Background: Latin American patients in the United States experience significant health disparities. Community health workers (promotoras de salud) reduce disparities by providing culturally appropriate education. While educational interventions have been studied in atopic dermatitis (AD), a chronic dermatologic condition affecting children, none have evaluated the use of promotoras in Spanish-speaking pediatric patients in the United States. Objective: To create and evaluate a promotora-led education program for Spanishspeaking caregivers of Latin American, pediatric patients with AD through a randomized, controlled, evaluator-blinded study. Methods: Children with moderate/severe AD (n = 48) were recruited from the pediatric dermatology clinic at Children's Health℠ in Dallas, TX and randomized to receive clinic education (n = 26) or clinic education plus promotora home visits (n = 22). The primary outcome was overall adherence to topical emollients over the 12-week study, quantified by MEMSCap™ devices; several secondary endpoints were evaluated. Results: Intention-to-treat analysis revealed a trend toward increased overall adherence to emollients over the 12-week study period in promotora (median [interquartile range, IQR]: 43% [26%-61%]) versus non-promotora (median [IQR]: 20% [11%-49%])

Background Perthes disease most commonly affects children 5 to 7 years old, and nonoperative management, such as weightbearing and activity restrictions, is generally recommended. In earlier research in children aged 8 to 14 years who had Perthes disease, we found that the restrictions were associated with worse mobility, but mental health or social health measures were not linked. However, Perthes disease most commonly affects children 5 to 7 years old who are more emotionally and cognitively immature. Children in this age group are beginning school and organized sports experiences while developing meaningful social relationships for the first time. Because of such different life experiences, it is important to One author (HKWK) holds a patent for an osteonecrosis treatment device. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Introduction: A recent cadaveric study supported that most immature hips are supplied by the artery of ligamentum teres and suggested this medial vascular source may influence the pattern of revascularization in Legg-Calve-Perthes disease (LCPD). The purposes of this study were to characterize the perfusion pattern of the capital femoral epiphysis and determine the role of the artery of ligamentum teres in early revascularization of LCPD. Methods: Retrospective review of perfusion magnetic resonance imaging (pMRI) from 64 hips in early stage LCPD (Waldenström stage I to IIa) was performed. Two independent graders categorized perfusion pattern based on the presence of perfusion medially (from artery of ligamentum teres) and/or laterally (from the medial femoral circumflex artery) on coronal and sagittal MRI series: type 1—lateral perfusion only, type 2—separate medial and lateral perfusion, or type 3—coalescent medial and lateral perfusion. Lateral pillar classification was obtained for hips that reached mid-fragmentation. Results: We identified 64 patients (75% male) with mean age at diagnosis of 8.5±2.1 years. 36% (23/64) hips underwent pMRI during stage I and 64% (41/64) during stage IIa. pMRI revealed separate and distinct medial and lateral sources of perfusion (type 2) in 50% (32/64) hips. In stage I, the distribution of type 1/2/3 hips was found to be 26%/52%/22%. However, in stage IIa there was a nonsignificant trend toward greater coalescence of the medial and lateral perfusion with a distribution of type 1/2/3 of 7%/49%/44% (P=0.07). There was a nonsignificant trend toward weak negative linear correlation between lower initial perfusion grade and worsened lateral pillar classification at mid-fragmentation (r=−0.25, P=0.05). Conclusion: The presence of separate and distinct areas of perfusion of medial and lateral capital femoral epiphysis provides further evidence of the role of the ligamentum teres vessels in revascularization during the early stages of LCPD. The changes in perfusion pattern with disease progression likely reflect that medial femoral circumflex artery and ligamentum teres vessel revascularization occur separately, but ultimately coalesce posteriorly over time. Level of Evidence: Level II—prognostic study.

BackgroundIndividuals with LDL-C ≥190 mg/dL (severe hypercholesterolemia) require treatment with high-intensity statins and should be evaluated for underlying causes including Familial Hypercholesterolemia (FH). The characteristics of patients with LDL-C ≥ 190 mg/dL has been reported in routine healthcare settings, but limited data exist about uninsured populations.ObjectivesTo examine the scope of LDL-C ≥ 190 mg/dL in a clinic serving uninsured populations.MethodsPatients with LDL-C ≥190 mg/dL at North Dallas Shared Ministries, a charity, community clinic in Dallas, TX, were identified via query of the electronic health record, and data was extracted from medical charts. Patients were interviewed to obtain family history and assess knowledge of cholesterol levels.ResultsAmong 662 patients with lipid measurements, 27 had LDL-C ≥ 190 mg/dL (67% female, 78% Hispanic, mean age 52 years). Median pretreatment LDL-C was 210.5 mg/dL. Almost all (93%) were prescribed a statin, but only 33% were prescribed high-intensity statin. Treated LDL-C was 141 mg/dL. No patients had an ICD-10 diagnosis of FH, and only 31% had laboratory tests for secondary causes of hypercholesterolemia. Only 15% had any documentation of family history of hypercholesterolemia and/or ASCVD. After interviewing, we discovered previously undocumented family history of hypercholesterolemia in 54% and ASCVD in 31%.ConclusionsAmong the uninsured with LDL-C ≥ 190 mg/dL in a community clinic, the use of high-intensity statins was suboptimal, and most were not evaluated for causes of severe hypercholesterolemia. Future efforts to address gaps and education are warranted to improve care for severe hypercholesterolemia patients in this vulnerable population.Condensed AbstractFew studies evaluate severe hypercholesterolemia in uninsured populations. We queried the electronic health record at a charity community clinic to characterize individuals with severe hypercholesterolemia. Our results suggest more education is needed for patients and providers regarding severe hypercholesterolemia and FH to better care for this vulnerable population.