A systematic review of primary healthcare provider education and training using the Chronic Care Model for childhood obesity.

The purpose of this systematic review was to examine 15 studies which evaluated interventions aimed at improving primary care providers' identification, assessment, prevention and/or management of obesity in children and adolescents. Interventions were evaluated in terms of length, components addressing nutrition, physical activity and behavioural counselling consistent with expert recommendations, and inclusion of components of the Chronic Care Model. Overall, training interventions were delivered face to face or in a combination of lecture, assigned readings, preceptorship with experienced providers, and critiqued evaluations of interactions of the provider with the patient and family. Many studies incorporated training of providers as an initial step prior to delivering an obesity intervention for children and adolescents measuring weight loss and behaviour change as outcomes. Each study was evaluated for components of the Chronic Care Model. The interventions most frequently utilized the elements of self-management support (69%), decision support (100%), delivery system support (77%) and clinical information systems (23%). Although science in this area is emerging, results suggest that intervention programmes that included more components of the Chronic Care Model were more effective.

Pediatric nurses: advocates against youth violence.

ISSUES AND PURPOSE: This article examines the issues of youth violence and the role of the pediatric nurse in addressing youth at risk for violence. An example of a school-based violence prevention program is included. CONCLUSIONS: Black adolescent males from lower socioeconomic backgrounds and violent communities tend to be at highest risk. However, the profile of risk for violence is expanding to include youth in rural and middle-class suburban settings. PRACTICE IMPLICATIONS: Pediatric nurses play a vital role in the identification of at-risk youth and in the planning and evaluation of interventions for youth violence prevention.

Assessing children with chalasia: rule out gastroesophageal reflux.

Chalasia, the regurgitation of gastric contents into the esophagus, is a common problem seen in infancy. In some cases, however, the symptoms can be more complex and extend beyond early infancy. In these infants and children, the pathologic condition of gastroesophageal reflux may exist. It can be a challenge to assess whether these patients require further investigation and treatment. This article outlines the difference between simple chalasia and pathologic gastroesophageal reflux. Information is given that enables the clinician to provide children and families anticipatory guidance regarding the medical workup and management of this problem. In addition, the article provides clinical algorithms to enhance the practitioner's understanding of the decision-making process involved in treating these patients.

Extended four-channel esophageal pH monitoring: the importance of acid reflux patterns at the middle and proximal levels.

Seventy-one extended multiple-level esophageal pH studies were performed in 61 infants and children suspected of having gastroesophageal reflux (GER). The patients were placed in one of six clinical groups based on their presenting symptomatology. They were classified as "normals" or "refluxers" based on a reflux score calculated from a pediatric modification of the Johnson and DeMeester distal esophageal pH criteria. For the total group, excluding postoperative patients, all differences noted in the distal esophagus between normals and refluxers persisted at the middle and proximal esophageal levels (P less than .001). Significant differences between normal and reflux patients were noted at all levels in the central nervous system damage and postoperative groups. Only the middle esophageal probe detected differences for all variables in the failure to thrive group (P less than .01). In the esophageal atresia group the middle level sensor detected differences in all parameters studied and the proximal sensor noted differences in three of the four parameters (P less than .01). Significant differences between normals and refluxers in the apnea group were best demonstrated in the proximal esophagus. There was no benefit in monitoring the pH of the more proximal esophageal levels in patients with esophagitis. Extended four-channel esophageal pH studies were highly effective in detecting clinically important GER. The patterns of reflux in infants and children vary markedly with the presenting symptoms. Distal esophageal pH monitoring may not demonstrate evidence of GER that would otherwise be detected by the middle and proximal esophageal sensors. This new ambulatory outpatient technique of pH monitoring in young patients suspected of having GER provides advantages over the conventional esophageal pH study.