Background. Pediatric obesity has become a significant public health concern. Pediatricians are the ideal group to help identify and treat this epidemic, but unfortunately, many pediatricians are not trained to discuss obesity with patients and their families. Standardized training initiatives for pediatric residents on prevention and/or management of obesity are needed to equip emerging pediatricians to combat the obesity epidemic. Objectives. This systematic literature review aims to examine the effectiveness of childhood obesity prevention/counseling resident training interventions. Methods. A comprehensive literature search was performed using preidentified search terms and limited to articles published prior to November 6, 2019. Articles were analyzed by 2 reviewers with a standardized evaluation tool. Results. A total of 698 articles were identified by the search. These were reduced to 111 articles after title review and 11 articles following abstract/full paper review. The 11 articles described 10 different obesity training interventions for residents. The articles varied in their size, length of training session, and study design. Despite these variations, all articles outlined positive outcomes, including an increase in physician confidence, positive changes in behavior, and/or improved electronic medical record documentation. Conclusions. With the continued increase in pediatric obesity, there is a need for practical, easy-to-implement, standardized trainings for pediatric residents on obesity prevention and treatment. More investigation needs to be done to look at long-term results of current interventions as well as other outcomes such as whether physicians are correctly identifying patients who are overweight or obese and whether there is improvement in patient follow-up.
Objective . To evaluate the impact of an obesity didactic session for pediatric physicians on confidence in counseling and identified overweight/obesity and follow-up recommendations. Methods . Pediatric residents underwent training and completed pre/post online surveys evaluating confidence in obesity prevention and identification. A booster training occurred 1 year later. Pre-/post-training scores were compared using χ 2 or Fisher’s exact tests. Electronic medical records data for patients ≥3 years with BMI-for-age percentile ≥85 during 3 months prior/following the training/booster compared frequency of overweight/obesity identification and follow-up recommendations (≤3 months recommended vs longer) using logistic regression adjusting for age and overweight/obese status. Results . Post trainings, improvements in confidence to define/screen for obesity were observed, with a decline between trainings. Overweight/obese identification and follow-up time recommendations improved post-training (identification: 14.2% to 27.4%, adjusted odds ratio [aOR] = 3.16, 95% confidence interval [CI] = 1.54-6.51; follow-up: 48.9% to 58.9%, aOR = 1.63, 95% CI = 1.01-2.64), aOR = 1.77, 95% CI = 1.10-2.85, and identification remained stable/above pre-training rates both pre-/post-booster (25.8%, aOR = 3.14, 95% CI = 1.53-6.45; and 22.1%, aOR = 2.57, 95% CI = 1.25-5.30, respectively). Recommended follow-up time rates continued to rise when measured pre-booster (60.6%, aOR = 1.77, 95% CI = 1.10-2.85), then declined (46.0%, aOR = 0.95, 95% CI = 0.60-1.52). Conclusion . This didactic session improved resident confidence in defining/screening, identification of overweight/obesity and follow-up recommendations; however, rates of identification remained low. The successes of this intervention support similar didactic sessions in residency programs and identifies opportunities for improved resident/attending education.
BackgroundAbout 10% of patients living with the human immunodeficiency virus (HIV) are coinfected with chronic hepatitis B infection (HBV). Individuals with HIV are at increased risk of having HBV progress to chronic infection. Current guidelines recommend at least two active agents against HBV in HIV/HBV coinfected patients one of which must include tenofovir. Due to the increased risk of developing fibrosis and hepatocellular cancer (HCC) in this population, current guidelines recommend yearly evaluation of the liver function with imaging, liver function tests (LFTs), and vaccination against Hepatitis A. In our study, we sought to determine the characteristics of dual-infected patients in our clinic and our management practices in accordance with guidelines.MethodsA retrospective, observational, single-center cohort study in adults coinfected with HIV and chronic HBV from 2013 to 2018 at an urban HIV outpatient practice. Patients with acute hepatitis B infection and isolated hepatitis B core antibody were not included in our study. The study assessed the management practices evaluating appropriate medication for HBV, screening for hepatocellular cancer, and Hepatitis A vaccination.ResultsOf the 3,248 HIV patients seen at our clinic within this period, 128 patients (3.9%) were HBV coinfected. Only active patients (N = 81) were included in the quality improvement analysis. Although 90% of coinfected patients were on appropriate anti-HBV therapy, and 96% had annual LFTs done, only 39.5% had documented hepatitis A vaccination and only a quarter (25.9%) had HCC screening done at the recommended interval.ConclusionLong-term management of HIV/HBV involves preventing and monitoring for liver failure and HCC. Based on our clinic data, our management practices for ensuring that our patients receive imaging for HCC will need to be revised. Disclosures All authors: No reported disclosures.
intervention sites. No improvements were observed in children's BMI. These results indicate that the youth advocacy can contribute toward creating environments that support healthy snacking within rural schools and food stores, which in turn can improve children's snacking behaviors, but that further interventions are needed to change children's BMI.
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