Journal of Pediatric Gastroenterology & Nutrition, 2020
The North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) de... more The North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) developed NASPGHAN Nutrition University (N2U) in 2012 to improve nutrition education for pediatric gastroenterology providers. A total of 543 providers (physicians, registered dietitians, and advanced practice nurses) have applied to N2U and 285 have attended this 2-day course. We used survey methodology to compare attendees to applicants who did not attend. Course attendees reported more confidence than nonattendees in the nutritional management of patients with short bowel syndrome, feeding disorders, and gastrointestinal allergies, even though they were seen at similar frequency in both groups. Eighty-eight percent of attendees disseminated the information they learned at N2U through venues such as grand rounds or guideline/policy development. These results demonstrate the benefit of N2U in enhancing nutrition education for pediatric gastroenterology practitioners.
Introduction: Cecal and ileal intubation rates in pediatric colonoscopy have not been widely stud... more Introduction: Cecal and ileal intubation rates in pediatric colonoscopy have not been widely studied, with available studies demonstrating ileal intubation rates up to 98%, and cecal intubation rates up to 92.5%, with significant variation amongst studies. Audit and feedback has been shown to improve endoscopist performance, including cecal intubation rates in adult colonoscopies. We investigate the effect of audit and feedback on ileal and cecal intubation rates in pediatric colonoscopies over the course of 5 years. Methods: PEDS-CORI and CORI2 (NIH and Due North Innovation, Portland, Oregon) was used to identify all colonoscopies taking place between 2012 and 2017 at three campuses of a large children's hospital. Flexible sigmoidoscopies were excluded from the study. Endoscopists who performed fewer than 3 colonoscopies a year were excluded. Cases where ileal or cecal intubation was not intended were excluded from the final calculation of ileal and cecal intubation rates. Cases with limiting anatomy (ie, Crohn's stricture) were not excluded from the overall denominator. Results: A total of 3331 colonoscopies were reviewed for ileal and cecal intubation rates. A personalized progress report detailing procedural outcomes, including the ileal and cecal intubation rates, was e-mailed regularly to each attending physician in the department starting in 2012. The overall group cecal intubation rate increased from 90.3% to 94.3% (p Z 0.02) and the overall group ileal intubation rate increased from 85.9% to 91.2% (p Z 0.015) from 2012 to 2013 (Table 1). The overall ileal and cecal intubation rates remained significantly higher than 2012 in the majority of the years following (Table 1). Individual rates had greater variance, with an overall trend in improvement in ileal and cecal intubation rates. The rates of adequate documentation for early termination of procedures improved during the duration of the study, from 61% of cases in 2012 without adequate documentation for reason for early termination of procedure to 23% in 2017 (p < 0.0001). Conclusion: The overall group ileal and cecal intubation rates increased after initiating regular audit and feedback in the form of personalized e-mailed reports. As cases with limiting anatomy were included, overall ileal and cecal intubation rates may have been influenced by severity of disease, and may not be reflective of a true targeted ileal or cecal intubation rate. The overall rates of adequate documentation also improved in this time period. This suggests that audit and feedback can be useful in pediatric endoscopy as a way to improve quality indicators, specifically ileal and cecal intubation rates.
Journal of Pediatric Gastroenterology and Nutrition, 2016
embodies the spirit of the NASPGHAN Distinguished Service award. She has worked tirelessly to imp... more embodies the spirit of the NASPGHAN Distinguished Service award. She has worked tirelessly to improve the lives of the children and built a distinguished career within the realm of pediatric gastroenterology and nutrition. She completed her undergraduate education in biology at Seton Hill University followed by a Doctorate of Medicine at the Medical College of
[Author Affiliation]Ann O. Scheimann. 1 Division of Pediatric Gastroenterology, Hepatology and Nu... more [Author Affiliation]Ann O. Scheimann. 1 Division of Pediatric Gastroenterology, Hepatology and Nutrition, Johns Hopkins School of Medicine, Baltimore, MD.Stephanie H. Abrams. 2 Children's Gastroenterology, Miller Children's Hospital, Long Beach, CA.Address correspondence to: Ann O. Scheimann, MD, MBA, Division of Pediatric Gastroenterology and Nutrition, Johns Hospital School of Medicine, 600 North Wolfe Street, CMSC 2-116, Baltimore MD 21287-2631, E-mail: [email protected] the Editor:We read with interest the recent pediatric weight management guidelines published by Estrada and colleagues from the Focus for a Fitter Future Working Group of National Association of Children's Hospitals and Related Institutions (NACHRI).1 While applauding the efforts of the authors for the document generated with the goal to provide guidance to practitioners regarding management of weight-related comorbidities, we were somewhat disappointed regarding recommendations provided for evaluation and treatment of nonalcoholic fatty liver disease (NAFLD) and minimal detail provided regarding sleep apnea.The diagnosis of NAFLD is a diagnosis of exclusion requiring exclusion of other causes of liver disease, including medication-induced liver disease. Use of "worsening" aminotransferases as an indicator for further evaluation can be problematic. The authors cited the recent publication by Schwimmer and colleagues regarding elevation of lab normal ranges without mentioning the recommended normative cut-off ranges proposed by the publication of 22.1 for girls and 25.8 for boys,2 proposing screening cut-off ranges for further evaluation per Figure 5 of alanine aminotransferase (ALT) 2-3 times the upper range of normal (in the 40 to 60 range). A recent publication by Molleston and colleagues of children enrolled in the The Nonalcoholic Steatohepatitis Research Network (NASH CRN) study showed the pitfalls of use of normal ALT (3 Additionally, a more recent publication by Schwimmer and colleagues4,5 reported that ALT 2 times the clinical upper limit of normal (ULN) had a sensitivity of 57% and specificity of 71% for NAFLD, demonstrating the limitation of these recommendations' threshold for ALT as a screening tool. Further, it was determined that 21% of children identified by pediatricians as having suspected NAFLD by screening did not have liver disease. Of those who were referred by pediatricians as having suspected NAFLD who actually had liver disease identified, 22% had a liver disease other than NAFLD (most commonly, autoimmune hepatitis).5For patients warranting further screening for causes of aminotransferase elevation and screening for causes of underlying liver disease, an extensive workup is proposed to screen for infectious, metabolic, and autoimmune liver disease without mention of checking a serum albumin to assess for synthetic function or exclusion of nonhepatic causes of aminotransferase elevation from muscle sources (creatine kinase) given that elevation in aminotransferases can be observed in children with underlying muscular dystrophy.4,6 While the recommendation by the authors is to rule out other forms of liver disease with worsening liver enzyme values, we would suggest that the literature supports ruling out other forms of liver disease, even if the value is stable at an ALT level of 1.5 times the ULN, if it has been elevated for >6 months.4 The treatment paradigm should include weight management as discussed, in addition to prevention of acquisition of other causes of liver disease/hepatic impairment. …
Acute pancreatitis is one of the leading causes of rising pediatric hospitalizations in North Ame... more Acute pancreatitis is one of the leading causes of rising pediatric hospitalizations in North America. The aim of this study was to assess the role of nutritional status and racial influences on the severity of acute pancreatitis in children. The institutional review board approved this retrospective chart review of children with the diagnosis of acute pancreatitis between the ages of 0 and 18 years hospitalized at the Johns Hopkins Hospital between 1998 and 2008. Parameters studied included biochemical markers associated with pancreatitis, review of severity of illness reflected through the length of stay, and pediatric intensive care unit admission. The length of in-patient hospitalization was longer for children with imaging findings of pseudocyst or pancreatic necrosis (23.1 ± 26.4 days vs 4.4 ± 10.6 days; P = 0.0074) and malnourished children versus normal weight and obese children (16.5 days for malnourished vs 10.6 days for normal weight vs 10.7 days for obese; P = 0.04). There was also a significant difference in the need for pediatric intensive care unit admission across ethnic groups (18% African American vs 7% white) (P = 0.04). Ethnicity and nutritional status may influence the severity and duration of hospitalization among children with pancreatitis.
The prevalence of obesity and obesity related comorbidities including diabetes and nonalcoholic f... more The prevalence of obesity and obesity related comorbidities including diabetes and nonalcoholic fatty liver disease (NAFLD) has been rising globally. Nonalcoholic fatty liver disease is emerging as a common liver disease among adults which can lead to the eventual development of complications including cirrhosis and hepatocellular carcinoma. With the rise of obesity in children, the development of detection methods for the presence of NAFLD is becoming imperative. Although the gold standard for diagnosis is liver biopsy, practical issues limit pediatric use and warrant development of noninvasive or minimally invasive screening tools for the detection and staging of NAFLD. A variety of diagnostic methods have been studied including use aminotransferases, imaging studies and serologic markers which have some population-based limitations. Additional factors such as gender and ethnicity may also play a role in the screening of NAFLD in pediatric population studies.
Standard weight-for-age and height-for-age charts have been used for many years to assess growth ... more Standard weight-for-age and height-for-age charts have been used for many years to assess growth and body compositions of children, including curves specific to the Prader-Willi syndrome (PWS). However, a number of direct measures of body compositions have been developed in recent years. Dural-energy x-ray absorptiometry (DXA) provides a measure of bone mineral content and bone mineral density for the whole body and at specific bone regions (spine, hip, forearm). This technology now has been extended to include assessment of the body's lean tissue mass and body fat mass. An alternate technique, called bioelectrical impedance analysis (BIA), has gained wide use in recent years as an indirect measure of the fat-free mass. The older, underwater weighing method is giving way to the air-displacement plethysmographic technique for assessing body fatness. Total body potassium still remains the method of choice for a direct assessment of body cell mass, and body nitrogen is recognized as the best assay for body protein mass. Imaging techniques, such as a computer tomography and magnetic resonance imaging, continue to receive increasing attention for body composition assays, especially for the subcutaneous vs. visceral distribution of body fat. Although total body water and extracellular water can be measured by dilution techniques, these methods are slowly being replaced by the BIA assay. When these various techniques are used in combination, the patient's nutritional status can be obtained based on a comprehensive 5-level multicompartment model of the body composition. Each of these methods will be reviewed, and their specific strengths and limitations presented, relative to their application for assessing changes in body composition of the PWS patient.▪ The Endocrinologist 2000; 10: 57S-62S
... Switch in Adolescents Ann O. Scheimann &amp; Merlin G. Butler &amp; Jennifer L. Mille... more ... Switch in Adolescents Ann O. Scheimann &amp; Merlin G. Butler &amp; Jennifer L. Miller &amp; Phillip DK Lee &amp; David A. Stevenson &amp; Janalee Heinemann &amp; Daniel J. Driscoll ... J Pediatr Orthop. 2006;26:673–9. 5. Hoybye C, Hilding A, Jacobsson H, et al. ...
Journal of the American Dietetic Association, 2008
Learning Outcome: Participants will learn about a family-centered approach to making changes in n... more Learning Outcome: Participants will learn about a family-centered approach to making changes in nutrition and exercise habits. Text: Community-based health programs that result in true lifestyle changes are needed to combat the increasing rate of childhood obesity. There is growing recognition of the importance of health interventions that actively involve both children and their parents. The "Discovering Healthy Families" (DHF) program is a family-focused program operated through a children's museum. DHF was structured around the assumption that a healthy family is a project of discovery, and the key element to improving lifestyle habits is the family unit The aim of DHF was to empower families to improve their eating and exercise habits. Participants included 33 families who were recruited from the membership of the Discovery Center at Murfree Spring. The four-month program included monthly special events. During these events, families received health coaching from senior-level and graduate nutrition and food science students. They also participated in educational activities and sampled foods in the demonstration kitchen. In between monthly events families received weekly coaching from their health coaches. At the beginning and end of the program, parents completed attitudinal and behavioral measures of family eating and physical activity habits. Families were very positive regarding their participation in the DHF program. Parents indicated that the program was beneficial; that the special events were worthwhile; that their eating habits and physical activity levels improved; and that they were satisfied with the coaching provided to them (all ps Ͻ .01). Based on the promising results of this pilot program, plans are underway for implementing the next DHF program.
Journal of Pediatric Gastroenterology and Nutrition, 2004
FIG. 1. Extensive hemorrhage and necrosis of the resected intestine (stain, hematoxylin and eosin... more FIG. 1. Extensive hemorrhage and necrosis of the resected intestine (stain, hematoxylin and eosin; original magnification, ×40).
Childhood obesity represents a significant challenge for paediatric healthcare delivery. As obesi... more Childhood obesity represents a significant challenge for paediatric healthcare delivery. As obesity rates increase, obese children and adolescents are at significant risk for the development of a myriad of medical and surgical problems as well as mental health problems. Moreover, children with mental health problems are increasingly presenting to their psychiatrists with obesity. Treatment of paediatric obesity requires a multidisciplinary approach with incorporation of the family into the treatment plan although still typically only offering suboptimal results. Paediatric providers from all disciplines should focus efforts primarily on obesity prevention and encouragement of healthy lifestyles, while incorporating treatment for obesity when such efforts fail. The goals of this article are to provide an overview of the epidemiology, pathophysiology, genetics, clinical features and treatment strategies for paediatric obesity.
Endoscopic balloon dilatation (EBD) is a recent addition to the options available for stricture t... more Endoscopic balloon dilatation (EBD) is a recent addition to the options available for stricture therapy. EBD offers direct stricture visualization unlike bougienage and fluoroscopically-guided balloon dilatation. Our approach involves identifying the stricture length and location and placing an age-aP~opriate size balloon dilator (Microvasive; Watertown, MA) within the stricture lumen followed by incremental balloon inflation until adequate dilation is achieved. Our results:
Journal of Pediatric Gastroenterology & Nutrition, 2020
The North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) de... more The North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) developed NASPGHAN Nutrition University (N2U) in 2012 to improve nutrition education for pediatric gastroenterology providers. A total of 543 providers (physicians, registered dietitians, and advanced practice nurses) have applied to N2U and 285 have attended this 2-day course. We used survey methodology to compare attendees to applicants who did not attend. Course attendees reported more confidence than nonattendees in the nutritional management of patients with short bowel syndrome, feeding disorders, and gastrointestinal allergies, even though they were seen at similar frequency in both groups. Eighty-eight percent of attendees disseminated the information they learned at N2U through venues such as grand rounds or guideline/policy development. These results demonstrate the benefit of N2U in enhancing nutrition education for pediatric gastroenterology practitioners.
Introduction: Cecal and ileal intubation rates in pediatric colonoscopy have not been widely stud... more Introduction: Cecal and ileal intubation rates in pediatric colonoscopy have not been widely studied, with available studies demonstrating ileal intubation rates up to 98%, and cecal intubation rates up to 92.5%, with significant variation amongst studies. Audit and feedback has been shown to improve endoscopist performance, including cecal intubation rates in adult colonoscopies. We investigate the effect of audit and feedback on ileal and cecal intubation rates in pediatric colonoscopies over the course of 5 years. Methods: PEDS-CORI and CORI2 (NIH and Due North Innovation, Portland, Oregon) was used to identify all colonoscopies taking place between 2012 and 2017 at three campuses of a large children's hospital. Flexible sigmoidoscopies were excluded from the study. Endoscopists who performed fewer than 3 colonoscopies a year were excluded. Cases where ileal or cecal intubation was not intended were excluded from the final calculation of ileal and cecal intubation rates. Cases with limiting anatomy (ie, Crohn's stricture) were not excluded from the overall denominator. Results: A total of 3331 colonoscopies were reviewed for ileal and cecal intubation rates. A personalized progress report detailing procedural outcomes, including the ileal and cecal intubation rates, was e-mailed regularly to each attending physician in the department starting in 2012. The overall group cecal intubation rate increased from 90.3% to 94.3% (p Z 0.02) and the overall group ileal intubation rate increased from 85.9% to 91.2% (p Z 0.015) from 2012 to 2013 (Table 1). The overall ileal and cecal intubation rates remained significantly higher than 2012 in the majority of the years following (Table 1). Individual rates had greater variance, with an overall trend in improvement in ileal and cecal intubation rates. The rates of adequate documentation for early termination of procedures improved during the duration of the study, from 61% of cases in 2012 without adequate documentation for reason for early termination of procedure to 23% in 2017 (p < 0.0001). Conclusion: The overall group ileal and cecal intubation rates increased after initiating regular audit and feedback in the form of personalized e-mailed reports. As cases with limiting anatomy were included, overall ileal and cecal intubation rates may have been influenced by severity of disease, and may not be reflective of a true targeted ileal or cecal intubation rate. The overall rates of adequate documentation also improved in this time period. This suggests that audit and feedback can be useful in pediatric endoscopy as a way to improve quality indicators, specifically ileal and cecal intubation rates.
Journal of Pediatric Gastroenterology and Nutrition, 2016
embodies the spirit of the NASPGHAN Distinguished Service award. She has worked tirelessly to imp... more embodies the spirit of the NASPGHAN Distinguished Service award. She has worked tirelessly to improve the lives of the children and built a distinguished career within the realm of pediatric gastroenterology and nutrition. She completed her undergraduate education in biology at Seton Hill University followed by a Doctorate of Medicine at the Medical College of
[Author Affiliation]Ann O. Scheimann. 1 Division of Pediatric Gastroenterology, Hepatology and Nu... more [Author Affiliation]Ann O. Scheimann. 1 Division of Pediatric Gastroenterology, Hepatology and Nutrition, Johns Hopkins School of Medicine, Baltimore, MD.Stephanie H. Abrams. 2 Children's Gastroenterology, Miller Children's Hospital, Long Beach, CA.Address correspondence to: Ann O. Scheimann, MD, MBA, Division of Pediatric Gastroenterology and Nutrition, Johns Hospital School of Medicine, 600 North Wolfe Street, CMSC 2-116, Baltimore MD 21287-2631, E-mail: [email protected] the Editor:We read with interest the recent pediatric weight management guidelines published by Estrada and colleagues from the Focus for a Fitter Future Working Group of National Association of Children's Hospitals and Related Institutions (NACHRI).1 While applauding the efforts of the authors for the document generated with the goal to provide guidance to practitioners regarding management of weight-related comorbidities, we were somewhat disappointed regarding recommendations provided for evaluation and treatment of nonalcoholic fatty liver disease (NAFLD) and minimal detail provided regarding sleep apnea.The diagnosis of NAFLD is a diagnosis of exclusion requiring exclusion of other causes of liver disease, including medication-induced liver disease. Use of "worsening" aminotransferases as an indicator for further evaluation can be problematic. The authors cited the recent publication by Schwimmer and colleagues regarding elevation of lab normal ranges without mentioning the recommended normative cut-off ranges proposed by the publication of 22.1 for girls and 25.8 for boys,2 proposing screening cut-off ranges for further evaluation per Figure 5 of alanine aminotransferase (ALT) 2-3 times the upper range of normal (in the 40 to 60 range). A recent publication by Molleston and colleagues of children enrolled in the The Nonalcoholic Steatohepatitis Research Network (NASH CRN) study showed the pitfalls of use of normal ALT (3 Additionally, a more recent publication by Schwimmer and colleagues4,5 reported that ALT 2 times the clinical upper limit of normal (ULN) had a sensitivity of 57% and specificity of 71% for NAFLD, demonstrating the limitation of these recommendations' threshold for ALT as a screening tool. Further, it was determined that 21% of children identified by pediatricians as having suspected NAFLD by screening did not have liver disease. Of those who were referred by pediatricians as having suspected NAFLD who actually had liver disease identified, 22% had a liver disease other than NAFLD (most commonly, autoimmune hepatitis).5For patients warranting further screening for causes of aminotransferase elevation and screening for causes of underlying liver disease, an extensive workup is proposed to screen for infectious, metabolic, and autoimmune liver disease without mention of checking a serum albumin to assess for synthetic function or exclusion of nonhepatic causes of aminotransferase elevation from muscle sources (creatine kinase) given that elevation in aminotransferases can be observed in children with underlying muscular dystrophy.4,6 While the recommendation by the authors is to rule out other forms of liver disease with worsening liver enzyme values, we would suggest that the literature supports ruling out other forms of liver disease, even if the value is stable at an ALT level of 1.5 times the ULN, if it has been elevated for >6 months.4 The treatment paradigm should include weight management as discussed, in addition to prevention of acquisition of other causes of liver disease/hepatic impairment. …
Acute pancreatitis is one of the leading causes of rising pediatric hospitalizations in North Ame... more Acute pancreatitis is one of the leading causes of rising pediatric hospitalizations in North America. The aim of this study was to assess the role of nutritional status and racial influences on the severity of acute pancreatitis in children. The institutional review board approved this retrospective chart review of children with the diagnosis of acute pancreatitis between the ages of 0 and 18 years hospitalized at the Johns Hopkins Hospital between 1998 and 2008. Parameters studied included biochemical markers associated with pancreatitis, review of severity of illness reflected through the length of stay, and pediatric intensive care unit admission. The length of in-patient hospitalization was longer for children with imaging findings of pseudocyst or pancreatic necrosis (23.1 ± 26.4 days vs 4.4 ± 10.6 days; P = 0.0074) and malnourished children versus normal weight and obese children (16.5 days for malnourished vs 10.6 days for normal weight vs 10.7 days for obese; P = 0.04). There was also a significant difference in the need for pediatric intensive care unit admission across ethnic groups (18% African American vs 7% white) (P = 0.04). Ethnicity and nutritional status may influence the severity and duration of hospitalization among children with pancreatitis.
The prevalence of obesity and obesity related comorbidities including diabetes and nonalcoholic f... more The prevalence of obesity and obesity related comorbidities including diabetes and nonalcoholic fatty liver disease (NAFLD) has been rising globally. Nonalcoholic fatty liver disease is emerging as a common liver disease among adults which can lead to the eventual development of complications including cirrhosis and hepatocellular carcinoma. With the rise of obesity in children, the development of detection methods for the presence of NAFLD is becoming imperative. Although the gold standard for diagnosis is liver biopsy, practical issues limit pediatric use and warrant development of noninvasive or minimally invasive screening tools for the detection and staging of NAFLD. A variety of diagnostic methods have been studied including use aminotransferases, imaging studies and serologic markers which have some population-based limitations. Additional factors such as gender and ethnicity may also play a role in the screening of NAFLD in pediatric population studies.
Standard weight-for-age and height-for-age charts have been used for many years to assess growth ... more Standard weight-for-age and height-for-age charts have been used for many years to assess growth and body compositions of children, including curves specific to the Prader-Willi syndrome (PWS). However, a number of direct measures of body compositions have been developed in recent years. Dural-energy x-ray absorptiometry (DXA) provides a measure of bone mineral content and bone mineral density for the whole body and at specific bone regions (spine, hip, forearm). This technology now has been extended to include assessment of the body's lean tissue mass and body fat mass. An alternate technique, called bioelectrical impedance analysis (BIA), has gained wide use in recent years as an indirect measure of the fat-free mass. The older, underwater weighing method is giving way to the air-displacement plethysmographic technique for assessing body fatness. Total body potassium still remains the method of choice for a direct assessment of body cell mass, and body nitrogen is recognized as the best assay for body protein mass. Imaging techniques, such as a computer tomography and magnetic resonance imaging, continue to receive increasing attention for body composition assays, especially for the subcutaneous vs. visceral distribution of body fat. Although total body water and extracellular water can be measured by dilution techniques, these methods are slowly being replaced by the BIA assay. When these various techniques are used in combination, the patient's nutritional status can be obtained based on a comprehensive 5-level multicompartment model of the body composition. Each of these methods will be reviewed, and their specific strengths and limitations presented, relative to their application for assessing changes in body composition of the PWS patient.▪ The Endocrinologist 2000; 10: 57S-62S
... Switch in Adolescents Ann O. Scheimann &amp; Merlin G. Butler &amp; Jennifer L. Mille... more ... Switch in Adolescents Ann O. Scheimann &amp; Merlin G. Butler &amp; Jennifer L. Miller &amp; Phillip DK Lee &amp; David A. Stevenson &amp; Janalee Heinemann &amp; Daniel J. Driscoll ... J Pediatr Orthop. 2006;26:673–9. 5. Hoybye C, Hilding A, Jacobsson H, et al. ...
Journal of the American Dietetic Association, 2008
Learning Outcome: Participants will learn about a family-centered approach to making changes in n... more Learning Outcome: Participants will learn about a family-centered approach to making changes in nutrition and exercise habits. Text: Community-based health programs that result in true lifestyle changes are needed to combat the increasing rate of childhood obesity. There is growing recognition of the importance of health interventions that actively involve both children and their parents. The "Discovering Healthy Families" (DHF) program is a family-focused program operated through a children's museum. DHF was structured around the assumption that a healthy family is a project of discovery, and the key element to improving lifestyle habits is the family unit The aim of DHF was to empower families to improve their eating and exercise habits. Participants included 33 families who were recruited from the membership of the Discovery Center at Murfree Spring. The four-month program included monthly special events. During these events, families received health coaching from senior-level and graduate nutrition and food science students. They also participated in educational activities and sampled foods in the demonstration kitchen. In between monthly events families received weekly coaching from their health coaches. At the beginning and end of the program, parents completed attitudinal and behavioral measures of family eating and physical activity habits. Families were very positive regarding their participation in the DHF program. Parents indicated that the program was beneficial; that the special events were worthwhile; that their eating habits and physical activity levels improved; and that they were satisfied with the coaching provided to them (all ps Ͻ .01). Based on the promising results of this pilot program, plans are underway for implementing the next DHF program.
Journal of Pediatric Gastroenterology and Nutrition, 2004
FIG. 1. Extensive hemorrhage and necrosis of the resected intestine (stain, hematoxylin and eosin... more FIG. 1. Extensive hemorrhage and necrosis of the resected intestine (stain, hematoxylin and eosin; original magnification, ×40).
Childhood obesity represents a significant challenge for paediatric healthcare delivery. As obesi... more Childhood obesity represents a significant challenge for paediatric healthcare delivery. As obesity rates increase, obese children and adolescents are at significant risk for the development of a myriad of medical and surgical problems as well as mental health problems. Moreover, children with mental health problems are increasingly presenting to their psychiatrists with obesity. Treatment of paediatric obesity requires a multidisciplinary approach with incorporation of the family into the treatment plan although still typically only offering suboptimal results. Paediatric providers from all disciplines should focus efforts primarily on obesity prevention and encouragement of healthy lifestyles, while incorporating treatment for obesity when such efforts fail. The goals of this article are to provide an overview of the epidemiology, pathophysiology, genetics, clinical features and treatment strategies for paediatric obesity.
Endoscopic balloon dilatation (EBD) is a recent addition to the options available for stricture t... more Endoscopic balloon dilatation (EBD) is a recent addition to the options available for stricture therapy. EBD offers direct stricture visualization unlike bougienage and fluoroscopically-guided balloon dilatation. Our approach involves identifying the stricture length and location and placing an age-aP~opriate size balloon dilator (Microvasive; Watertown, MA) within the stricture lumen followed by incremental balloon inflation until adequate dilation is achieved. Our results:
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