Annette C. Frauman

Effects of a school-based intervention to reduce cardiovascular disease risk factors in elementary-school children: The Cardiovascular Health in Children (CHIC) Study

OBJECTIVE To test a classroom-based intervention to reduce cardiovascular disease risk factors in elementary school children. STUDY DESIGN This was a randomized, controlled field trial in 12 schools across North Carolina, stratified by geographic region and urban/rural setting. Subjects were 1274 third and fourth graders (48% boys). The intervention, taught by regular classroom and physical education teachers, provided all children an 8-week exercise program and 8 weeks of classes on nutrition and smoking. Data were analyzed at the school level with survey regression models and at the individual level with multivariate analysis of variance and analysis of covariance models; 95% confidence intervals were computed. RESULTS Children in the intervention group had significantly greater knowledge (7.9% more correct) and a significant increase in self-reported physical activity than children in the control group. Trends for the intervention group were a reduction in total cholesterol level (-5.27 mg/dl), an increase in aerobic power, a reduction in body fat, and smaller rise in diastolic blood pressure than control children. CONCLUSIONS This classroom-based, public health approach improved childrens cardiovascular disease risk profiles; it is practical and fairly easy to incorporate into the school day. All children directly receive the potential benefits of the intervention without a risk of labeling. This program can improve health knowledge, habits, and health outcomes of young children at a time when health habits are being formed.

School-based Interventions Improve Heart Health in Children With Multiple Cardiovascular Disease Risk Factors

Objective. To determine the immediate effects of two types of elementary school-based interventions on children with multiple cardiovascular disease (CVD) risk factors. Design. Randomized, controlled field trial. Setting. Conducted in 18 randomly selected elementary schools across North Carolina. Study Participants. Four hundred twenty-two children age 9 ± 0.8 years with at least two risk factors at baseline: low aerobic power and either high serum cholesterol or obesity. Intervention. Both 8-week interventions consisted of a knowledge and attitude program and an adaptation of physical education. The classroom-based intervention was given by regular teachers to all children in the 3rd and 4th grades. The risk-based intervention was given in small groups only to children with identified risk factors. Children in the control group received usual teaching and physical education. Outcome Measures. The primary outcome measure was cholesterol; additional measures were blood pressure, body mass index, body fat, eating and activity habits, and health knowledge. Results. Both interventions produced large reductions in cholesterol (−10.1 mg/dL and −11.7 mg/dL) compared with a small drop (−2.3 mg/dL) in the controls. There was a trend for systolic blood pressure to increase less in both intervention groups than in the controls. Both intervention groups had a small reduction in body fat and higher health knowledge than the control group. Conclusions. Both brief interventions can improve the CVD risk profile of children with multiple risk factors. The classroom-based approach was easier to implement and used fewer resources. This population approach should be considered as one means of early primary prevention of CVD.

Predictors of a Health‐Promoting Life‐style Among Well Adult Clients in a Nursing Practice

&NA; The self‐reported health‐promoting life‐style (HPL) of 130 well adults in a primary care clinical population was examined in relation to the cognitive/perceptual and sociodemographic factors hypothesized in Penders Health Promotion Model (1987) to predict this behavior. Subjects were randomly drawn from the clients of a group nurse practitioner practice emphasizing health maintenance. Data were collected by mailed survey (response rate, 59%) with one telephone prompt. The mean age of the subjects was 39.7 years; 72.3% were female; 51.2% were married; 47.7% had college degrees; and 67.4% were white. Blacks were underrepresented in the sample compared to the practice population (= 7.56, p= .006). Using multiple regression, the definition of health, importance of health, health locus of control, age, gender, marital status, race, education, income, and rural/urban residence were studied to determine their effects on health‐promoting behavior. Results generally supported the Pender Model. Defining health eudiamonistically, that is, as exuberant well‐being (rather than adaptive, functional, or absence of disease), predicted HPL. Ranking health above other values such as achievement and harmony had no effect; chance health locus of control had a negative relationship. In the final regression model, predictors of HPL were eudiamonistic conception of health and college education (p= .0001, R2= 17). Based on this data, considerations of a clients’health conception when framing health‐promotion messages is warranted in this population.

Cognitive, Psychosocial, and Physical Development in Infants and Children with End-Stage Renal Disease

The purpose of this article is to synthesize research related to the cognitive, physical, and psychosocial development of children with end-stage renal disease who are receiving conservative management, hemodialysis or peritoneal dialysis, or who have received transplants. An impressive array of research in these three areas of development was found, but more work is needed. Suggestions are made for more multicenter research with larger sample sizes and greater generalizability. In addition, more developmental research that includes measures of renal disease, such as age at onset, severity of disease, and length of time in renal failure, is needed.

Well child care for the chronically ill child

Abstract Chronically ill children have the same need for well child care services as other children; however, these needs often are not met in the specialty clinics in which the children receive care. A framework is proposed that the pediatric or public health nurse can use for assessing, modifying if necessary, and implementing child health services for chronically ill children. Provision of the same developmental, screening, and preventive health services that well children normally receive can assist greatly in promoting optimal function in the chronically ill child.