ABSTRACT
OBJECTIVE: The goal was to link hypertension and the metabolic syndrome in adulthood directly to blood pressures measured decades earlier for the same individuals as children and to establish criterion values for blood pressure that predict hypertension and the metabolic syndrome later in life. METHODS: We analyzed serial data for 240 men and 253 women in the Fels Longitudinal Study. We derived age- and gender-specific childhood blood pressures that predict hypertension and the metabolic syndrome in adulthood, and we validated these criterion values in a larger sample. RESULTS: Blood pressure diverged between adults with and without the metabolic syndrome beginning at age 5 for boys and age 8 for girls. The odds ratios for developing hypertension at > or = 30 years of age ranged from 1.1 for 14- to 18-year-old boys to 3.8 for 5- to 7-year-old boys and from 2.7 for 8- to 13-year-old girls to 4.5 for 5- to 7-year-old girls, if their blood pressure exceeded criterion values at a single examination in childhood. The corresponding odds ratios for the metabolic syndrome, with or without hypertension, ranged from 1.2 for 14- to 18-year-old boys to 2.6 for 8- to 13-year-old boys and from 1.5 for 14- to 18-year-old girls to 3.1 for 5- to 7-year-old girls. The relative risk of adult hypertension ranged from 1.5 to 3.8 for boys and from 1.5 to 4.7 for girls, and that of the metabolic syndrome ranged from 1.1 to 1.8 for boys and from 1.2 to 5.6 for girls. These relative risks varied directly with the number of examinations at which systolic blood pressure exceeded criterion values. CONCLUSION: Children with systolic blood pressures above the criterion values established in this longitudinal study are at increased risk of hypertension and the metabolic syndrome later in life.
Subject(s)
Hypertension/epidemiology , Metabolic Syndrome/epidemiology , Systole , Adult , Age Factors , Child , Child, Preschool , Female , Forecasting , Humans , Longitudinal Studies , Male , Middle AgedABSTRACT
BACKGROUND: Patient satisfaction is an important component of quality of care. To date, no studies have looked at differences in faculty and resident patient satisfaction in a pediatric practice. PURPOSE: The purpose was to compare physician measures of patient satisfaction among residents in training and faculty attendings. METHODS: We conducted satisfaction surveys containing 4 questions related to physician performance at a children's health clinic. We compared satisfaction scores across training levels of physicians. RESULTS: We analyzed 676 surveys. The 2nd-year and 3rd/4th-year residents had similar high scores on all questions compared to faculty preceptors. The 1st-year residents scored significantly lower than faculty preceptors, 3rd/4th-year residents, and 2nd-year residents on 1 question and the combined average of the 3 physician-specific questions. CONCLUSIONS: The 1st-year residents scored lower on patient satisfaction than physicians at higher levels of training. The 2nd-year and 3rd/4th-year residents achieved high satisfaction scores in a primary care clinic, comparable to scores of experienced practitioners.
Subject(s)
Ambulatory Care , Faculty, Medical , Patient Satisfaction , Pediatrics , Students, Medical , Humans , Internship and Residency , Ohio , Outpatient Clinics, Hospital , Surveys and QuestionnairesABSTRACT
OBJECTIVE: Our aim was to examine the degree to which changes in BMI percentile reflect changes in body fat and lean body mass during childhood and how age and gender affect these relationships. METHODS: This analysis used serial data on 494 white boys and girls who were aged 8 to 18 years and participating in the Fels Longitudinal Study (total 2319 observations). Total body fat (TBF), total body fat-free mass (FFM), and percentage of body fat (%BF) were determined by hydrodensitometry, and then BMI was partitioned into its fat and fat-free components: fat mass index (FMI) and FFM index (FFMI). We calculated predicted changes (Delta) in FMI, FFMI, and %BF for each 10-unit increase in BMI percentile using mixed-effects models. RESULTS: FFMI had a linear relationship with BMI percentile, whereas FMI and %BF tended to increase dramatically only at higher BMI percentiles. Gender and age had significant effects on the relationship between BMI percentile and FFMI, FMI, and %BF. Predicted Delta%BF for boys 13 to 18 years of age was negative, suggesting loss of relative fatness for each 10-unit increase in BMI percentile. CONCLUSIONS: In this longitudinal study of white children, FFMI consistently increased with BMI percentile, whereas FMI and %BF had more complicated relationships with BMI percentile depending on gender, age, and whether BMI percentile was high or low. Our results suggest that BMI percentile changes may not accurately reflect changes in adiposity in children over time, particularly among male adolescents and children of lower BMI.
Subject(s)
Body Composition , Body Mass Index , Adolescent , Aging , Body Fat Distribution , Child , Female , Growth , Humans , Longitudinal Studies , Male , Obesity/diagnosis , Sex CharacteristicsSubject(s)
Cardiology , Physicians, Family , Adolescent , Adult , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/therapy , Chest Pain/diagnosis , Chest Pain/etiology , Child , Diagnosis, Differential , Heart Defects, Congenital/complications , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/therapy , Heart Murmurs/diagnosis , Heart Murmurs/therapy , Humans , Practice Guidelines as Topic , Referral and Consultation , Sports/classificationABSTRACT
Lymphocytic interstitial pneumonitis (LIP) in children has been most commonly associated with human immunodeficiency virus (HIV) infection. Epstein-Barr virus (EBV) associated LIP without HIV infection has been reported only in adults. EBV associated LIP has been reported in children, but only with concurrent HIV infection. We report a case of EBV associated, HIV negative LIP in a child.
