A 6-month, office-based, low-carbohydrate diet intervention in obese teens.

BACKGROUND: Previous studies have shown the success of a low-carbohydrate diet (LCD) in adults. In one study, the LCD has also been shown as safe and effective in teens, the study period was only 12 weeks. Furthermore, there is no information on whether the LCD is a practical intervention in a pediatric office setting. OBJECTIVE: The object of this study was to demonstrate the effectiveness of a LCD in obese children in a primary care pediatric setting. DESIGN/METHODS: The study was done in 11 community pediatric practices. Children ages 12 to 18 years with a body mass index (BMI) greater than 95th percentile were put on a LCD of less than 50 grams of carbohydrate daily. RESULTS: A total of 38 of the 63 teens finished the 6-month study and 32 (84%) lost weight (range from a gain of 5.5 kg to a loss of 23.9 kg). There was also a significant decrease in mean BMI (34.9 to 32.5). CONCLUSIONS: The LCD appears to an effective and practical office-based intervention in obese teenagers.

Screening for domestic violence in the pediatric office: a multipractice experience.

The purpose of our study was to screen for domestic violence (DV) in 4 different pediatric practice settings. Women who accompanied their children to well-child visits were eligible. The women were screened with a 6-question tool previously piloted by our group, which included questions on partner abuse, child abuse, and pet abuse. Over a 1-year period, 435 women were screened. Of these women, 95 (22%) described DV at some point in their lives. Sixty-nine (16%) reported abuse longer than 2 years before the screen and 26 (6%) reported more recent abuse. While 11 of 117 women screened in the more affluent private practice reported a history of past abuse, no women in that group reported DV occurring within 24 months. The proportion of women reporting violence did not differ significantly by site, but the proportion of patients reporting new violence was significantly lower at the private practice site by Chi-square analysis. In conclusion, women screened in a variety of pediatric settings will disclose DV. Recent abuse is more likely to be reported in settings with indigent patients. All pediatricians should be screening for DV and have protocols in place to offer women the services they need if DV is revealed.

Treatment of otitis media with observation and a safety-net antibiotic prescription.

OBJECTIVE: Several studies have demonstrated that acute otitis media (AOM) in children can be managed without antibiotics. Because children with AOM have traditionally been treated with antibiotics in the United States, there are concerns that parents may not be comfortable with their children being treated with pain control alone. Recently, Cates in England showed that antibiotic usage for AOM could be decreased by prescribing a safety-net antibiotic prescription (SNAP) to be filled if symptoms do not resolve with observation after 48 hours. It is not clear whether a SNAP will be acceptable to parents in other settings such as the United States. The objective of our study was to determine whether parents in the United States find a SNAP for AOM acceptable and whether antibiotic usage could be decreased by its use. METHODS: A pediatric practice-based research network in a midwestern community of 1.8 million was the setting for this study. The Cincinnati Pediatric Research Group (CPRG) includes practices in Ohio, Kentucky, and Indiana. Children who were between 1 and 12 years of age and presented to the offices of the CPRG with uncomplicated AOM were eligible for the study. Children were excluded when they had temperature >101.5 degrees F, had an ear infection in the past 3 months, showed signs of another bacterial infection, or were toxic appearing. Families were given acetaminophen, ibuprofen, or topical otic anesthetic drops for pain control. They were also given a prescription for an antibiotic and instructed not to fill it unless symptoms either increased or did not resolve after 48 hours. The data were entered directly by investigators via an Internet site. RESULTS: A total of 194 children were enrolled in 11 offices over 12 months; 175 (90%) completed the follow-up interview. The average child's age was 5.0 years. Only 55 (31%) of the 175 who were contacted for follow-up had filled their antibiotic prescription. Compared with their previous experience, parents were overwhelmingly willing to treat AOM with pain medication alone (chi(2) = 111). Seventy-eight percent (95% confidence interval: 71%-84%) of parents reported that the pain medication was effective. Sixty-three percent (95% confidence interval: 55%-70%) of parents reported that they would be willing to treat future AOM episodes without antibiotics and with pain medication alone. CONCLUSIONS: A subset of parents find a safety-net prescription and pain control acceptable in the treatment of AOM, and antibiotic usage can be lowered with this strategy.