Correlation of Lipid Profile and Risk of Developing Type 2 Diabetes Mellitus in 10-14 Year Old Children.

BACKGROUND/AIMS: The role of lipid profile in predicting the risk of Type 2 diabetes mellitus (T2DM) in children is not clearly established. Our aim is to screen non-diabetic children aged 10-14 years for risk of developing T2DM and evaluate the association of abnormal lipids and socioeconomic status (SES). METHODS: Data on race/ethnicity, family history, body mass index percentile, blood pressure and presence of neck pigmentation (acanthosis nigricans) were collected from 149 non-diabetic children. Using these factors, children were classified into low risk (<3 risk factors) and high risk (>3 risk factors) groups. Logistic regression model and chi-square tests were used to evaluate the association of blood lipid profile and demographic variables. Independent t-test was used to compare the ratio of Total Cholesterol (TC) and High Density Lipids (HDL) with T2DM risk. RESULTS: 60% of children were at high risk for developing T2DM. HDL (p<0.001), triglycerides (p=0.02) and TC/HDL ratio (p<.001) were significantly abnormal in high risk group. Low SES showed a marginal association with high risk group. There were no gender or age differences between high and low risk groups. CONCLUSIONS: The significant determinants associated with high risk group were modifiable factors providing an opportunity for early intervention and prevention.

Pediatric asthma for the primary care practitioner.

Asthma is a complex disease, involving many different allergic, inflammatory, and environmental components. It is a disease for which patient and family education and a team-based approach are paramount for successful management. Guidelines have been put forth by the National Heart, Lung and Blood Institute, which provide a helpful framework in which to begin to manage patients and to navigate the many medication choices available. It is only through diligent attention to control of asthma symptoms that improved quality of life and prevention of long-term sequelae are possible for the pediatric patient with asthma.

The integration of the "spirituality in medicine" curriculum into the osteopathic communication curriculum at Kansas City University of Medicine and Biosciences.

With grant funding from the John Templeton Spirituality and Medicine Curricular Award to the George Washington Institute for Spirituality and Health, faculty at Kansas City University of Medicine and Biosciences (KCUMB) developed the "Spirituality in Medicine" curriculum. In developing the curriculum, faculty took into consideration competencies required by the Association of American Medical Colleges and qualitative results from surveys of medical school applicants and enrolled students. Strategies for curriculum delivery included lectures, panel discussions, role-playing, and training in the use of a spirituality assessment tool. A majority of the 250 students who received the training in 2010-2011 were able to demonstrate the following competencies: (1) being sensitive to patients' spiritual and cultural needs, (2) assessing patients' and their own spiritual needs, (3) appropriately using chaplain services for patient care, and (4) understanding the effects of health disparities and ethical issues on patient care. Challenges to implementation included a reduction in chaplain availability due to the economic downturn, a lack of student exposure to direct patient care during shadowing, too little religious diversity among chaplains, and changes in assignment schedules. New competencies required by the National Board of Osteopathic Medical Examiners overlap with and help ensure sustainability of the Spirituality in Medicine curriculum. KCUMB leaders have incorporated the use of the spirituality assessment tool into other parts of the curriculum and into service experiences, and they have introduced a new elective in palliative care. Synergistic efforts by faculty leaders for this initiative were critical to the implementation of this curriculum.

Examining body mass index in an urban core population: from health screening to physician visit.

UNLABELLED: BACKGROUND. Childhood obesity is commonly encountered in the primary care office and disproportionately affects those from low income or minority backgrounds. OBJECTIVE: To determine how accurately primary care clinicians in an urban setting identified patients with body mass indices (BMIs) at or above the 95th percentile for age and to determine which obesity treatment strategies are used. MATERIALS AND METHODS: The study population consisted of school-aged, inner-city children with a BMI at or above the 95th percentile for age whose charts were made available for data collection by retrospective chart review. RESULTS: A total of 158 patient medical charts were reviewed. Of these, 90 (57%) patients failed to be identified by the provider as having an elevated BMI. Obesity treatment was initiated in only 68 (43%) of these patients. CONCLUSIONS: Providers are not effectively recognizing childhood obesity and are not consistently implementing effective obesity treatment strategies.

The prevalence of infections with Trichophyton tonsurans in schoolchildren: the CAPITIS study.

BACKGROUND: Although Trichophyton tonsurans has become the leading cause of tinea capitis in the United States, reported infection rates vary widely, and prevalence estimates for the pediatric population at large remain poorly characterized. METHODS: A prospective, cross-sectional, surveillance study of children attending kindergarten through fifth grade in 44 schools across the bi-state (Kansas/Missouri), Kansas City metropolitan area was conducted. Fungal cultures were collected from all participants, and molecular analyses were used to characterize the patterns of infection within the population. RESULTS: Of 10,514 children (age: 8.3 +/- 1.9 years) examined for the presence of T tonsurans on their scalps, 6.6% exhibited positive cultures. Infection rates at participating schools ranged from 0% to 19.4%, exceeding 30% at a given grade level in some schools. Black children demonstrated the highest rates of infection (12.9%), with prevalence estimates for the youngest members of this racial group approaching 18%. Infection rates for Hispanic (1.6%) and white (1.1%) children were markedly lower. A single genetic strain of T tonsurans was identified in only 16.6% of classrooms, whereas each child harbored a unique genetic strain in 51.4%. CONCLUSIONS: We report a large-scale, citywide, surveillance study of T tonsurans infection rates among children in primary school in a metropolitan area. The striking prevalence rates and genetic heterogeneity among the fungal isolates confirm the relatively large degree to which this pathogen has become integrated into metropolitan communities.