Randomized trial of teaching brief motivational interviewing to pediatric trainees to promote healthy behaviors in families.

HYPOTHESIS: That pediatric resident trainees would demonstrate increased counseling skill following training in brief motivational interviewing (MI). DESIGN: Randomized controlled trial. SETTING: University of Washington Pediatric Residency. PARTICIPANTS: Pediatric residents (N = 18), including residents in postgraduate years 1, 2, 3, and 4. INTERVENTIONS: Collaborative Management in Pediatrics, a 9-hour behavior change curriculum based on brief MI plus written feedback on communication skills (based on a 3-month Objective Standardized Clinical Evaluation [OSCE]). MAIN OUTCOME MEASURE: The percentage of MI-consistent behavior (%MICO), a summary score for MI skill, was assessed via OSCEs in which standardized patients portray parents of children with asthma in 3 clinical scenarios (stations). The OSCEs were conducted at baseline and 3 and 7 months. Blinded coders rated videotaped OSCEs using a validated tool to tally communication behaviors. Training effects were assessed using linear regression controlling for baseline %MICO. Global ratings of counseling style served as secondary outcome measures. RESULTS: Trained residents demonstrated a trend toward increased skill (%MICO score) at 3 months compared with control residents. At 7 months, %MICO scores increased 16% to 20% (P < .02) across all OSCE stations after the combined intervention of Collaborative Management in Pediatrics training plus written feedback. The effect of training on global ratings supported the main findings. CONCLUSIONS: Pediatric trainees' skills in behavior change counseling improved following the combination of training in brief MI plus personalized feedback.

Hospital-based influenza vaccination of children: an opportunity to prevent subsequent hospitalization.

OBJECTIVE: We performed this study to determine the frequency of previous hospitalization among children hospitalized with influenza. METHODS: The Pediatric Health Information System database (discharges that occurred between January 1, 2001, and December 31, 2006) was used to determine the proportion of children hospitalized with influenza or respiratory illness who had a previous hospitalization during the most recent influenza-vaccination season. Subjects included pediatric patients (through 18 years of age). The index hospitalization was defined as the first influenza or respiratory illness hospitalization for a child that occurred during the study period and between November 1 and April 30. A previous hospitalization during the most recent influenza-vaccination season was defined as a hospitalization for any reason in the 0.5 to 6 months before the index hospitalization but not before September 1 or on or after March 1. RESULTS: Overall, 16% of children hospitalized with influenza and 12% of children hospitalized with influenza or a respiratory illness had a previous hospitalization during the most recent influenza-vaccination season. Approximately 23% of the children hospitalized with influenza and a comorbidity had a previous hospitalization during the most recent influenza-vaccination season. CONCLUSION: Hospital-based programs for influenza vaccination have the potential to reach children at highest risk of influenza complications and to reduce the rates of pediatric hospitalization for treatment of influenza-related illness.

SREBP-2 and SCAP isoforms and risk of early onset myocardial infarction.

BACKGROUND: Cholesterol metabolism is mediated, in part, by the sterol-regulatory element binding proteins (SREBPs) that are activated by a SREBP cleavage-activating protein (SCAP). We examined whether coding variations in the interacting domains of both genes, are related to early-onset MI risk in a population-based case-control study from western Washington State. METHODS: Cases were 257 women, aged 18-59 years, and 320 men, aged 18-49 years, with first acute non-fatal MI; controls were 353 women and 311 men, similar in age, identified from the community who had no history of clinical CHD or stroke. Genotyping of the SREBF-2 G1784C polymorphism (SREBP-2-595A/G isoforms), and the SCAP A2386G polymorphism (SCAP-796I/V isoforms), were performed. RESULTS: After adjustment for age and race, the SREBP-2-595A isoform was associated with increased MI risk among men (OR=1.63, 95% CI=1.26-2.12). In contrast, there was little evidence for an association among women in a multiplicative model. However, compared to SREBP-2-595G homozygotes, homozygote women for the SREBP-2-595A isoform were at nearly two-fold increased risk (OR=1.95, 95% CI=1.07-3.54). Overall, SCAP genotypes were neither associated with MI in men nor in women. However, in men, SCAP genotypes were found to modify the association between SREBF-2 and MI (p-value for interaction=0.01). CONCLUSION: The SREBP-2-595A isoform was associated with an increased risk of early-onset MI in U.S. men. The SCAP polymorphism appeared to modify the associations of SREBF-2 genotype with MI risk among men. These novel findings require confirmation in other populations.

Unmet dental care needs among children with special health care needs: implications for the medical home.

BACKGROUND: Little is known about the characteristics of children with special health care needs (CSHCN) who have unmet dental care needs. OBJECTIVE: We sought to describe the magnitude of unmet needs for dental care among CSHCN and to characterize those with unmet dental care needs. DESIGN, SETTING, AND SUBJECTS: We used data from the National Survey of Children with Special Health Care Needs, which used a telephone survey to identify 750 CSHCN from each of the 50 states and the District of Columbia. Families of 38,866 CSHCN were interviewed, and the data were weighted to represent 9.32 million CSHCN nationally. OUTCOME: Our primary outcome of interest was unmet dental care need, defined as whether CSHCN were said to have needed dental care but were unable to obtain it. We also considered reasons why a child had an unmet dental care need and compared other categories of health care service needs and unmet needs with dental care. Bivariate and multivariate analyses were conducted to determine factors associated with unmet dental care needs. RESULTS: Overall, 78% of CSHCN were reported as needing dental care in the past 12 months, which was second only to prescription medications in the frequency of need. Of those who reported a dental care need, an estimated 755,581 or 10.4% of CSHCN did not receive all of the dental care they needed. Relative to all other health care service categories, unmet dental care needs affected the most children. Poorer children, uninsured children, children with lapses in insurance, and children with greater limitations attributable to disability had significantly greater odds of unmet dental care needs in multivariate analyses. Children with a personal doctor or nurse were significantly less likely to have unmet dental care needs. CONCLUSIONS: Dental care is the most prevalent unmet health care need for CSHCN, affecting substantially more children than any other health care need category. Moreover, the perceived need for dental care for CSHCN exceeds the need for either preventive or specialty medical care. Given these findings, dental care should be an integral and explicitly stated part of the comprehensive coordinated services that the medical home aims to provide for CSHCN. Greater efforts to improve access to dental care for poor and more disabled CSHCN are needed.

Calcium, vitamin D, dairy products, and risk of colorectal cancer in the Cancer Prevention Study II Nutrition Cohort (United States).

OBJECTIVE: Calcium, vitamin D, and dairy product intake may reduce the risk of colorectal cancer. We therefore examined the association between these factors and risk of colorectal cancer in a large prospective cohort of United States men and women. METHODS: Participants in the Cancer Prevention Study II Nutrition Cohort completed a detailed questionnaire on diet, medical history, and lifestyle in 1992-93. After excluding participants with a history of cancer or incomplete dietary information, 60,866 men and 66,883 women remained for analysis. During follow-up through 31 August 1997 we documented 421 and 262 cases of incident colorectal cancers among men and women, respectively. Multivariate-adjusted rate ratios (RR) were calculated using Cox proportional hazards models. RESULTS: Total calcium intake (from diet and supplements) was associated with marginally lower colorectal cancer risk in men and women (RR = 0.87, 95% CI 0.67-1.12, highest vs lowest quintiles, p trend = 0.02). The association was strongest for calcium from supplements (RR = 0.69, 95% CI 0.49-0.96 for > or = 500 mg/day vs none). Total vitamin D intake (from diet and multivitamins) was also inversely associated with risk of colorectal cancer, particularly among men (RR = 0.71, 95% CI 0.51-0.98, p trend = 0.02). Dairy product intake was not related to overall risk. CONCLUSIONS: Our results support the hypothesis that calcium modestly reduces risk of colorectal cancer. Vitamin D was associated with reduced risk of colorectal cancer only in men.

A prospective study of whole grains, fruits, vegetables and colon cancer risk.

OBJECTIVE: We examined the relation between whole grains, fruit, vegetables and dietary fiber and colon cancer risk in the prospective Cancer Prevention Study II Nutrition Cohort. METHODS: In 1992-1993, 62,609 men and 70,554 women completed questionnaires on medical history, diet and lifestyle behaviors. After exclusions, we confirmed 298 cases of incident colon cancer among men and 210 among women through August 31, 1997. RESULTS: Multivariate rate ratios (RR) and 95% confidence intervals (CI) for all dietary factors were null. However, a statistically non-significant 30% reduction in risk was observed for men with the highest vegetable intakes (RR = 0.69, CI = 0.47-1.03, top versus bottom quintile, p trend = 0.10). Men with very low (lowest tertile within the lowest quintile) intakes of vegetables and dietary fiber were at increased risk compared to those in the highest four quintiles of intake (vegetables RR = 1.79, CI = 1.22-2.61, p trend = 0.04, and fiber RR = 1.96, CI = 1.24-3.10, p trend = 0.006). Women with very low intakes of fruit were also at increased risk (RR = 1.86, CI = 1.18-2.94, p trend = 0.06). CONCLUSIONS: Higher intakes of plant foods or fiber were not related to lower risk of colon cancer. However, our data suggest that very low intakes of plant foods may increase risk, and that certain phytochemical subgroups may decrease risk.