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| New
York Academic
Minerva Web
Journal |
| January
2005 Volume 5,
Number 01 |
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Paper
0501:
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The
Efficacy of
Nutrition Counseling
in Overweight
Pre-School Children
at the Parson’s
Manor WIC Center
C.
Johnson, D.O., H. Enubuzor M.D. , and Y. Schussel Ph D.,
SVCMC /NY Med.
Coll., Bklyn/Queens.,
NY
Introduction:
One out of every
five children in the
U.S. is overweight,
and this number is
continuing to grow.
The prevalence of
childhood obesity
has risen
dramatically in the
past several decades
with 25-30%
affected. It has
become a nutritional
concern among
low-income,
pre-school children;
a primary target
population of WIC. 1
OBJECTIVES:
1)
To determine if
counseling has
positive effects on
BMI
(weight-for-height
at or above 95th
percentile) in
overweight children
age 2-5.
2) To assess
parents perceptions
& attitudes
towards counseling.
3) To assess
challenges/possible
causes of failure in
the management of
overweight children.
4)Organize an
effective
intervention
strategy if deemed
necessary.
METHODS:
Statistical
data was obtained
from Info Share
2000. In addition, a
33- item
questionnaire of
validated questions 4
targeting children
ages 2-5, was
developed to be
completed by
parents/guardians.
100 Survey
Questionnaires were
collected at random,
during WIC
renewals/counseling
sessions. Using this
data along with
information obtained
from chart review, a
retrospective study
was done to assess
the effects of
nutritional
counseling on BMI in
pre-school
children.
RESULTS:
Based on the
fact that 25-30%
children are
overweight: 28,572
& 2077 of
children in the
borough of Queens
and target
population,
respectively are at
risk. The number of single parent families in catchment area is
significantly high,
when compared to the
borough (11.6 &
7.1% respectively)
.The average per
capita income was
16,000. The average
age of children
studied was 32+10
months. 3% were
considered
overweight.
Their mean
weight at birth was
6.79+1.21
lbs. 84% were
breastfed for an
average of 7.3+5
months.
88% were
formula-fed.
On average,
mothers attending
the WIC clinic had
2.2 children. 48%
were single mothers,
43% of whom were
employed, while 25%
had not finished
high school.
53% were on
Medicaid. 54%
considered their
children very
active.
Children
watched TV 2.8
hours/day, and ate
fast food 1.78
times/wk.
CONCLUSIONS:
National
Surveys indicate
that overweight
children in America
are a growing
problem and that
children from lower
income, ethnically
diverse populations
are at greater risk
than those of higher
socioeconomic
status. 3
The
Parson’s WIC site
serves a
predominantly
low-socioeconomic,
diverse community
where preliminary
findings indicate
that counseling does
have some effect on
dietary
modifications and is
deemed helpful by
many parents.
NYAMWJ 2005,
5:Abstract 0501
Presented to the
Fourth BWAFP
Research Forum
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| Paper
0502: |
The
Asthma
Dialogues:
Training
Healthcare
Providers,
Evaluating
Patients
Robert Morrow,
MD, Michael
Mulvihill. and
Jason Fletcher
Department of
Family and
Social Medicine,
Montefiore
Medical Center,
AECOM, Bronx, NY
PURPOSE:
Using skills
training to
improve the
asthma skills of
healthcare
providers, and
patient
outcomes, in an
urban Health
Plan
METHODS:
The training
uses a
self-efficacy
model of
education. Using
realistic
clinical
simulations, we
focus on
diagnosis, level
of severity, and
appropriate
management. The
tools of asthma
care, as well as
the issues of
access and
chronic care,
are explored in
a practical
manner. The
progress of the
learners is
evaluated by the
use of pre and
post clinical
simulations, as
well as pre and
post
self-efficacy
scales. The
material has
been delivered
in a series of
two small group
training
sessions and two
follow-up
computerized
modules.. The
Health Plan
collected data
on visit rates,
ED use,
hospitalization
rates,
appropriate
medication use,
and Plan costs.
A before-after
design was used
evaluate the
learners [n=300]
and Plan
measures.
RESULTS:
Learners
reported fewer
barriers after
the
intervention.
Following
completion,
providers are
significantly
more likely to
make appropriate
use of
prescriptions,
asthma equipment
and patient
training.
Significant
increases are
also seen in
intended use of
action plan
development, and
contact
availability,
and significant
reductions in
planned ED
referrals and
hospitalization.
Patient outcome
data show
significant,
important drops
in ED use,
hospitalization,
inappropriate
medications, and
Plan costs per
asthmatic.
CONCLUSIONS:
Skills based
training leads
to measurable
improvements in
healthcare
providers’
planned
decisions,
perceived
barriers to
care, and in
patient outcomes
measures. The
use of process
measures of
learners and
patient outcomes
measures are
promising and
mutually
reinforcing
approaches to
evaluate
professional
education.
NYAMWJ
2005, 5:Abstract
0502
Presented to the
Fourth BWAFP
Research Forum
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| Paper 0503:
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Bronx Medical Students Attack the
Obesity Epidemic: A Health Not Cosmetics Initiative.
Jose Rodriguez, MD
AECOM, Bronx, NY
Abstract:
The Health Not Cosmetics initiative is a community based health education
project
designed to address the obesity epidemic in the Bronx.
The physician-developed project connects to medical student education
through the required community project in the 3rd year Family
Medicine clerkship. The medical students are involved in literature searches
supporting project interventions, group education sessions, and developing
resources for the program. As a result they establish a connection with the
community, learn through the literature and teach lifestyle modification,
experience practical lessons in cultural competency, and create tools that are
used to increase outreach, reinforce positive change and motivate the
community. These skills are not
addressed in other aspects of the clinical medical school curriculum.
Student/Patient outcomes from the project will be discussed.
Objectives and Goals of Presentation:
Upon completion of this discussion, participants will:
1) Identify how students can take a concept, under the leadership of a
physician, and build creative approaches to lifestyle modification behavior
change.
2) Identify how a community project can motivate medical students to become
interested in COPC, obesity prevention and treatment, and lifestyle
modification to achieve health and overall cultural competence skills need to
practice primary care.
3) Identify all the approaches students can be involved in to achieve a common
goal, lifestyle change among patients in an ambulatory care setting.
4) View outcomes (actual artifacts) of student ideas (web site, magnets,
recipe booklet, logo, van educational material, food diary, healthy choices
for supermarkets and restaurants, newsletter, posters)
5) Explore the possibilities of doing a similar project in participant’s
residencies and medical schools.
6) Examine teaching relationships between faculty and students and how they
can produce behavioral change.
Rationale of relevance to participants:
Passion, enthusiasm and dedication are essential when teaching Family
Medicine to medical students. One
obese Family Physician, recognizing the need for change in his own life, began
to modify his lifestyle to become healthier.
As he did this, it became evident that there were significant barriers
that needed to be overcome, both for him and his patients, unique to their
neighborhood. A project was
developed to address these barriers and to educate the population about the
severe consequences of the obesity epidemic.
Medical students were enlisted and the "Health not Cosmetics"
project was born. The
project has a multifaceted approach: Group
lifestyle classes, individual counseling, community mapping, website
development and modification, production of culturally sensitive educational
materials, appropriate the establishment of a community Vehicle Assisted
Nutrition (VAN) mobile intervention. The medical students do these
interventions, with the Family Physician working a supervisory role. This
project required skills medical students have buried during their first two
years of medical school: creativity, and hands on learning.
They also are teaching lifestyle modification, understanding the
culture of our urban, poor, Bronx community and connecting to the patients'
stories. This project is the only place in the medical school
curriculum where the students can learn and teach lifestyle modification in a
way that the patients can understand and
the project activities also place the students directly into the
community, even outside of the confines of the provider offices. As they connect to the patients and teach lifestyle
modification, they also made individual positive changes within their own
world. This presentation
will bring you into the world of the Tremont section of the Bronx and the
excitement created by the Health Not Cosmetics program.
It will also show how students of very different cultural backgrounds
can identify with and positively influence our Bronx patients.
Description of Content of the Proposed Session and the means by which
participants would be involved:
A typical medical student experience in the Albert Einstein College of
Medicine 4 week
Family Medicine clerkship will be portrayed.
We will discuss the initial meetings with
the medical students as well as the method of teaching.
In short, an actual medical
student encounter will be role modeled. In
the first meeting, the project is presented
and the objectives of the rotation are discussed. The students are instructed that the
project has three parts: teaching the patients in a lifestyle modification
class,
conducting a literature review and the producing a "creative piece."
The
curriculum of the patient class is discussed and students observe a patient
class led
by the physician. The physician then presents the vision of what can be
accomplished
in the rotation and the students brainstorm ideas for the next three classes
they will
teach. In addition a creative resource is identified and students begin to
think about
development of the resource. Students are directed to explore the educational
framework of the community project in the literature. Wherever possible actual
student
work will be shown (using media and actual resources developed) to exemplify
the
quality of their experience. In addition, student response to the project
experience,
quantitative and qualitative, will be shared. Patient responses and results
will also be
shared. Participants will be
asked to comment on the project, make suggestions and
discuss feasibility of establishing a community project in their curriculum.
We will
use the internet, power point and newsprint to engage the audience.
As part of the presentation, we will use the same techniques used with
the medical students to develop new ideas and creative energy.
NYAMWJ
2005, 5:Abstract 0503
Presented to the Fourth BWAFP Research Forum
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Paper 0504:
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Vaginitis of Unknown Etiology
Andreas Cohrssen, MD and Matt Anderson, MD
Beth Israel Medical Center and Montefiore Medical Center, NY
30% of the 10 Million annual office visits for vaginitis cannot be assigned a
specific diagnosis, even if a comprehensive research work-up is conducted.
In this presentation, the authors will outline a study project to evaluate other
factors that may be implicated in the presentation of vaginitis.
Interested PGY III Family Practice Residents can apply for a funded fellowship
position.
NYAMWJ
2005, 5:Abstract 0504
Presented to the Fourth BWAFP Research Forum
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Paper 0505:
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Anemia in the inner city pregnant population.
C. Allen, MD and A. Hamaoui, MD
Hartsdale, NY
NYAMWJ 2005,
5:Abstract 0505
Presented to the Fourth BWAFP Research Forum
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