RCHC Community Project Abstracts

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Mexican American attitudes and perspectives regarding Type II Diabetes and its modifiable risk factors.
Date of project: 9/23/2002

CONTEXT: Mexican Americans have a genetic predisposition to Type II Diabetes Mellitus, whcih theoretically evolved from a "thrifty gene". In an increasingly obese and sedentary society, the frequency with which Mexican American youth and young adults are acquiring Type II DM is reaching epidemic proportions. OBJECTIVE: To explore cultural-specific attitudes and beliefs pertaining to Type II DM and its modifiable risk factors with the goal of providing valuable information about prevention strategies in a culturally-sensitive manner. DESIGN: A cross-sectional survey of 15 parents of school-aged patients at the Woodburn Pediatric Clinic appearing for routine clinic visits. Specific information about respondents included age, country of birth, and linguistic capabilities. Children's ages, weights (kg), and heights (meters) were recorded. BMI's were calculated using the equation kg/meters squared. Respondents answered 10 short-answer and 5 multiple-choice questions in their language of choice (Spanish and English), which addressed attitudes and beliefs surrounding four major themes: Diabetes, obesity, eating habits, and physical activity. Brief 5-10 minute follow-up interviews conducted by a skilled bilingual investigator provided clarifications of both questions and answers and explored additional commentaries on behalf of respondents. RESULTS: One-third of patients were considered obese (95th percentile or greater for weight) The majority of parents attributed diabetes and obesity to the excessive consumption of foods high in fat and carbohydrates. Only two believed diabetes was due to a "susto" (fright). Parents of obese children were concerned about their children's weight. Most parents felt that it was important to provide a variety of fruits and vegetables to their children and convince them that fruits and vegetables were necessary for good health. Half of the children engaged in sedentary activities (TV, video games, computer) for 3 or more hours per day. Seven of the children engaged in near daily physical activity, however the majority of these had a BMI at or above the 90th percentile. Parents who were active on a daily basis attributed activity to work-related activity (3) or walking 1/2 to 2 miles per day (3). The remaining nine were minimally active or sedentary. Parents encouraged their kids to engage in sports so they can be healthy, but only three were proactive about exercising for health and involving their kids in habitual exercise regimens. CONCLUSIONS: Mexican American parents are appropriately aware of the role of excessive fats and carbohydrates as a risk factor for diabetes. However, there is little awareness about the role of physical activity in diabetes prevention. In general parents do little to encourage their children to exercise, nor do they model physically active lifestyles to their children. Recommendations for cultural-specific approaches to diabetes prevention were provided based on these findin

Examination of risk factors for the development of osteoporosis in adolescent girls at the Woodburn Pediatric Clinic.
Date of project: 7/1/2002

Osteoporosis is a major health issue in America, affecting 30% to 40% of adults older than 60. Although osteoporosis is most prevalent in the older population, it is now understood that its roots lie with the pediatric population. The failure to achieve an adequate peak bone mass is a significant risk factor for future development of osteoporosis, and this process is almost complete by the onset of adulthood. This study attempts to identify the prevalence of risk factors in 9 to 13 year old girls that may predispose them to the development of osteoporosis. Data was collected by surveying girls regarding their dietary habits, exercise routine, medication use, and family history of osteoporosis. A chart review of well child exams for children of the same age was completed to assess how the Woodburn Pediatric Clinic addresses the issue of bone health. The findings of this study estimate that 60% of female patients in this age range were not consuming the recommended 1300 mg of calcium daily, 50% were not participating in regular weight-bearing exercises, and 33% already had a known family history of osteoporosis. The chart review demonstrated that the Woodburn Pediatric healthcare team is addressing nutrition and exercise in a broad sense, but fail to specifically evaluate and educate patients about the risk of developing osteoporosis. It is recommended that clinicians begin screening girls for inadequate calcium intake and exercise and providing counseling regarding preventing osteoporosis beginning at the 5-year-old well child exam.

Coding Practices in a Rural Oregon Health Clinic: An audit report on acute care visits.
Date of project: 3/25/2002

This study is intended to elucidate the general coding practices for an acute evaluation and management (E/M) encounter at a rural pediatric clinic. It entails the external audit of progress notes for acute E/M encounters during the first few weeks of one of the busiest months of the year for acute pediatric care, and will identify any flaws in the coding practices for such encounters. The basis for this study is to provide valuable feedback on coding practices and whether those practices are in compliance with established rules and guidelines set up by the Health Care Financing Administration (HCFA). The practice of over-coding or under-coding will be specifically addressed, and suggestions will be made about possible changes in documenting habits that more accurately reflect a fair and equitable assessment of the level of care provided for an acute E/M encounter.

Issues Regarding Charting in a Rural Oregon Health Clinic
Date of project: 2/11/2002

In any clinic, it is important to have a system in place that allows one to have quick and easy access to a patient's history. Many clinics and hospitals are using a computerized record keeping system that has separate 'pages' with information regarding prior visits, diagnoses, and both current and past medications. But what happens in a clinic that uses hand-written records? What type of system works in this setting? I haven chosen to explore this issue in a pediatric clinic in Woodburn, OR by examining the system that is now in place and then making some recommendations regarding possible future chart changes.

A Survey Of Teacher Satisfaction With The Woodburn Pediatric Clinic's Monitoring Practices Of Students Diagnosed With Attention Deficit-Hyperactivity Disorder.
Date of project: 11/5/2001

Attention-deficit/hyperactivity disorder is the most common school-aged behavioral problem with a prevalence of 3-5%. The Woodburn Pediatric Clinic has a large subset of these patients on its census. Management and monitoring included a questionnaire sent to the teachers and counselors of these patients concerning AD/HD-specific behaviors. This study investigated the efficacy of this questionnaire by employing a teacher survey. Generally, feedback concerning the questionnaire was positive. Suggestions for improvement centered on changing the format from fax to e-mail and giving respondents more lead time in completing the questionnaire.

Use of Anthropometry in an Outpatient Office Setting: Screening for Fetal Alcohol Syndrome and Fetal Alcohol Effects.
Date of project: 5/6/2002

Fetal alcohol syndrome (FAS) is a pattern of physical, behavioral, and cognitive defects seen in individuals exposed to alcohol in utero. Fetal alcohol effects (FAE) consists of more subtle symptoms sometimes presenting as poor academic achievement and behavioral problems. The FAS and especially the FAE phenotype is highly variable and may be difficult to distinguish from other conditions such as attention-deficit hyperactivity disorder (ADHD). ADHD is a common childhood psychiatric disorder consisting of behaviors that include one of the following hallmarks of hyperactivity, inattention and/or impulsivity. Anthropometry is a technique that objectifies craniofacial features for use in plastic surgery, dysmorphology and medical genetics. Recently, Moore et. al. 2001 described a method utilizing anthropometry that was 96% accurate for differentiating between individuals with or without exposure to alcohol in utero. Using this same tool we screened 21 children and were able to correctly identify two children with known FAS, and by using less stringent criteria were able to identify 6 more children with suspected alcohol exposure in utero. Interestingly, 4 out of these 6 children had known diagnoses of ADHD.

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