A Virtual Childhood Obesity Collaborative: Satisfaction With Online Continuing Education.

INTRODUCTION: This descriptive study evaluated school-based health center (SBHC) providers' satisfaction with Web-based continuing education as part of a virtual childhood obesity intervention. METHOD: Thirty-six participants from 24 SBHCs in six states participated in the training modules. Modules were divided into four learning sessions, with a total of 17 training modules. Participants completed satisfaction surveys after each module, as well as an overall survey at the end of the training. Questions were rated on a 4-point Likert scale (4 = strongly agree, 3 = agree, 2 = disagree, 1 = strongly disagree). RESULTS: Participation in the first two learning sessions was higher than the last two. Provider satisfaction of training modules by question type and content area was quite high (µ = 3.66-3.33). Overall satisfaction means ranged from 3.76 to 3.24. Many providers also reported plans to make changes in their practice after completing the training. DISCUSSION: This study demonstrated that a virtual childhood obesity collaborative is an acceptable delivery method for continuing education.

Clinician adherence to childhood overweight and obesity recommendations by race/ethnicity of the child.

PURPOSE: This study describes school-based health center (SBHC) providers' adherence to obesity guidelines. DESIGN AND METHODS: Providers (n = 28) were from SBHCs in six states serving children 5-12 years of age. A random sample of well-child charts (n = 850) were audited for body mass index percentage, blood pressure percentage, overweight/obesity diagnosis, and laboratory assessment. RESULTS: Body mass index percentage was documented on 73% of charts and blood pressure percentage on 30.5%. Providers accurately diagnosed 40% overweight and 49.3% obese children. Laboratory guidelines were followed in 80.4% of cases. Assessments differed by child's race/ethnicity (p < .05), with most criteria having higher adherence in minority youth. PRACTICE IMPLICATIONS: There is a need for increased accuracy in how SBHC providers screen overweight/obese children.

School-based health center providers' treatment of overweight children.

This descriptive study was to determine self-reported treatment practices of school-based health center (SBHC) providers when caring for overweight/obese children. Providers (N=33) from SBHCs in 6 states (AZ, CO, NM, MI, NY, and NC) completed a baseline survey before being trained on obesity recommendations. SBHC providers reported patient/parent barriers to be more significant to treatment than clinician/setting barriers (p<0.0001). Most providers (97%) indicated childhood overweight needs treatment, yet only 36% said they initiate treatment in children who do not want to control their weight. SBHC providers also did not commonly refer overweight/obese children to specialists.

Identification and assessment of childhood obesity by school-based health center providers.

INTRODUCTION: School-based health centers (SBHCs) serve many overweight/obese children, yet little is known about provider adherence to obesity guidelines. The purpose of this descriptive study was to evaluate obesity care assessment practices of SBHC providers prior to completing training on obesity guidelines. METHOD: Providers (n = 33) from SBHCs in six states (AZ, CO, NM, MI, NY, and NC) completed The International Life Science Institute Research Foundation Assessment of Overweight in Children and Adolescents Survey. RESULTS: Most providers reported using body mass index percentile (93.9%) to assess weight. In caring for overweight/obese children, providers reported screening for hypertension 100% of the time and cardiovascular disease 93.9% of the time, and approximately two thirds reported requesting total cholesterol and lipid profile laboratory assessments. Some assessment guidelines were not routinely followed. DISCUSSION: SBHCs serve a high-risk population, and providers in this study may benefit from additional training on assessment guidelines and quality improvement processes to improve adherence to current guidelines.

Comparing the Effectiveness of CDSS on Provider's Behaviors to Implement Obesity Prevention Guidelines.

Obesity is a global epidemic demanding the use of clinical decision support tools to help clinicians in the identification, assessment and management of healthy weight gain in children. Over the last decade, numerous systematic reviews have shown that clinical decision support systems (CDSS) have positively impacted clinician's performance for drug ordering/dosing and preventive care reminders. CDSS that are built into the clinician's workflow at the point of care also have a positive impact on provider's performance. There are limited studies that examine CDSS in nursing practice. This paper describes a comparative effectiveness study being conducted in school-based clinics to examine the impact of web-based training with and without a CDSS that contains tailored recommendations. The study involves the use of a CDSS tool focused on cardiovascular risks, HeartSmartKids™. This research is an important example of an interdisciplinary team using information technology to address the global issue of obesity prevention.

Do executive and reactive disinhibition mediate the effects of familial substance use disorders on adolescent externalizing outcomes?

The present study examined the potential mediating roles of executive and reactive disinhibition in predicting conduct problems, attention-deficit/hyperactivity disorder (ADHD) symptoms, and substance use among adolescents with and without a family history of substance use disorders. Using data from 247 high-risk adolescents, parents, and grandparents, structural equation modeling indicated that reactive disinhibition, as measured by sensation seeking, mediated the effect of familial drug use disorders on all facets of the adolescent externalizing spectrum. Executive disinhibition, as measured by response disinhibition, spatial short term memory, and "trait" impulsivity, was associated with ADHD symptoms. Moreover, although executive functioning weakness were unrelated to familial substance use disorders, adolescents with familial alcohol use disorders were at risk for "trait" impulsivity marked by a lack of planning. These results illustrate the importance of "unpacking" the broad temperament style of disinhibition and of studying the processes that underlie the commonality among facets of the externalizing spectrum and processes that predict specific externalizing outcomes.

Developmental pathways to conduct problems: a further test of the childhood and adolescent-onset distinction.

This study tested several theoretically important differences between youth with a childhood-onset and youth with an adolescent-onset to their severe conduct problems. Seventy-eight pre-adjudicated adolescent boys (ranging in age from 11 to 18) housed in two short-term detention facilities and one outpatient program for youth at risk for involvement in the juvenile justice system participated in the current study. The sample was divided into those with a childhood-onset to their serious conduct problem behavior (n = 47) and those with an adolescent-onset (n = 31). The childhood-onset group showed greater levels of dysfunctional parenting, callous-unemotional traits, and affiliation with delinquent peers. The only variable more strongly associated with the adolescent-onset group was lower scores on a measure of traditionalism.

Callous-unemotional traits in predicting the severity and stability of conduct problems and delinquency.

The current study tests whether the presence of callous-unemotional (CU) traits designates a group of children with conduct problems who show an especially severe and chronic pattern of conduct problems and delinquency. Ninety-eight children who were selected from a large community screening of school children in grades 3, 4, 6 and 7 were followed across four yearly assessments. Children with conduct problems who also showed CU traits exhibited the highest rates of conduct problems, self-reported delinquency, and police contacts across the four years of the study. In fact, this group accounted for at least half of all of the police contacts reported in the sample across the last three waves of data collection. In contrast, children with conduct problems who did not show CU traits continued to show higher rates of conduct problems across the follow-up assessments compared to non-conduct problem children. However, they did not show higher rates of self-reported delinquency than non-conduct problem children. In fact, the second highest rate of self-reported delinquency in the sample was found for the group of children who were high on CU traits but without conduct problems at the start of the study.

The 4 year stability of psychopathic traits in non-referred youth.

One significant limitation in research extending the construct of psychopathy to youth has been the absence of longitudinal studies testing the stability of psychopathic traits prior to adulthood. To begin to address this limitation, the current study estimated the stability of psychopathic traits over a 4 year period in a sample of non-referred children in the third, fourth, sixth, and seventh grades at the first assessment. For parent ratings of psychopathic traits, stability estimates using intra-class correlation coefficients ranged from 0.80 to 0.88 across 2-4 years, with a stability estimate of 0.93 across all four assessments. There were also distinct trends in the patterns of stability found in the sample. Specifically, children rated as being initially high on these traits were more likely to be rated lower at later assessments than was the case for children rated initially low on these traits. Finally, the child's level of conduct problems, the socioeconomic status of the child's family, and the quality of parenting the child received were the most consistent predictors of stability of psychopathic traits.