Evaluation of general practitioners' assessment of overweight among children attending the five-year preventive child health examination: a cross-sectional survey

Electronic registry for the management of childhood obesity in Greece

BACKGROUND

Obesity in childhood and adolescence represents a major health problem in our century. In Greece, more than 30%-35% of children and adolescents are either overweight or obese.

MATERIALS AND METHODS

Using information and communication technologies, we developed a "National Registry for the Prevention and Management of Overweight and Obesity in Childhood and Adolescence" for guidance and training of Pediatricians and General Practitioners. The application supports interoperability with other national infrastructures and multi-layered security spanning preventive, detective and administrative controls. The Patient Summary Dataset includes information on medical history, family history, medications, immunizations, clinical examination and laboratory findings and appointment booking service.

RESULTS

The application was launched in September 2015 and is accessible by: http://app.childhood-obesity.gr/. Based on the data that the doctor registers, the system calculates a personalized therapeutic algorithm that provides information on diet, physical exercise and sleep, as well as guidance on laboratory investigations and referral to specialized centres. A pilot study performed in 1270 children and adolescents indicated that using this system resulted in a reduction in obesity rates by 30% and overweight rates by 35% within 1 year.

CONCLUSIONS

This National e-Health System appears to be effective in the management of overweight and obesity in childhood and adolescence.

How accurate is diagnosis of congenital anomalies made by family physicians?

BACKGROUND

Although family physicians have a key role in clinical management of many diseases and in community health, the accuracy of the diagnosis for congenital anomalies by family physicians still needs more investigations. The aim of this study was to assess the accuracy of family physicians in case detection and diagnosis of congenital anomalies in rural areas, northwest of Iran.

METHODS

In a community-based study of 22500 children born between 2004 and 2012, all 172 cases of congenital anomalies diagnosed by family physicians were assessed by a qualified pediatrician in 47 health houses in rural areas of Tabriz District, northwest Iran. A group of 531 children was compared as control subjects.

RESULTS

The overall sensitivity and specificity of family physicians‟ diagnosis for congenital anomalies were estimated 98% (95% Confidence Interval (CI): 95.9 to 100) and 100% (95% CI: 99.3 to 100), respectively. Sensitivity for diagnosis of congenital heart diseases was 97% (95% CI: 93 to 100), and for genitourinary tract, it was 86% (95% CI: 59 to 100). Specificity was estimated 100% for both groups of heart and genitourinary tract anomalies.

CONCLUSION

The performance of family physicians was found accurate enough in the diagnosis of congenital anomalies. Health care system may consider family physician program as an effective approach to detect and clinical management of congenital anomalies.

Prediction of adolescent and adult adiposity outcomes from early life anthropometrics

OBJECTIVES

Maternal body mass index (BMI), birth weight, and preschool BMI may help identify children at high risk of overweight as they are (1) similarly linked to adolescent overweight at different stages of the obesity epidemic, (2) linked to adult obesity and metabolic alterations, and (3) easily obtainable in health examinations in young children. The aim was to develop early childhood prediction models of adolescent overweight, adult overweight, and adult obesity.

METHODS

Prediction models at various ages in the Northern Finland Birth Cohort born in 1966 (NFBC1966) were developed. Internal validation was tested using a bootstrap design, and external validation was tested for the model predicting adolescent overweight using the Northern Finland Birth Cohort born in 1986 (NFBC1986).

RESULTS

A prediction model developed in the NFBC1966 to predict adolescent overweight, applied to the NFBC1986, and aimed at labelling 10% as "at risk" on the basis of anthropometric information collected until 5 years of age showed that half of those at risk in fact did become overweight. This group constituted one-third of all who became overweight.

CONCLUSIONS

Our prediction model identified a subgroup of children at very high risk of becoming overweight, which may be valuable in public health settings dealing with obesity prevention.

Cardiometabolic risk assessments by body mass index z-score or waist-to-height ratio in a multiethnic sample of sixth-graders

Convention defines pediatric adiposity by the body mass index z-score (BMIz) referenced to normative growth charts. Waist-to-height ratio (WHtR) does not depend on sex-and-age references. In the HEALTHY Study enrollment sample, we compared BMIz with WHtR for ability to identify adverse cardiometabolic risk. Among 5,482 sixth-grade students from 42 middle schools, we estimated explanatory variations (R²) and standardized beta coefficients of BMIz or WHtR for cardiometabolic risk factors: insulin resistance (HOMA-IR), lipids, blood pressures, and glucose. For each risk outcome variable, we prepared adjusted regression models for four subpopulations stratified by sex and high versus lower fatness. For HOMA-IR, R² attributed to BMIz or WHtR was 19%–28% among high-fatness and 8%–13% among lower-fatness students. R² for lipid variables was 4%–9% among high-fatness and 2%–7% among lower-fatness students. In the lower-fatness subpopulations, the standardized coefficients for total cholesterol/HDL cholesterol and triglycerides tended to be weaker for BMIz (0.13–0.20) than for WHtR (0.17–0.28). Among high-fatness students, BMIz and WHtR correlated with blood pressures for Hispanics and whites, but not black boys (systolic) or girls (systolic and diastolic). In 11-12 year olds, assessments by WHtR can provide cardiometabolic risk estimates similar to conventional BMIz without requiring reference to a normative growth chart.