Disease Management Update
Volume III, No. 41
February 1, 2007
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Table of Contents
- Children Having Surgery Often Overweight, Obese
- Disease Management Q&A: Efficiently Tackling Childhood Obesity
- HealthSounds Podcast: Cultural Competency
- Primary Language an Indicator for Obesity Risk
- Cultural Diversity in Healthcare: Addressing the Challenges of a Multicultural Society
1. Children Having Surgery Often Overweight, Obese
A very high proportion of children who are having surgery are overweight or obese, and because of the excess weight have a greater chance of experiencing problems associated with the surgery, according to research from the University of Michigan (U-M) Health System published in the Journal of the National Medical Association.
Researchers looked at a database of all 6,017 pediatric surgeries at the U-M Hospital from 2000 to 2004 and found that nearly a third of the patients — 31.5 percent — were at least overweight. More than half of those qualified as obese. A child or teenager is considered overweight with a body mass index (BMI, a measure of weight in kilograms divided by height-squared in meters-squared) in or above the 95th percentile of his or her age and gender.
While all age ranges in the study involved high rates of overweight and obesity, the highest was in boys and girls ages 8 to 12, typically the age just before entering puberty. The surgeries most frequently performed on these children included the removal of tonsils and adenoids, as well as other surgeries to assist with breathing problems and sleep apnea; orthopedic surgeries to fix broken bones and other ailments; and procedures to mend digestive and gastrointestinal issues.
To learn more about this study, please visit:
2. Disease Management Q&A: Efficiently Tackling Childhood Obesity
Each week, a healthcare professional responds to a reader's
query on an industry issue. This week's expert is Barbara J. Moore, Ph.D., president and chief executive officer of Shape Up America! and the former chief nutritionist and primary technical policy advisor at Weight Watchers International.
Question: What kind of programs would have the greatest impact most quickly for childhood obesity problems? If you could only do one or two initiatives, what would you start with?
Response: I would start with parenting skill building. This process should begin prior to conception. You should be counseling parents who are trying to conceive. You should also counsel pregnant women because there's some evidence that they are more open to suggestions and behavioral lifestyle changes while they are pregnant and anticipating the birth of the new baby. There's evidence that the pregnancy to pre-school period is a critical period for what we call self-regulation.
There are also very good interventions that have shown that vigorous physical activity — after-school programs where the kids have their heart rates up for as much as 90 accumulated minutes — has a powerful beneficial impact on body fat in teenagers as well as in preteens. Children are not as turned off to vigorous physical activity as adults are. But there is good evidence that if you get kids to exercise vigorously and do not pay attention to their nutritional status you can actually cause a decrease in bone mineral density of these children. Exercising and healthy eating go hand in hand — any program that would emphasize one over the other is making a mistake.
For more details on assessing and preventing overweight and obesity in children; the Institute of Medicine's action plan for confronting the epidemic; and engaging a child's support network of family, school and community resources, please visit:
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3. HealthSounds Podcast: Cultural Competency
In this week's Disease Management podcast, Elsa Batica, cross-cultural health development and training manager with Children's Hospitals and Clinics of Minnesota, gives her personal perspective on cultural competence and discusses how her organization takes advantage of community resources. Meanwhile, Patti Ludwig-Beymer, administrative director for nursing research and education at Edward Hospital and Health Services, discusses the importance of staff education in building a culturally competent organization and viewing cultural competency as a process rather than an outcome.
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4. Primary Language an Indicator for Obesity Risk
Children from families in which English is the second language (ESL) are at higher risk for being overweight, according to Mayo Clinic researchers studying obesity among rural children in Head Start programs and reporting in the journal Ethnicity & Disease.
The study of 788 children in two Minnesota counties also found that Mexican children "were almost twice as likely to be overweight as Caucasian children and the rest of ethnic groups, including non-Mexican Hispanic children."
Researchers studied children ages three to five years who were enrolled in Head Start programs between 1998 and 2001. They were surprised to learn that the primary language spoken at home influences whether a child is at risk for becoming overweight. The researchers said the primary language spoken at home was "newly identified" as being a risk and merits further investigation.
The ESL children had a "significantly higher prevalence" of overweight (15.5 percent) than did children for whom English was the primary language (9.7 percent). "The language barrier may be more significant than we think in limiting [ESL families] from access to healthy foods," said co-author Young Juhn, M.D., of the Mayo Clinic.
To see more of this study's results, please visit:
6. Cultural Diversity in Healthcare: Addressing the Challenges of a Multicultural Society
Changing demographics, extensive mobility and upsurges in ethnic diversity present new demands for cultural competency in healthcare. Often, organizations are ill-equipped to handle specific challenges associated with such increases, including surpassing linguistic barriers and paying adequate attention to cultural sensitivities. To that effect, some progressive organizations are implementing diversity training to teach professionals how to better accommodate the needs of an increasingly socially and ethnically stratified population.
In a recent online survey by the Healthcare Intelligence Network (HIN), participants detailed their companies' approaches to cultural diversity issues. The survey results identified training opportunities that highlight an industrial receptiveness to cater to the distinct needs of increasingly diverse populations.
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