Self-Reported Versus Actual Weight and Height Data Contribute to Different Weight Misperception Classifications

Objectives: The purpose of the study was to examine potential differences between two approaches to defining adolescent weight misperception. Specifically, weight status perception was compared with self-reported weight status and actual weight status (based on body mass index percentiles calculated from self-reported and actual weights and heights, respectively). Furthermore, the accuracy of assigning weight status based on body mass index percentiles calculated from self-reported weights and heights was assessed by comparing them with actual weight status. Methods: Data were extracted from Team Up for Healthy Living, an 8-week, school-based obesity prevention program in southern Appalachia. Participants (N = 1509) were predominately white (93.4%) and ninth graders (89.5%), with approximately equivalent representation of both sexes (50.7% boys). Results: The study revealed significant differences between the approaches to defining weight misperception (χ2 = 16.2; P = 0.0003). Conclusions: Researchers should interpret study findings with awareness of potential differences based on the method of calculating weight misperception

The Family Check-Up in a Pediatric Clinic: An Integrated Care Delivery Model to Improve Behaviors in the Home Environment

This study examines the feasibility of adapting the Family Check Up (FCU), an evidence-based program to identify and manage behavioral concerns in children ages 4 and 5 years, within a pediatric primary care clinic with an integrated mental health professional. Methods: Caregivers attending their child’s 4 and 5 year-old well child visit were asked to complete a screening tool (Pediatric Symptom Checklist-17; PSC-17) measuring behavioral concerns as part of routine care. Families who screened positively, were referred to the FCU and asked to participate in a study evaluating the intervention. The FCU is a 2-session intervention during which information on home environment and parenting style was collected through tailored questionnaires, videotaped interactions, and a clinical interview. Feasibility was examined using portions of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (REAIM) framework from the Dissemination and Implementation Science field. This study presents preliminary data on the domains of Reach and Adoption over the first 5 months of the FCU. Results: The number of families referred who attended at least one session (Reach) was 77.2%. Current data shows that use of the PSC-17 screening instrument (Adoption) is 91.4% for well child checks and 25% for acute visits. Adoption of those referred to the FCU is 84%, indicating most families screening positively for behavioral concerns were successfully referred to the FCU. Conclusion: Initial results suggest Reach and Adoption rates support the feasibility of adapting a behavioral intervention for delivery in the pediatric clinic. Notably, having an existing integrated care delivery model is a critical piece to this early success. Future directions will continue to explore feasibility of the remaining REAIM domains

The National School Lunch Program in Rural Appalachian Tennessee – or Why Implementation of the Healthy, Hunger Free Kids Act of 2010 was Met with Challenges: A Brief Report

Purpose: The purpose of this study was to investigate challenges faced by high schools in rural Appalachia in implementing the Healthy, Hunger Free Kids Act of 2010 (HHFKA). Methodology: We used qualitative, secondary analysis to analyze a collection of thirteen focus groups and 22 interviews conducted in 2013-14 among parents, teachers, and high school students in six counties in rural Appalachian Tennessee (n=98). Results: Five basic themes were identified during the thematic analysis: poor food quality prior to implementation of the HHFKA school nutrition reforms; students’ preference for low-nutrient energy-dense foods; low acceptance of healthier options after implementation of the HHFKA school nutrition reforms; HHFKA school nutrition reforms not tailored to unique needs of under-resourced communities; and students opting out of the National School Lunch Program after implementation of the HHFKA school nutrition reforms. Rural communities face multiple and intersecting challenges in implementing the HHFKA school nutrition reforms. Conclusion: As a result, schools in rural Appalachia may be less likely to derive benefits from these reforms. The ability of rural schools to take advantage of school nutrition reforms to improve student health may depend largely on factors unique to each community or school

Primary Care Practice Addressing Child Overweight and Obesity: A Survey of Primary Care Physicians at Four Clinics in Southern Appalachia

Objective: The prevalence of childhood overweight and obesity in southern Appalachia is among the highest in the United States (US). Primary care providers are in a unique position to address the problem; however, little is known about attitudes and practices in these settings. Methods: A 61-item healthcare provider questionnaire assessing current practices, attitudes, perceived barriers, and skill levels in managing childhood overweight and obesity was distributed to physicians in four primary care clinics. Questionnaires were obtained from 36 physicians. Results: Physicians\u27 practices to address childhood overweight and obesity were limited, despite the fact that most physicians shared the attitude that childhood overweight and obesity need attention. While 71% of physicians reported talking about eating and physical activity habits with parents of overweight or obese children, only 19% reported giving these parents the tools they needed to make changes. Approximately 42% determined the parents\u27 readiness to make small changes for their overweight or obese children. Physicians\u27 self-perceived skill level in managing childhood overweight and obesity was found to be a key factor for childhood overweight- and obesity- related practices. Conclusion: Primary care physicians in southern Appalachia currently play a limited role in the prevention or intervention of childhood overweight and obesity. Training physicians to improve their skills in managing childhood overweight and obesity may lead to an improvement in practice

Developing a Coordinated School Health Approach to Child Obesity Prevention in Rural Appalachia: Results of Focus Groups with Teachers, Parents, and Students

INTRODUCTION: High prevalence rates of obesity, particularly among those residing in US rural areas, and associated physical and psychosocial health consequences, direct attention to the need for effective prevention programs. The current study describes an initial step in developing a school-based obesity prevention program in rural Appalachia, USA. The program, modeled on the Centers for Disease Control and Prevention Coordinated School Health (CSH) Program, includes a community-based participatory research approach to addressing the health needs specific to this region. METHODS: Focus groups with teachers, parents, and 4th grade students were used to understand perceptions and school policy related to nutrition, physical activity, and the role of the school in obesity prevention. RESULTS: Results revealed that these community stakeholders were concerned about the problem of child obesity and supported the idea of their school doing more to improve the diet and physical activity of its students. Specifically, all groups thought that foods and drinks consumed by students at school should be healthier and that they should have more opportunities for physical activity. However, they cited limitations of the school environment, academic pressures, and lack of parental support as potential barriers to making such changes. Parents were most concerned that their children were not getting enough to eat and they and the teachers were not in favor of BMI screening at the school. Parents were in favor of increasing physical activity during school and thought that parent volunteers should help students select foods in the cafeteria. Students cited examples of how diet and physical activity affect their health and school performance, and thought that they should have more physical education time and recess. CONCLUSIONS: The data collected in the current study contributed to the limited knowledge base regarding rural populations as well as identified strengths and potential barriers to assist with the development of a pilot program based on the CSH model, Winning with Wellness

Parent-Led Activity and Nutrition (plan) for Healthy Living: Design and Methods

Child obesity has become an important public health concern, especially in rural areas. Primary care providers are well positioned to intervene with children and their parents, but encounter many barriers to addressing child overweight and obesity. This paper describes the design and methods of a cluster-randomized controlled trial to evaluate a parent-mediated approach utilizing physician\u27s brief motivational interviewing and parent group sessions to treat child (ages 5–11 years) overweight and obesity in the primary care setting in Southern Appalachia. Specific aims of this pilot project will be 1) to establish a primary care based and parent-mediated childhood overweight intervention program in the primary care setting, 2) to explore the efficacy of this intervention in promoting healthier weight status and health behaviors of children, and 3) to examine the acceptability and feasibility of the approach among parents and primary care providers. If proven to be effective, this approach may be an exportable model to other primary care practices

Irritability and Intractable Crying

Now in its Second Edition, this text focuses exclusively on the management of hospitalized pediatric patients from admission to discharge. It is an excellent resource for residency programs, hospitalist fellowships, and continuing education for physicians whose practice includes the management of hospitalized newborns and children. Because pediatric hospital care is provided by a wide variety of healthcare professionals and in many different hospital settings, this text provides a framework for unified management and effective and efficient care. This edition includes new sections on emergency medicine and psychiatric hospitalization and expanded coverage of management of children with complex and chronic conditions