abstract Background To evaluate the effect of diabetes comorbidities by baseline healthcare utilization on receipt of recommended eye examinations. Methods Retrospective analysis of 310 691 nonelderly adults with type 2 diabetes in the IBM MarketScan Commercial Database from 2016 to 2019. Patients were grouped based on diabetes‐concordant (related) or ‐discordant (unrelated) comorbidities. Logistic regression was used to estimate the prevalence ratio (PR) for eye examinations by comorbidity status, healthcare utilization, and an interaction between comorbidities and utilization, controlling for age, sex, region, and major eye disease. Results Prevalence of biennial eye examinations varied by the four comorbidity groups: 43.5% (diabetes only), 52.7% (concordant + discordant comorbidities), 48.0% (concordant comorbidities only), and 45.3% (discordant comorbidities only). In the lowest healthcare utilization tertile, the concordant‐only and concordant + discordant groups had lower prevalence of examinations compared to diabetes only (PR 0.95 [95% CI 0.92–0.98] and PR 0.91 [95% CI 0.88–0.95], respectively). In the medium utilization tertile, the discordant‐only and concordant + discordant groups had lower prevalence of examinations (PR 0.89 [0.83–0.95] and PR 0.94 [0.90–0.98], respectively). In the highest utilization tertile, the concordant‐only and concordant + discordant groups had higher prevalence of examinations. Conclusions Among patients with low healthcare utilization, having comorbid conditions is associated with lower prevalence of eye examinations. Among those with medium healthcare utilization, patients with diabetes‐discordant comorbidities are particularly vulnerable. This study highlights populations of diabetes patients who would benefit from increased assistance in receiving vision‐preserving eye examinations

Adolescent Pregnancy and Attained Height among Black South African Girls: Matched-Pair Prospective Study.

IMPORTANCE:The impact of adolescent pregnancy on offspring birth outcomes has been widely studied, but less is known about its impact on the growth of the young mother herself. OBJECTIVE:To determine the association between adolescent pregnancy and attained height. DESIGN:Prospective birth cohort study. SETTING:Cohort members followed from birth to age 20 y in Soweto, South Africa. PARTICIPANT:From among 840 Black females with sufficient data, we identified 54 matched pairs, in which a girl who became pregnant before the age of 17 years was matched with a girl who did not have a pregnancy by age 20 y. Pairs were matched on age at menarche and height-for-age z scores in the year before the case became pregnant (mean 15.0 y). MAIN OUTCOME MEASURES:The two groups were compared with respect to attained height, measured at mean age 18.5 y. RESULTS:Mean age at conception was 15.9 years (range: 13.7 to 16.9 y). Mean height at matching was 159.4 cm in the adolescent pregnancy group and 159.3 cm in the comparison group (p = 0.3). Mean attained height was 160.4 cm in the adolescent pregnancy group and 160.3 cm in the comparison group (p = 0.7). CONCLUSIONS:Among Black females in Soweto, South Africa, adolescent pregnancy was not associated with attained height

Postinfancy growth, schooling, and cognitive achievement: Young Lives

A menudo se supone que el retraso en el crecimiento de la vida temprana y los déficits cognitivos resultantes son muy difíciles de revertir después de la infancia. Utilizamos datos de Young Lives, que es una cohorte observacional de 8062 niños en Etiopía, India, Perú y Vietnam, para determinar si los cambios en el crecimiento después de la infancia están asociados con escolaridad y rendimiento cognitivo a la edad de 8 años. Representamos el crecimiento por puntaje z de altura para la edad en 1 y [HAZ (1)] y puntaje z de altura para la edad a los 8 años que no fue pronosticado por la HAZ (1). También caracterizamos el crecimiento como recuperado (atrofiado a la edad de 1 año y no a la edad de 8 años), vacilado (no atrofiado a la edad de 1 año y atrofiado a los 8 años), atrofiado persistente (atrofiado a edades de 1 y 8 años) o nunca retraso en el crecimiento (no atrofiado a edades de 1 y 8 años). Las medidas de resultado se evaluaron a los 8 años de edad

Postinfancy growth, schooling, and cognitive achievement: Young Lives

A menudo se supone que el retraso en el crecimiento de la vida temprana y los déficits cognitivos resultantes son muy difíciles de revertir después de la infancia. Utilizamos datos de Young Lives, que es una cohorte observacional de 8062 niños en Etiopía, India, Perú y Vietnam, para determinar si los cambios en el crecimiento después de la infancia están asociados con escolaridad y rendimiento cognitivo a la edad de 8 años. Representamos el crecimiento por puntaje z de altura para la edad en 1 y [HAZ (1)] y puntaje z de altura para la edad a los 8 años que no fue pronosticado por la HAZ (1). También caracterizamos el crecimiento como recuperado (atrofiado a la edad de 1 año y no a la edad de 8 años), vacilado (no atrofiado a la edad de 1 año y atrofiado a los 8 años), atrofiado persistente (atrofiado a edades de 1 y 8 años) o nunca retraso en el crecimiento (no atrofiado a edades de 1 y 8 años). Las medidas de resultado se evaluaron a los 8 años de edad

Mean Height-for-age Z score by age, girls in the Birth-to-Twenty Plus study.

<p>Mean Height-for-age Z score by age, girls in the Birth-to-Twenty Plus study.</p

Mean height (cm) by age, matched-paired girls in the Birth-to-Twenty Plus Study.

<p>Mean height (cm) by age, matched-paired girls in the Birth-to-Twenty Plus Study.</p