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Baer RJ, Bandoli G, Jelliffe-Pawlowski LL, Rhee KE, Chambers CD. Pregnancies complicated by Bulimia Nervosa are at increased risk of chorioamnionitis, anemia, and preterm birth. Am J Obstet Gynecol 2024:S0002-9378(24)00435-6. [PMID: 38460834 DOI: 10.1016/j.ajog.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/05/2024] [Accepted: 03/06/2024] [Indexed: 03/11/2024]
Affiliation(s)
- Rebecca J Baer
- Department of Pediatrics, University of California San Diego, La Jolla, CA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA.
| | - Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Laura L Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Kyung E Rhee
- Department of Pediatrics, University of California San Diego, La Jolla, CA
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2
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Adise S, Rhee KE, Laurent J, Holzhausen EA, Rezvan PH, Alderete TL, Vidmar AP. Limitations of BMI z scores for assessing weight change: A clinical tool versus individual risk. Obesity (Silver Spring) 2024; 32:445-449. [PMID: 38192094 PMCID: PMC10922421 DOI: 10.1002/oby.23957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 01/10/2024]
Abstract
Although pediatric growth curves provide clinical utility, using these metrics for within-person change over time can be misleading. As research is focused on understanding cardiometabolic consequences of weight gain, it is important to use precise metrics to analyze these longitudinal research questions. Despite several foundational recommendations to limit the use of reference pediatric growth curves (e.g., BMI z scores) for within-person longitudinal research, it has evolved into the "gold standard" for using growth curves for pediatric weight gain analyses. Therefore, the objective of this paper is to discuss (A) the methodology used to create reference growth curves; (B) the appropriate use of reference pediatric BMI growth curves within the context of cross-sectional and longitudinal analyses in research; and (C) how to select metrics based on desired evaluations. Careful consideration using standardized references scores is essential when assessing obesity-related questions and comorbid risk over time in pediatric populations.
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Affiliation(s)
- Shana Adise
- Children’s Hospital Los Angeles and Keck School of Medicine of USC, Department of Pediatrics, Division of Endocrinology, Diabetes and Metabolism, Los Angeles, CA
| | - Kyung E. Rhee
- University of California, San Diego, Department of Pediatrics, La Jolla, CA
| | | | | | - Panteha Hayati Rezvan
- Children’s Hospital Los Angeles, The Saban Research Institute, Biostatistics and Data Management Core, Los Angeles, CA
| | - Tanya L. Alderete
- University of Colorado Boulder, Department of Integrative Physiology, Boulder, CO
| | - Alaina P. Vidmar
- Children’s Hospital Los Angeles and Keck School of Medicine of USC, Department of Pediatrics, Division of Endocrinology, Diabetes and Metabolism, Los Angeles, CA
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3
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Rao S, Gross RS, Mohandas S, Stein CR, Case A, Dreyer B, Pajor NM, Bunnell HT, Warburton D, Berg E, Overdevest JB, Gorelik M, Milner J, Saxena S, Jhaveri R, Wood JC, Rhee KE, Letts R, Maughan C, Guthe N, Castro-Baucom L, Stockwell MS. Postacute Sequelae of SARS-CoV-2 in Children. Pediatrics 2024; 153:e2023062570. [PMID: 38321938 PMCID: PMC10904902 DOI: 10.1542/peds.2023-062570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 02/08/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused significant medical, social, and economic impacts globally, both in the short and long term. Although most individuals recover within a few days or weeks from an acute infection, some experience longer lasting effects. Data regarding the postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC) in children, or long COVID, are only just emerging in the literature. These symptoms and conditions may reflect persistent symptoms from acute infection (eg, cough, headaches, fatigue, and loss of taste and smell), new symptoms like dizziness, or exacerbation of underlying conditions. Children may develop conditions de novo, including postural orthostatic tachycardia syndrome, myalgic encephalomyelitis/chronic fatigue syndrome, autoimmune conditions and multisystem inflammatory syndrome in children. This state-of-the-art narrative review provides a summary of our current knowledge about PASC in children, including prevalence, epidemiology, risk factors, clinical characteristics, underlying mechanisms, and functional outcomes, as well as a conceptual framework for PASC based on the current National Institutes of Health definition. We highlight the pediatric components of the National Institutes of Health-funded Researching COVID to Enhance Recovery Initiative, which seeks to characterize the natural history, mechanisms, and long-term health effects of PASC in children and young adults to inform future treatment and prevention efforts. These initiatives include electronic health record cohorts, which offer rapid assessments at scale with geographical and demographic diversity, as well as longitudinal prospective observational cohorts, to estimate disease burden, illness trajectory, pathobiology, and clinical manifestations and outcomes.
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Affiliation(s)
- Suchitra Rao
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Rachel S. Gross
- Departments of Pediatrics
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Sindhu Mohandas
- Division of Infectious Diseases
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Cheryl R. Stein
- Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Abigail Case
- Department of Pediatrics and Rehabilitation Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Benard Dreyer
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nathan M. Pajor
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - H. Timothy Bunnell
- Biomedical Research Informatics Center, Nemours Children’s Health, Nemours Children’s Hospital, Delaware, Wilmington, Delaware
| | - David Warburton
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Elizabeth Berg
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Jonathan B. Overdevest
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Mark Gorelik
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Joshua Milner
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Sejal Saxena
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Ravi Jhaveri
- Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - John C. Wood
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kyung E. Rhee
- Department of Pediatrics, University of California, San Diego, School of Medicine, San Diego, California
| | - Rebecca Letts
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Christine Maughan
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Nick Guthe
- Population Health, NYU Grossman School of Medicine, New York, New York
| | | | - Melissa S. Stockwell
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
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4
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Inwards-Breland DJ, Yeh D, Marinkovic M, Richardson TR, Marino-Kibbee B, Bayley A, Rhee KE. Facilitators and barriers to using telemedicine for gender-affirming care in gender-diverse youth: A qualitative study. J Telemed Telecare 2024:1357633X241231015. [PMID: 38400512 DOI: 10.1177/1357633x241231015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Access to gender-affirming care (GAC) is limited for gender-diverse (GD) youth, with the potential for further limitations given the current political climate. GAC has been shown to improve the mental health of GD youth and telemedicine (TM) could increase access to GAC. With limited data on the acceptability and feasibility of TM for GAC among GD youth, we sought to further explore their perspectives on the use of TM in their care. METHODS We used a semi-structured interview guide, with prompts developed to explore participants' knowledge of TM, identify factors that influenced use, and advantages or disadvantages of use. RESULTS Thirty GD participants aged 13-21 years old participated in TM. While TM was not the preferred option for medical visits, it was recognized as a practical option for providing GAC. Various actual and perceived disadvantages noted by youth included, technical issues interrupting the visit, not receiving care equivalent to that of an in-person visit, having to see themselves on the screen, family members interrupting visits, and meeting new staff while connecting to a TM visit. The advantages, however, were an increased autonomy and convenience of TM, especially when used for specific aspects of GAC. DISCUSSION The use of TM in GAC could be optimized by limiting camera use, eliminating/reducing staff involvement, being sensitive to privacy issues, and alternating TM with in-person visits. Clinicians should be cognizant of patient preferences and concerns and be flexible with visit types.
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Affiliation(s)
| | - Debra Yeh
- UC San Diego School of Medicine, Department of Pediatrics, La Jolla, CA, USA
| | - Maja Marinkovic
- UC San Diego School of Medicine, Department of Pediatrics, La Jolla, CA, USA
| | | | | | | | - Kyung E Rhee
- UC San Diego School of Medicine, Department of Pediatrics, La Jolla, CA, USA
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Scott VP, Rhee KE. Using the lens of trauma informed care to inform pediatric obesity management. Curr Opin Pediatr 2024; 36:49-56. [PMID: 37965895 DOI: 10.1097/mop.0000000000001314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE OF REVIEW Summarize the evolution of the trauma-informed care (TIC) approach in pediatrics, highlight the importance of using this lens in pediatric obesity management and treating the whole patient and family, and suggest recommendations for providers to incorporate TIC into their practice. RECENT FINDINGS Implementing TIC in pediatric obesity management is recommended and offers an approach to address trauma-related symptoms associated with obesity. The TIC framework creates a safe, nurturing space to have open conversations with patients and families to promote resilience and reduce stigma related to obesity without re-traumatization. Screening tools may expose symptoms related to trauma, but are limited. Provider training is available and development of TIC related skills may be improved through using the arts and humanities. Success of TIC requires a tailored, integrated healthcare system approach with commitment from all levels. SUMMARY The TIC approach offers providers skills to uncover trauma-related symptoms and address obesity-related health disparities while reducing stigma. Collaboration across all levels of the healthcare system and community partners is essential. Further research is warranted on the effectives of this approach in pediatric obesity prevention and management.
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Affiliation(s)
- Vanessa P Scott
- UC San Diego School of Medicine, Department of Pediatrics, UC San Diego Health, Academic General Pediatrics, La Jolla, California, USA
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6
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Yu JC, Rhee KE, Dworsky ZD, Larrow A, Passarelli P, Patel A. Improving Pediatric Fellows' Feedback Skills and Confidence Through Objective Structured Examinations. J Grad Med Educ 2024; 16:64-69. [PMID: 38304600 PMCID: PMC10829923 DOI: 10.4300/jgme-d-23-00332.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/20/2023] [Accepted: 11/27/2023] [Indexed: 02/03/2024] Open
Abstract
Background Medical trainees must learn how to provide effective feedback as an essential communication skill, yet few models exist for training and assessing these skills. Objective To develop an observed structured feedback examination (OSFE) to provide feedback training to pediatric fellows and assess changes in skills and self-reported confidence. Methods This educational study was conducted from 2019 to 2020 at an academic children's hospital. Our team developed the OSFE and trained standardized feedback recipients and faculty. Fellows completed baseline self-assessments (31 items) on prior exposure to feedback training, application of skills, and confidence. They then participated in the OSFE, giving feedback to a standardized recipient using a standardized scenario, and were scored by faculty and recipients using a 15-item checklist for performance. Next, fellows participated in feedback training and received individualized feedback, after which they repeated the OSFE and confidence self-assessment. Three months later, fellows completed self-assessments on confidence and application of skills and another OSFE to assess retention. Descriptive statistics and signed rank sum test were used for analysis. Results Of 60 eligible fellows, 19 participated (32%), with 100% follow-up. After training and individualized feedback, all fellows improved feedback skills as measured by OSFE performance (mean change +0.89). All items, measured on a 5-point Likert scale, were sustained 3 months later (mean change +0.92). All fellows reported improved confidence in feedback knowledge (mean change +2.07 post, +1.67 3 months post). Conclusions Feedback training using simulation and individualized feedback moderately improved fellows' performance, confidence, and 3-month retention of feedback skills.
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Affiliation(s)
- Jennifer C. Yu
- Jennifer C. Yu, MD, is Faculty, Department of Pediatrics, Rady Children’s Hospital San Diego, University of California San Diego, San Diego, California, USA
| | - Kyung E. Rhee
- Kyung E. Rhee, MD, MSc, MA, is Faculty, Department of Pediatrics, Rady Children’s Hospital San Diego, University of California San Diego, San Diego, California, USA
| | - Zephyr D. Dworsky
- Zephyr D. Dworsky, MD, at the time of the study was a Clinical Fellow, Department of Pediatrics, Rady Children’s Hospital San Diego, University of California San Diego, San Diego, California, USA, and is now Faculty, Department of Pediatrics, Barbara Bush Children’s Hospital, Tufts University, Medford, Massachusetts, USA
| | - Annie Larrow
- Annie Larrow, MD, MS, at the time of the study was a Clinical Fellow, and is now Faculty, Department of Pediatrics, Rady Children’s Hospital San Diego, University of California San Diego, San Diego, California, USA
| | - Patrick Passarelli
- Patrick Passarelli, MD, was Chief Resident, Department of Pediatrics, Rady Children’s Hospital San Diego, University of California San Diego, San Diego, California, USA, and is now a Hospitalist, Department of Internal Medicine and Pediatrics, Arnot Ogden Medical Center, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA; and
| | - Aarti Patel
- Aarti Patel, MD, MEd, is Faculty, Department of Pediatrics, Rady Children’s Hospital San Diego, University of California San Diego, San Diego, California, USA
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Chen C, Eichen D, Kang Sim DE, Strong D, Boutelle KN, Rhee KE. Change in Weight Status Among Children Who Do and Do Not Participate in Intensive Health Behavior and Lifestyle Treatment for Obesity. Child Obes 2024. [PMID: 38265804 DOI: 10.1089/chi.2023.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Background: Primary care providers (PCPs) are expected to provide weight management counseling despite having low confidence in their ability to be effective. This analysis examined change in weight status between children who received usual care from their PCP and those who received one of two structured weight management programs in a randomized control trial. Methods: Data from parent-child dyads who were referred to the Guided Self-Help Obesity Treatment in the Doctor's Office study, but did not participate, were examined to determine change in weight status compared with those who participated in the trial. Families were divided into four groups: Group 1, structured treatment with high attendance; Group 2, structured treatment with low attendance; Group 3, PCP/usual care with some weight management counseling; and Group 4, PCP/usual care with no counseling. Anthropometric data and PCP delivery of weight management counseling were abstracted from the electronic health record. Main outcomes were changes in child BMI z-scores, BMI as a percentage relative to the 95th percentile, and BMI as a difference relative to the 95th percentile at the end of treatment and 6-month follow-up for each group. Results: Groups 1 and 2 showed significant decreases in weight status over time, with Group 1 showing the greatest decrease. Groups 3 and 4 remained relatively stable. Changes in weight status in Groups 2, 3, and 4 were significantly different from Group 1 at post-treatment. Conclusions: While structured weight management programs have a significant impact on weight status, those who received some counseling by their PCP did not show significant increases in weight status and were relatively weight stable. Efforts should be broadened to support PCPs as they provide weight management counseling in the office.
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Affiliation(s)
- Cathy Chen
- Northern California Kaiser Permanente Medical Group, Sacramento, CA, USA
| | - Dawn Eichen
- Department of Pediatrics, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - D Eastern Kang Sim
- Department of Pediatrics, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - David Strong
- Department of Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Kerri N Boutelle
- Department of Pediatrics, School of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Kyung E Rhee
- Department of Pediatrics, School of Medicine, University of California San Diego, San Diego, CA, USA
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Adise S, Boutelle KN, Rezvan PH, Kan E, Rhee KE, Goran MI, Sowell ER. Sex-specific impulsivity, but not other facets of executive function, predicts fat and sugar intake two-years later amongst adolescents with a healthy weight: Findings from the ABCD study. Appetite 2024; 192:107081. [PMID: 37839556 PMCID: PMC10842015 DOI: 10.1016/j.appet.2023.107081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/29/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Abstract
During adolescence, processes that control food intake (executive functions [EF]) undergo extensive refinement; underlying differences in EF may explain the inability to resist overeating unhealthy foods. Yet, overeating fat and sugar also causes changes to EF and cognition but disentangling these relationships has been difficult, as previous studies included youth with obesity. Here, amongst youth initially of a healthy weight, we evaluate whether 1) sex-specific underlying variation in EF/cognition at 9/10-years-old predict fat/sugar two-years later (Y2) and 2) if these relationships are moderated by body mass index (BMI), using linear mixed effects models (controlled for puberty, caregiver education; random effect: study site). Data were leveraged from Adolescent Brain Cognitive Development Study (n = 2987; 50.4% male; 15.4% Latino/a/x; 100% healthy weight at baseline; 12.4% overweight/obese by Y2, data release 4.0). EF and cognition (e.g., inhibition, cognition, motor, memory, impulsivity) were assessed with the NIH toolbox, Rey Auditory Verbal Learning Task, Little Man Task, the BIS/BAS, and UPPS-P. A saturated fat/added sugar (kcals) composite score was extracted from the validated Kids Food Block Screener. For males, greater baseline impulsivity (e.g., Positive Urgency, Lack of Planning and Perseverance) and reward (e.g., Fun seeking, Drive) was related to greater Y2 intake. For both sexes, greater baseline Negative Urgency and higher BMI was related to greater Y2 intake. No other relationships were observed. Our findings highlight a phenotype that may be more at risk for weight gain due to overconsumption of fat/sugar. Thus, prevention efforts may wish to focus on impulsive tendencies for these foods.
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Affiliation(s)
- Shana Adise
- Department of Pediatrics, Division of Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, United States.
| | - Kerri N Boutelle
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States; Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States; Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Panteha Hayati Rezvan
- Biostatistics and Data Management Core, The Saban Research Institute, Children's Hospital of Los Angeles, Los Angeles, CA, United States
| | - Eric Kan
- Department of Pediatrics, Division of Pediatric Research Administration, Children's Hospital of Los Angeles, Los Angeles, CA, United States
| | - Kyung E Rhee
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
| | - Michael I Goran
- Department of Pediatrics, Division of Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Elizabeth R Sowell
- Department of Pediatrics, Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, United States
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9
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Makowski C, Westwater ML, Rhee KE, Bischoff-Grethe A, Wierenga CE. Characterization of parent and youth-reported eating disorder symptoms and premorbid factors in the Adolescent Brain Cognitive Development Study. medRxiv 2023:2023.12.18.23300155. [PMID: 38196622 PMCID: PMC10775341 DOI: 10.1101/2023.12.18.23300155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Objective Eating Disorders (EDs) often start in adolescence, though the prevalence, trajectory of symptom onset and predictors of illness are poorly understood, especially across sociodemographically diverse youth. Here, we leverage data from the Adolescent Brain Cognitive Development℠ (ABCD) Study, a large demographically representative longitudinal sample of youth in the US, to characterize the prevalence of parent- and youth-reported ED symptoms and their sociodemographic characteristics at baseline (ages 9-11) and two-years later (2-year; ages 11-14). Method A tetrachoric factor analysis summarized clusters of ED symptoms, which were compared between parent and youth reports. Cognitive, mental and physical health variables at baseline were used to predict youth-reported symptoms at 2-year using a mixed-effects logistic regression. Results Three factors emerged reflecting "weight distress", "weight control", and "bingeing", with prevalence rates ranging from 1.5 to 7.3%. All symptoms loaded on similar factors between reporters. Rates of symptom endorsement were similar for males and females, with disproportionately higher rates across factors for youth who self-identified as sexual minority, Hispanic, Black, or Mixed race participants, and those from a disadvantaged socioeconomic background, compared to the full ABCD sample. Youth and parent reports at 2-year showed ~17% overlap. A distinct pattern of cognitive variables emerged as significant predictors of later youth-reported ED concerns, whereas mental health symptoms and traits were non-specific and associated with all ED factors. Conclusion Identifying the landscape of ED symptoms across demographic groups, reporters and their premorbid factors in late childhood is critical to inform prevention and early intervention efforts, with particularly important implications for historically understudied racial and sexual minority groups.
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Affiliation(s)
| | - Margaret L. Westwater
- Department of Psychiatry, University of Oxford
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine
| | - Kyung E. Rhee
- Department of Pediatrics, University of California San Diego
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10
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Polich M, Mannino-Avila E, Edmunds M, Rungvivatjarus J, Patel A, Stucky-Fisher E, Rhee KE. Disparities in Management of Acute Gastroenteritis in Hospitalized Children. Hosp Pediatr 2023; 13:1106-1114. [PMID: 38013511 DOI: 10.1542/hpeds.2023-007283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Acute gastroenteritis (AGE) is a common health care problem accounting for up to 200 000 pediatric hospitalizations annually. Previous studies show disparities in the management of children from different ethnic backgrounds presenting to the emergency department with AGE. Our aim was to evaluate whether differences in medical management also exist between Hispanic and non-Hispanic children hospitalized with AGE. METHODS We performed a single-center retrospective study of children aged 2 months to 12 years admitted to the pediatric hospital medicine service from January 2016 to December 2020 with a diagnosis of (1) acute gastroenteritis or (2) dehydration with feeding intolerance, vomiting, and/or diarrhea. Differences in clinical pathway use, diagnostic studies performed, and medical interventions ordered were compared between Hispanic and non-Hispanic patients. RESULTS Of 512 admissions, 54.9% were male, 51.6% were Hispanic, and 59.2% were on Medicaid. There was no difference between Hispanic and non-Hispanic patients in reported nausea or vomiting at admission, pathway use, or laboratory testing including stool studies. However, after adjusting for covariates, Hispanic patients had more ultrasound scans performed (odds ratio 1.65, 95% confidence interval 1.04-2.64) and fewer orders for antiemetics (odds ratio 0.53, 95% CI 0.29-0.95) than non-Hispanic patients. CONCLUSIONS Although there were no differences in many aspects of AGE management between Hispanic and non-Hispanic patients, there was still variability in ultrasound scans performed and antiemetics ordered, despite similarities in reported abdominal pain, nausea, and vomiting. Prospective and/or qualitative studies may be needed to clarify underlying reasons for these differences.
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Affiliation(s)
- Michelle Polich
- Rady Children's Hospital, San Diego, California, and University of California San Diego, San Diego, California
| | - Elizabeth Mannino-Avila
- Rady Children's Hospital, San Diego, California, and University of California San Diego, San Diego, California
| | - Michelle Edmunds
- Rady Children's Hospital, San Diego, California, and University of California San Diego, San Diego, California
| | - Jane Rungvivatjarus
- Rady Children's Hospital, San Diego, California, and University of California San Diego, San Diego, California
| | - Aarti Patel
- Rady Children's Hospital, San Diego, California, and University of California San Diego, San Diego, California
| | - Erin Stucky-Fisher
- Rady Children's Hospital, San Diego, California, and University of California San Diego, San Diego, California
| | - Kyung E Rhee
- Rady Children's Hospital, San Diego, California, and University of California San Diego, San Diego, California
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11
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Baer RJ, Bandoli G, Jelliffe-Pawlowski LL, Rhee KE, Chambers CD. Adverse live-born pregnancy outcomes among pregnant people with anorexia nervosa. Am J Obstet Gynecol 2023:S0002-9378(23)02056-2. [PMID: 38008148 DOI: 10.1016/j.ajog.2023.11.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Previous findings related to the association of adverse pregnancy outcomes with anorexia nervosa are mixed. OBJECTIVE This study aimed to investigate the association of adverse live-born pregnancy outcomes with anorexia nervosa using adjustment modeling accounting for confounding factors, and a mediation analysis addressing the contribution of underweight prepregnancy body mass index and gestational weight gain to those outcomes. STUDY DESIGN The sample included California live-born singletons with births between 2007 and 2021. The administrative data set contained birth certificates linked to hospital discharge records. Anorexia nervosa diagnosis during pregnancy was obtained from International Classification of Diseases codes on hospital discharge records. Adverse pregnancy outcomes examined included gestational diabetes, gestational hypertension, preeclampsia, anemia, antepartum hemorrhage, premature rupture of membranes, premature labor, cesarean delivery, oligohydramnios, placenta previa, chorioamnionitis, placental abruption, severe maternal morbidity, small for gestational age, large for gestational age, low birthweight, and preterm birth (by timing and indication). Risk of each adverse outcome was calculated using Poisson regression models. Unadjusted risk of each adverse outcome was calculated, and then the risks were adjusted for demographic factors. The final adjusted model included demographic factors, anxiety, depression, substance use, and smoking. A mediation analysis was performed to estimate the excess risk of adverse outcomes mediated by underweight prepregnancy body mass index and gestational weight gain below the American College of Obstetricians and Gynecologists recommendation. RESULTS The sample included 241 pregnant people with a diagnosis of anorexia nervosa and 6,418,236 pregnant people without an eating disorder diagnosis. An anorexia nervosa diagnosis during pregnancy was associated with many adverse pregnancy outcomes in unadjusted models (relative risks ranged from 1.65 [preeclampsia] to 3.56 [antepartum hemorrhage]) in comparison with people without an eating disorder diagnosis. In the final adjusted models, birthing people with an anorexia nervosa diagnosis were more likely to have anemia, preterm labor, oligohydramnios, severe maternal morbidity, a small for gestational age or low-birthweight infant, and preterm birth between 32 and 36 weeks with spontaneous preterm labor (adjusted relative risks ranged from 1.43 to 2.55). Underweight prepregnancy body mass index mediated 7.78% of the excess in preterm births and 18.00% of the excess in small for gestational age infants. Gestational weight gain below the recommendation mediated 38.89% of the excess in preterm births and 40.44% of the excess in low-birthweight infants. CONCLUSION Anorexia nervosa diagnosis during pregnancy was associated with a number of clinically important adverse pregnancy outcomes in comparison with people without an eating disorder diagnosis. Adjusting for anxiety, depression, substance use, and smoking during pregnancy decreased this risk. A substantial percentage of the excess risk of adverse outcomes was mediated by an underweight prepregnancy body mass index, and an even larger proportion of excess risk was mediated by gestational weight gain below the recommendation. This information is important for clinicians to consider when caring for patients with anorexia nervosa. Considering and treating anorexia nervosa and comorbid conditions and counseling patients about mediating factors such as preconception weight and gestational weight gain may improve live-born pregnancy outcomes among people with anorexia nervosa.
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Affiliation(s)
- Rebecca J Baer
- Department of Pediatrics, University of California San Diego, San Diego, CA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA.
| | - Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, San Diego, CA
| | - Laura L Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Kyung E Rhee
- Department of Pediatrics, University of California San Diego, San Diego, CA
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Gauglitz JM, West KA, Bittremieux W, Williams CL, Weldon KC, Panitchpakdi M, Di Ottavio F, Aceves CM, Brown E, Sikora NC, Jarmusch AK, Martino C, Tripathi A, Meehan MJ, Dorrestein K, Shaffer JP, Coras R, Vargas F, Goldasich LD, Schwartz T, Bryant M, Humphrey G, Johnson AJ, Spengler K, Belda-Ferre P, Diaz E, McDonald D, Zhu Q, Elijah EO, Wang M, Marotz C, Sprecher KE, Vargas-Robles D, Withrow D, Ackermann G, Herrera L, Bradford BJ, Marques LMM, Amaral JG, Silva RM, Veras FP, Cunha TM, Oliveira RDR, Louzada-Junior P, Mills RH, Piotrowski PK, Servetas SL, Da Silva SM, Jones CM, Lin NJ, Lippa KA, Jackson SA, Daouk RK, Galasko D, Dulai PS, Kalashnikova TI, Wittenberg C, Terkeltaub R, Doty MM, Kim JH, Rhee KE, Beauchamp-Walters J, Wright KP, Dominguez-Bello MG, Manary M, Oliveira MF, Boland BS, Lopes NP, Guma M, Swafford AD, Dutton RJ, Knight R, Dorrestein PC. Author Correction: Enhancing untargeted metabolomics using metadata-based source annotation. Nat Biotechnol 2023; 41:1656. [PMID: 37853256 DOI: 10.1038/s41587-023-02025-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Affiliation(s)
- Julia M Gauglitz
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Kiana A West
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Wout Bittremieux
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Candace L Williams
- Beckman Center for Conservation Research, San Diego Zoo Wildlife Alliance, Escondido, CA, USA
| | - Kelly C Weldon
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
- Center for Microbiome Innovation, Joan and Irwin Jacobs School of Engineering, University of California San Diego, La Jolla, CA, USA
| | - Morgan Panitchpakdi
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Francesca Di Ottavio
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
| | - Christine M Aceves
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Elizabeth Brown
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
- Division of Biological Sciences, University of California San Diego, La Jolla, CA, USA
| | - Nicole C Sikora
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Alan K Jarmusch
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Cameron Martino
- Center for Microbiome Innovation, Joan and Irwin Jacobs School of Engineering, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
- Bioinformatics and Systems Biology Program, University of California San Diego, La Jolla, CA, USA
| | - Anupriya Tripathi
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
- Division of Biological Sciences, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Michael J Meehan
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Kathleen Dorrestein
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Justin P Shaffer
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Roxana Coras
- Division of Rheumatology, Allergy & Immunology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Fernando Vargas
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
- Division of Biological Sciences, University of California San Diego, La Jolla, CA, USA
| | | | - Tara Schwartz
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - MacKenzie Bryant
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Gregory Humphrey
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Abigail J Johnson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Katharina Spengler
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
| | - Pedro Belda-Ferre
- Center for Microbiome Innovation, Joan and Irwin Jacobs School of Engineering, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Edgar Diaz
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Daniel McDonald
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Qiyun Zhu
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Emmanuel O Elijah
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Mingxun Wang
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Clarisse Marotz
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Kate E Sprecher
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Daniela Vargas-Robles
- Servicio Autónomo Centro Amazónico de Investigación y Control de Enfermedades Tropicales Simón Bolívar, Puerto Ayacucho, Amazonas, Venezuela
| | - Dana Withrow
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Gail Ackermann
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Lourdes Herrera
- Department of Pediatrics, Billings Clinic, Billings, MT, USA
| | - Barry J Bradford
- Department of Animal Science, Michigan State University, East Lansing, MI, USA
| | - Lucas Maciel Mauriz Marques
- Department of Pharmacology, Ribeirão Preto Medicinal School, Center of Research in Inflammatory Diseases, University of São Paulo, Ribeirão Preto, Sao Paolo, Brazil
| | - Juliano Geraldo Amaral
- Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Bahia, Brazil
| | - Rodrigo Moreira Silva
- NPPNS, Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Sao Paolo, Brazil
| | - Flavio Protasio Veras
- Department of Pharmacology, Ribeirão Preto Medicinal School, Center of Research in Inflammatory Diseases, University of São Paulo, Ribeirão Preto, Sao Paolo, Brazil
| | - Thiago Mattar Cunha
- Department of Pharmacology, Ribeirão Preto Medicinal School, Center of Research in Inflammatory Diseases, University of São Paulo, Ribeirão Preto, Sao Paolo, Brazil
| | - Rene Donizeti Ribeiro Oliveira
- Department of Internal Medicine, Ribeirão Preto Medical School, Center of Research in Inflammatory Diseases, University of São Paulo, Ribeirão Preto, Sao Paolo, Brazil
| | - Paulo Louzada-Junior
- Department of Internal Medicine, Ribeirão Preto Medical School, Center of Research in Inflammatory Diseases, University of São Paulo, Ribeirão Preto, Sao Paolo, Brazil
| | - Robert H Mills
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
- Department of Pharmacology, University of California San Diego, La Jolla, CA, USA
| | - Paulina K Piotrowski
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Stephanie L Servetas
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Sandra M Da Silva
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Christina M Jones
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Nancy J Lin
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Katrice A Lippa
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Scott A Jackson
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Rima Kaddurah Daouk
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
- Duke Institute of Brain Sciences, Duke University, Durham, NC, USA
| | - Douglas Galasko
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Parambir S Dulai
- Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | - Curt Wittenberg
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - Robert Terkeltaub
- Division of Rheumatology, Allergy & Immunology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- San Diego VA Healthcare System, San Diego, CA, USA
| | - Megan M Doty
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
- Division of Neonatology, Department of Pediatrics, Kapi'olani Medical Center for Women and Children, John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Jae H Kim
- Division of Neonatology, Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kyung E Rhee
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Julia Beauchamp-Walters
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Kenneth P Wright
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Maria Gloria Dominguez-Bello
- Department of Biochemistry and Microbiology, School of Environmental and Biological Sciences; Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Mark Manary
- Department of Pediatrics, Washington University, St. Louis, MO, USA
| | - Michelli F Oliveira
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Brigid S Boland
- Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Norberto Peporine Lopes
- NPPNS, Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Sao Paolo, Brazil
| | - Monica Guma
- Division of Rheumatology, Allergy & Immunology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Austin D Swafford
- Center for Microbiome Innovation, Joan and Irwin Jacobs School of Engineering, University of California San Diego, La Jolla, CA, USA
| | - Rachel J Dutton
- Division of Biological Sciences, University of California San Diego, La Jolla, CA, USA
| | - Rob Knight
- Center for Microbiome Innovation, Joan and Irwin Jacobs School of Engineering, University of California San Diego, La Jolla, CA, USA.
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA.
- Department of Medicine, University of California San Diego, La Jolla, CA, USA.
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA, USA.
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA.
| | - Pieter C Dorrestein
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA.
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA.
- Center for Microbiome Innovation, Joan and Irwin Jacobs School of Engineering, University of California San Diego, La Jolla, CA, USA.
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA.
- Department of Pharmacology, University of California San Diego, La Jolla, CA, USA.
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Adise S, Ottino-Gonzalez J, Goedde L, Marshall AT, Kan E, Rhee KE, Goran MI, Sowell ER. Variation in executive function relates to BMI increases in youth who were initially of a healthy weight in the ABCD Study. Obesity (Silver Spring) 2023; 31:2809-2821. [PMID: 37731207 PMCID: PMC10592557 DOI: 10.1002/oby.23811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/06/2023] [Accepted: 05/01/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The study aim was to determine whether (A) differences in executive function (EF) and cognition precede weight gain or (B) weight gain causes changes to EF and cognition. METHODS Data were gathered from the Adolescent Brain Cognitive Development (ABCD) Study (release 4.0; ages 9-12 years old [N = 2794]; 100% had healthy weight at baseline [i.e., 9/10 years old], 12.4% had unhealthy weight by ages 11/12 years). EF and cognition were assessed across several domains (e.g., impulsivity, inhibitory control, processing speed, memory); BMI was calculated from height and weight. Nested random-effects mixed models examined (A) BMI ~ EF × Time (i.e., variation in EF/cognition precedes weight gain) and (B) EF ~ BMI × Time (weight gain causes changes to EF/cognition) and controlled for sex, puberty, and caregiver education; random effects were site and subject. RESULTS Variation in impulsivity, memory, learning, and processing speed was associated with greater increases in BMI trajectories from 9 to 12 years old. Weight gain was associated with a decrease in inhibitory control, but no other associations were observed. CONCLUSIONS Underlying variation in EF and cognition may be important for weight gain, but 2 years of weight gain may not be enough to have clinical implications for EF and cognition beyond inhibitory control. These findings suggest that more attention should be paid to the inclusion of EF programs in obesity prevention efforts.
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Affiliation(s)
- Shana Adise
- Department of Pediatrics, Division of Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Jonatan Ottino-Gonzalez
- Department of Pediatrics, Division of Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Lauren Goedde
- Department of Pediatrics, Division of Pediatric Research Administration, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Andrew T. Marshall
- Department of Pediatrics, Division of Neurology, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Eric Kan
- Department of Pediatrics, Division of Neurology, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Kyung E. Rhee
- Department of Pediatrics, University of California, San Diego, San Diego, California, United States of America
| | - Michael I. Goran
- Department of Pediatrics, Division of Neurology, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Elizabeth R. Sowell
- Department of Pediatrics, Division of Pediatric Research Administration, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
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Abstract
Background: Many parents and providers adopt a "wait and see" approach to obesity (OB) management. The goal of this study was to determine the likelihood that youth with overweight (OW) or OB would become normal weight over time. Methods: Data from the nationally representative Population Assessment of Tobacco and Health Study were used to examine the proportion of teens (aged 12-17 years) with OW/OB who tracked into a lower weight category over four waves of data collection (2013-2018). Analysis was restricted to those who completed all four waves of assessments (n = 10,086). Repeated-measures logistic regression models were used to describe the odds of having a BMI within the normal weight range at Waves 2-4, given an OW or obese weight status in the previous wave. Results: At Wave 1, 65% of the sample was normal weight, 18% had OW, and 17% had OB. By Wave 4, 24% had OW and 20% had OB. The adjusted odds of reporting a normal weight relative to OW/OB decreased by 13% each year. In Wave 4, only 2% [standard error (SE) 0.4%] of boys and 2% (SE 0.3%) of girls transitioned from OB to normal weight. For youth with OB in Wave 1, the probability of being in the normal weight category in Wave 2 was 0.04 (95% confidence interval 0.035-0.052), and decreased thereafter. Conclusion: Very few teens were able to return to normal weight once they developed OW/OB. Adopting a "wait and see" approach to OB management may be detrimental to a child's health.
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Affiliation(s)
- Kyung E Rhee
- Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
| | - David Strong
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
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Gross R, Thaweethai T, Rosenzweig EB, Chan J, Chibnik LB, Cicek MS, Elliott AJ, Flaherman VJ, Foulkes AS, Witvliet MG, Gallagher R, Gennaro ML, Jernigan TL, Karlson EW, Katz SD, Kinser PA, Kleinman LC, Lamendola-Essel MF, Milner JD, Mohandas S, Mudumbi PC, Newburger JW, Rhee KE, Salisbury AL, Snowden JN, Stein CR, Stockwell MS, Tantisira KG, Thomason ME, Truong DT, Warburton D, Wood JC, Ahmed S, Akerlundh A, Alshawabkeh AN, Anderson BR, Aschner JL, Atz AM, Aupperle RL, Baker FC, Balaraman V, Banerjee D, Barch DM, Baskin-Sommers A, Bhuiyan S, Bind MAC, Bogie AL, Buchbinder NC, Bueler E, Bükülmez H, Casey B, Chang L, Clark DB, Clifton RG, Clouser KN, Cottrell L, Cowan K, D’Sa V, Dapretto M, Dasgupta S, Dehority W, Dummer KB, Elias MD, Esquenazi-Karonika S, Evans DN, Faustino EVS, Fiks AG, Forsha D, Foxe JJ, Friedman NP, Fry G, Gaur S, Gee DG, Gray KM, Harahsheh AS, Heath AC, Heitzeg MM, Hester CM, Hill S, Hobart-Porter L, Hong TK, Horowitz CR, Hsia DS, Huentelman M, Hummel KD, Iacono WG, Irby K, Jacobus J, Jacoby VL, Jone PN, Kaelber DC, Kasmarcak TJ, Kluko MJ, Kosut JS, Laird AR, Landeo-Gutierrez J, Lang SM, Larson CL, Lim PPC, Lisdahl KM, McCrindle BW, McCulloh RJ, Mendelsohn AL, Metz TD, Morgan LM, Müller-Oehring EM, Nahin ER, Neale MC, Ness-Cochinwala M, Nolan SM, Oliveira CR, Oster ME, Payne RM, Raissy H, Randall IG, Rao S, Reeder HT, Rosas JM, Russell MW, Sabati AA, Sanil Y, Sato AI, Schechter MS, Selvarangan R, Shakti D, Sharma K, Squeglia LM, Stevenson MD, Szmuszkovicz J, Talavera-Barber MM, Teufel RJ, Thacker D, Udosen MM, Warner MR, Watson SE, Werzberger A, Weyer JC, Wood MJ, Yin HS, Zempsky WT, Zimmerman E, Dreyer BP. Researching COVID to enhance recovery (RECOVER) pediatric study protocol: Rationale, objectives and design. medRxiv 2023:2023.04.27.23289228. [PMID: 37214806 PMCID: PMC10197716 DOI: 10.1101/2023.04.27.23289228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Importance The prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or "Long COVID") in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults. Observations We describe the protocol for the Pediatric Observational Cohort Study of the NIH's RE searching COV ID to E nhance R ecovery (RECOVER) Initiative. RECOVER-Pediatrics is an observational meta-cohort study of caregiver-child pairs (birth through 17 years) and young adults (18 through 25 years), recruited from more than 100 sites across the US. This report focuses on two of five cohorts that comprise RECOVER-Pediatrics: 1) a de novo RECOVER prospective cohort of children and young adults with and without previous or current infection; and 2) an extant cohort derived from the Adolescent Brain Cognitive Development (ABCD) study ( n =10,000). The de novo cohort incorporates three tiers of data collection: 1) remote baseline assessments (Tier 1, n=6000); 2) longitudinal follow-up for up to 4 years (Tier 2, n=6000); and 3) a subset of participants, primarily the most severely affected by PASC, who will undergo deep phenotyping to explore PASC pathophysiology (Tier 3, n=600). Youth enrolled in the ABCD study participate in Tier 1. The pediatric protocol was developed as a collaborative partnership of investigators, patients, researchers, clinicians, community partners, and federal partners, intentionally promoting inclusivity and diversity. The protocol is adaptive to facilitate responses to emerging science. Conclusions and Relevance RECOVER-Pediatrics seeks to characterize the clinical course, underlying mechanisms, and long-term effects of PASC from birth through 25 years old. RECOVER-Pediatrics is designed to elucidate the epidemiology, four-year clinical course, and sociodemographic correlates of pediatric PASC. The data and biosamples will allow examination of mechanistic hypotheses and biomarkers, thus providing insights into potential therapeutic interventions. Clinical Trialsgov Identifier Clinical Trial Registration: http://www.clinicaltrials.gov . Unique identifier: NCT05172011.
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Affiliation(s)
- Rachel Gross
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Tanayott Thaweethai
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Erika B. Rosenzweig
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - James Chan
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Lori B. Chibnik
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Mine S. Cicek
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Rochester, MN, USA
| | - Amy J. Elliott
- Avera Research Institute, Avera Health, Sioux Falls, SD, USA
| | - Valerie J. Flaherman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Andrea S. Foulkes
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | | | - Richard Gallagher
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Maria Laura Gennaro
- Public Health Research Institute and Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Terry L. Jernigan
- Center for Human Development, Cognitive Science, Psychiatry, Radiology, University of California San Diego, La Jolla, CA, USA
| | | | - Stuart D. Katz
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Patricia A. Kinser
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Lawrence C. Kleinman
- Department of Pediatrics, Division of Population Health, Quality, and Implementation Sciences (POPQuIS), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Joshua D. Milner
- Department of Pediatrics, Columbia University Medical Center: Columbia University Irving Medical Center, New York, NY, USA
| | - Sindhu Mohandas
- Department of Infectious Diseases, Children’s Hospital Los Angeles and the Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Praveen C. Mudumbi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
| | - Kyung E. Rhee
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Amy L. Salisbury
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Jessica N. Snowden
- Departments of Pediatrics and Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Cheryl R. Stein
- Department of Child and Adolescent Psychiatry, Hassenfeld Children’s Hospital at NYU Langone, New York, NY, USA
| | - Melissa S. Stockwell
- Department of Pediatrics, Division of Child and Adolescent Health, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, NY, USA
| | - Kelan G. Tantisira
- Division of Pediatric Respiratory Medicine, University of California San Diego, San Diego, CA, USA
| | - Moriah E. Thomason
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Dongngan T. Truong
- Division of Pediatric Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
| | - David Warburton
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - John C. Wood
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Shifa Ahmed
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Almary Akerlundh
- Department of Pulmonary Research, Rady Children’s Hospital-San Diego, San Diego, CA, USA
| | | | - Brett R. Anderson
- Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Judy L. Aschner
- Department of Pediatrics, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Andrew M. Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Robin L. Aupperle
- Oxley College of Health Sciences, Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Fiona C. Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Venkataraman Balaraman
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Dithi Banerjee
- Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital, Kansas City, MO, USA
| | - Deanna M. Barch
- Department of Psychological & Brain Sciences, Psychiatry, and Radiology, Washington University in St. Louis, Saint Louis, MO, USA
| | | | - Sultana Bhuiyan
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Marie-Abele C. Bind
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Amanda L. Bogie
- Department of Pediatrics, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Natalie C. Buchbinder
- Center for Human Development, University of California San Diego, San Diego, CA, USA
| | - Elliott Bueler
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Hülya Bükülmez
- Department of Pediatrics, Division of Rheumatology, The MetroHealth System, Case Western Reserve University, Cleveland, OH, USA
| | - B.J. Casey
- Department of Neuroscience and Behavior, Barnard College - Columbia University, New York, NY, USA
| | - Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Duncan B. Clark
- Departments of Psychiatry and Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Katharine N. Clouser
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Lesley Cottrell
- Department of Pediatrics, West Virginia University, Morgantown, WV, USA
| | - Kelly Cowan
- Department of Pediatrics, Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Viren D’Sa
- Department of Pediatrics, Rhode Island Hospital, Providence, RI, USA
| | - Mirella Dapretto
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Soham Dasgupta
- Department of Pediatrics, Norton Children’s Hospital, University of Louisville, Louisville, KY, USA
| | - Walter Dehority
- Department of Pediatrics, Division of Infectious Diseases, University of New Mexico, Albuquerque, NM, USA
| | - Kirsten B. Dummer
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Matthew D. Elias
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shari Esquenazi-Karonika
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Danielle N. Evans
- Arkansas Children’s Research Institute, Arkansas Children’s Hospital, Little Rock, AR, USA
| | | | - Alexander G. Fiks
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel Forsha
- Department of Cardiology, Children’s Mercy Kansas City, Ward Family Heart Center, Kansas City, MO, USA, Kansas City, MO, USA
| | - John J. Foxe
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Naomi P. Friedman
- Institute for Behavioral Genetics and Department of Psychology and Neuroscience, University of Colorado Boulder, Bolder, CO, USA
| | - Greta Fry
- Pennington Biomedical Research Center Clinic, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Sunanda Gaur
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Dylan G. Gee
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ashraf S. Harahsheh
- Department of Pediatrics, Division of Cardiology, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Andrew C. Heath
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Mary M. Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Christina M. Hester
- Division of Practice-Based Research, Innovation, & Evaluation, American Academy of Family Physicians, Leawood, KS, USA
| | - Sophia Hill
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Laura Hobart-Porter
- Departments of Pediatrics and Physical Medicine & Rehabilitation, Section of Pediatric Rehabilitation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Travis K.F. Hong
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Carol R. Horowitz
- Center for Health Equity and Community Engaged Research and Department of Population Health Science and Policy, New York, NY, USA
| | - Daniel S. Hsia
- Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Matthew Huentelman
- Division of Neurogenomics, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Kathy D. Hummel
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - William G. Iacono
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Katherine Irby
- Department of Pediatrics, Arkansas Children’s Hospital, University of Arkansas Medical School, Little Rock, AR, USA
| | - Joanna Jacobus
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Vanessa L. Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Pei-Ni Jone
- Department of Pediatrics, Pediatric Cardiology, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David C. Kaelber
- Departments of Pediatrics, Internal Medicine, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Tyler J. Kasmarcak
- Department of Pediatric Clinical Research, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew J. Kluko
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Jessica S. Kosut
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Angela R. Laird
- Department of Physics, Florida International University, Miami, FL, USA
| | - Jeremy Landeo-Gutierrez
- Department of Pediatrics, Respiratory Medicine Division, University of California San Diego, San Diego, CA, USA
| | - Sean M. Lang
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Christine L. Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Peter Paul C. Lim
- Department of Pediatric Infectious Disease, Avera McKennan University Health Center, University of South Dakota, Sioux Falls, SD, USA
| | - Krista M. Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Brian W. McCrindle
- Department of Pediatrics, University of Toronto, Labatt Family Heart Center, The Hospital for Sick Children, Toronto, ON, Canada
| | - Russell J. McCulloh
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Alan L. Mendelsohn
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Torri D. Metz
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, USA
| | - Lerraughn M. Morgan
- Department of Pediatrics, Valley Children’s Healthcare, Department of Pediatrics, Madera, CA, Madera, CA, USA
| | | | - Erica R. Nahin
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Michael C. Neale
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Manette Ness-Cochinwala
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sheila M. Nolan
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Carlos R. Oliveira
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew E. Oster
- Department of Pediatric Cardiology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - R. Mark Payne
- Department of Pediatrics, Division of Pediatric Cardiology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hengameh Raissy
- Department of Pediatrics, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA
| | - Isabelle G. Randall
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Suchitra Rao
- Department of Pediatrics, Division of Infectious Diseases, Epidemiology and Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Harrison T. Reeder
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Johana M. Rosas
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Mark W. Russell
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA
| | - Arash A. Sabati
- Department of Pediatric Cardiology, Phoenix Children’s Hospital, Phoenix, AZ, USA
| | - Yamuna Sanil
- Division of Pediatric Cardiology, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Alice I. Sato
- Department of Pediatric Infectious Disease, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael S. Schechter
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital, Kansas City, MO, USA
| | - Divya Shakti
- Department of Pediatrics, Pediatric Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kavita Sharma
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lindsay M. Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Michelle D. Stevenson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Maria M. Talavera-Barber
- Department of Pediatrics, Avera McKennan Hospital and University Health Center, Sioux Falls, SD, USA
| | - Ronald J. Teufel
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Deepika Thacker
- Nemours Cardiac Center, Nemours Childrens Health, Delaware, Wilmington, DE, USA
| | - Mmekom M. Udosen
- RECOVER Neurocognitive and Wellbeing/Mental Health Team, NYU Grossman School of Medicine, New York, NY, USA
| | - Megan R. Warner
- Department of Pulmonary Research, Rady Children’s Hospital-San Diego, San Diego, CA, USA
| | - Sara E. Watson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
| | - Alan Werzberger
- Department of Pediatrics, Columbia University Medical Center: Columbia University Irving Medical Center, New York, NY, USA
| | - Jordan C. Weyer
- Center for Individualized Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Marion J. Wood
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - H. Shonna Yin
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - William T. Zempsky
- Department of Pediatrics, Connecticut Children’s Medical Center, Hartford, CT, USA
| | - Emily Zimmerman
- Department of Communication Sciences & Disorders, Northeastern University, Boston, MA, USA
| | - Benard P. Dreyer
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
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16
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Manzano MA, Strong DR, Rhee KE, Liang J, Boutelle KN. Discordance between assessments of food cue responsiveness: Implications for assessment in youth with overweight/obesity. Appetite 2023; 186:106575. [PMID: 37100119 DOI: 10.1016/j.appet.2023.106575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 04/28/2023]
Abstract
Food cue responsiveness (FCR), broadly defined as behavioral, cognitive, emotional and/or physiological responses to external appetitive cues outside of physiological need, contributes to overeating and obesity among youth and adults. A variety of measures purportedly assess this construct, ranging from youth- or parent-report surveys to objective eating tasks. However, little research has assessed their convergence. It is especially important to evaluate this in children with overweight/obesity (OW/OB), as reliable and valid assessments of FCR are essential to better understand the role of this critical mechanism in behavioral interventions. The present study examined the relationship between five measures of FCR in a sample of 111 children with OW/OB (mean age = 10.6, mean BMI percentile = 96.4; 70% female; 68% white; 23% Latinx). Assessments included: objectively measured eating in the absence of hunger (EAH), parasympathetic activity when exposed to food, parent reported food responsiveness subscale from the Child Eating Behavior Questionnaire (CEBQ-FR), child self-reported Power of Food total score (C-PFS), and child self-reported Food Cravings Questionnaire total score (FCQ-T). Statistically significant spearman correlations were found between EAH and CEBQ-FR (ρ = 0.19, p < 0.05) and parasympathetic reactivity to food cues with both C-PFS (ρ = -0.32, p = 0.002) and FCQ-T (ρ = -0.34, p < 0.001). No other associations were statistically significant. These relationships remained significant in subsequent linear regression models controlling for child age and gender. The lack of concordance between measures assessing highly conceptually related constructs is of concern. Future studies should seek to elucidate a clear operationalization of FCR, examine the associations between FCR assessments in children and adolescents with a range of weight statuses, and evaluate how to best revise these measures to accurately reflect the latent construct being assessed.
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Affiliation(s)
- Michael A Manzano
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, United States; University of California San Diego, Department of Pediatrics, United States.
| | - David R Strong
- University of California San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, United States
| | - Kyung E Rhee
- University of California San Diego, Department of Pediatrics, United States
| | - June Liang
- University of California San Diego, Department of Pediatrics, United States
| | - Kerri N Boutelle
- University of California San Diego, Department of Pediatrics, United States; University of California San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, United States; University of California San Diego, Department of Psychiatry, United States
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17
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Winckler B, Nguyen M, Khare M, Patel A, Crandal B, Jenkins W, Fisher E, Rhee KE. Geographic Variation in Acute Pediatric Mental Health Utilization. Acad Pediatr 2023; 23:448-456. [PMID: 35940570 DOI: 10.1016/j.acap.2022.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify locations with higher need for acute pediatric mental health (MH) interventions or services and describe these communities' socio-demographic characteristics. METHODS This single-center retrospective study included patients 5 to 18 years old with an emergency department (ED) or hospital admission between 2017 and 2019 for a primary known MH diagnosis or symptoms. We extracted visit data from the electronic medical record, mapped patients to their home census tract, calculated normalized visit rates by census tract, and performed spatial analysis to identify nonrandom geographic clusters and outliers of high utilization. Census tract utilization rates were stratified into quartiles, and socioeconomic and demographic characteristics obtained from the US Census Bureau were compared using analysis of variance, chi-square tests, and multivariable analysis. RESULTS There were 10,866 qualifying visits across 617 census tracts. ED and hospital admission rates ranged from 2.7 to 428.6 per 1000 children. High utilization clusters localized to neighborhoods with lower socioeconomic status (p < .05). Southern regions with high utilizers were more likely to have fewer children per neighborhood, higher rates of teen births, and lower socioeconomic status. Multivariate analysis showed regions with high utilizers had fewer children per neighborhood, lower median household income, and more families that lacked computer access. CONCLUSION ED and hospital utilization for pediatric MH concerns varied significantly by neighborhood and demographics. Divergent social factors map onto these locations and are related to MH utilization. Leveraging geography can be a powerful tool in the development of targeted, culturally tailored interventions to decrease acute pediatric MH utilization and advance child MH equity.
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Affiliation(s)
- Britanny Winckler
- Division of Pediatric Hospital Medicine (B Winckler, M Khare, A Patel, E Fisher, and KE Rhee), Rady Children's Hospital/University of California San Diego, San Diego, Calif.
| | - Margaret Nguyen
- Division of Pediatric Emergency Medicine (M Nguyen), Rady Children's Hospital/University of California San Diego, San Diego, Calif
| | - Manaswitha Khare
- Division of Pediatric Hospital Medicine (B Winckler, M Khare, A Patel, E Fisher, and KE Rhee), Rady Children's Hospital/University of California San Diego, San Diego, Calif
| | - Aarti Patel
- Division of Pediatric Hospital Medicine (B Winckler, M Khare, A Patel, E Fisher, and KE Rhee), Rady Children's Hospital/University of California San Diego, San Diego, Calif
| | - Brent Crandal
- Behavioral Health Quality Improvement (B Crandal), Rady Children's Hospital San Diego, San Diego, Calif
| | - Willough Jenkins
- Department of Psychiatry (W Jenkins), Rady Children's Hospital/University of California San Diego, San Diego, Calif
| | - Erin Fisher
- Division of Pediatric Hospital Medicine (B Winckler, M Khare, A Patel, E Fisher, and KE Rhee), Rady Children's Hospital/University of California San Diego, San Diego, Calif
| | - Kyung E Rhee
- Division of Pediatric Hospital Medicine (B Winckler, M Khare, A Patel, E Fisher, and KE Rhee), Rady Children's Hospital/University of California San Diego, San Diego, Calif
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18
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Tam I, Huang M, Patel A, Rhee KE. Optimizing Care for Spanish-Speaking Patients and Families in the Hospital: Defining the Gaps and Interventions. Acad Pediatr 2023; 23:261-262. [PMID: 36283623 DOI: 10.1016/j.acap.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/19/2022] [Accepted: 10/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Ivy Tam
- Department of Pediatrics, Rady Children's Hospital San Diego and University of California San Diego (I Tam, M Huang, A Patel, and KE Rhee), San Diego, Calif; Department of Pediatrics, The Children's Hospital at Montefiore and Albert Einstein College of Medicine (I Tam), Bronx, NY.
| | - Maria Huang
- Department of Pediatrics, Rady Children's Hospital San Diego and University of California San Diego (I Tam, M Huang, A Patel, and KE Rhee), San Diego, Calif
| | - Aarti Patel
- Department of Pediatrics, Rady Children's Hospital San Diego and University of California San Diego (I Tam, M Huang, A Patel, and KE Rhee), San Diego, Calif
| | - Kyung E Rhee
- Department of Pediatrics, Rady Children's Hospital San Diego and University of California San Diego (I Tam, M Huang, A Patel, and KE Rhee), San Diego, Calif
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19
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Adise S, Marshall AT, Hahn S, Zhao S, Kan E, Rhee KE, Herting MM, Sowell ER. Longitudinal assessment of brain structure and behaviour in youth with rapid weight gain: Potential contributing causes and consequences. Pediatr Obes 2023; 18:e12985. [PMID: 36253967 DOI: 10.1111/ijpo.12985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 08/15/2022] [Accepted: 09/12/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Independent of weight status, rapid weight gain has been associated with underlying brain structure variation in regions associated with food intake and impulsivity among pre-adolescents. Yet, we lack clarity on how developmental maturation coincides with rapid weight gain and weight stability. METHODS We identified brain predictors of 2-year rapid weight gain and its longitudinal effects on brain structure and impulsivity in the Adolescent Brain Cognitive DevelopmentSM Study®. Youth were categorized as Healthy Weight/Weight Stable (WSHW , n = 527) or Weight Gainers (WG, n = 221, >38lbs); 63% of the WG group were healthy weight at 9-to-10-years-old. RESULTS A fivefold cross-validated logistic elastic-net regression revealed that rapid weight gain was associated with structural variation amongst 39 brain features at 9-to-10-years-old in regions involved with executive functioning, appetitive control and reward sensitivity. Two years later, WG youth showed differences in change over time in several of these regions and performed worse on measures of impulsivity. CONCLUSIONS These findings suggest that brain structure in pre-adolescence may predispose some to rapid weight gain and that weight gain itself may alter maturational brain change in regions important for food intake and impulsivity. Behavioural interventions that target inhibitory control may improve trajectories of brain maturation and facilitate healthier behaviours.
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Affiliation(s)
- Shana Adise
- Division of Pediatric Research Administration, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Andrew T Marshall
- Division of Neurology, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Sage Hahn
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
| | - Shaomin Zhao
- Division of Neurology, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Eric Kan
- Division of Pediatric Research Administration, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Kyung E Rhee
- Department of Pediatrics, University of California, San Diego, San Diego, California, USA
| | - Megan M Herting
- Departments of Population and Public Health Sciences and Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Elizabeth R Sowell
- Division of Neurology, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
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20
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Gray S, Lee B, Levy M, Rungvivatjarus T, Patel A, Mannino Avila E, Fisher E, Rhee KE. Oral Feeding on High-Flow Nasal Cannula in Children Hospitalized With Bronchiolitis. Hosp Pediatr 2023; 13:159-167. [PMID: 36628547 DOI: 10.1542/hpeds.2022-006740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Oral feeding by children with bronchiolitis on high-flow nasal cannula (HFNC) is questioned, resulting in high practice variability. Our objective was to determine the incidence of aspiration pneumonia and adverse feeding events in otherwise healthy children with bronchiolitis on HFNC who fed orally from admission. METHODS We conducted a single-center, retrospective chart review, in a tertiary children's hospital, of 876 children who were <24 months old, admitted for bronchiolitis, and treated with HFNC in the pediatric ward from March 2017 to May 2020. Primary outcomes included the incidence of aspiration pneumonia and adverse feeding events. Secondary outcomes included escalation of care, frequency and duration of nil per os status, length of stay, and 7-day readmission. RESULTS Most patients (77.2%) met inclusion criteria and were fed orally within 2 hours of admission. The average maximum HFNC flow rate was 8 L/min (1 L/kg/min); the average maximum respiratory rate was 62 ± 10. Adverse feeding events occurred in 11 patients (1.6%), of which 3 had a concern for possible microaspiration. None were diagnosed with or treated for aspiration pneumonia. Few patients (8.1%) were made nil per os while on HFNC but returned to oral feeding by discharge. CONCLUSION Among those with bronchiolitis on HFNC who received oral nutrition on admission, there were few incidences of adverse feeding events and no diagnoses of aspiration pneumonia, suggesting that oral feeding while on HFNC can be well-tolerated in similar populations. However, this study was limited by its single-center retrospective design, and future prospective studies are needed.
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21
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Boutelle KN, Rhee KE, Manzano MA, Bernard RS, Strong DR, Eichen DM, Anderson CCA, Marcus BH, Akshoomoff N, Crow SJ. Design of the FRESH-DOSE study: A randomized controlled noninferiority trial evaluating a guided self-help family-based treatment program for children with overweight or obesity. Contemp Clin Trials 2023; 124:106996. [PMID: 36343880 PMCID: PMC9968239 DOI: 10.1016/j.cct.2022.106996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
Overweight and obesity affect 45% of children and increases the risk for several negative health sequelae. Family-Based Behavioral Treatment (FBT) is the most efficacious treatment for child weight management and consists of nutrition and physical activity education, behavior change skills and parenting skills training. FBT is time and staff intensive and can include 20, 60-min separate groups for parents and children, as well as 20-min behavior coaching sessions to help problem solve barriers to implementing the skills learned and individualize the program. Guided self-help (GSH) therapies involve providing families a manual to review independently and brief coaching sessions by an interventionist to facilitate adherence. We developed a GSH version of FBT (gshFBT) which provides a manual to both parents and children and includes 14, 20-min coaching sessions over 6-months. The current study randomized 150 children (mean age = 10.1 years (SD = 1.38); mean BMI% = 97.3% (SD = 2.84); mean BMIz = 2.09 (SD = 0.40); 49% female; 43% Hispanic) and one of their parents (mean age = 41.8 years (SD = 6.52); mean BMI = 32.0 (SD = 7.24); 87.3% female; 43% Hispanic) to either a group-based FBT program or a gshFBT program. Assessments are conducted at baseline, post-treatment (6 months), 6-month follow-up (12 months) and 12-month follow-up (18 months). Primary outcomes are child weight change (BMIz) and cost effectiveness. Recruitment occurred between May 2017 and October 2021 and follow-up assessments are underway. Given the public health concern for children with obesity and the low level of access to FBT, gshFBT could prove extremely useful to provide intervention to a greater proportion of the population.
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Affiliation(s)
- Kerri N Boutelle
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Kyung E Rhee
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Michael A Manzano
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court Suite 102, San Diego, CA 92120, USA
| | - Rebecca S Bernard
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - David R Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Dawn M Eichen
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Cheryl C A Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, Brown University, School of Public Health, 121 South Main Street, box G-S121-3, Providence, RI 02912-G, USA
| | - Natacha Akshoomoff
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota, F282/2A West 2450 Riverside Ave, Minneapolis, MN 55454, USA
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22
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Beauchamp-Walters J, Aleti G, Herrera L, Debelius J, Lima N, Dalal P, Hong S, Knight R, Rhee KE. Impact of exclusive enteral nutrition on the gut microbiome of children with medical complexity. JPEN J Parenter Enteral Nutr 2023; 47:77-86. [PMID: 35526141 DOI: 10.1002/jpen.2392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/19/2022] [Accepted: 05/01/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Children with medical complexity (CMC) often require enteral tube feedings to meet their nutrition needs. Many, however, experience symptoms of feeding intolerance, such as vomiting and pain. The goal of this analysis was to examine the relationship between diet and the gut microbiome, controlling for medications, among CMC receiving enteral tube feedings, CMC consuming oral nutrition, and healthy controls. Given the variety of available commercial formula preparations, we were also interested in examining the impact of different formula types on the CMC microbiome. METHODS Fecal samples from 91 children (57 CMC and 34 healthy controls) were collected and analyzed. Parents completed clinical and dietary questionnaires. 16S ribosomal RNA amplicon sequencing was completed using the QIIME2 pipeline. RESULTS A significant decrease in alpha diversity among CMC receiving exclusive enteral nutrition (CMC EEN) compared with healthy controls (Shannon P = 0.006 and Faith's phylogenetic distance P = 0.006) was found that was not observed between CMC receiving oral nutrition and healthy controls. Significant differences in beta diversity were also observed between CMC EEN and healthy controls, with CMC EEN having a greater relative abundance of Enterobacteriaceae and obligate anaerobes. Differences were also noted between CMC EEN and CMC receiving oral nutrition (Aitchison distance P = 0.001); however, no differences were observed between CMC receiving oral nutrition and healthy controls. CONCLUSION Despite similarities in medication profiles, CMC EEN have decreased alpha diversity and differences in beta diversity compared with healthy controls not observed in CMC receiving oral nutrition, highlighting the impact of diet over medications.
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Affiliation(s)
- Julia Beauchamp-Walters
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA.,Rady's Children's Hospital, San Diego, California, USA
| | - Gajender Aleti
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Lourdes Herrera
- Department of Pediatrics, Billings Clinic, Billings, Montana, USA
| | - Justine Debelius
- Centre for Translational Microbiome Research, Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Natalie Lima
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, California, USA
| | - Pritha Dalal
- Rady's Children's Hospital, San Diego, California, USA.,Department of Orthopedics, University of California San Diego, La Jolla, California, USA
| | - Suzi Hong
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA.,Department of Computer Science and Engineering, Jacobs School of Engineering, University of California San Diego, La Jolla, California, USA.,Department of Bioengineering, Jacobs School of Engineering, University of California San Diego, La Jolla, California, USA.,Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA
| | - Kyung E Rhee
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA.,Rady's Children's Hospital, San Diego, California, USA
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23
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Rungvivatjarus T, Huang MZ, Winckler B, Chen S, Fisher ES, Rhee KE. Parental Factors Affecting Pediatric Medication Management in Underserved Communities. Acad Pediatr 2023; 23:155-164. [PMID: 36100181 DOI: 10.1016/j.acap.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/28/2022] [Accepted: 09/05/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Medication errors and adverse drug events are common in the pediatric population. Limited English proficiency and low health literacy have been associated with decreased medication adherence, increased medication errors, and worse health outcomes. This study explores parental factors affecting medication management in underserved communities. METHODS Using qualitative methods, we identified factors believed to affect medication management among parents. We conducted focus group discussions between December 2019 and September 2020. We recruited parents and health care professionals from local community partners and a tertiary care children's hospital. Sessions were recorded and transcribed. Three investigators created the coding scheme. Two investigators independently coded each focus group and organized results into themes using thematic analysis. RESULTS Eleven focus groups were held (n = 45): 4 English-speaking parent groups (n = 18), 3 Spanish-speaking parent groups (n = 11), and 4 health care professional groups (n = 16). We identified 4 main factors that could impact medication delivery: 1) limited health literacy among parents and feeling inadequate at medication administration (knowledge/skill gap), 2) poor communication between caregivers (regarding medication delivery, dosage, frequency, and purpose) and between providers (regarding what has been prescribed), 3) lack of pediatric medication education resources, and 4) personal attitudes and beliefs that influence one's medication-related decisions. CONCLUSIONS The compounding effect of these factors - knowledge, communication, resource, and personal belief - may put families living in underserved communities at greater risk for medication errors and suboptimal health outcomes. These findings can be used to guide future interventions and may help optimize medication delivery for pediatric patients.
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Affiliation(s)
- Tiranun Rungvivatjarus
- Department of Pediatrics, University of California San Diego (T Rungvivatjarus, MZ Huang, S Chen, ES Fisher, KE Rhee), San Diego, Calif; Rady Children's Hospital (T Rungvivatjarus, MZ Huang, ES Fisher, KE Rhee), San Diego, Calif.
| | - Maria Z Huang
- Department of Pediatrics, University of California San Diego (T Rungvivatjarus, MZ Huang, S Chen, ES Fisher, KE Rhee), San Diego, Calif; Rady Children's Hospital (T Rungvivatjarus, MZ Huang, ES Fisher, KE Rhee), San Diego, Calif
| | - Britanny Winckler
- Division of Hospital Medicine (B Winckler), Children's Hospital of Orange County, Orange, Calif
| | - Scarlett Chen
- Department of Pediatrics, University of California San Diego (T Rungvivatjarus, MZ Huang, S Chen, ES Fisher, KE Rhee), San Diego, Calif
| | - Erin S Fisher
- Department of Pediatrics, University of California San Diego (T Rungvivatjarus, MZ Huang, S Chen, ES Fisher, KE Rhee), San Diego, Calif; Rady Children's Hospital (T Rungvivatjarus, MZ Huang, ES Fisher, KE Rhee), San Diego, Calif
| | - Kyung E Rhee
- Department of Pediatrics, University of California San Diego (T Rungvivatjarus, MZ Huang, S Chen, ES Fisher, KE Rhee), San Diego, Calif; Rady Children's Hospital (T Rungvivatjarus, MZ Huang, ES Fisher, KE Rhee), San Diego, Calif
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24
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Gauglitz JM, West KA, Bittremieux W, Williams CL, Weldon KC, Panitchpakdi M, Di Ottavio F, Aceves CM, Brown E, Sikora NC, Jarmusch AK, Martino C, Tripathi A, Meehan MJ, Dorrestein K, Shaffer JP, Coras R, Vargas F, Goldasich LD, Schwartz T, Bryant M, Humphrey G, Johnson AJ, Spengler K, Belda-Ferre P, Diaz E, McDonald D, Zhu Q, Elijah EO, Wang M, Marotz C, Sprecher KE, Vargas-Robles D, Withrow D, Ackermann G, Herrera L, Bradford BJ, Marques LMM, Amaral JG, Silva RM, Veras FP, Cunha TM, Oliveira RDR, Louzada-Junior P, Mills RH, Piotrowski PK, Servetas SL, Da Silva SM, Jones CM, Lin NJ, Lippa KA, Jackson SA, Daouk RK, Galasko D, Dulai PS, Kalashnikova TI, Wittenberg C, Terkeltaub R, Doty MM, Kim JH, Rhee KE, Beauchamp-Walters J, Wright KP, Dominguez-Bello MG, Manary M, Oliveira MF, Boland BS, Lopes NP, Guma M, Swafford AD, Dutton RJ, Knight R, Dorrestein PC. Enhancing untargeted metabolomics using metadata-based source annotation. Nat Biotechnol 2022; 40:1774-1779. [PMID: 35798960 PMCID: PMC10277029 DOI: 10.1038/s41587-022-01368-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 05/20/2022] [Indexed: 01/30/2023]
Abstract
Human untargeted metabolomics studies annotate only ~10% of molecular features. We introduce reference-data-driven analysis to match metabolomics tandem mass spectrometry (MS/MS) data against metadata-annotated source data as a pseudo-MS/MS reference library. Applying this approach to food source data, we show that it increases MS/MS spectral usage 5.1-fold over conventional structural MS/MS library matches and allows empirical assessment of dietary patterns from untargeted data.
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Affiliation(s)
- Julia M Gauglitz
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Kiana A West
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Wout Bittremieux
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Candace L Williams
- Beckman Center for Conservation Research, San Diego Zoo Wildlife Alliance, Escondido, CA, USA
| | - Kelly C Weldon
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
- Center for Microbiome Innovation, Joan and Irwin Jacobs School of Engineering, University of California San Diego, La Jolla, CA, USA
| | - Morgan Panitchpakdi
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Francesca Di Ottavio
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
| | - Christine M Aceves
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Elizabeth Brown
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
- Division of Biological Sciences, University of California San Diego, La Jolla, CA, USA
| | - Nicole C Sikora
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Alan K Jarmusch
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Cameron Martino
- Center for Microbiome Innovation, Joan and Irwin Jacobs School of Engineering, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
- Bioinformatics and Systems Biology Program, University of California San Diego, La Jolla, CA, USA
| | - Anupriya Tripathi
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
- Division of Biological Sciences, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Michael J Meehan
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Kathleen Dorrestein
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Justin P Shaffer
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Roxana Coras
- Division of Rheumatology, Allergy & Immunology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Fernando Vargas
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
- Division of Biological Sciences, University of California San Diego, La Jolla, CA, USA
| | | | - Tara Schwartz
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - MacKenzie Bryant
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Gregory Humphrey
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Abigail J Johnson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Katharina Spengler
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
| | - Pedro Belda-Ferre
- Center for Microbiome Innovation, Joan and Irwin Jacobs School of Engineering, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Edgar Diaz
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Daniel McDonald
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Qiyun Zhu
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Emmanuel O Elijah
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Mingxun Wang
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Clarisse Marotz
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Kate E Sprecher
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Daniela Vargas-Robles
- Servicio Autónomo Centro Amazónico de Investigación y Control de Enfermedades Tropicales Simón Bolívar, Puerto Ayacucho, Amazonas, Venezuela
| | - Dana Withrow
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Gail Ackermann
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Lourdes Herrera
- Department of Pediatrics, Billings Clinic, Billings, MT, USA
| | - Barry J Bradford
- Department of Animal Science, Michigan State University, East Lansing, MI, USA
| | - Lucas Maciel Mauriz Marques
- Department of Pharmacology, Ribeirão Preto Medicinal School, Center of Research in Inflammatory Diseases, University of São Paulo, Ribeirão Preto, Sao Paolo, Brazil
| | - Juliano Geraldo Amaral
- Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Bahia, Brazil
| | - Rodrigo Moreira Silva
- NPPNS, Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Sao Paolo, Brazil
| | - Flavio Protasio Veras
- Department of Pharmacology, Ribeirão Preto Medicinal School, Center of Research in Inflammatory Diseases, University of São Paulo, Ribeirão Preto, Sao Paolo, Brazil
| | - Thiago Mattar Cunha
- Department of Pharmacology, Ribeirão Preto Medicinal School, Center of Research in Inflammatory Diseases, University of São Paulo, Ribeirão Preto, Sao Paolo, Brazil
| | - Rene Donizeti Ribeiro Oliveira
- Department of Internal Medicine, Ribeirão Preto Medical School, Center of Research in Inflammatory Diseases, University of São Paulo, Ribeirão Preto, Sao Paolo, Brazil
| | - Paulo Louzada-Junior
- Department of Internal Medicine, Ribeirão Preto Medical School, Center of Research in Inflammatory Diseases, University of São Paulo, Ribeirão Preto, Sao Paolo, Brazil
| | - Robert H Mills
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
- Department of Pharmacology, University of California San Diego, La Jolla, CA, USA
| | - Paulina K Piotrowski
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Stephanie L Servetas
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Sandra M Da Silva
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Christina M Jones
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Nancy J Lin
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Katrice A Lippa
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Scott A Jackson
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Rima Kaddurah Daouk
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
- Duke Institute of Brain Sciences, Duke University, Durham, NC, USA
| | - Douglas Galasko
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Parambir S Dulai
- Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | - Curt Wittenberg
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - Robert Terkeltaub
- Division of Rheumatology, Allergy & Immunology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- San Diego VA Healthcare System, San Diego, CA, USA
| | - Megan M Doty
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
- Division of Neonatology, Department of Pediatrics, Kapi'olani Medical Center for Women and Children, John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Jae H Kim
- Division of Neonatology, Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kyung E Rhee
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Julia Beauchamp-Walters
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Kenneth P Wright
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Maria Gloria Dominguez-Bello
- Department of Biochemistry and Microbiology, School of Environmental and Biological Sciences; Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Mark Manary
- Department of Pediatrics, Washington University, St. Louis, MO, USA
| | - Michelli F Oliveira
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Brigid S Boland
- Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Norberto Peporine Lopes
- NPPNS, Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Sao Paolo, Brazil
| | - Monica Guma
- Division of Rheumatology, Allergy & Immunology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Austin D Swafford
- Center for Microbiome Innovation, Joan and Irwin Jacobs School of Engineering, University of California San Diego, La Jolla, CA, USA
| | - Rachel J Dutton
- Division of Biological Sciences, University of California San Diego, La Jolla, CA, USA
| | - Rob Knight
- Center for Microbiome Innovation, Joan and Irwin Jacobs School of Engineering, University of California San Diego, La Jolla, CA, USA.
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA.
- Department of Medicine, University of California San Diego, La Jolla, CA, USA.
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA, USA.
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA.
| | - Pieter C Dorrestein
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, USA.
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA.
- Center for Microbiome Innovation, Joan and Irwin Jacobs School of Engineering, University of California San Diego, La Jolla, CA, USA.
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA.
- Department of Pharmacology, University of California San Diego, La Jolla, CA, USA.
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25
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Larrow A, Doshi A, Fisher E, Patel A, Marc-Aurele K, Rhee KE, Beauchamp-Walters J. Empowering Pediatric Palliative Homecare Patients and Caregivers with Symptom Management Plans. J Pain Symptom Manage 2022; 64:340-348. [PMID: 35835428 DOI: 10.1016/j.jpainsymman.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/14/2022] [Accepted: 06/29/2022] [Indexed: 11/20/2022]
Abstract
Pediatric palliative home-based care has been shown to improve symptoms, quality of life, and coordination of care. Despite these successes, hospital utilization in our own palliative home-based care population remained high as some caregivers lacked confidence to manage symptoms at home and had difficulty in recalling or accessing "sick care plans." Our team developed the Symptom Management Plan (SMP), a multi-system "sick care plan," as a quality improvement project with the aim of improving caregiver confidence to manage symptoms at home. An Electronic Health Record-based SMP template was created for common symptoms: respiratory distress, seizures, feeding intolerance, and constipation with core subspecialists' input. Individualized SMPs were created and reviewed with caregivers at every subsequent palliative home nursing visit. Caregivers were surveyed on their confidence 3 and 6-months post-implementation. Resource utilization was analyzed throughout implementation. At 6 months, 73% of caregivers reported "better" or "much better" confidence in managing their child's symptoms after using the SMP, and 76% of caregivers perceived the SMP prevented urgent care or emergency department (ED) visits. After the SMP was launched, the rate of ED visits decreased from 0.86 to 0.47 per 100 patient-days, and admissions decreased from 0.56 to 0.39 per 100 patient-days. These rates further decreased to 0.31 ED visits and 0.19 admissions per 100 patient-days within 4 and 6 months. Introducing the SMP for our home-based palliative care patients was associated with improved caregiver confidence in managing acute symptoms at home and a reduction in hospital utilization.
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Affiliation(s)
- Annie Larrow
- University of California San Diego Department of Pediatrics, Rady Children's Hospital, San Diego, CA.
| | - Ami Doshi
- University of California San Diego Department of Pediatrics, Rady Children's Hospital, San Diego, CA
| | - Erin Fisher
- University of California San Diego Department of Pediatrics, Rady Children's Hospital, San Diego, CA
| | - Aarti Patel
- University of California San Diego Department of Pediatrics, Rady Children's Hospital, San Diego, CA
| | - Krishelle Marc-Aurele
- University of California San Diego Department of Pediatrics, Rady Children's Hospital, San Diego, CA
| | - Kyung E Rhee
- University of California San Diego Department of Pediatrics, Rady Children's Hospital, San Diego, CA
| | - Julia Beauchamp-Walters
- University of California San Diego Department of Pediatrics, Rady Children's Hospital, San Diego, CA
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26
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Orchanian SB, Gauglitz JM, Wandro S, Weldon KC, Doty M, Stillwell K, Hansen S, Jiang L, Vargas F, Rhee KE, Lumeng JC, Dorrestein PC, Knight R, Kim JH, Song SJ, Swafford AD. Multiomic Analyses of Nascent Preterm Infant Microbiomes Differentiation Suggest Opportunities for Targeted Intervention. Adv Biol (Weinh) 2022; 6:e2101313. [PMID: 35652166 PMCID: PMC10321678 DOI: 10.1002/adbi.202101313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/01/2022] [Indexed: 01/28/2023]
Abstract
The first week after birth is a critical time for the establishment of microbial communities for infants. Preterm infants face unique environmental impacts on their newly acquired microbiomes, including increased incidence of cesarean section delivery and exposure to antibiotics as well as delayed enteral feeding and reduced human interaction during their intensive care unit stay. Using contextualized paired metabolomics and 16S sequencing data, the development of the gut, skin, and oral microbiomes of infants is profiled daily for the first week after birth, and it is found that the skin microbiome appears robust to early life perturbation, while direct exposure of infants to antibiotics, rather than presumed maternal transmission, delays microbiome development and prevents the early differentiation based on body site regardless of delivery mode. Metabolomic analyses identify the development of all gut metabolomes of preterm infants toward full-term infant profiles, but a significant increase of primary bile acid metabolism only in the non-antibiotic treated vaginally birthed late preterm infants. This study provides a framework for future multi-omic, multibody site analyses on these high-risk preterm infant populations and suggests opportunities for monitoring and intervention, with infant antibiotic exposure as the primary driver of delays in microbiome development.
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Affiliation(s)
- Stephanie B Orchanian
- Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, 92093, USA
| | - Julia M Gauglitz
- Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, 92093, USA.,Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, 92093, USA.,Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Stephen Wandro
- Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, 92093, USA
| | - Kelly C Weldon
- Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, 92093, USA.,Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, 92093, USA.,Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Megan Doty
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Kristina Stillwell
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Shalisa Hansen
- Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, 92093, USA
| | - Lingjing Jiang
- Division of Biostatistics, University of California San Diego, La Jolla, CA, 92093, USA
| | - Fernando Vargas
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, 92093, USA.,Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, 92093, USA.,Division of Biological Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Kyung E Rhee
- Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, 92093, USA.,Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Julie C Lumeng
- Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Pieter C Dorrestein
- Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, 92093, USA.,Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, 92093, USA.,Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, CA, 92093, USA.,Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Rob Knight
- Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, 92093, USA.,Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, 92093, USA.,Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA, 92093, USA.,Department of Bioengineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Jae H Kim
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Se Jin Song
- Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, 92093, USA
| | - Austin D Swafford
- Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, 92093, USA
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Rhee KE, Herrera L, Strong D, Kang-Sim E, Shi Y, Boutelle KN. Guided Self-Help for Pediatric Obesity in Primary Care: A Randomized Clinical Trial. Pediatrics 2022; 150:188283. [PMID: 35712916 DOI: 10.1542/peds.2021-055366] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Our aim was to compare the effect of 2 treatment models on attendance and child weight status: a less intense guided self-help (GSH) program delivered in the primary care setting versus traditional family-based behavioral treatment (FBT) delivered in an academic center. METHODS We conducted a randomized clinical trial among 164 children between 5 and 13 years old with a BMI ≥85th percentile and their parents. The intervention group (GSH) received 14 individual sessions over 6 months, with 5.3 hours of treatment. The control group (FBT) received 20 group-based sessions over 6 months, with 20 hours of treatment. Main outcomes included proportion of sessions families attended and change in child BMI z-score (BMIz), percentage from the 95th BMI percentile, difference from the 95th BMI percentile at the end of treatment, and 6-month follow-up. RESULTS Mean age of children was 9.6 years, BMI z-score 2.1, 49% female, and >90% Latino. The odds of attending GSH compared to FBT was 2.2 (P < 0.01). Those assigned to GSH had a 67% reduced risk of attrition (hazard ratio = 0.33, 95% confidence interval 0.22-0.50, P < .001). Intent-to-treat analysis showed no between-group differences in change in BMIz and percentage from the 95th BMI percentile over time. Combined, there was a significant reduction in BMIz from baseline to posttreatment (β = -0.07 (0.01), P < .01, d: 0.60) and a slight increase from posttreatment to follow-up (β = 0.007 (0.13), P = .56). CONCLUSIONS This study provides support for a novel, less intense GSH model of obesity treatment, which can be implemented in the primary care setting. Future studies should examine effective approaches to dissemination and implementation of GSH in different settings to increase access to treatment.
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Affiliation(s)
| | - Lourdes Herrera
- Department of Pediatrics, Wake Forrest University, Winston-Salem, North Carolina
| | | | | | | | - Kerri N Boutelle
- Departments of Pediatrics.,Family Medicine and Public Health.,Psychiatry, University of California San Diego, San Diego, California
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28
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Abstract
Universal lipid screening (ULS) is recommended for all 9- to 11-year-old children. We investigated ULS outcomes and long-term pediatrician management of children with dyslipidemia using a retrospective chart review of well-child visits between 2014 and 2016. Descriptive statistics summarized demographics, ULS results, and follow-up visits/testing. Pearson χ2 test examined differences between those with and without an abnormal screen. A total of 1039 children aged 9 to 11 years were seen for a well-child visit; only 33.3% (343/1039) completed screening. Of children screened, 18.1% (62/343) had abnormal screen results and were more likely to have an elevated body mass index (P < .001), though 30.1% (19/62) had no risk factors. A total of 10.2% (35/343) had dyslipidemia. A total of 77.1% of children with dyslipidemia received nutrition/exercise counseling and 57.1% received dietitian referrals; only 68.6% had a follow-up visit and 31.4% had repeat lipid testing. Pediatricians would benefit from more practical strategies for universal testing such as point-of-care testing and long-term management to ensure ULS is an effective screening tool.
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Affiliation(s)
| | - Leah Kern
- University of California, San Diego, CA, USA,Leah Kern, UCSD Pediatrics, 7910 Frost Street #350, San Diego, CA 92123, USA.
| | - Helen Wang
- University of California, San Diego, CA, USA
| | - Janet Crow
- University of California, San Diego, CA, USA
| | - Kyung E. Rhee
- UCSD Center for Healthy Eating and Activity Research, San Diego, CA, USA
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Eichen DM, Strong DR, Rhee KE, Boutelle KN. The complicated relationship among parent and child disinhibited eating behaviors. Appetite 2022; 171:105923. [PMID: 35026372 DOI: 10.1016/j.appet.2022.105923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 11/29/2022]
Abstract
Disinhibited eating behaviors (e.g., loss of control eating (LOC) and eating in the absence of hunger (EAH)) contribute to overeating and obesity. This study aimed to evaluate whether these traits are related in parent-child dyads and how the reporter of child eating behavior (parent or child) impacts this relationship. Two-hundred and ninety treatment-seeking children, ages 8-13, with overweight or obesity (BMI percentile for age and sex 85-99.9%) and their parents were included. LOC and EAH were assessed by child report for self, parent report for self, and parent report for child. Parent and child disinhibited eating behaviors were related only when parents reported on both their own and their child's eating behaviors (p-values < 0.04). Child report of LOC and EAH for self was not associated with parent report of LOC and EAH for self (p-values > 0.05). There was a significant interaction between parent's EAH and BMI as it related to parent report of child EAH (B = 0.02; SE = 0.005; p = 0.004) such that parents with lower BMI reported their own EAH to be lower than parents with higher BMI, but parent report of child EAH was similar regardless of the parent's BMI. Disinhibited eating behaviors were related only when a single parent reported on both their own and their child's behavior, suggesting a potential reporting bias. Given that the relation between parent and child disinhibited eating behaviors varies based on who is reporting the child's behavior, it may be important to consider both parent and child report when designing research studies or in clinical settings while also recognizing potential reporting biases.
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Affiliation(s)
- Dawn M Eichen
- University of California San Diego, Department of Pediatrics, San Diego, CA, USA.
| | - David R Strong
- University of California San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, San Diego, CA, USA
| | - Kyung E Rhee
- University of California San Diego, Department of Pediatrics, San Diego, CA, USA
| | - Kerri N Boutelle
- University of California San Diego, Department of Pediatrics, San Diego, CA, USA; University of California San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, San Diego, CA, USA; University of California San Diego, Department of Psychiatry, San Diego, CA, USA
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30
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Dworsky ZD, Rhee KE, Patel AR, McMahon MK, Pierce HC, Stucky Fisher E. Assessing Parental Discharge Readiness by Using the Ticket to Home Survey Tool. Hosp Pediatr 2022; 12:85-93. [PMID: 34889352 DOI: 10.1542/hpeds.2021-005832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Ticket to Home (TTH), a survey tool designed to assess parental comprehension of their child's hospitalization and postdischarge care needs, allows providers to address knowledge gaps before discharge. Our goal was to evaluate the impact of TTH on parents' retention of discharge teaching. METHODS In this pilot study, we enrolled a convenience sample of families admitted to pediatric hospital medicine and randomly assigned families on the basis of team assignment. The intervention group received TTH before discharge. The control group received usual care (without TTH survey tool). Both groups were sent a survey 24 to 72 hours postdischarge to assess parental understanding of discharge teaching. A senior-level provider also completed a survey; responses were compared with evaluate parent level of understanding. Descriptive statistics and logistic regression were used for analysis. RESULTS Although 495 parents consented to participate, only 100 completed the necessary surveys (41 intervention and 59 control). Both groups showed high parent-provider concordance regarding reason for admission (92.7% intervention versus 86.4% control; P = .33). The intervention group had significantly higher concordance for return precautions (90.2% vs 58.2%; P < .001), which remained significant when controlling for covariates (odds ratio 6.24, 95% confidence interval 1.78-21.93). Most parents in the intervention group felt sharing TTH responses with their medical team was beneficial (95.0%). CONCLUSIONS Parents who received TTH before discharge were more likely to accurately recall return precautions and valued sharing TTH results with the team. Given that response bias may have affected pilot results, additional studies in which researchers use larger samples with more diverse patient populations is required.
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Affiliation(s)
- Zephyr D Dworsky
- Rady Children's Hospital San Diego and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, San Diego, California
| | - Kyung E Rhee
- Rady Children's Hospital San Diego and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, San Diego, California
| | - Aarti R Patel
- Rady Children's Hospital San Diego and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, San Diego, California
| | - Molly K McMahon
- Rady Children's Hospital San Diego and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, San Diego, California.,College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California
| | - Heather C Pierce
- Rady Children's Hospital San Diego and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, San Diego, California
| | - Erin Stucky Fisher
- Rady Children's Hospital San Diego and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, San Diego, California
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Tam I, Gist L, Patel A, Fisher E, Rhee KE. The Parent's Perspective: A Focus Group Study on Spanish Interpreter Services for Hospitalized Children. Acad Pediatr 2022; 22:98-106. [PMID: 34273559 DOI: 10.1016/j.acap.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The US Census confirms a rise in Spanish-speakers, many of whom have limited English proficiency (LEP) and require interpreters. Parent perceptions of interpreter services throughout hospitalization are unknown. OBJECTIVE To explore Spanish-speaking LEP parents' views regarding roles of interpreters and providers (attending, resident, or nurse) during a hospital encounter, optimal modalities of interpretation, and barriers to services. METHODS Spanish-speaking LEP parents of children discharged from the hospital medicine service participated in focus groups. Sessions were audio-recorded and transcribed in Spanish, translated into English, and verified for translation accuracy. Qualitative methods were used for thematic analysis. RESULTS Four sessions (n = 23 participants representing 15 families) were held. Parents felt the interpreter's primary role was to act as a conduit for word-for-word interpretation. They desired kind and trustworthy interpreters with medical knowledge. They saw providers as leaders of the encounter who should allot enough time for interpretation, not use Spanish unless they were fluent, and give frequent medical updates. In-person interpreters were preferred over telephone and video for their ability to convey body language and build relationships. Barriers to requesting interpreters included embarrassment and inability to directly request services, which resulted in using family members as interpreters. On family-centered rounds, parents preferred professional interpreters over bilingual providers. CONCLUSIONS Modifications are required to improve interpreter services to meet the needs of LEP families. Parents emphasized in-person interpreters' social skills, frequent provider updates, and additional navigation support as essential components of effective care. Next steps include implementing guidelines and interventions to optimize interpreter services.
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Affiliation(s)
- Ivy Tam
- Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego (I Tam, L Gist, A Patel, E Fisher, and KE Rhee); Department of Pediatrics, The Children's Hospital at Montefiore and Albert Einstein College of Medicine (I Tam), Bronx, NY..
| | - Lauren Gist
- Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego (I Tam, L Gist, A Patel, E Fisher, and KE Rhee)
| | - Aarti Patel
- Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego (I Tam, L Gist, A Patel, E Fisher, and KE Rhee)
| | - Erin Fisher
- Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego (I Tam, L Gist, A Patel, E Fisher, and KE Rhee)
| | - Kyung E Rhee
- Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego (I Tam, L Gist, A Patel, E Fisher, and KE Rhee)
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32
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Manzano MA, Strong DR, Kang Sim DE, Rhee KE, Boutelle KN. Psychometric properties of the Child Eating Behavior Questionnaire (CEBQ) in school age children with overweight and obesity: A proposed three-factor structure. Pediatr Obes 2021; 16:e12795. [PMID: 33945226 DOI: 10.1111/ijpo.12795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/13/2021] [Accepted: 04/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Obesity in youth is a significant public health concern, with eating behaviors being a major contributor. The Child Eating Behavior Questionnaire (CEBQ) was developed to evaluate the appetitive characteristics of young children, across a myriad of eating domains. Despite the breadth of its use, the psychometric properties of the measure in children with overweight/obesity (OW/OB), particularly treatment seeking youth, remains largely unexplored. METHODS The psychometric properties of the CEBQ were examined in a sample of school age children (8-12) with OW/OB. Parent-child dyads (N = 148) completed assessments prior to beginning a family weight management program. Exploratory factor analysis (EFA) was performed utilizing polychoric correlations, and emerging subscales were assessed to ensure that the range of response scores demonstrated adequate variability. Indices of the number of factors to be retained included acceleration factor (2), optimal coordinates (4), Velicer's MAP (5) and parallel analysis (11). These indices were used in combination with clinical utility to determine the final factor structure. RESULTS A three-factor structure emerged. The first factor combined many food responsiveness, enjoyment of food, satiety responsiveness and slowness in eating items, with the latter two domains loading negatively. The second factor retained the food fussiness subscale, and the third factor included items from the emotional over- and under-eating subscales. CONCLUSIONS These results suggest that in children with OW/OB, eating behaviors may be optimally assessed using three domains: reward-based eating, emotional eating and picky eating. Future research should explore how this structure holds in non-treatment-seeking samples and across wider socio-demographic profiles.
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Affiliation(s)
- Michael A Manzano
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - David R Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - D Eastern Kang Sim
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Kyung E Rhee
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Kerri N Boutelle
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA.,Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA
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33
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Rhee KE, Manzano M, Goffin S, Strong D, Boutelle KN. Exploring the relationship between appetitive behaviours, executive function, and weight status among preschool children. Pediatr Obes 2021; 16:e12774. [PMID: 33530135 PMCID: PMC9186098 DOI: 10.1111/ijpo.12774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 12/15/2020] [Accepted: 01/15/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The goal was to conduct exploratory analysis to determine if executive functions (EFs) and food responsiveness/satiety responsiveness (appetitive behaviours that describe one's tendency to eat in the presence of food or food cues) interact to influence weight status among preschool children participating in a trial promoting self-regulation around energy-dense foods. METHODS At baseline, parents completed the Behaviour Rating Inventory of Executive Function-Preschool and the Child Eating Behaviour Questionnaire. Children completed anthropometric measurements at the preschool. Spearman's correlation, linear regression, and tests of interaction were conducted. The relationship between weight status and EFs among those who were high vs low in food responsiveness and satiety responsiveness was examined. RESULTS Children (n = 92) had a mean age of 5.1 years and body mass index (BMI) percentile of 57.6; half (54%) were male. There were significant correlations between food responsiveness and several EFs (emotional control, inhibitory control, working memory, and plan/organize). In the stratified analysis, children with high food responsiveness or low satiety responsiveness had higher BMI percentiles as emotional control skills worsened. BMI percentiles were not elevated among children with low food responsiveness and poor emotional control. CONCLUSION These results suggest that EFs may be more relevant to weight status if preschool children had high levels of food responsiveness or low levels of satiety responsiveness (ie, increased tendency to be influenced by environmental food cues). This analysis should be replicated with direct measures of executive function and appetitive behaviours in larger samples of young children to examine longitudinal impact on weight status.
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Affiliation(s)
- Kyung E. Rhee
- Department of Pediatrics, University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093. USA
| | - Michael Manzano
- Department of Pediatrics, University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093. USA.,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120. USA
| | - Stanny Goffin
- Department of Pediatrics, University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093. USA
| | - David Strong
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093. USA
| | - Kerri N. Boutelle
- Department of Pediatrics, University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093. USA.,Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093. USA.,Department of Psychiatry, University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093. USA
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Rhee KE, Herrera L, Strong D, DeBenedetto AM, Shi Y, Boutelle KN. Design of the GOT Doc study: A randomized controlled trial comparing a Guided Self-Help obesity treatment program for childhood obesity in the primary care setting to traditional family-based behavioral weight loss. Contemp Clin Trials Commun 2021; 22:100771. [PMID: 33997462 PMCID: PMC8095104 DOI: 10.1016/j.conctc.2021.100771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 03/11/2021] [Accepted: 04/05/2021] [Indexed: 11/26/2022] Open
Abstract
Currently one-third of children in the United States have overweight or obesity (OW/OB). The goal of Healthy People 2020 is to reduce the proportion of children with OW/OB and increase the proportion of primary care visits that include nutrition and weight-related counseling. Unfortunately, many health care providers find it difficult to offer effective weight-related counseling and treatment in the primary care setting. Therefore, new models of care are needed that allow a greater proportion of children with OW/OB and their parents to access care and receive quality weight management treatment. The current paper describes the GOT Doc study which is designed to test the effectiveness of a Guided Self-Help (GSH) model of obesity treatment that can be delivered in the primary care setting compared to a traditional Family-Based Behavioral weight loss treatment (FBT) delivered at an academic center. We will assess the impact of this program on attendance (access to care) and changes in child BMI percentile/z-score. We will also examine the impact of this treatment model on change in child lifestyle behaviors, parent support behaviors, and parent self-efficacy and empowerment to make behavior change. Finally, we will assess the cost-effectiveness of this model on changes in child BMI percentile/z-score. We believe the GSH intervention will be a cost-effective model of obesity management that can be implemented in community practices around the country, thereby increasing access to treatment for a broader proportion of our population and decreasing rates of childhood obesity. Effective childhood obesity treatment is not widely available or easily accessible. Guided Self-Help (GSH) model of treatment has been developed for pediatric obesity. GSH is easier to implement and can be delivered in the primary care setting. GSH can increase access to much needed treatment. Evaluation of its effectiveness in the primary care setting is needed.
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Key Words
- Childhood obesity
- Community-based intervention
- Early and Periodic Screening, Diagnosis, and Treatment program, EPSDT
- Electronic health record, EHR
- Family-Based Behavioral Therapy, FBT
- Family-based behavioral therapy
- Guided Self-Help, GSH
- Guided self-help
- Guided self-help Obesity Treatment in the primary care setting, GOT Doc
- Overweight or obesity, OW/OB
- Primary care
- Primary care provider, PCP
- Quality of Lifev, QOL
- Treatment
- U.S. Preventive Services Task Force, USPSTF
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Affiliation(s)
- Kyung E Rhee
- University of California, San Diego, Department of Pediatrics, United States
| | - Lourdes Herrera
- University of California, San Diego, Department of Pediatrics, United States.,Wake Forrest University, Department of Pediatrics, United States
| | - David Strong
- University of California, San Diego, Department of Family Medicine and Public Health, United States
| | | | - Yuyan Shi
- University of California, San Diego, Department of Family Medicine and Public Health, United States
| | - Kerri N Boutelle
- University of California, San Diego, Department of Pediatrics, Department of Family Medicine and Public Health, And Department of Psychiatry, United States
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35
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Boutelle KN, Strong D, Liang J, Rhee KE, Rock CL, Wilfley D, Epstein L, Crow SJ. Comparative Costs of a Parent-Only and Parent and Child Treatment for Children with Overweight or Obesity. Obesity (Silver Spring) 2021; 29:388-392. [PMID: 33491321 PMCID: PMC9261273 DOI: 10.1002/oby.23069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Models such as family-based treatment (FBT), delivered to both the parent and child, are considered the most efficacious intervention for children with obesity. However, recent research suggests that parent-based treatment (PBT; or parent-only treatment) is noninferior to FBT. The aim of this study was to evaluate the comparative costs of the FBT and PBT models. METHODS A total of 150 children with overweight and obesity and their parents were randomized to one of two 6-month treatment programs (FBT or PBT). Data was collected at baseline, during treatment, and following treatment, and and trial-based analyses of the costs were conducted from a health care sector perspective and a limited societal perspective. RESULTS Results suggest that PBT, compared with FBT, had lower costs per parent-child dyad from the health care sector perspective (PBT = $2,886; FBT = $3,899) and from a limited societal perspective (PBT = $3,231; FBT = $4,279). CONCLUSIONS These findings suggest that a PBT intervention has lower costs and is noninferior to an FBT intervention for both child and parent weight loss.
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Affiliation(s)
- Kerri N Boutelle
- Department of Pediatrics, UC San Diego, La Jolla, California, USA
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, USA
- Department of Psychiatry, UC San Diego, San Diego, California, USA
| | - David Strong
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, USA
| | - June Liang
- Department of Pediatrics, UC San Diego, La Jolla, California, USA
| | - Kyung E Rhee
- Department of Pediatrics, UC San Diego, La Jolla, California, USA
| | - Cheryl L Rock
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, USA
| | - Denise Wilfley
- Departent of Psychiatry, Washington University St Louis, St Louis, Missouri, USA
| | - Leonard Epstein
- Department of Pediatrics, University of Buffalo, Buffalo, New York, USA
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
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36
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Palmer CE, Sheth C, Marshall AT, Adise S, Baker FC, Chang L, Clark DB, Coronado C, Dagher RK, Diaz V, Dowling GJ, Gonzalez MR, Haist F, Herting MM, Huber RS, Jernigan TL, LeBlanc K, Lee K, Lisdahl KM, Neigh G, Patterson MW, Renshaw P, Rhee KE, Tapert S, Thompson WK, Uban K, Sowell ER, Yurgelun-Todd D. A Comprehensive Overview of the Physical Health of the Adolescent Brain Cognitive Development Study Cohort at Baseline. Front Pediatr 2021; 9:734184. [PMID: 34692610 PMCID: PMC8526338 DOI: 10.3389/fped.2021.734184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/30/2021] [Indexed: 02/03/2023] Open
Abstract
Physical health in childhood is crucial for neurobiological as well as overall development, and can shape long-term outcomes into adulthood. The landmark, longitudinal Adolescent Brain Cognitive Development StudySM (ABCD study®), was designed to investigate brain development and health in almost 12,000 youth who were recruited when they were 9-10 years old and will be followed through adolescence and early adulthood. The overall goal of this paper is to provide descriptive analyses of physical health measures in the ABCD study at baseline, including but not limited to sleep, physical activity and sports involvement, and body mass index. Further this summary will describe how physical health measures collected from the ABCD cohort compare with current normative data and clinical guidelines. We propose this data set has the potential to facilitate clinical recommendations and inform national standards of physical health in this age group. This manuscript will also provide important information for ABCD users and help guide analyses investigating physical health including new avenues for health disparity research as it pertains to adolescent and young adult development.
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Affiliation(s)
- Clare E Palmer
- Center for Human Development, University of California, San Diego, San Diego, CA, United States
| | - Chandni Sheth
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Andrew T Marshall
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Shana Adise
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, United States
| | - Linda Chang
- Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD, United States
| | - Duncan B Clark
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Clarisa Coronado
- Center for Human Development, University of California, San Diego, San Diego, CA, United States
| | - Rada K Dagher
- Division of Scientific Programs, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Vanessa Diaz
- Center for Human Development, University of California, San Diego, San Diego, CA, United States
| | - Gayathri J Dowling
- Division of Extramural Research, National Institute on Drug Abuse, Bethesda, MD, United States
| | - Marybel R Gonzalez
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Frank Haist
- Center for Human Development, University of California, San Diego, San Diego, CA, United States.,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Megan M Herting
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States
| | - Rebekah S Huber
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Terry L Jernigan
- Center for Human Development, University of California, San Diego, San Diego, CA, United States
| | - Kimberly LeBlanc
- Division of Extramural Research, National Institute on Drug Abuse, Bethesda, MD, United States
| | - Karen Lee
- Child Development and Behavior Branch, National Institute of Child Health and Human Development, Bethesda, MD, United States
| | - Krista M Lisdahl
- Department of Psychology, University of Wisconsin, Milwaukee, WI, United States
| | - Gretchen Neigh
- Department of Neurobiology and Anatomy, Virginia Commonwealth University, Richmond, VT, United States
| | - Megan W Patterson
- Department of Psychology and Neuroscience, University of Colorado Denver-Anschutz Medical Campus, Denver, CO, United States
| | - Perry Renshaw
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Kyung E Rhee
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
| | - Susan Tapert
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Wesley K Thompson
- Population Neuroscience and Genetics Lab, University of California, San Diego, San Diego, CA, United States
| | - Kristina Uban
- Public Health, University of California, Irvine, Irvine, CA, United States
| | - Elizabeth R Sowell
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Deborah Yurgelun-Todd
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States
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37
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Hingle MD, Shanks CB, Parks C, Prickitt J, Rhee KE, Wright J, Hiller-Venegas S, Yaroch AL. Examining Equitable Online Federal Food Assistance during the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A Case Study in 2 Regions. Curr Dev Nutr 2020; 4:nzaa154. [PMID: 33073163 PMCID: PMC7543249 DOI: 10.1093/cdn/nzaa154] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 08/15/2020] [Accepted: 09/23/2020] [Indexed: 11/13/2022] Open
Abstract
The USDA Supplemental Nutrition Assistance Program (SNAP) provides food and financial assistance to food-insecure individuals and families. In the midst of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, SNAP benefits evolved. Policy changes and federal legislation expanded SNAP eligibility, raised benefit levels, and introduced program waivers that enabled online ordering to reduce participants' exposure to community-acquired SARS-CoV-2. Although rapid expansion of SNAP benefits in the online space represents significant progress for federal food assistance, changes also introduced unforeseen partiality in how benefits and services were accessed and utilized, as illustrated by 2 populations and regions in the early months of the SARS-CoV-2 pandemic: low-income older adults in rural Alabama and low-income Hispanic adults in urban California. Opportunities exist to build on the recent progress in SNAP, while also ensuring continued inclusiveness of eligible persons. Efforts should be informed by evidence that supports equitable access to federal food assistance.
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Affiliation(s)
- Melanie D Hingle
- Department of Nutritional Sciences, The University of Arizona, Tucson, AZ, USA
| | - Carmen Byker Shanks
- Department of Health and Human Development, Food and Health Lab, Montana State University, Bozeman, MT, USA
| | | | - Joseph Prickitt
- University of California, San Diego, School of Medicine, Center for Community Health, San Diego, CA, USA
| | - Kyung E Rhee
- Department of Pediatrics, University of California, San Diego, School of Medicine, La Jolla, CA, USA
| | - Jimmy Wright
- Wright's Markets, Wright2U.com, Wright Food Solutions , Opelika, AL, USA
| | - Sarah Hiller-Venegas
- Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, La Jolla, CA, USA
| | - Amy L Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
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38
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Eichen DM, Mestre ZL, Strong DR, Rhee KE, Boutelle KN. Defining and identifying predictors of rapid response to pediatric obesity treatment. Pediatr Obes 2020; 15:e12621. [PMID: 32100412 PMCID: PMC7202991 DOI: 10.1111/ijpo.12621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/23/2019] [Accepted: 01/20/2020] [Indexed: 11/28/2022]
Abstract
Early weight loss (rapid response [RR]) is associated with better outcomes in adults. Less is known about RR in children enrolled in weight-loss treatment. The aim of the current study was to establish an RR weight-loss threshold following 4 weeks of pediatric obesity treatment and identify characteristics associated with achieving RR. One hundred thirty-seven children aged 8 to 12 with overweight/obesity and parents participated in 6 months of family-based or parent-based treatment. Receiver operating characteristic curves evaluated how weight loss at week 4 related to decreases of 5% at posttreatment and 10% at 6- and 18-month follow-ups of standardized body mass index (BMIz), percentage distance of a child's BMI from the median BMI for sex and age, and percentage above the 95th percentile. Weight loss of 2.4% to 3.4% at week 4 predicted 5% change at posttreatment (AUC's = .68-.75; P's ≤ .002) and 10% change at 6-month follow-up (AUC's = .63-.70; P's ≤ .02). No model was significant at 18-month follow-up. Amount of parent weight (lbs) change at week 4 was associated with child achieving RR. Males and Non-Hispanic Whites were more likely to achieve RR. This threshold could be used to mark early significant progress and guide clinical evaluations of treatment response to paediatric obesity treatment.
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Affiliation(s)
- Dawn M Eichen
- University of California San Diego, Department of
Pediatrics, San Diego, CA USA
| | - Zoe L Mestre
- SDSU/UC San Diego Joint Doctoral Program in Clinical
Psychology, San Diego, CA USA
| | - David R Strong
- University of California San Diego, Department of Family
Medicine and Public, San Diego, CA USA
| | - Kyung E Rhee
- University of California San Diego, Department of
Pediatrics, San Diego, CA USA
| | - Kerri N Boutelle
- University of California San Diego, Department of
Pediatrics, San Diego, CA USA,University of California San Diego, Department of Family
Medicine and Public, San Diego, CA USA,University of California San Diego, Department of
Psychiatry, San Diego, CA USA
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39
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Kang Sim DE, Strong DR, Manzano MA, Rhee KE, Boutelle KN. Evaluation of dyadic changes of parent-child weight loss patterns during a family-based behavioral treatment for obesity. Pediatr Obes 2020; 15:e12622. [PMID: 32048808 PMCID: PMC9261271 DOI: 10.1111/ijpo.12622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Family-based treatment (FBT) for children with overweight and obesity is a package that includes nutrition and physical activity education, as well as parenting and behavior therapy skills. To date, the majority of research suggests that one of the best predictors of child weight loss is parent weight loss. However, the bidirectional processes facilitating parent-child weight loss are not well understood. OBJECTIVE To evaluate the strength and direction of parent-child weight-change patterns during a 6-month intervention with FBT for childhood obesity. METHODS Parent-child weight change dynamics were evaluated using a bivariate multilevel approach. RESULTS Significant positive weight reductions throughout treatment were observed among both parents and children (P's < .01 for both parent and child). In the model adjusting for the conditional influence of attendance over time, parents' initial weight loss was associated with subsequent weight loss by their child (B = 0.102, P < .05; d = 0.352) across the first 10 sessions. Child's weight loss also was associated with subsequent weight loss by their parent (B = 0.105, P < .01; d = 0.412) across the first 10 sessions. A small and negative effects of parents' weight loss on children and children's weight loss on parents from sessions 10 to 20 may have been reflective of slowed rates of weight loss as treatment progressed. CONCLUSIONS Together these data suggest that parent-child dyads mutually influence weight loss in FBT. Future studies should leverage how to make best clinical use of these dynamic effects in the context of family-based interventions.
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Affiliation(s)
| | - David R. Strong
- Department of Family Medicine and Public Health, UC San Diego
| | - Michael A. Manzano
- Department of Pediatrics, UC San Diego,SDSU/ UC San Diego Joint Doctoral Program in Clinical Psychology
| | | | - Kerri N. Boutelle
- Department of Pediatrics, UC San Diego,Department of Family Medicine and Public Health, UC San Diego,Department of Psychiatry, UC San Diego
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40
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Abstract
Nationally recommended universal lipid screening (ULS) in children aged 9 to 11 years is low. Little is known about parents' understanding of screening. We conducted a survey exploring parental knowledge and attitudes regarding ULS. Of 91 parent respondents, 81.3% were female, 69.2% were non-Hispanic white, 90.1% had a college/graduate degree, and 63.7% had a family history of abnormal cholesterol. Overall, 45.5% agreed that ULS should be done for all children, 30.8% disagreed, and 23.1% were unsure. Parents' support for ULS was significantly associated with their attitudes toward screening rather than their knowledge about cholesterol, family history of cardiovascular disease or abnormal cholesterol, age, race/ethnicity, or gender. Parents were less likely to agree that ULS should be done if they thought that cholesterol screening should be done based on a child's health or family history rather than for all children (P < .001), or if they thought that cholesterol screening was unnecessary (P < .001).
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Affiliation(s)
- Leah Kern
- University of California, San Diego, CA, USA
| | | | - Helen Wang
- University of California, San Diego, CA, USA
| | - Tuo Lin
- University of California, San Diego, CA, USA
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41
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Khare M, Azim A, Kneese G, Haag M, Weinstein K, Rhee KE, Foster BA. Vancomycin Dosing in Children With Overweight or Obesity: A Systematic Review and Meta-analysis. Hosp Pediatr 2020; 10:359-368. [PMID: 32213528 DOI: 10.1542/hpeds.2019-0287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
CONTEXT Vancomycin is a medication with potential for significant harm with both overdosing and underdosing. Obesity may affect vancomycin pharmacokinetics and is increasingly common among children. OBJECTIVE We aimed to determine if children with overweight or obesity have increased vancomycin trough concentrations with total body weight (TBW) dosing compared with children with normal weight. DATA SOURCES We conducted a search of Medline and Medline In-Process & Other Non-Indexed Citations from 1952 (the year vancomycin was discovered) to November 2017. STUDY SELECTION Search terms included vancomycin, body weight, and body composition terms and were limited to children. Studies were reviewed and screened by ≥2 reviewers. DATA EXTRACTION The primary outcome was vancomycin level. Data were extracted by 2 reviewers. We performed quality assessment using the Newcastle-Ottawa quality assessment scale. RESULTS We identified 271 records. After abstract and full-text screening, we identified 7 studies for full review. Six of the 7 studies used a matched case-control design, although there was significant variation in study methodology. Four of the 7 studies were included in a meta-analysis, which revealed a small but significant difference in vancomycin trough levels between children with normal weight and children with overweight or obesity when dosed by using TBW (N = 521; mean difference 2.2 U [95% confidence interval: 1.0-3.4]). CONCLUSIONS High-quality data to guide vancomycin dosing in children with obesity are lacking. More studies evaluating dosing strategies in children with obesity are warranted because using TBW to dose vancomycin may lead to higher vancomycin concentrations and potential toxicity.
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Affiliation(s)
- Manaswitha Khare
- Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Aniqa Azim
- School of Medicine, Oregon Health and Science University, Portland, Oregon; and
| | - Garrett Kneese
- School of Medicine, Oregon Health and Science University, Portland, Oregon; and
| | - Meredith Haag
- School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kelsey Weinstein
- School of Medicine, Oregon Health and Science University, Portland, Oregon; and
| | - Kyung E Rhee
- Department of Pediatrics, University of California, San Diego, San Diego, California
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42
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Tam I, Huang MZ, Patel A, Rhee KE, Fisher E. Spanish Interpreter Services for the Hospitalized Pediatric Patient: Provider and Interpreter Perceptions. Acad Pediatr 2020; 20:216-224. [PMID: 31445969 DOI: 10.1016/j.acap.2019.08.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Many Americans have limited English proficiency (LEP) and difficulty communicating with health care providers, creating inequitable health care delivery. Despite widespread interpreter availability in hospitals, perceptions of interpreter services in the pediatric inpatient setting are largely unknown. OBJECTIVE To investigate staff perspectives regarding: 1) roles of the interpreter and provider (attending, resident, and nurse) during an encounter, 2) modalities of interpretation, and 3) barriers to services. METHODS Focus groups were conducted with: 1) hospital-employed Spanish interpreters, 2) Pediatric Hospital Medicine attendings, 3) pediatric and internal medicine-pediatric residents, and 4) medical unit nurses. Sessions were audio-recorded and transcribed. Using Atlas.ti, 2 investigators created the coding scheme, independently coded the data, and achieved consensus. Qualitative methods were used for thematic analysis. RESULTS Fourteen groups (n = 59 participants) were held: 3 interpreter groups (n = 10), 3 attending groups (n = 14), 2 resident groups (n = 17), and 6 nurse groups (n = 18). Most believed the interpreter's role was to serve as a conduit (provide word-for-word interpretation), act as a cultural broker, and maintain transparency (not withhold information). All groups felt providers should interact with families as they would with English-speaking families. In-person interpreters were preferred over telephone and video for being more accurate, efficient, and personable. Barriers to accessing services included time needed for interpretation, overconfidence in language skills, variable family dynamics, and identification of LEP families. CONCLUSIONS In-person interpreters are highly valued, fulfilling complex roles. However, operational and human factors limit access to services in the hospital. These findings, along with family perspectives, can be used to optimize interpretation experiences.
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Affiliation(s)
- Ivy Tam
- Department of Pediatrics (I Tam, MZ Huang, A Patel, KE Rhee, and E Fisher), Rady Children's Hospital San Diego and University of California San Diego, San Diego, Calif; Department of Pediatrics (I Tam), The Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY.
| | - Maria Z Huang
- Department of Pediatrics (I Tam, MZ Huang, A Patel, KE Rhee, and E Fisher), Rady Children's Hospital San Diego and University of California San Diego, San Diego, Calif
| | - Aarti Patel
- Department of Pediatrics (I Tam, MZ Huang, A Patel, KE Rhee, and E Fisher), Rady Children's Hospital San Diego and University of California San Diego, San Diego, Calif
| | - Kyung E Rhee
- Department of Pediatrics (I Tam, MZ Huang, A Patel, KE Rhee, and E Fisher), Rady Children's Hospital San Diego and University of California San Diego, San Diego, Calif
| | - Erin Fisher
- Department of Pediatrics (I Tam, MZ Huang, A Patel, KE Rhee, and E Fisher), Rady Children's Hospital San Diego and University of California San Diego, San Diego, Calif
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43
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Quinn RA, Melnik AV, Vrbanac A, Fu T, Patras KA, Christy MP, Bodai Z, Belda-Ferre P, Tripathi A, Chung LK, Downes M, Welch RD, Quinn M, Humphrey G, Panitchpakdi M, Weldon KC, Aksenov A, da Silva R, Avila-Pacheco J, Clish C, Bae S, Mallick H, Franzosa EA, Lloyd-Price J, Bussell R, Thron T, Nelson AT, Wang M, Leszczynski E, Vargas F, Gauglitz JM, Meehan MJ, Gentry E, Arthur TD, Komor AC, Poulsen O, Boland BS, Chang JT, Sandborn WJ, Lim M, Garg N, Lumeng JC, Xavier RJ, Kazmierczak BI, Jain R, Egan M, Rhee KE, Ferguson D, Raffatellu M, Vlamakis H, Haddad GG, Siegel D, Huttenhower C, Mazmanian SK, Evans RM, Nizet V, Knight R, Dorrestein PC. Global chemical effects of the microbiome include new bile-acid conjugations. Nature 2020; 579:123-129. [PMID: 32103176 PMCID: PMC7252668 DOI: 10.1038/s41586-020-2047-9] [Citation(s) in RCA: 266] [Impact Index Per Article: 66.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 01/03/2020] [Indexed: 12/26/2022]
Abstract
A mosaic of cross-phylum chemical interactions occurs between all metazoans and their microbiomes. A number of molecular families that are known to be produced by the microbiome have a marked effect on the balance between health and disease1-9. Considering the diversity of the human microbiome (which numbers over 40,000 operational taxonomic units10), the effect of the microbiome on the chemistry of an entire animal remains underexplored. Here we use mass spectrometry informatics and data visualization approaches11-13 to provide an assessment of the effects of the microbiome on the chemistry of an entire mammal by comparing metabolomics data from germ-free and specific-pathogen-free mice. We found that the microbiota affects the chemistry of all organs. This included the amino acid conjugations of host bile acids that were used to produce phenylalanocholic acid, tyrosocholic acid and leucocholic acid, which have not previously been characterized despite extensive research on bile-acid chemistry14. These bile-acid conjugates were also found in humans, and were enriched in patients with inflammatory bowel disease or cystic fibrosis. These compounds agonized the farnesoid X receptor in vitro, and mice gavaged with the compounds showed reduced expression of bile-acid synthesis genes in vivo. Further studies are required to confirm whether these compounds have a physiological role in the host, and whether they contribute to gut diseases that are associated with microbiome dysbiosis.
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Affiliation(s)
- Robert A Quinn
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA.,Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI, USA
| | - Alexey V Melnik
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA
| | - Alison Vrbanac
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Ting Fu
- Gene Expression Laboratory, Salk Institute for Biological Studies, San Diego, CA, USA
| | - Kathryn A Patras
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Mitchell P Christy
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA
| | - Zsolt Bodai
- Department of Chemistry and Biochemistry, University of California San Diego, San Diego, CA, USA
| | - Pedro Belda-Ferre
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Anupriya Tripathi
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA.,Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Lawton K Chung
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Michael Downes
- Gene Expression Laboratory, Salk Institute for Biological Studies, San Diego, CA, USA
| | - Ryan D Welch
- Gene Expression Laboratory, Salk Institute for Biological Studies, San Diego, CA, USA
| | - Melissa Quinn
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Greg Humphrey
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Morgan Panitchpakdi
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA
| | - Kelly C Weldon
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA.,UCSD Center for Microbiome Innovation, University of California San Diego, San Diego, CA, USA
| | - Alexander Aksenov
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA
| | - Ricardo da Silva
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA
| | | | - Clary Clish
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Sena Bae
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Himel Mallick
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Eric A Franzosa
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jason Lloyd-Price
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Robert Bussell
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Taren Thron
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Andrew T Nelson
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA
| | - Mingxun Wang
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA
| | - Eric Leszczynski
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Fernando Vargas
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA
| | - Julia M Gauglitz
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA
| | - Michael J Meehan
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA
| | - Emily Gentry
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA
| | - Timothy D Arthur
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Alexis C Komor
- Department of Chemistry and Biochemistry, University of California San Diego, San Diego, CA, USA
| | - Orit Poulsen
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Brigid S Boland
- Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - John T Chang
- Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - William J Sandborn
- Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Meerana Lim
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Neha Garg
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, GA, USA.,Emory-Children's Cystic Fibrosis Center, Atlanta, GA, USA
| | - Julie C Lumeng
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Ruchi Jain
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Marie Egan
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Kyung E Rhee
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - David Ferguson
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Manuela Raffatellu
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Hera Vlamakis
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Gabriel G Haddad
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Dionicio Siegel
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA
| | - Curtis Huttenhower
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Sarkis K Mazmanian
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Ronald M Evans
- Gene Expression Laboratory, Salk Institute for Biological Studies, San Diego, CA, USA.,Howard Hughes Medical Institute, The Salk Institute for Biological Studies, San Diego, CA, USA
| | - Victor Nizet
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA.,Department of Pediatrics, University of California San Diego, San Diego, CA, USA.,UCSD Center for Microbiome Innovation, University of California San Diego, San Diego, CA, USA
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA.,UCSD Center for Microbiome Innovation, University of California San Diego, San Diego, CA, USA.,Department of Computer Science and Engineering, University of California San Diego, San Diego, CA, USA.,Department of Engineering, University of California San Diego, San Diego, CA, USA
| | - Pieter C Dorrestein
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA. .,Department of Pediatrics, University of California San Diego, San Diego, CA, USA. .,UCSD Center for Microbiome Innovation, University of California San Diego, San Diego, CA, USA.
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Lee B, Hershey D, Patel A, Pierce H, Rhee KE, Fisher E. Reducing Unnecessary Testing in Uncomplicated Skin and Soft Tissue Infections: A Quality Improvement Approach. Hosp Pediatr 2020; 10:129-137. [PMID: 31941651 DOI: 10.1542/hpeds.2019-0179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Skin and soft tissue infections are common pediatric diagnoses with substantial costs. Recent studies suggest blood cultures are not useful in management of uncomplicated skin and soft tissue infections (uSSTIs). Complete blood cell count, erythrocyte sedimentation rate, and C-reactive protein are also of questionable value. We aimed to decrease these tests by 25% for patients with uSSTIs admitted to the pediatric hospital medicine service within 3 months. METHODS An interdisciplinary team led a quality improvement (QI) project. Baseline assessment included review of the literature and 12 months of medical records. Key stakeholders identified drivers that informed the creation of an electronic order set and development of a pediatric hospital medicine-emergency department collaborative QI project. The primary outcome measure was mean number of tests per patient encounter. Balancing measures included unplanned readmissions and missed diagnoses. RESULTS Our baseline-year rate was 3.4 tests per patient encounter (573 tests and 169 patient encounters). During the intervention year, the rate decreased by 35% to 2.2 tests per patient encounter (286 tests and 130 patient encounters) and was sustained for 14 months postintervention. There were no unplanned readmissions or missed diagnoses for the study period. Order set adherence was 80% (83 out of 104) during the intervention period and sustained at 87% postintervention. CONCLUSIONS Our interdisciplinary team achieved our aim, reducing unnecessary laboratory testing in patients with an uSSTI without patient harm. Awareness of local culture, creation of an order set, defining appropriate patient selection and testing indications, and implementation of a collaborative QI project helped us achieve our aim.
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Affiliation(s)
- Begem Lee
- Rady Children's Hospital-San Diego, San Diego, California; and
- Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Daniel Hershey
- Rady Children's Hospital-San Diego, San Diego, California; and
- Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Aarti Patel
- Rady Children's Hospital-San Diego, San Diego, California; and
- Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Heather Pierce
- Rady Children's Hospital-San Diego, San Diego, California; and
- Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Kyung E Rhee
- Rady Children's Hospital-San Diego, San Diego, California; and
- Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Erin Fisher
- Rady Children's Hospital-San Diego, San Diego, California; and
- Department of Pediatrics, University of California, San Diego, San Diego, California
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Eichen DM, Rhee KE, Strong DR, Boutelle KN. Impact of Race and Ethnicity on Weight-Loss Outcomes in Pediatric Family-Based Obesity Treatment. J Racial Ethn Health Disparities 2020; 7:643-649. [PMID: 31919695 DOI: 10.1007/s40615-019-00694-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/18/2019] [Accepted: 12/27/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Minority children are disproportionately affected by obesity and little is known about how race/ethnicity impacts outcomes in pediatric weight-loss treatment. This study aimed to evaluate whether race/ethnicity affected weight-loss outcomes in a pediatric obesity intervention. Secondary aims included evaluating whether race/ethnicity was associated with energy intake, exercise, program adherence, acceptability, and attendance. METHODS One hundred fifty parent/child dyads (age 8-12 years, BMI% 85-99.9; 32% Hispanic, 24% Non-Hispanic, Non-White, 44% Non-Hispanic White) participated in a randomized control trial evaluating weight loss in family-based behavioral treatment with (FBT) or without child participation (i.e., Parent-Based Treatment, PBT). Assessments occurred at baseline, mid-treatment (month 3), post-treatment (month 6), and follow-up (months 12 and 24). Analyses included linear mixed effect models, linear models, and a negative binomial model. RESULTS Weight loss in Hispanic, Non-Hispanic White, and Non-Hispanic, Non-White children was not significantly different by race/ethnicity at months 6, 12, and 24 (p = 0.259) and was similar across both treatments (FBT = - 0.16 BMIz; PBT = - 0.21 BMIz; p = 0.61). There were no differences in energy intake, physical activity, acceptability ratings, or adherence to treatment (as measured by a post-treatment survey) (p's > 0.123). However, Hispanic families attended fewer treatment visits than Non-Hispanic White families (p = 0.017). CONCLUSION On average, children lost weight participating in our pediatric obesity treatment and there was no statistical difference in weight loss between groups. Future research evaluating whether culturally adapted treatments would be more effective for racial/ethnic minorities or whether the personalization inherent in family-based behavioral treatment may be sufficient is needed.
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Affiliation(s)
- Dawn M Eichen
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.
| | - Kyung E Rhee
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - David R Strong
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Kerri N Boutelle
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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46
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Kang Sim DE, Strong DR, Manzano M, Eichen DM, Rhee KE, Tanofsky-Kraff M, Boutelle KN. Evaluating psychometric properties of the Emotional Eating Scale Adapted for Children and Adolescents (EES-C) in a clinical sample of children seeking treatment for obesity: a case for the unidimensional model. Int J Obes (Lond) 2019; 43:2565-2572. [PMID: 31395924 PMCID: PMC6957223 DOI: 10.1038/s41366-019-0427-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 06/24/2019] [Accepted: 06/30/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Emotional Eating Scale - Adapted for Children and Adolescents (EES-C) assesses children's urge to eat in response to experiences of negative affect. Prior psychometric studies have demonstrated the high reliability, concurrent validity, and test-retest reliability of theoretically defined subconstructs among non-clinical samples of children and adolescents who were primarily healthy weight; however, no psychometric studies exist investigating the EES-C among clinical samples of children with overweight/obesity (OW/OB). Furthermore, studies conducted in different contexts have suggested a discordant number of subconstructs of emotions related to eating. The purpose of this study was to evaluate the validity of the EES-C in a clinical sample of children seeking weight-loss treatment. METHOD Using a hierarchical bi-factor approach, we evaluated the validity of the EES-C to measure a single general construct, a set of two separate correlated subconstructs, or a hierarchical arrangement of two constructs, and determined reliability in a clinical sample of treatment-seeking children with OW/OB aged 8-12 years (N = 147, mean age = 10.4 years.; mean BMI z = 2.0; female = 66%; Hispanic = 32%, White and other = 68%). RESULTS Comparison of factor-extraction methods suggested a single primary construct underlying EES-C in this clinical sample. The bi-factor indices provided clear evidence that most of the reliable variance in the total score (90.8 for bi-factor model with three grouping factors and 95.2 for bi-factor model with five grouping factors) was attributed to the general construct. After adjusting for relationships with the primary construct, remaining correlations among sets of items did not suggest additional reliable constructs. CONCLUSION Results suggest that the primary interpretive emphasis of the EES-C among treatment-seeking children with overweight or obesity should be placed on a single general construct, not on the 3- or 5- subconstructs as was previously suggested.
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Affiliation(s)
- D Eastern Kang Sim
- Department of Pediatrics, UC San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA, 92093, USA.
| | - David R Strong
- Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0725, USA
| | - Michael Manzano
- Department of Pediatrics, UC San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA, 92093, USA
- San Diego State University/ University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - Dawn M Eichen
- Department of Pediatrics, UC San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA, 92093, USA
| | - Kyung E Rhee
- Department of Pediatrics, UC San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA, 92093, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Kerri N Boutelle
- Department of Pediatrics, UC San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA, 92093, USA
- Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0725, USA
- Department of Psychiatry, UC San Diego, 9500 GiIman Drive, MC 0874, La Jolla, CA, 92093, USA
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Boutelle KN, Manzano MA, Strong DR, Rhee KE. Evaluating the Acceptability and Feasibility of Providing Egg or Cereal Breakfast during a Family-Based Treatment for Children with Overweight/Obesity: The Families and Breakfast Pilot Trial. Child Obes 2019; 15:502-509. [PMID: 31436494 DOI: 10.1089/chi.2018.0331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Family-based behavioral treatment (FBT) is the most successful weight-loss treatment for children with overweight and obesity, however, long-term success is only achieved by a third of children over time. The use of foods that induce satiety, such as eggs, could improve adherence to calorically restricted diets in children and improve outcomes. This study explored the consumption of eggs (FBT+egg) or cereal (FBT+cereal) for breakfast as part of an FBT program, when breakfast foods were provided to families. Methods: Fifty 8-12-year-old children with overweight and obesity and their parents were randomized to a 4-month FBT+egg or FBT+cereal treatment program. Families were provided the ingredients for their assigned breakfast at each treatment session, and instructed to consume the breakfast a minimum of 5 days per week. Families attended assessments at baseline, post-treatment, and 4-months post-treatment. Results: Results showed that both treatments were well liked, FBT attendance was similar, and there was high compliance with consumption of the specified breakfast. Children experienced moderate weight loss at post-treatment [-0.11 standardized BMI (BMIz)] through 4-month follow-up (-0.09 BMIz), with no statistically significant differences (mean difference -0.05 BMIz, 95% confidence interval -0.19 to 0.09) observed between egg and cereal conditions across any anthropometric or appetitive measures. Conclusions: The use of eggs for breakfast in children enrolled in FBT was well tolerated, and future studies should include larger samples and longer follow-up periods to assess the potential differential effects of prescribed breakfasts on children's weight and eating behaviors.
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Affiliation(s)
- Kerri N Boutelle
- Department of Pediatrics, University of California, San Diego, La Jolla, CA.,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Michael A Manzano
- Department of Pediatrics, University of California, San Diego, La Jolla, CA.,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - David R Strong
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | - Kyung E Rhee
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
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Rungvivatjarus T, Kuelbs CL, Miller L, Perham J, Sanderson K, Billman G, Rhee KE, Fisher ES. Medication Reconciliation Improvement Utilizing Process Redesign and Clinical Decision Support. Jt Comm J Qual Patient Saf 2019; 46:27-36. [PMID: 31653526 DOI: 10.1016/j.jcjq.2019.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 09/02/2019] [Accepted: 09/04/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite years of attention, hospitals continue to struggle to implement successful medication reconciliation. This study aimed to increase the percentage of hospital admission medication reconciliation (AdmMedRec) completion to ≥ 95% in 12 months at a large academic children's hospital. METHODS A quality improvement (QI) project was initiated in April 2017 by an interdisciplinary team of physicians, nurses, pharmacists, and analysts, co-led by a pediatric hospitalist and chief medical information officer. Interventions were implemented through sequential Plan-Do-Study-Act cycles. Process maps, fishbone diagrams, and failure mode and effects analysis were used to identify AdmMedRec failures. Baseline data from 12,481 admission encounters July 2016-April 2017 were analyzed. Interventions included electronic health record (EHR) workflow redesign, clarification of clinicians' responsibilities, targeted training, Best Practice Advisory alert, and weekly reporting of specialty- and physician-specific performance data. Data from 13,082 postintervention period admission encounters were examined. Reconciliation by therapeutic drug classes was calculated as a proxy for quality. RESULTS AdmMedRec completion rate increased from a baseline of 73% to 95% within 7 months from the start of this project and was sustained at 94% during the postintervention period. Psychiatry and hospital medicine demonstrated the largest improvements, with rates increasing from 17% to 88% and 76% to 98%, respectively. Percentages of reconciled medications in all 13 therapeutic classes, including high-risk drugs, improved significantly (p < 0.05). CONCLUSIONS Using an interdisciplinary team and interventions focused on process and culture changes, this QI initiative was successful at increasing AdmMedRec rates and reducing omission errors across all therapeutic drug classes.
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Boutelle KN, Kang Sim DE, Manzano M, Rhee KE, Crow SJ, Strong DR. Role of appetitive phenotype trajectory groups on child body weight during a family-based treatment for children with overweight or obesity. Int J Obes (Lond) 2019; 43:2302-2308. [PMID: 31591483 PMCID: PMC6858531 DOI: 10.1038/s41366-019-0463-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 07/10/2019] [Accepted: 07/16/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Emerging evidence suggests that individual appetitive traits may usefully explain patterns of weight loss in behavioral weight loss treatments for children. The objective of this study was to identify trajectories of child appetitive traits and the impact on child weight changes over time. METHODS Secondary data analyses of a randomized noninferiority trial conducted between 2011 and 2015 evaluated children's appetitive traits and weight loss. Children with overweight and obesity (mean age = 10.4; mean BMI z = 2.0; 67% girls; 32% Hispanic) and their parent (mean age = 42.9; mean BMI = 31.9; 87% women; 31% Hispanic) participated in weight loss programs and completed assessments at baseline, 3, 6,12, and 24 months. Repeated assessments of child appetitive traits, including satiety responsiveness, food responsiveness and emotional eating, were used to identify parsimonious grouping of change trajectories. Linear mixed-effects models were used to identify the impact of group trajectory on child BMIz change over time. RESULTS One hundred fifty children and their parent enrolled in the study. The three-group trajectory model was the most parsimonious and included a high satiety responsive group (HighSR; 47.4%), a high food responsive group (HighFR; 34.6%), and a high emotional eating group (HighEE; 18.0%). Children in all trajectories lost weight at approximately the same rate during treatment, however, only the HighSR group maintained their weight loss during follow-ups, while the HighFR and HighEE groups regained weight (adjusted p-value < 0.05). CONCLUSIONS Distinct trajectories of child appetitive traits were associated with differential weight loss maintenance. Identified high-risk subgroups may suggest opportunities for targeted intervention and maintenance programs.
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Affiliation(s)
- Kerri N Boutelle
- Department of Pediatrics, UC San Diego, La Jolla, CA, USA. .,Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA. .,Department of Psychiatry, UC San Diego, La Jolla, CA, USA.
| | | | - Michael Manzano
- Department of Pediatrics, UC San Diego, La Jolla, CA, USA.,SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, La Jolla, CA, USA
| | - Kyung E Rhee
- Department of Pediatrics, UC San Diego, La Jolla, CA, USA
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - David R Strong
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA
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50
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Abstract
BACKGROUND Antibiotics are frequently prescribed to children, and may be an environmental influence that contributes to the increasing prevalence of childhood obesity. The aim of this study was to examine the effect of antibiotic use in the first year of life on child growth trajectories from birth to age 6 years including significant covariates. METHODS Data from 586 children in the Infant Feeding Practices II (IFPS II) and 6 year follow-up study (6YFU) were included. Antibiotic exposures, weight and height measurements were collected from birth through the first 12 months, and then again at 6 years. Linear mixed effects growth modeling, controlling for exclusive breastfeeding, socio-demographic factors, smoking during pregnancy, gestational diabetes, and maternal pre-pregnancy weight status, was used to examine the association between antibiotic exposure and child growth trajectories through age 6 years. RESULTS The majority of infants (60.58%) did not receive any antibiotics; 33.79% received 1-2 courses and 5.63% received 3 or more antibiotic courses during the first year. In the unadjusted model, children with 1-2 antibiotic exposures had a 0.17 (SE 0.08) higher rate of change in BMI z-score (BMIz) than children without any antibiotics, and children with ≥3 exposures had a 0.42 (SE 0.16) higher rate of change in BMIz (p = 0.009). Growth trajectory over time for those who had ≥3 antibiotics was greater than those without any antibiotics (p = 0.002). CONCLUSIONS Efforts to guide the judicious use of antibiotics should continue, particularly in the first year of life.
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Affiliation(s)
- Elizabeth E. Dawson-Hahn
- Department of Pediatrics, University of Washington, Seattle, WA USA
- Seattle Children’s Research Institute, Center for Child Health, Behavior and Development, M/S CW8-6, PO Box 5371, Seattle, WA 98145 USA
| | - Kyung E. Rhee
- Department of Pediatrics, UCSD School of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA, San Diego, CA 92093 USA
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