Primary_Secondary_Tertiary

Running Head: Childhood Obesity Childhood Obesity: Primary, Secondary, and Tertiary Health Promotion Dawn McGaffick Grand Canyon University: NRS 429 March 6, 2011 Childhood Obesity: Primary, Secondary, and Tertiary Health Promotion In today’s healthcare environment, patients are waiting to receive care until it becomes life-altering, causing higher degrees of illness. Currently, there is a huge push to encourage people to receive healthcare earlier so serious problems can be caught or avoided all together. Health promotion is the way people can help prevent illnesses such as hypertension, diabetes, cardiac problems, and obesity. Health promotion is a way to “Find the cause or source of the problem, identify risk factors, and then determine occurrence rates” (Williams, 2008). There are three levels of health promotion. Starting with primary health promotion; helping educate patients and their families to understand and know the risk factors of the diseases. Primary health promotion is found in primary care clinics. Secondary health promotion is detecting the disease early in the progression. Early detection gives healthcare workers the ability to teach the patient and families ways to prevent the illness from getting worse. The final level of health promotion is tertiary prevention. During this time, nurses need to educate families on how to take care of the person with the disease. During this level of promotion the nurse needs to help families cope with the results of the disease and its progression. Obesity is one of the areas that healthcare workers can see the progression throughout the different tiers of health promotion. Obesity not only affects the United States but is a world-wide epidemic. Melnyk, Small, & Moore state in their article that nearly 22,000,000 children under the age of five are overweight worldwide. (2008). Early detection is the key in helping to prevent this disease from progressing to death. Finding out the predisposing factors that cause a person to be prone to obesity is the first place healthcare should look. The article written by Dolinsky, Siega-Riz, Perrin, and Armstrong goes back to pregnancy as a starting point to prevent obesity. The article talks about a proper weight gain during pregnancy, risk factors of the mother, such as diabetes, maternal obesity, and maternal stress as impacting the predisposition of infants to obesity (2011). Infants with a high birth weight also have a greater chance of obesity. The article also looks at breast fed infants along with bottle fed infants. Bottle fed infants have a higher risk of becoming obese children. Other determinants of children becoming obese listed in the article include, overfeeding or underfeeding children, amount of sleep, watching television, and childcare environment (2011). Primary care personnel need to monitor growth of infants at well-baby care visits, “The rate of weight gain in the first six months of life can predict the development of overweight by age four years” (Dolinsky, Siega-Riz, Perrin, & Armstrong, 2011, p. 38). Healthcare settings need to set up ways to screen adolescents to determine if they are headed down the road of childhood obesity. Nurses come into contact with children many times throughout their practice. It is their responsibility to help families understand the consequences of obesity. Many adults do not see childhood obesity as a health risk. They feel that their children will grow out of it. Childhood obesity is a pathway for many other health risk factors. Obese children are at a higher risk for cardiovascular disease, hypertension, type 2 diabetes, and psychosocial difficulties, such as depression, and low self esteem. Using screening tools will help to determine children at risk, “School nurses in collaboration with a multidisciplinary team, are involved in screening programmes and support for children who are underweight or at risk of being overweight or obese” (Lazarou & Kouta, 2010, p. 645). Using a growth chart at well care visits can help determine children who have a high risk of obesity. If a child consistently presents at the well care visits weighing in at the 95% or greater is at a higher risk for obesity. Using body mass index (BMI) will also determine children at risk. Screening is important, but finding what the needs of the family and their cultural beliefs are will go a long way in preventing childhood obesity. Lazarou & Kouta address meeting families where their needs are in a holistic manner by working with a team of multidisciplinary personnel. Giving families resources on how to provide healthy lunches for children in schools, providing help with psychosocial issues, and cultural beliefs and influences can help to reduce obesity (2010). What happens when children present to the clinics with secondary problems resulting from obesity. Hopefully with increased knowledge we will be able to avoid the need for treatment of obesity, but for now it’s important to know treatment methods. Many research studies have been done to determine the affects of treatment methods, but many of the studies have not been effective in seeing long term how successful they are. Melnyk, Small, & Moore discuss key factors that are included in causing childhood obesity. These factors include sedentary behaviors, with a decrease in sedentary activities and dietary intake. It is also known that genetics as well as family, environment, and community also play a role in childhood obesity (2008). The article discusses interventions that include healthy eating, increasing activity, and behavioral modification which will decrease obesity. Melnyk, Small, & Moore also remind healthcare personnel that there is a need to be culturally sensitive to the families (2008). When looking at teens, you must also consider the psychosocial aspects of their beings. Many obese teens will suffer from depression and anxiety. Treating them for this may also help to treat obesity. Early detection is the key to preventing childhood obesity. Nurses must use tools they have to determine children at risk. Whether they use screening tools or encouraging healthy behaviors with diet and activity, nurses must have a plan to treat obesity. It is vital that we include families in the interventions used to fight childhood obesity. By working with families and schools to encourage healthy behavior and eating, we will be able to fight childhood obesity. References Dolinsky, D., Siega-Riz, A.M., Perrin, E., Armstrong, S.C. (2011). Recognizing and preventing childhood obesity. Contemporary Pediatrics, 32-42. Retrieved February 25, 2011 from EBSCOhost. Lazarou, C., Kouta, C. (2010). The role of nurses in the prevention and management of obesity. British Journal of Nursing, 19(10), 641-647. Retrieved February 25, 2011 from EBSCOhost. Melnyk, B.M., Small, L., Moore, N. (2008). The worldwide epidemic of child and adolescent overweight and obesity: Calling all clinicians and researchers to intensify efforts in prevention and treatment. Worldviews on Evidence-Based Nursing, Third quarter, 109- 112. Retrieved February 25, 2011 from EBSCOhost. Williams, H. (2008). Primary prevention in health promotion. Pulse. Retrieved February 26, 2011 from http://findarticles.com/p/articles/mi_6876/is_2_45/ai_n28548304/ RECOGNIZING AND PREVENTING CHILDHOOD OBESITY Challenging pediatricians with averting this epidemic even in their littlest patients DIANA H DOLiNSKY, MD; ANNA MARIA SIEGA-RIZ, PHD, RD; ELIANA PERRIN, MD, MPH; SARAH C ARMSTRONG, MD Childhood obesity is one of the most challenging problems facing pediatricians today. Approximately 10% of children younger than 2 years old and 21% of children between 2 and 5 years of age are overweight.' However, there are disparities in the prevalence of childhood obesity. For example, non-Hispanic black and Hispanic preschool-aged children have a higher prevalence of obesity than non-Hispanic white children; in older children, socioeconomic disparities also exist.^-^ Young children with excess weight have an increased risk for obesity in the future."* Unfortunately, few effective treatments exist for children who already are overweight. Therefore, prevention of obesity is paramount. How early should prevention begin' Experts have suggested that gestation to early infancy is a critical period in which physiologic changes occur that greatly influence a child's later risk for obesity.^ Will recognizing the early signs and red flags associated with the development of obesity lead to a change in the growth trajectory and long-term health of the next generation' Normal growth patterns in infants and toddlers The 2000 Centers for Disease Control and Prevention (CDC) growth curves for children aged birth to 20 years have been used by clinicians throughout the United States to guide them in defining children at risk of undernutrition and overnutrition. The data is based on several sources: birth data from vital statistics files in Missouri and Wisconsin; data for 0- to 5-month-old children from the Pédiatrie Nutrition Surveillance System (PedNSS, a sample from predominantly low-income families); and data for children 2 to 3 months old and older collected from the National Health and Nutrition Examination Surveys (NHANES) from 1963 through 1994.'' The CDC body mass index (BMI [weight in DR DOLINSK"V is the Snyderman Foundation Fellow in Childhood Obesity Prevention and Personalized Medicine, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina. is associate dean of academic affairs and professor of epidemiology and nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. • is associate professor of pediatrics, Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, at the University of North Carolina at Chapel Hill. is assistant professor and director of the Healthy Lifestyles Program, Department of Pediatrics, Duke University iVIedical Center. The authors have nothing to disclose regarding affiliation with, or financial interests in, any organization that may have an interest in any part of this article. 32 CONTEMPORARY PEDIATRICS JANUARY 2011 kilograms/height in meters squared]) growth curves help providers to identify obesity and overweight in children aged 2 years and older. However, the CDC does not have a BMI growth curve for children aged 0 to 2 years. In 2007, as a surrogate for BMI in this age group, an expert committee comprised of representatives from 15 professional organizations recommended the use of weight-for-height growth curves to define overweight as those children who exceed the 95th percentile.^ However, a definition for obesity in children under 2 years old still does not exist. On September 10, 2010, the CDC released a recommendation that all US medical providers use the World Health Organization (WHO) growth curves for children aged 0 to 24 months."'' The reasons for this recommendation are compelling. Although the CDC growth curves are a growth reference, describing how a particular group of children grew at a certain time, the WHO curves represent a growth standard, describing how healthy children grow in optimal conditions." In the CDC sample, the rates of breastfeeding initiation, exclusivity, and duration are variable but overall very low.'" For example, in NHANES III (1988-1994), which is a component of the CDC growth curves, 45% of children were never breastfed, and only 21% of children were breastfed for at least 4 months." In contrast, WHO growth standards use a sample of infants who were breastfed for 12 months and predominantly breastfed for at least 4 months. Since growth patterns differ between breastfed and formula-fed infants, the WHO growth curves show a faster weight gain in the first few months of life than the CDC growth curves; by about 3 months, this pattern reverses. In addition, the new CDC recommendations suggest the 2nd and 98th percentiles on the growth charts as the cutoffs for eoneerns of unhealthy growth." As elinieians begin to use the WHO charts, they will see that fewer young children will be classified as underweight. Likely, clinicians will note that a slowed weight gain between 3 and 18 months among breastfed infants is normal, and they will be more likely to reassure parents that supplementation or a switch to formula feeding is unnecessary. In addition, it is anticipated that clinicians will more easily identify formula-fed infants who are gaining weight too rapidly, because these children will more likely be crossing growth percentiles in an upward direction. CONTINUED ON PAGE 37 C o n t e m p o r a r y P e d i a t r i c s . c om JANUARY 2011 CO NTEM PO R AR Y PEDÍ ATRICS 33 in Study 494-01 had an afebrilc seizure 6 days after tfie first dose, one participant in Study 494-01 had a possible seizure the same day as the third dose, and two participants in Study 5A9908 had a febnie seizure 2 and 4 days, respectively, after the fourth dose Among the four participants who experienced a seizure within 7 days following Control vaccines, one participant had an afebnie seizure the same day as the first dose of DAPTACEL t iPOL * ActHIB vaccines, one participant had an afebrile seizure the same day as the second dose of HCPDT + POLIOVAX + ActHIB vaccrnes, and two participants had a febnie seizure 6 and 7 days, respectively, after the fourth dose of HCPDT + POIIOVAX • ActHIB vaccines Sertous AdvHH Events In Study P3T06, within 30 days following any of Doses 1 -3 of Pentacel or Control vaccines, 19 of 484 (3 9%) participants who received Pentacel vaccine and 50 of 1,455 (3.4%) participants who received DAPTACEL t IPOl + ActHIB vaccines experienced a senous adverse event Within 30 days following Dose 4 of Pentacel or Control vaccines, 5 of 431 (1.2%) participants who received Pentacei vaccine and 4 of 418 (1.0%) participants who received DAPTACEL + ActHIB vaccines experienced a serious adverse event. In Study 494-01 within 30 days following any of Doses 1-3 of Pentacel or Control vaccines, 23 of 2,506 (0.9%) participants who received Pentacel vaccine and 11 of 1,032 (11%) participants who received HCPDT » POLIOVAX -• ActHIB vaccines expenenced a serious adverse event Within 30 days following Dose 4 of Pentacel or Control vaccines, 6 of 1,862 (0 3%) participants who received Pentacel vaccine and 2 of 739 (0.3%) participants who received HCPDT t POLIOVAX -f ActHIB vaccines experienced a serious adverse event. Across Studies 494-01, 494-03 and P3T06, within 30 days following any of Doses 1-3 of Pentacel or Control vaccines, overall, the most frequently reported serious adverse events were bronchiolitis, dehydration, pneumonia and gastroenteritis Across Studies 494-01, 494-03, 5A9908 and P3T06, within 30 days following Dose 4 of Pentacel or Control vaccines, overall, the most frequently reported serious adverse events were dehydration, gastroenteritis, asthma, and pneumonia. Across Studies 494-01, 494-03, 5A9908 and P3T06, h«(o cases of encephalopathy were reported, both in participants who had received Pentacel vaccine (N = 5,979) One case occurred 30 days post-vaccination and was secondary to cardiac arrest following cardiac surgery One infant who had onset of neurologic symptoms 8 days post-vaccination was subsequently found to have stnjctural cerebral abnonnalities and was diagnosed with congenital encephalopathy A total of 5 deaths occurred during Studies 494-01, 494-03, 5A9908 and P3T06: 4 in children who had received Pentacel vaccine (N = 5,979) and one in a participant who had received DAPTACEL -t IPOL t ActHIB vaccines (N = 1,455) There were no deaths reported in children who received HCPDT + POLIOVAX + ActHIB vaccines (N = 1,032). Causes of death among children who received Pentacel vaccine were asphyxia due to suffocation, head trauma. Sudden Infant Death syndrome, and neuroblastoma (8, 23, 52 and 256 days post-vaccination, respectively) One participant with ependymoma died secondary to aspiration 222 days following DAPTACEL + IPOL + ActHIB vaccines Data from Post-Marketing Experience The following additional adverse events have been spontaneously reported dunng the post marlceting use ol Pentacel vaccine worldwide, since 1997 Between 1997 and 2007, Pentacel vaccine was primarily used in Canada Because these events are reported voluntarily from a population of uncertain size, it may not be possible to reliably estimate their frequency or establish a causal relationship to vaccine exposure The following adverse events were included based on one or more of the following factors: severity, frequency of reporting, or strength of evidence for a causal relationship to Pentacel vaccine. Cardiac disorders (cyanosis); gastrointestinal disorders (vomiting, diarrhea); general disorders and administration site conditions (injection site reactions [including inflammation, mass, abscess and sterile abscess], extensive swelling of the injected limb [including swelling that involved adjacent jointsl, vaccination failure/therapeubc response decreased (invasive H irriluemae type b disease); immune system disorders (hypersensibvity, such as rash and urticaria); infections and infestations (meningitis, rhinitis, viral infection); metabolism and nutrition disorders (decreased appetite); nervous system disorders (somnolence, HHE, depressed level of consciousness); psychiatric disorders (screaming); respiratory, thoracic and mediastinal disorders (apnea, cough); skin and subcutaneous tissue disorders (erythema, skin discoloration); vascular disorders (pallor). DRUG INTERACTIONS Concomitant Administration with Other Vaccines In clinical trials, Pentacel vaccine was administered concomitantly with one or mort* of the foilowing US licensed vaccines; hepatitis B vaccine, 7-valent pneumococcal conjugate vaccine, MMR and vanceila vaccines When Pentacel vaccine is given at the same time as another Injectable vaccine(s), the vaccine(s) should be administered with different synnges and at different in/ection sites STORAGE AND HANDUNC Pentacel vaccine should be stored at 2* to S"C (35" to 4«"F). Do not freeze. Product which has been exposed to freezing should not be used. Do not use after expiration date shown on the label PATIENT COUNSELING INFORMATION Before administration of Pentacel vaccine, health-care pe5onnel should intorm the parent or guardian of the benefits and risks of the vaccine and the importance of completing the immunization sehes unless a contraindication to further immunization exists The health-care provider should infonn the parent or guardian about the potential for adverse reactions that have been temporally associated with Pentacel vaccine Of other vaccines containing similar ingredients. The health-care provider should provide the Vaccine Information Statements (VIS) which are required by the National Childhood Vaccine ln|ury Act of 1986 to be given with each immunization The parent or guardian should be instnicted to report adverse reactions to their health-care provider. REFERENCES 1, Stratton KR, et al. editors Adverse events associated with childhood vaccnes, evidence bearing on causality Washington, DC: National Academy Press; 1994. p. 67-117 2, Braun MM. Report of a US Public Health Service workshop on hypotonic-hyporesponsive episode (HHE) after pertussis immunization Pediatrics 1998;102(5)1-5. Product information as of December 2009. Manufactured by SanofI Pasteur Umlted Toronto Ontario Canada and SinofI Pasteur SA Lyon France Distributed by; SinofI Pasteur Inc Swiftwater PA 18370 USA Pentacef* is a registered trademark of the sanofl pasteur group, and its subsidiaries. Mia201B3-2 R1-1209USA 2027314-242 »PREVENTING CHILDHOOD OBESITY CONTINUED FROM PAGE 3 3 Pediatricians will then have an opportunity to counsel parents of these infants at an age at which the amount and type of infant feeding can be modified. Risk factors for obesity Pregnancy/Prenatal In agreement with the Barker hypothesis that events in utero and early in life greatly affect the risk of adult disease,'' some in utero risk factors appear to affect a fetus' later risk of obesity. Although controversy exists over what exactly constitutes appropriate gestational weight gain (GWG), excess GWG appears to be related to the child's later risk of being overweight." Recommendations for appropriate GWG set forth by the Institute of Medicine and adopted by the American College of Obstetricians and Gynecologists have been recently revised (Table).'""'^ Excess GWG appears to be associated with delivering a large-for-gestational age (LGA) infant." Subsequently, a higher birth weight places these infants at an increased risk for future obesity.'" Excess GWG also has been associated with offspring obesity in the early childhood years, independent of the effects of birth weight." In addition, pregestational maternal obesity leads to an increased risk of obesity in the child throughout life." Gestational diabetes mellitus and maternal smoking during pregnancy are other factors strongly associated with future obesity of a child.^''•^' Although limited and somewhat controversial data are available, high levels of stress and food insecurity during pregnancy are possible additional risk factors that may be related to future obesity"-^' Aside from obesity, these risk factors lead to other detrimental health outcomes. Eor example, excess GWG is strongly associated with preterm birth, and both maternal obesity and gestational diabetes mellitus are associated with an increased risk of intrauterine or neonatal death and congenital malformations, including cardiac defects and neural tube defects.^"* ^^ To prevent obesity and other medical complications, these are all important topics to address when counseling future parents. CONTEMPORARY PEDIATRICS 37 »PREVENTING CHILDHOOD OBESITY I Appropriate gestational weight gain Prepregnancy BiVII