John Olsson

Insulin Resistance Status: Predicting Weight Response in Overweight Children

OBJECTIVE To assess the relationship between insulin resistance and body mass index (BMI) z score associated with dietary modification that focuses on limiting sweetened beverage consumption in overweight children. DESIGN A retrospective cohort study conducted between July 1, 2004, and April 28, 2006. SETTING Community-based primary care practices treating children. PATIENTS Forty-five children (aged < or =18 years) at or above the 95th percentile of BMI for age and sex. Intervention Children and parents were instructed by a dietitian regarding caloric reduction and modification of sweetened beverage intake. MAIN OUTCOME MEASURES Insulin resistance at baseline was calculated from fasting insulin and glucose levels (ie, homeostatic model assessment [HOMA]) and change in BMI z score from baseline to 12-week follow-up. RESULTS Change in BMI z score in response to a decrease in sweetened beverages correlated (Pearson product moment correlation coefficient = 0.42; P < .01) with baseline insulin resistance. Those with a decrease in or an unchanged BMI z score had significantly greater insulin resistance than those whose BMI z score increased (mean [SD] HOMA, 6.2 [4.2] vs 2.6 [2.0], P < .01). Linear regression confirmed that HOMA was a significant predictor of change in BMI z score when controlling for age, race, and sex. CONCLUSIONS Among overweight children in primary care practices, a significant relationship was found between insulin resistance and the change in BMI z score associated with a dietitian-mediated intervention that includes a focus on decreasing sweetened beverage consumption. Estimating insulin resistance may inform dietary recommendations for overweight children.

In brief: hypokalemia.

1. Treva Caraway Ingram, MD 2. John M. Olsson, MD 1. Brody School of Medicine East Carolina University Greenville, NC Fluid and Electrolytes: Clinical Aspects. Hellerstein S. Pediatr Rev.1993;17 :103– 115[OpenUrl][1] Potassium Homeostasis and Hypokalemia. Linshaw MA. Pediatr Clin North Am.1987;34 :649– 681[OpenUrl][2][PubMed][3][Web of Science][4] Disorders of Potassium. Schaefer TJ, Wolford RW. Emerg Med Clin North Am.2005;23 :723– 747[OpenUrl][5][CrossRef][6][PubMed][7][Web of Science][8] Potassium, the most abundant cation in the intracellular space, is involved in a number of homeostatic processes, including regulation of cellular metabolism and maintenance of intracellular volume and cellular resting membrane potential. Proper functioning of all tissues, especially muscles and nerves, depends on normal concentrations of potassium. Potassium concentrations are regulated principally by the kidneys, which secrete or reabsorb potassium in response to various signals. Aldosterone is the primary hormone regulating potassium excretion, but other agents and processes also affect it. Glucocorticoids, antidiuretic hormone, high urinary flow rate, and increased sodium delivery to the distal nephron increase potassium excretion; insulin and catecholamines decrease its excretion. Insulin and catecholamines also increase the … [1]: {openurl}?query=rft.jtitle%253DPediatr%2BRev.%26rft.volume%253D17%26rft.spage%253D103%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: {openurl}?query=rft.jtitle%253DPediatric%2Bclinics%2Bof%2BNorth%2BAmerica%26rft.stitle%253DPediatr%2BClin%2BNorth%2BAm%26rft.aulast%253DLinshaw%26rft.auinit1%253DM.%2BA.%26rft.volume%253D34%26rft.issue%253D3%26rft.spage%253D649%26rft.epage%253D681%26rft.atitle%253DPotassium%2Bhomeostasis%2Band%2Bhypokalemia.%26rft_id%253Dinfo%253Apmid%252F3295721%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [3]: /lookup/external-ref?access_num=3295721&link_type=MED&atom=%2Fpedsinreview%2F29%2F9%2Fe50.atom [4]: /lookup/external-ref?access_num=A1987H641000009&link_type=ISI [5]: {openurl}?query=rft.jtitle%253DEmergency%2Bmedicine%2Bclinics%2Bof%2BNorth%2BAmerica%26rft.stitle%253DEmerg%2BMed%2BClin%2BNorth%2BAm%26rft.aulast%253DSchaefer%26rft.auinit1%253DT.%2BJ.%26rft.volume%253D23%26rft.issue%253D3%26rft.spage%253D723%26rft.epage%253Dix%26rft.atitle%253DDisorders%2Bof%2Bpotassium.%26rft_id%253Dinfo%253Adoi%252F10.1016%252Fj.emc.2005.03.016%26rft_id%253Dinfo%253Apmid%252F15982543%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [6]: /lookup/external-ref?access_num=10.1016/j.emc.2005.03.016&link_type=DOI [7]: /lookup/external-ref?access_num=15982543&link_type=MED&atom=%2Fpedsinreview%2F29%2F9%2Fe50.atom [8]: /lookup/external-ref?access_num=000230779600008&link_type=ISI

Allocation of Health Care Resources: Principles for Decision-making

1. Hellen Ransom, DHCE* 2. John M. Olsson, MD, CPE† 1. *Department of Bioethics and Interdisciplinary Studies, 2. †Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC * Abbreviations: CT: : computed tomography MCO: : managed care organization MRI: : magnetic resonance imaging Pediatricians engage in making decisions on allocation of health care resources on a daily basis. However, they may not be aware of the ethical principles underlying those decisions and how to apply those principles in the process of allocating health care resources. After completing this article, readers should be able to: 1. Identify the ethical principles that should be considered when making decisions on allocating health care resources. 2. Apply ethical principles in clinical settings with limited health care resources. 3. Discuss the role of the institutional ethics committee in assisting clinicians in making point-of-care health care allocation decisions. Health care resources are defined as all materials, personnel, facilities, funds, and anything else that can be used for providing health care services. Health care has long been a limited resource for which there has been an unlimited demand; everyone needs health care. Until the 20th century, US health care was allocated by the ability to pay or barter, with small numbers of individuals consuming the bulk of the resources, leaving few resources available to others. During the past 100 years, increased interest in good personal and public health resulted in the development of various forms of health insurance. Health insurance became available through employer-sponsored insurance plans and, in the 1960s, entitlement programs—including Medicare and Medicaid. In spite of the presence of these forms of payment, demands for all aspects of health care continue to exceed its available resources. Millions of people in the United States, including children, continue to lack health insurance or avenues to access health care resources. Likewise, the costs associated with health care have increased dramatically as technology has advanced, …

Use of Health Care Services by Pediatrics Residents: A CORNET Study

BACKGROUND The personal health practices of residents and their access to health care has not been well explored. Suboptimal personal health care habits and practices among many physicians may evolve during residency. OBJECTIVE To identify the nature and extent of pediatrics resident health care use and the factors that restrict or facilitate use. METHODS A web-based survey was sent to pediatrics residents from 19 continuity practice sites enrolled in the nationwide Continuity Research Network (CORNET) during April through June 2010. Outcome measures included self-report of health care use, involvement in an established care relationship with a primary care provider, and barriers residents encountered in receiving care. RESULTS Of 1210 eligible residents, 766 (63%) completed the survey. Respondents were 73% women; each postgraduate training year was equally represented. More than one-half of residents (54%) stated they had an established care relationship (ECR) with a primary care provider. Interns were less likely to have an ECR when compared with upper level residents; female residents were twice as likely to have an ECR compared with male residents. Although 22% (172 of 766) of the respondents reported they had a chronic health condition, only 69% (118 of 172) of those individuals had an established care provider. The most significant barrier to obtaining health care was resident concern for time away from work and the potential increased workload for colleagues. CONCLUSIONS A slight majority of pediatrics residents stated they had an established relationship with a primary care provider. The most common barriers to seeking routine and acute care were work related.