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Biomedical subjects

Philip R Nader

Publications and source records attributed to Philip R Nader.

At least 19 recordsLinked to original sources
PubMed2006

Evaluation of residency training in the delivery of culturally effective care.

OBJECTIVE: To augment resident training in the delivery of culturally effective care in order to improve clinician capacity to effectively care for patients from diverse backgrounds. METHODS: Residents from the Naval Medical Center San Diego and the University of California San Diego participated in experiential learning and service activities. Programme evaluation assessed aspects of the delivery of culturally effective care in community settings. A community-based participatory approach to engaging residents in the delivery of culturally effective care and evaluation of the effectiveness of this approach are described. RESULTS: A significant pre-post rotation increase was noted in residents' self-perceived ability to identify culture-related issues that may impact on the patient's view of illness (P<0.001) and ability to address a culture-related issue (P<0.001). Community evaluations rated residents positively on behaviours that reflected communication skills and professionalism, but less positively on knowledge about communities. CONCLUSIONS: The authors conclude that resident exposure to the block rotation curriculum contributes to improved knowledge of the skills necessary to provide culturally effective care in diverse community settings.

Adult↗
PubMed2006

Identifying risk for obesity in early childhood.

OBJECTIVES: Our aim with this study was to assist clinicians by estimating the predictive value of earlier levels of BMI status on later risk of overweight and obesity during the middle childhood and early adolescent years. METHODS: We present growth data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, a longitudinal sample of 1042 healthy US children in 10 locations. Born in 1991, their growth reflects the secular trend of increasing overweight/obesity in the population. Height and weight of participating children in the study were measured at 7 time points. We examined odds ratios for overweight and obesity at age 12 years comparing the frequency with which children did versus did not reach specific BMI percentiles in the preschool- and elementary-age periods. To explore the question of whether and when earlier BMI was predictive of weight status at age 12 years, we used logistic regression to obtain the predicted probabilities of being overweight or obese (BMI > or = 85%) at 12 years old on the basis of earlier BMI. RESULTS: Persistence of obesity is apparent for both the preschool and elementary school period. Children who were ever overweight (> 85th percentile), that is, > or = 1 time at ages 24, 36, or 54 months during the preschool period were > 5 times as likely to be overweight at age 12 years than those who were below the 85th percentile for BMI at all 3 of the preschool ages. During the elementary school period, ages 7, 9, and 11 years, the more times a child was overweight, the greater the odds of being overweight at age 12 years relative to a child who was never overweight. Sixty percent of children who were overweight at any time during the preschool period and 80% of children who were overweight at any time during the elementary period were overweight at age 12 years. Follow-up calculations showed that 2 in 5 children whose BMIs were > or = 50th percentile by age 3 years were overweight at age 12 years. No children who were < 50th percentile for BMI at all points during elementary school were overweight at age 12 years. Children who have higher range BMIs earlier, but not at the 85th percentile, are also more likely to be overweight at age 12 years. Even at time points before and including age 9 years, children whose BMIs are between the 75th and 85th percentile have an approximately 40% to 50% chance of being overweight at age 12 years. Children at 54 months old whose BMIs are between the 50th and 75th percentile are 4 times more likely to be overweight at age 12 years than their contemporaries who are < 50th percentile, and those whose BMIs are between the 75th and 85th percentile are > 6 times more likely to be overweight at age 12 years than those < 50th percentile. CONCLUSIONS: The data from this study indicate that children with BMIs > 85th percentile, as well as with BMIs in the high reference range are more likely than children whose BMI is < 50th percentile to continue to gain weight and reach overweight status by adolescence. Pediatricians can be confident in counseling parents to begin to address the at-risk child's eating and activity patterns rather than delaying in hopes that overweight and the patterns that support it will resolve themselves in due course. Identifying children at risk for adolescent obesity provides physicians with an opportunity for earlier intervention with the goal of limiting the progression of abnormal weight gain that results in the development of obesity-related morbidity.

Adolescent↗
PubMed2005

Acculturation, parent-child acculturation differential, and chronic disease risk factors in a Mexican-American population.

Acculturation is typically defined in terms of individual responses to a dominant culture. In the present study, we examined the effects of different levels of acculturation among family members. Specifically, we looked at the health and risk behavior in Mexican-American children as related to a variety of psychosocial predictors, especially the differences in orientation toward Mexican- and Anglo-American cultures between them and their parents. Mother and child pairs (n = 106) noted their orientation toward both Anglo and Mexican cultures. Children's dietary and sedentary behaviors, tobacco and alcohol use (and susceptibility to use), and depressive symptoms were also measured. Males were more likely to be sedentary and consume higher levels of total fat and saturated fat, whereas girls reported higher levels of depression. Anglo-oriented youth consumed lower levels of calories from fat but also more alcohol than did their Mexican-oriented counterparts. The latter was particularly the case among those children who were relatively more Anglo oriented than were their parents. Parent-child acculturation differential in terms of the differences in Mexican orientation, in comparison, predicted susceptibility to tobacco use. However, the sum of the absolute values of these two differences predicted only lifetime alcohol use, and in a counter-intuitive direction. This familial measure of acculturation shows some promise, but additional formative research is needed to operationalize this construct.

Acculturation↗
PubMed2004

School-based health education programs can be maintained over time: results from the CATCH Institutionalization study.

BACKGROUND: Developing and evaluating interventions to influence students' opportunities for healthful choices has been a focus of school-based health promotion research; however, few studies have examined the sustainability of these programs and viability of continued organizational implementation. METHODS: The purpose of this study was to determine the maintenance of Child and Adolescent Trial for Cardiovascular Health (CATCH) school-level changes in former intervention (n = 56) and former comparison (n = 20) schools 5 years post-intervention. Twelve schools unexposed to CATCH were measured as controls. Macronutrient content of 5 days of school lunch menus, amount and type of physical education (PE) classes, and health instruction practices in the classroom were assessed. An institutionalization score for schools was developed, using program maintenance variables: % kcal from fat and saturated fat in school lunches, % PE class spent in vigorous and moderate-to-vigorous physical activity, and class time devoted to CATCH topics. RESULTS: Menus from 50% of former intervention cafeterias met the Eat Smart guidelines for fat, compared to 10% of former control cafeterias and 17% of unexposed school cafeterias (P < 0.005). There were no significant differences in implementation of CATCH PE goals between conditions. Although the total time spent teaching CATCH was low in former CATCH schools, the former intervention schools spent significantly more time teaching CATCH and taught more lessons as compared to former comparison schools. Former intervention schools had a higher mean institutionalization score than former comparison schools (P < 0.001). Training had the greatest impact on maintenance of CATCH. CONCLUSIONS: Results from this study suggest that changes in the school environment to support healthful behaviors can be maintained over time. Staff training is an important factor in achieving institutionalization of these programs.

Adolescent↗
PubMed2003

Frequency and intensity of activity of third-grade children in physical education.

BACKGROUND: Health recommendations are for preadolescent children to have daily school physical education (PE) classes that engage children in moderate to vigorous physical activity at least 50% of class time. OBJECTIVE: To observe activity of children in PE classes in third grades across 10 different sites. DESIGN: Observational study. SETTING: Six hundred eighty-four elementary schools in 10 sites. SUBJECTS: A total of 814 children (414 boys, 400 girls; mean age, 9.0 years) enrolled in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. METHODS: Each child was observed during 1 scheduled PE class. MAIN OUTCOME MEASURE: The SOFIT (System for Observing Fitness Instruction Time) observation method, a validated, heart rate observation system, yields levels of activity the child is engaged in as well as the lesson context, type of teacher, and location of the PE class. RESULTS: Children averaged 2.1 PE lessons per week, of 33 minutes each. Only 5.9% of children had daily PE. Children accrued 4.8 very active and 11.9 minutes of moderate to vigorous physical activity per PE lesson, 15.0% and 37.0% of lesson time, respectively. Lesson length and number of minutes per week were similar for boys and girls; however, boys spent proportionately more PE time in very active and moderate to vigorous activity. This resulted in boys having a higher energy expenditure rate than girls. CONCLUSION: Children observed in this study received 25 min/wk of moderate to vigorous activity in school PE, falling far short of national recommendations.

Child↗
PubMed2003

A prenatal intervention study to improve timeliness of immunization initiation in Latino infants.

This was a prospective randomized cohort study to assess the effectiveness of an educational immunization intervention with pregnant Latinas on timely initiation of infant immunization. Study participants were recruited from two community clinics in north San Diego County. A total of three hundred and fifty-two Latinas in the third trimester of pregnancy were recruited and randomly assigned to intervention or control groups. Participants received either a culturally and linguistically appropriate session on infant immunization (intervention) or a session on prevention of Sudden Infant Death Syndrome (control). The main outcome measures were pre-post immunization knowledge change and infant immunization status at 92 days. Immunization knowledge increased significantly in the intervention group [p < .0001, 95%CI (1.76, 2.47)]. No difference was found between groups in immunization series initiation: 95 percent of the children in the intervention group were up-to-date by 92 days from birth, and 93 percent of the control group was up-to-date at 92 days. The lack of significant association between receiving immunization education and infant immunization series initiation suggests that parent education may be necessary but not sufficient for timely immunization, particularly in clinics with effective well-child programs. Given the significant increase in immunization knowledge, the broader and perhaps more important implication is that language- and culturally specific infant health education messages in the prenatal period may have a positive long-term impact on the child's health and promote well-child care overall. Future studies should assess the role of prenatal well-child education in the context of clinics with low immunization levels.

Adult↗
PubMed2003

Retaining school children and families in community research: lessons from the Study of Children's Activity and Nutrition (SCAN).

Retaining school-aged study participants poses a major challenge in any longitudinal research study. Dropouts produce bias in the remaining sample and this loss may affect study findings and their interpretation. Dominant factors that influence retention in pediatric research studies include family versus individual participation, patient management strategies of study personnel, knowledge about the condition or therapy, age and gender factors, credibility within the community, monetary incentives, and altruism. Eleven years after baseline assessment, Studies of Children's Activity and Nutrition boasts a 53% retention of the original biethnic cohort in San Diego. Retention occurred partly due to a trained measurement team which completed sequential observations primarily in family homes and implemented continuous participant follow-up procedures. Approaches for increasing student retention based on carefully designed studies and adherence indicators can assist researchers seeking maximum retention of school-aged participants.

Adolescent↗
PubMed2003

Two national surveys on pediatric training and activities in school health: 1991 and 2001.

OBJECTIVE: To determine from 2 surveys, in 1991 and 2001, 1) the proportion of pediatricians and which pediatricians report doing school health, 2) which school health activities are most commonly engaged in and whether this has changed, 3) whether training/education during residency influences doing school health later in practice, and 4) whether the amount or nature of residency training in school health (as reported by practicing pediatricians) increased over time, as recommended by various task forces. METHODS: Surveys were mailed to a 10% randomly selected group of the voting membership of the American Academy of Pediatrics. RESULTS: An estimated 50% to 70% of pediatricians report doing school health, and a consistent 20% report having had training in school health. The nature of school health work varies in urban, suburban, and rural areas, and pediatricians who practice in rural areas are more likely to be involved in school health. When resident education in school health is offered during residency, it is associated with a higher likelihood of pediatricians' doing school health later in practice. Recent trainees report having more residency training in school health, yet fewer recent trainees report doing school health compared with their older colleagues. CONCLUSIONS: The gap between those who do school health and have received education in school health during residency has continued over at least a 10-year period. Recommendations include specification of school health and community pediatrics competencies for the effective practice of pediatrics in the future.

Adolescent Medicine↗
PubMed2002

Tracking of physical and physiological risk variables among ethnic subgroups from third to eighth grade: the Child and Adolescent Trial for Cardiovascular Health cohort study.

BACKGROUND: The Child and Adolescent Trial for Cardiovascular Health (CATCH), a multisite field trial, tested the effectiveness of multiple interventions for cardiovascular disease risk behaviors in children in third through fifth grades. This paper reports the tracking of physiologic variables through eighth grade. METHODS: The cohort began with 5,106 third grade students from diverse ethnic backgrounds: 69% Caucasian, 14% Hispanic, 13% African American, and 4% other. Seventy-two percent of students were remeasured. Measures described are serum lipids, blood pressure, and body anthropometrics. Tracking was examined across three time points (third, fifth, and eighth grades) with a scaled Kendall concordance coefficient and percentage retention within quintiles across time. RESULTS: For the overall sample, tacking was strongest for body mass index (BMI) (Kendall coefficient = 0.86) and weight (0.86), followed by skinfold thicknesses (0.72-0.78), serum lipids (0.67-0.72), and blood pressure (0.45-0.51). For BMI, 96% of students stayed within +/-1 quintile from third to fifth grades; 90% stayed within this range from third to eighth grades. CONCLUSIONS: There were small but noticeable gender and ethnic differences: tracking was stronger among boys and African American students. These results demonstrate that the children's relative level of cardiovascular risk remained stable over a 6-year period.

Adolescent↗
PubMed2002

Provider-staff discrepancies in reported immunization knowledge and practices.

BACKGROUND: The purpose of the study was to compare immunization-relevant knowledge, certainty about knowledge, self-efficacy, vested interest, and reported practices of providers and clinical staff in the same clinics. METHODS: A valid and reliable instrument measuring the aforementioned issues was developed and administered to a sample of 50 providers and 60 members of the clinical staff. RESULTS: Providers were significantly more knowledgeable than staff (P < 0.001); however, they were not more certain about their knowledge (P = 0.52) nor were they more confident in their capability to properly immunize all children in their practice (P = 0.10). Providers reported lower vested interest in immunizations than clinical staff (P < 0.05). Both groups were equally likely to immunize a child with a cold. Providers were less likely to defer needed immunizations for a 15-month-old child, and they were more likely to administer multiple injections to an 18-month-old (both P < 0.05). Providers were more likely than staff to immunize during acute and chronic illness visits (both P < 0.001), and both groups were equally likely to immunize during preventive visits. CONCLUSIONS: Discrepancies in reported immunization practices between providers and staff may be a barrier to full immunization.

Attitude of Health Personnel↗
PubMed2002

Serum cholesterol levels in children are associated with dietary fat and fatty acid intake.

BACKGROUND: Recent studies in adults suggest that individual dietary fatty acids differ markedly in their effects on serum lipids and lipoprotein levels. However, these associations have rarely been studied in children. OBJECTIVE: To assess, using regression procedures, the associations in children between specific fatty acids and nonfasting serum lipids and cholesterol after controlling for total energy and total fat intake, SUBJECTS: The sample consisted of 1,182 children who participated in the Child and Adolescent Trial for Cardiovascular Health. The sample was equally distributed across 4 sites (Louisiana, Texas, Minnesota, California). The sample was 48% boys; 71% white, 15% Hispanic-American, 10% African-American, 2% Asian, and 2% from other or unspecified racial/ethnic heritage. DESIGN: In this randomized multicenter trial with 56 intervention and 40 control elementary schools, food record-assisted 24-hour dietary recalls and serum lipid measurements were collected for each child at baseline (3rd grade) and at the 5th grade follow-up. STATISTICAL ANALYSES: Repeated-measures analysis of variance was used to evaluate the association between nutrient composition of the diet and serum lipids. Independent dietary variables included amount and type of fat, individual fatty acids, protein, carbohydrate, and fiber. The dependent variables were the absolute values of serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) both at baseline (3rd grade) and at follow-up (5th grade). RESULTS: Increased total fat (b=0.053; P<.03) was associated with increased TC in the model when energy was held constant, whereas increased carbohydrate was associated with decreased TC (b=-0.021, P<.02) and HDL-C (b=-0.010, P<.005) levels. Increased total protein (b=0.017, P<.05) was associated with increased HDL-C when energy was held constant. Saturated fat (b=0.004, P<.04), unsaturated fat (b=0.004, P<.03), and myristic fatty acid (b=0.021, P<.01) all increased TC in the model when total fat and total energy were held constant. CONCLUSIONS/APPLICATIONS: We conclude that using a modeling approach, the effect of diet on serum lipids in children is similar to that observed in adults. Total fat and saturated fat were positively associated with TC and HDLC levels, saturated fat was positively associated with TC, and carbohydrate was inversely associated with both TC and HDL-C. In the statistical model, substitution of unsaturated fatty acids, monounsaturated fatty acids, or oleic acid for saturated fat, while holding total fat and energy constant, slightly lowered TC. In contrast, substitution of total fat for carbohydrate in the model increased TC and, thus, did not seem to be associated with an apparent health advantage except for HDL-C elevating effects. However, consumption of individual fats tends to be highly correlated, and we were unable to determine if these biological effects were operating independently.

Child↗
PubMed2002

Tracking dietary intake in white and Mexican-American children from age 4 to 12 years.

OBJECTIVE: To examine the tracking (ie, the stability over time) of dietary intake in Mexican-American and white children aged 4 to 12 years. SUBJECTS: Children 4 years of age (n=351) were assessed at baseline and 65% (n=228) completed the 8-year study. DESIGN: Cardiovascular disease-related dietary intake was defined as energy, percent of energy from fat, and sodium (mg/1,000 kcal). From age 4 to 7 years, a modified 24-hour recall with observation of lunch and dinner and interview of the primary food preparer for unobserved foods was used to describe dietary intake. For children aged 11 to 12 years, a standardized 24-hour recall was used. STATISTICAL ANALYSES: A mixed effects model that adjusted for sex, ethnicity, and measurement wave allowed for separation of shorter-term variations in diet from more stable ("between subject") variations. Extent of between-subject variance is an indication of tracking. RESULTS: From age 4 to age 7, there were statistically significant between-subject variance components for energy (P<.00001), percent of energy from fat (P<.00001), and sodium per 1,000 kcals (P<.001); for ages 11 and 12, energy intake was significant (P<.00001). There were no significant associations for dietary intake from age 4 to 12 years. CONCLUSIONS/APPLICATIONS: It seems that dietary intakes are stable over short periods and at earlier ages compared with longer intervals and later ages. Nutrition interventions are needed in childhood and throughout adolescence.

Age Factors↗
PubMed2002

Missed opportunities to immunize: psychosocial and practice correlates.

BACKGROUND: The goal of this pilot study was to correlate missed opportunities to immunize young children with providers' psychosocial characteristics and self-reported immunization practices. METHODS: In a population of children aged 0 to 36 months, missed opportunities to immunize were established for a sample of 28 providers, who also responded to a valid and reliable instrument measuring the aforementioned variables. RESULTS: Missed opportunities were significantly lower among providers with higher vested interest (r=-0.45, p=0.02) and tended to be lower among providers with more positive attitudes toward having all children properly immunized at every healthcare visit (r=-0.33, p =0.09). Neither knowledge nor perceived barriers correlated significantly with missed opportunities. Providers missed opportunities to immunize in over half of the visits studied (mean, 0.58), yet all of them reported always immunizing at preventive and follow-up visits, almost all (96.3%) at chronic illness visits, and a majority (78.6%) at acute care visits. As a result, none of the self-reported immunization practices was significantly correlated with missed opportunities. CONCLUSIONS: Missed opportunities appear to be best predicted by motivational psychosocial factors and not by knowledge or perceived barriers. Self-reported immunization practices do not correspond to actual immunization behavior.

Child, Preschool↗
PubMed2002

Maintenance of lightweight correlates with decreased cardiovascular risk factors in early adolescence.

PURPOSE: To describe predictors of lightweight in 11-year-olds and how weight changes between ages 9-11 years affected selected cardiovascular risk factors. METHODS: Cohort study among an ethnically and geographically diverse group of 5098 nine-year-olds who participated in the Child and Adolescent Trial for Cardiovascular Health (CATCH) and were followed from 1991 to 1994 until age 11 years. Lightweight (body mass index [BMI] <15th percentile) was defined from gender- and age-adjusted data on the total population in the National Health and Nutrition Examination Survey I of 1971 to 1973. Weight (BMI) category at follow-up (age 11 years) was the dependent variable in the logistic regression. Gender, race/ethnicity, school site, weight category at baseline, and participation in the CATCH (intervention or control group) were examined for possible predictors. RESULTS: The prevalence of lightweight was much lower than the 15% expected at both ages 9 and 11 years; 4.7% for males (M) and 7.4% for females (F) and at age 11 years; 5.9% for M and 8.3% for F. Lightweight at age 9 years was the best predictor of lightweight at age 11 years (OR = 56.8; CI 41.3, 78.2). Normal-weight children who entered the overweight category exhibited striking adverse percent changes in serum cholesterol and in both serum high-density cholesterol and apolipoprotein B cholesterol levels. Among children in each weight group at age 9 years, the heavier children at age 11 years had higher percent changes in systolic blood pressure, and lower times on the 9-min run. Maintenance of lightweight was associated with the most favorable pattern of cardiovascular risk factors. Differences between groups were not found for percent change in total calorie intake or percentage of calories from fat. Normal-weight children who became overweight exhibited striking percentage increases in levels of serum cholesterol and in serum apolipoprotein B cholesterols. CONCLUSIONS: Population-based anticipatory guidance about weight should focus on all children in mid-childhood, not only those at the upper extremes of weight. These who are genetically lean and healthy should be encouraged to remain so. Maintenance or achievement of lightweight was associated with favorable changes in systolic blood pressure in CATCH children during early adolescence. Those below the 5th percentile should be assessed and treated if eating disorders, undernutrition, or chronic illness are present. Optimal weight and optimal health should not be confused.

Blood Pressure↗
PubMed2002

Childhood movement skills: predictors of physical activity in Anglo American and Mexican American adolescents?

We assessed the relationship between young children's movement skills and their physical activity in early adolescence. Balance, agility, eye-hand coordination, and skinfold thicknesses in 207 Mexican American and Anglo American children (104 boys, 103 girls) were measured at ages 4, 5, and 6 years. Habitual physical activity was assessed at the age of 12 years by two interviewer-administered 7-day recalls. Ethnic differences in movement skills were not found. Young girls were better at jumping and balancing, and young boys were better at catching. Tracking of skills was low, and children's early childhood skills were not related to their physical activity 6 years later. Further studies involving additional movement skills and other populations are recommended to determine if enhanced movement skills in children promote subsequent physical activity.

Child, Preschool↗
PubMed2002

Home environmental influences on children's television watching from early to middle childhood.

Identifying correlates of children's television (TV) watching could help identify strategies to reduce children's TV watching and impact children's weight status. Children's TV time and home environment factors were assessed longitudinally among 169 families with children followed from 6 to 12 years of age. TV watching increased with age, as did the number of in-home TVs and the presence of videocassette recorders (VCRs), the frequency of meal eating while watching TV, and the percentage of children with bedroom TVs. Greater meal eating while watching TV was consistently related to overall TV watching and increases in TV watching over time. The number of in-home TVs and the presence of a bedroom TV were less consistent correlates. TV watching was related to weight status when children were younger, and when children were older, more than 2 hours of TV daily was a risk factor for higher weight. Modifying TV access, particularly by reducing the frequency of meals eaten while watching TV, could promote lower children's TV watching and adiposity.

Body Weight↗