The Challenge of Childhood Obesity—Opportunity to Respond

We are pleased to invite you to participate in a project designed to improve care for overweight children or children at risk of becoming overweight.  A partnership among the University of South Florida, Nemours, and Florida Pediatric Society created the Florida Improvement Network for Kids (FINK).  FINK has been funded through a grant from The Blue Foundation for a Healthy Florida, Inc. and will focus the initial efforts on providing healthcare professionals resources for addressing childhood obesity.

The project will help participants tailor, create, and share tools and resources under ongoing guidance.  The aim of this project is to assist clinicians in engaging delivery systems changes needed at the practice level to implement best practices and ultimately improve the care delivered for children who are overweight or obese.  Physicians, nurses, and staff at 20-25 practices from across the state will have the opportunity to collaborate with colleagues who are committed to learning and have an interest in sharing their insights to improve how they deliver care to their patients.  Interested practitioners can select involvement through one of three levels of participation and receive CME’s for their work at the top two levels of involvement. 

A Serious Problem

The epidemic of children who are overweight or obese has resulted in increased childhood morbidity and threatens to unravel health care gains of the past several decades.  Greater than 16 percent of children 6–19 years old are considered overweight (BMI > 95 percentile).  Earlier onset of childhood overweight has been associated with higher BMI in adulthood and their health concerns are compounded.

Early recognition and intervention is necessary to address the rapid growth of overweight among children.  Yet the 1999-2002 National Health and Nutrition Examination Survey (NHANES) reported only 36.7 percent of overweight children and teens aged 2-19 years had been told by a doctor or other health-care professional that they were overweight.  Further, there is an inverse relationship between age group and this communication.  The youngest children with potentially malleable habits were less likely to be informed than teens. 

Health care practitioners have the potential to generate a substantial impact on families with overweight children through early recognition of excessive weight gain by routine tracking of BMI percentile and health supervision through encouraging healthy eating habits, motivating them to make changes in sedentary behaviors, and promoting physical activity. 
Managed Access to Child Health, Inc. (MATCH) is a not-for-profit organization working to support a focused, effective approach to addressing important child health issues in Northeast Florida.  MATCH provides a venue where the child health leadership and stakeholders can come together to discuss priorities and coordinate resources to meet the community’s needs.
If you would like the package and application faxed or mailed to you, or more information about the project and the March 31st Child and Adolescent Obesity Conference/Workshop, contact Judith at 360-7070, ext 309.
Originally published in the M.A.T.C.H. Bulletin, News for the Pediatric Community, Vol. 2 No. 1,  January, 2007    

Immunization Reduces Disease Risk Inherent with Patient Contact

For health-care workers (HCWs), direct patient contact is an occupational necessity. But it also carries the risk of transmitting or contracting diseases, such as influenza, and pertussis.
Studies have shown that hospital outbreaks of diseases such as influenza have resulted from transmission from patient to HCW and vice versa.1 The path of transmission is usually undetected before an outbreak.
For all HCWs with the vital role of patient contact, immunization offers the best defense against disease transmission.
HCW immunization remains low
Despite organizational efforts to encourage influenza vaccinations, national influenza immunization rates among HCWs remain below 40 percent.2 The Centers for Disease Control and Prevention (CDC) recommends annual flu shots for all HCWs, yet a high percentage of them remain unprotected each year.2 Influenza immunization can help protect HCWs and reduce the national burden of morbidity and mortality associated with the disease.2
Another disease, pertussis, commonly called whooping cough, reached a 45-year high in 2004 with nearly 26,000 reported cases.3 Adults, whose childhood immunity to pertussis may have worn off, are often unknowingly a major source of pertussis infection for infants, who suffer the most severe and deadly consequences from this vaccine-preventable disease.3
Now, with the availability of tetanus/diphtheria/acellular pertussis (Tdap) booster vaccines, the Advisory Committee on Immunization Practices (ACIP) recently voted to recommend that all HCWs receive a Tdap vaccine as soon as feasible.4 The ACIP recommendation is intended to increase protection against pertussis and to prevent pertussis transmission to infants. Specifically, the ACIP is focusing on health care personnel who work in hospitals or ambulatory care settings and have direct patient contact. Priority should be given to health care personnel who have direct contact with infants younger than 12 months of age.4
The benefits of influenza vaccination are borne out in a review of 12 influenza seasons in a tertiary-care facility5
The relationship between staff vaccination coverage and annual incidence of nosocomial influenza was assessed for 12 influenza seasons in one institution from 1987-2000. During this period, staff vaccination increased from 4 percent in 1987-1988 to 67 percent during 1999-2000, and HCWs accounted for 42 percent of all confirmed influenza cases during 1990-1993, and for 9 percent of cases during 1997-2000.5
There was also a progressive and significant reduction in the relative frequency of nosocomial influenza cases among hospitalized patients with confirmed influenza during this period, falling from 32 percent in 1987-1988 to 0 in 1999-2000 (P<.0001).5
HCWs need to lead the way in reducing transmission of vaccine-preventable diseases
The benefits HCWs accrue from influenza and Tdap vaccinations are far-reaching:
• Reduce the incidence of hospital-acquired (nosocomial) outbreaks6
• Decrease transmission of influenza, pertussis, or other vaccine-preventable diseases to their patients, their families, or community6
• Reduce the number of HCW sick days and absenteeism from respiratory infections by as much as 28 percent1
• Promote herd immunity among HCWs by increasing the percentage of workers who are immunized, which reduces the risk of disease transmission1—thus protecting the health of all HCWs, even those non-compliant with immunizations1
• Reduce disruptions and costs incurred by HCWs and hospitals resulting from pertussis outbreaks7
• Cut down on double shifts, staff shortages, and use of replacement workers, factors shown to lower workplace quality and increase adverse events in patients6

ACIP recommendations for HCW Tdap vaccination:3
On February 22, 2006, ACIP voted to recommend Tdap vaccine for HCWs as soon as feasible. HCWs in direct contact with infants less than 12 months of age should receive a Tdap vaccination. Use of an interval between this Tdap vaccination and the last Td vaccination as short as 2 years is recommended and even encouraged.
CDC recommendations for HCW influenza vaccination:2
All HCWs should receive annual influenza vaccine. Timing: Begin in October and continue throughout the influenza season.

References: 1. Centers for Disease Control and Prevention (CDC). Influenza vaccination of Health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP).MMWR. 2006;55(RR-2):1-16. 2. CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2006;55(RR-10):1-43. 3. CDC. Pertussis. In: Atkinson W, Hamborsky J, McIntyre L, Wolfe C, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book. 9th ed.Washington, DC: Public Health Foundation; 2006:79-96. 4. CDC. National Immunization Program. ACIP votes to recommend use of combined tetanus, diphtheria and pertussis (Tdap) vaccine for adults (Advisory Committee on Immunization Practices): March 2, 2006. Available at: http://www.cdc.gov/nip/vaccine/tdap/tdap_adult_recs.pdf. Accessed July 10, 2006. 5. Salgado CD, Giannetta ET, Hayden FG, Farr BM. Preventing nosocomial influenza by improving the vaccine acceptance rate of clinicians. Infect Control Hosp Epidemiol. 2004;25:923-928. 6. National Foundation for Infectious Diseases. Improving influenza vaccination rates in health care workers: strategies to increase protection for workers and patients. 2004:1-21. 7. Calugar A, Ortega-Sánchez IR, Tiwari T, Oakes L, Jahre JA, Murphy TV. Nosocomial pertussis: costs of an outbreak and benefits of vaccinating health care workers. Clinical Infect Dis. 2006;42:981-988.