Oscillometric blood pressure standards for children.

We previously reported blood pressure (BP) readings obtained by the Dinamap (DIN) (Model 8100) were 10 mmHg higher than those obtained by auscultatory methods and thus were not interchangeable. DIN BP data on 7208 schoolchildren ages 5 to 17 were analyzed to generate normative DIN BP standards and to examine the rational for presenting BP standards according to age and height percentiles. Three BP measurements were taken in the sitting position using a BP cuff width 40% to 50% of the circumference of the arm. Boys' systolic pressures (SP) were significantly (p < 0.05) greater (up to 11 mmHg) than those of the girls in subjects age 13 to 17 years. SP levels were most closely correlated with weight (r = 0.595), followed by height (r = 0.560) and age (r = 0.518). When BP levels were adjusted for age and weight, the correlation coefficient of DIN SP with height was negligible (r = 0.026 for boys; r = 0.085 for girls), whereas when adjusted for age and height, the correlation of SP with weight remained high (r = 0.303 for boys; r = 0.216 for girls), indicating that height is not an important independent predictor of BP levels. In conclusion, Dinamap-specific BP standards presented in this report are the only standards that have been generated according to the current BP guidelines recommended by national committees. We found no rational for presenting BP standards according to age and height percentiles.

Legislation, policy, and tobacco use among youth: implications for health care providers.

This paper addresses implications of recent tobacco legislation, policy, and tobacco use among youth in the context of health care policy and services. Tobacco use prevalence and definitions and diagnoses of nicotine addiction and dependence are described. Assessment of smoking prevalence in Texas provides a case study of the problem and potential solutions for tobacco use among youth. The case study highlights specific implications to be considered when providing health care focused on prevention and risk reduction for youth. The paper concludes with implications and critical Internet resources for health care providers engaging in youth tobacco control.

Prevalence of overweight in a triethnic pediatric population of San Antonio, Texas.

OBJECTIVES: To investigate the prevalence of overweight among different ethnic and gender groups of children and adolescents in the San Antonio, Texas, area and to compare the prevalence with that of the US national figures. DESIGN: Cross-sectional study SUBJECTS: A total of 7208 schoolchildren in kindergarten through 12th grade. There were 4215 Mexican American (MA) (58.5%), 2040 non-Hispanic white (NHW) (28.3%) and 953 African American (AA) (13.2%) subjects. MEASUREMENTS: Weight, height and skinfold thicknesses. RESULTS: The body mass index (BMI, kg/m2) values of MA boys were almost consistently and significantly (P<0.05) larger than NHW boys and showed a tendency to be larger than AA boys, beginning as early as age 6 and continuing through age 17. Although rarely significant, a similar trend in ethnic difference was also noted for girls, with the smallest BMI seen in NHW girls. The subscapular skinfold thickness (SST) for MA boys and girls was significantly (P<0.05) larger than that for NHW counterparts and showed a tendency to be larger than AA counterparts. No significant ethnic differences were present in the triceps skinfold thickness (TST) for girls, but MA boys' TST were occasionally larger (P<0.05) than other ethnic-gender groups. Girls' TST were frequently larger (P<0.05) than boys for each ethnic groups. Using the population data from the National Health and Nutrition Examination Survey (NHANES) I as reference, the prevalence of overweight (BMI> or =95th percentile) was greater in MA (15-28%) and AA (11-29%) boys and girls than in NHW (7-17%) counterparts. The combined prevalence of overweight and 'at risk of overweight' (BMI>85th percentile) was much larger in MA boys (40-50%), MA girls (34-52%), and AA girls (33-51%) than other subgroups. The onset of overweight is quite early, starting at 5-6 y of age, especially in girls. Compared to the data from national surveys, the prevalence of overweight found in this study is higher than reported nationally. We found a marked increase in the skinfold thickness, especially SST for boys, but the increase is less for girls. CONCLUSIONS: The prevalence of overweight is higher in MA boys and girls and AA girls than other ethnic-gender groups in the San Antonio, Texas, area. The prevalence of childhood overweight in the San Antonio area is higher than national figures. The findings of increasing prevalence and early onset of childhood overweight are concerning, because these are known risk factors for diabetes and diseases of many other organ systems. Measures to prevent, reduce or treat childhood obesity are urgently needed.

Comparison of auscultatory and oscillometric blood pressures.

OBJECTIVE: To study the differences in blood pressure readings between the auscultatory and oscillometric (Dinamap model 8100; Critikon, Tampa, Fla) methods. DESIGN: Survey of 2 blood pressure instruments. SETTING: Public schools. PARTICIPANTS: Seven thousand two hundred eight schoolchildren aged 5 through 17 years. MAIN OUTCOME MEASURE: Blood pressure levels. RESULTS: For all children combined, Dinamap systolic pressure readings were 10 mm Hg higher (95% confidence interval, -4 to 24 mm Hg) than the auscultatory systolic pressure readings. Dinamap diastolic pressure readings were 5 mm Hg higher (95% confidence interval, -14 to 23 mm Hg) than the auscultatory Korotkoff phase V diastolic pressure readings. CONCLUSION: These findings preclude the interchange of readings by the 2 methods. Caution must be exercised in the diagnosis of hypertension when an automated device is used.

The San Antonio Biethnic Children's Blood Pressure Study: anthropometric findings.

Cardiovascular diseases and diabetes are very prevalent today, and early detection of the precursors of these diseases is important. Increased weight and body mass indexes (BMIs) are known to be risk factors for these adult diseases. The objectives of this portion of the study were to obtain anthropometric measurements known to correlate with children's blood pressure levels and to compare these measurements among Mexican-American (M-A) females and males and non-Hispanic white (W) females and males. These data will allow healthcare providers to know normal weights and BMIs for different ethnic groups so that early detection of risk factors can be done. Anthropometric measurements (weight, height, BMI, subscapular and triceps skinfold thickness, and arm circumference) were obtained on 4,195 M-A and 2,039 W children in kindergarten through 12th grade in two school districts in the San Antonio, Texas, area. Data were statistically analyzed and related to age. M-A males had a tendency to be heavier than W males throughout the ages studied. M-A females had a tendency to be heavier than W females until 11 years of age, but that trend was reversed between ages 14 and 18. For all four subgroups, there was a marked skewness toward obesity based on BMI (kg/m2). Height of M-A children beginning as early as 5 years of age was slightly but significantly (P > or = .05) less than that of W children of the same gender. M-A males and females had either a tendency for or significantly higher values (P > or = .05) for BMI than W counterparts. M-A children had larger subscapular and triceps skinfold thickness than their W counterparts, with females showing greater values than males. The data indicate that there are several important differences in weight, height, BMI, and skinfold thickness between M-A and W children and between boys and girls as noted above. There are also considerable increases in weight with a relatively stable height in all four subgroups since the last published growth charts.

The San Antonio Biethnic Children's Blood Pressure Study: auscultatory findings.

INTRODUCTION: The purpose of this study were to: (a) examine for possible ethnicity-related and gender-related differences in blood pressure (BP) in Mexican American and non-Hispanic White schoolchildren; (b) compare auscultatory and oscillometric BP levels; and (c) establish auscultatory BP standards using the width of the BP cuff based on the circumference of the arm in schoolchildren in K-12. METHODS: Participants were 6259 schoolchildren in kindergarten through 12th grade in the San Antonio, Texas, area. Auscultatory and oscillometric BP readings were obtained in random sequence, using BP cuff width 40% to 50% of the circumference of the upper arm. Averages of 3 readings were used for statistical analyses. RESULTS: Auscultatory systolic pressures (SPs) in preadolescent Mexican American boys and girls were higher (1 to 3 mm Hg) auscultatory (SP) than in their White counterparts, but the difference was clinically not important. Diastolic pressures (DP) showed no important differences. Auscultatory SPs in 13- to 18-year-old boys of both ethnic groups were significantly (P < .05) higher (3 to 12 mm Hg) than they were for girls, with no ethnic differences. Oscillometric SP was higher than auscultatory SP in children of all ages studied. Oscillometric (DP) was slightly lower (0 to 5 mm Hg) than was auscultatory K4 and higher (4 to 5 mm Hg) than was auscultatory K5 DP. DISCUSSION: No important ethnicity-related difference was found for auscultatory BP, but significant gender-related differences (boys greater than girls) were found in SP in subjects ages 13 to 18 years. Differences in BP readings by oscillometric and auscultatory methods do not allow interchange of readings. This study provides, for the first time, auscultatory BP standards using BP cuff width 40% to 50% of the arm circumference.

Physical examination of children and adolescents.

This article describes the differences in the physical examination of the child and adolescent from that of the adult. A system-by-system approach is used, and only variations in history and physical examination of the child and adolescent are given. It is vital that the nurse practitioner understand these differences when providing health care services to children and adolescents.

The pain experience in infants, children, and adolescents.

Postoperative pain in adults has become a subject that has seen increasing research. The result of that research has been an increase in the type and quality of interventions available for pain relief. Although infants, children, and adolescents also experience postoperative pain, the research and interventions have been slower in arriving. Perhaps this is caused, in part, by the inability of this population to express the pain experience. It may also be because of the reluctance of health care providers to objectively assess and intervene in the pain experience of infants, children, and adolescents. The purpose of this article is to explore the pain experience of infants, children, and adolescents so the perioperative nurse will be better equipped to handle this experience with the patient and the family.

Preoperative assessment of the infant, child, and adolescent.

The preoperative nursing assessment is a valuable tool for perioperative nurses. This article describes the pediatric history, approach to pediatric physical examination, methods of examination, and a system-by-system review of important considerations for the pediatric patient.

Blood pressure measurement in children: a brief review.

Blood pressure measurement in children is difficult and many inaccuracies are seen because of the method of measurement of the blood pressure cuff and the choice of apparatus with which to measure the blood pressure. This article will briefly review the ways in which blood pressures are measured in children and the accuracy of these different measures. Perioperative nurses should be acutely aware of the confusion in literature concerning blood pressure measurement in children. It is hoped that this discussion will help the perioperative nurse to choose the appropriate size cuff and the most accurate method of measurement.

The military nurse experiment in Vietnam: stress and impact.

Demographic, health, and psychosocial data from two studies are presented on military nurses assigned to Vietnam. Army nurse subjects in the first study were grouped for comparison on three major variables: assignment to Vietnam before versus after the 1968 TET Offensive, type of nursing duties performed, and years of experience as a registered nurse (RN) prior to assignment in Vietnam. The second study compared another group of Army nurses with a group of Air Force and Navy nurses also assigned to Vietnam. Army nurses with less than two years RN experience prior to their assignment were found to be more at risk for such negative outcomes as difficulty establishing personal relationships and difficulty coping with stressful situations. Stress experiences, career dissatisfaction data, and health problems of military nurses and their children are reported. Also described are positive experiences of nurses in developing personal relationships in a rewarding professional environment.