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1.
Obes Sci Pract ; 5(1): 46-58, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30847225

ABSTRACT

OBJECTIVE: To determine the efficacy of a 4-month school-based health, nutrition and exercise intervention on body fatness and examine possible effects of demographic and anthropometric covariates. METHODS: Height, weight, waist circumference and body composition were measured in a diverse population of 644 NYC middle school students (mean ± SD age 12.7 ± 0.9 years; 46% male; 38% Hispanic, 17% East Asian, 15% South Asian, 13.5% African American, 8.5% Caucasian, 8% other) during the fall and spring semesters. Year 1 participants (n = 322) were controls. Experimental participants (year 2, n = 469) received a 12-session classroom-based health and nutrition educational programme with an optional exercise intervention. RESULTS: Groups were demographically and anthropometrically similar. The intervention resulted in significant reductions in indices of adiposity (ΔBMI z-scores [-0.035 ± 0.014; p = 0.01], Δ% body fat [-0.5 ± 0.2; p < 0.0001] and Δwaist circumference [-0.73 ± 0.30 cm; p < 0.0001]). Intervention effects were greater (p = 0.01) in men (ΔBMI z-score = -0.052 ± 0.015) versus women (0.022 ± 0.018), participants who were obese (ΔBMI z-score -0.083 ± 0.022 kg m-2) versus lean (-0.0097 ± 0.020 kg m-2) and South Asians (Δ% body fat -1.03 ± 0.35) versus total (-0.49 ± 0.20%) participants (p = 0.005). CONCLUSION: A 4-month school-based health intervention was effective in decreasing measures of adiposity in middle school students, particularly in men, participants who were obese and South Asians.

2.
Horm Res Paediatr ; 80(5): 318-27, 2013.
Article in English | MEDLINE | ID: mdl-24217195

ABSTRACT

AIM: Advanced glycation end products (AGEs) and/or their receptors (RAGE) are significantly positively correlated with adiposity, inflammation, dyslipidemia, and insulin resistance in adults. However, the relationships between AGEs, RAGE, and adiposity-related comorbidites in children have not been well studied. METHODS: In a cross-sectional study of 88 children (age 11-15 years) from the New York area enrolled in the Reduce Obesity and Diabetes (ROAD) study, we examined the correlation of the AGE N(ε)-(carboxymethyl)lysine (CML), soluble RAGE (sRAGE), and endogenous secretory RAGE (esRAGE) with adiposity, inflammatory markers [interleukin-6 (IL-6), C-reactive protein, tumor necrosis factor-α], adiponectin, lipids, insulin sensitivity, and insulin secretory capacity. RESULTS: Pediatric CML levels were ~20% below average adult levels. CML was significantly (p < 0.05) positively correlated with age and insulin sensitivity and negatively with adiposity, dyslipidemia and IL-6. sRAGE correlated positively with esRAGE and negatively with adiposity and IL-6. Both sRAGE and esRAGE correlated negatively with insulin secretory capacity. CONCLUSION: Our findings suggest that unlike adults, CML is negatively associated with adiposity and adiposity-related comorbidity risk in children. As in adults, sRAGE and esRAGE were, to varying degrees, negatively correlated with body fatness and risk factors for adiposity-related comorbidities.


Subject(s)
Adiposity , Glycation End Products, Advanced/blood , Inflammation Mediators/blood , Adiponectin/blood , Adolescent , Adult , Biomarkers/blood , C-Reactive Protein/metabolism , Child , Cross-Sectional Studies , Female , Humans , Interleukin-6/blood , Male , Receptor for Advanced Glycation End Products/blood , Tumor Necrosis Factor-alpha/blood
3.
Educ Health (Abingdon) ; 20(1): 11, 2007 May.
Article in English | MEDLINE | ID: mdl-17647178

ABSTRACT

BACKGROUND: There is a growing need for appropriate training models in the area of cultural competence. An Objective Structured Clinical Exam (OSCE) format is ideal for this endeavor, since it allows for skills practice and feedback. As a result, we designed the first formative Culture OSCE at Maimonides Medical Center and have been implementing it since 1999. PROGRAM DEVELOPMENT: An interdisciplinary committee developed the OSCE as a formative assessment. Stations were designed based on a review of the literature and real situations experienced in the hospital. A two-hour workshop introducing the concept of cultural competence precedes the OSCE. The emphasis is on skills that are generalizable to encounters with any culture. Standardized patients are recruited from the relevant cultural groups or are trained to understand specific cultural issues. Costumes and props are utilized to enhance the authenticity of the encounter. Faculty, recruited and trained to observe encounters, gives constructive feedback, thus enhancing faculty development in this area as well. A rating scale was developed which incorporates communication and cultural skills as two separate dimensions of the encounter. PROGRAM EVALUATION: Written feedback is obtained from residents, the trained faculty observers and the standardized patients. Resident feedback has demonstrated good face validity. A post-OSCE debriefing session allows residents an opportunity to consolidate learning and give oral feedback. CONCLUSION: The Maimonides Medical Center Pediatrics Department designed the first Culture OSCE. This is deemed to be a valuable training tool, and serves to highlight the importance of cultural competence within the Department.


Subject(s)
Cultural Diversity , Internship and Residency , Patient Simulation , Physician-Patient Relations , Teaching/methods , Educational Measurement , Faculty , Humans , Models, Educational , New York City , Program Development , Program Evaluation , Reproducibility of Results , Staff Development
7.
Pediatr Ann ; 24(8): 419-20, 422-5, 1995 Aug.
Article in English | MEDLINE | ID: mdl-7478773

ABSTRACT

There clearly are a large number of opportunities to use the media to influence legislation and legislative initiatives. There are a number of examples of legislation or laws that now exist as a result of pediatricians using the media effectively. National requirements for child auto restraints, Consumer Product Safety Commission regulations on children's toys, safety caps on medications, bicycle helmet laws, and increasing restrictions on guns can all be traced, in part, to the timely and appropriate use of the media. North Carolina safe gun laws to protect children resulted from pediatricians using some unfortunate and tragic incidents to dramatize the need for gun control. Highlighting the inappropriate care for children in emergency situations in New Jersey contributed to the movement to enact pediatric emergency care guidelines for that state. Finally, the effective use of the media by the AAP has brought a number of serious, child-related issues to the legislative forefront resulting in improved conditions for children. It is not easy, though. To use the media effectively takes persistence, thoughtful attention to developing relationships with the professionals in the media, and careful follow-up. It's important that pediatricians speak out on behalf of children and children's needs. The media, when used properly and knowledgeably, can be a powerful ally and contributor to a better outcome.


Subject(s)
Legislation as Topic , Mass Media , Patient Advocacy/legislation & jurisprudence , Health Services/standards , Humans , United States
8.
10.
Acad Med ; 65(7): 461-3, 1990 Jul.
Article in English | MEDLINE | ID: mdl-2242202

ABSTRACT

Following reports of concern among health-care workers regarding the occupational risk of infection with the human immunodeficiency virus (HIV), a symposium was designed in 1987 to demonstrate to health-care providers at three hospitals in The Bronx, New York, the low risk of occupational HIV infection and techniques for avoiding infection. After the symposium, 103 of the health-care providers who had attended it completed a questionnaire assessing the impact of the symposium on their attitudes; the responses from 100 of these providers were used in this study. Twenty-nine of the responding providers reported that the symposium had increased their concerns regarding their risk of HIV infection; this group was composed of seven of the 15 medical students who responded, 12 of the 36 housestaff, seven of the 28 faculty, and three of the 21 other medical staff. The findings of the present study suggest that a symposium designed to decrease concerns of occupational HIV infection among health-care workers may have the opposite effect on some of those who attend it, especially medical students. Education alone may be inadequate to reassure some providers. The authors recommend small-group sessions addressing the emotional aspects of health-care providers' concerns.


Subject(s)
Acquired Immunodeficiency Syndrome/psychology , Attitude of Health Personnel , Inservice Training , Occupational Diseases/psychology , Pediatrics/statistics & numerical data , Personnel, Hospital/education , Acquired Immunodeficiency Syndrome/prevention & control , Adult , Female , Humans , Male , Middle Aged , New York City , Occupational Diseases/prevention & control , Personnel, Hospital/psychology , Surveys and Questionnaires
11.
Pediatrics ; 84(2): 211-4, 1989 Aug.
Article in English | MEDLINE | ID: mdl-2748246

ABSTRACT

Concerns regarding accidental needle puncture wounds, needle injuries among house officers have increased following reports of human immunodeficiency virus (HIV) transmission via this route. Pediatric house officers training in areas with large numbers of children infected with HIV may face a significant risk of occupational HIV infection via needle injury. The cumulative incidence of needle injury among pediatric house officers in New York who completed at least 1 year of training was ascertained. A questionnaire designed to elicit retrospective information regarding needle injuries was completed by 294 house officers in medical school-affiliated pediatric training programs. A total of 205 (69.7%) had stuck themselves or been stuck with a needle contaminated with a patient's blood, and 48 (17%) reported a needle injury involving a needle contaminated with the blood of a patient with suspected HIV infection. Only 11 of the 48 had received counselling or HIV testing following their possible HIV exposure. These data indicate that needle injury among pediatric house officers in New York is common. Reducing occupational risk is an especially compelling policy issue for pediatric training programs in areas where HIV is endemic.


Subject(s)
Acquired Immunodeficiency Syndrome/transmission , Internship and Residency , Needles , Pediatrics/education , Wounds, Penetrating/epidemiology , Adult , Female , Humans , Male , Middle Aged , New York City , Occupational Diseases/epidemiology
13.
Am J Public Health ; 78(4): 455-9, 1988 Apr.
Article in English | MEDLINE | ID: mdl-3348474

ABSTRACT

To assess the degree of house officers' concerns about acquiring AIDS (acquired immunodeficiency syndrome) from their patients, we surveyed 263 medical and pediatric interns and residents in four housestaff training programs affiliated with seven New York City hospitals with large AIDS patient populations; 258 questionnaires (98 per cent) were returned. Thirty-six per cent of medical and 17 per cent of pediatric house officers reported percutaneous exposures to needles contaminated with blood of AIDS patients. Forty-eight per cent of medical and 30 per cent of pediatric house officers reported a moderate to major concern about acquiring AIDS from their patients. Greater concern about personal risk was noted in those house officers who were earlier in their residency training, who reported having treated a greater number of AIDS patients, and who were in medicine rather than pediatrics programs. Twenty-five per cent of all respondents reported that they would not continue to care for AIDS patients if given a choice. The results demonstrate a substantial degree of concern about acquiring AIDS among house officers caring for AIDS patients and suggest the need for housestaff program administrators for formally address these concerns.


Subject(s)
Acquired Immunodeficiency Syndrome/psychology , Attitude of Health Personnel , Internship and Residency , Occupational Diseases/psychology , Pediatrics/education , Acquired Immunodeficiency Syndrome/transmission , Adult , Female , HIV Seropositivity/psychology , Humans , Male , Mandatory Programs , Moral Obligations , New York City , Occupational Diseases/transmission
15.
Prostaglandins Leukot Med ; 26(2): 143-55, 1987 Feb.
Article in English | MEDLINE | ID: mdl-3031694

ABSTRACT

Leukotrienes (LT) have been proposed to be important mediators in the etiology of the acute asthma attack (AAA). We therefore studied blood LT levels in 18 children having AAA. Heparinized blood samples were obtained before and after treatment with epinephrine injections and/or metaproterenol inhalations in the emergency room. The samples were acidified and subjected to Sep-pak chromatography. Reverse phase high performance liquid chromatography (RP-HPLC), ultraviolet (UV) spectroscopy and bioassay on guinea pig ileum were used to identify the LT based on comparison to data produced by standard synthetic LT samples. Radioimmunoassay (RIA) was used to further confirm the presence of LT. LT C, D and E were detected in the plasma of children having AAA. Only LT C levels were significantly elevated over control values. The mean blood LT C level of control patients was 1.6 +/- 1.2 nanograms per milliliter (ng/ml, mean +/- SEM) while that of the asthma patients was 73.8 +/- 18.2 ng/ml prior to treatment. After emergency room treatment the asthma patients had a mean blood LT C level of 22.5 +/- 11.7 ng/ml. Lowered levels of LT C accompanied improved clinical condition of the patients. This finding indicates that the AAA in children is associated with elevated blood levels of LT C.


Subject(s)
Asthma/blood , SRS-A/blood , Adolescent , Asthma/drug therapy , Child , Child, Preschool , Epinephrine/therapeutic use , Female , Humans , Leukotriene E4 , Male , Metaproterenol/therapeutic use , SRS-A/analogs & derivatives
17.
J Pediatr ; 106(1): 15-20, 1985 Jan.
Article in English | MEDLINE | ID: mdl-3965674

ABSTRACT

The Welch Allyn AudioScope is a new screening instrument that allows both audiometric testing at 500, 1000, 2000, and 4000 Hz at 25 dB hearing level and otoscopic examination. Sixty-eight patients between 3 and 9 years of age with normal hearing or a variety of hearing losses comprised the study population. Immediately after receiving an audiologic evaluation the subjects were screened with a traditional screening audiometer and two examinations with the AudioScope, performed in a clinic examining room by pediatricians and nurse practitioners unaware of the children's hearing status. The AudioScope was as accurate as traditional hearing screening in identifying children with normal hearing and those with hearing loss. Log-linear modeling demonstrated that the results of AudioScope testing were similar to those of traditional hearing screening. However, the false positive rate was higher at 500 Hz for the first AudioScope examination, suggesting the need for two AudioScope tests. The AudioScope was quick and easy to use, nonthreatening to the subjects, less expensive than a pure-tone screening audiometer, and does not require a sound-treated room.


Subject(s)
Hearing Disorders/diagnosis , Hearing Tests/instrumentation , Audiometry , Child , Child, Preschool , Evaluation Studies as Topic , False Negative Reactions , False Positive Reactions , Hearing , Humans , Statistics as Topic
19.
J Med Educ ; 59(4): 331-40, 1984 Apr.
Article in English | MEDLINE | ID: mdl-6708071

ABSTRACT

Self-help support groups for medical students represent one strategy for dealing with the emotional stresses of medical training and the diminished human sensitivity of students that often accompanies that experience. Support groups at the Albert Einstein College of Medicine were evaluated by 26 students who completed a nine-part questionnaire. The respondents indicated that they were primarily drawn to these groups because of a desire for social affiliation and an opportunity to express their feelings in a "safe" environment. Members shared in the leadership responsibilities of the group and dealt with external personal problems of the students rather than with the internal group dynamics. The gains derived from participation in these groups included opportunities for nonprofessional contact with faculty members, getting help and support from fellow students, and participation in stimulating discussions about the medical field. Students rated the groups as "meaningful" and expressed a desire for more frequent meetings.


Subject(s)
Social Environment , Social Support , Students, Medical/psychology , Adult , Female , Group Processes , Humans , Male , Peer Group , Social Adjustment , Surveys and Questionnaires
20.
N Engl J Med ; 309(6): 336-9, 1983 Aug 11.
Article in English | MEDLINE | ID: mdl-6866069

ABSTRACT

To assess the value of routine chest radiography during acute first attacks of asthma, we studied 371 consecutive children over one year of age who presented with an initial episode of wheezing. Three hundred fifty children (94.3 per cent) had radiographic findings that were compatible with uncomplicated asthma and were considered negative. Twenty-one (5.7 per cent) had positive findings: atelectasis and pneumonia were noted in seven, segmental atelectasis in six, pneumonia in five, multiple areas of subsegmental atelectasis in two, and pneumomediastinum in one. The patients with positive films were more likely to have a respiratory rate above 60 or a pulse rate above 160 (P less than 0.001), localized rales or localized decreased breath sounds before treatment (P less than 0.01), and localized rales (P less than 0.005) and localized wheezing (P less than 0.02) after treatment; also, these patients were admitted to the hospital more often (P less than 0.001). Ninety-five per cent (20 of 21) of the children with positive films could be identified before treatment on the basis of a combination of tachypnea, tachycardia, fever, and localized rales or localized decreased breath sounds. Most first-time wheezers will not have positive radiographs; careful clinical evaluation should reveal which patients will have abnormal radiographs and will therefore benefit from the procedure.


Subject(s)
Asthma/diagnostic imaging , Radiography, Thoracic , Asthma/diagnosis , Child , Child, Preschool , Diagnosis, Differential , Emergencies , Humans , Infant , Prospective Studies , Respiration , Respiratory Sounds
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