National trends in the management of cardiovascular disease risk factors in children: second NHLBI survey of primary care physicians.

Abstract:

BACKGROUND:The evidence that atherosclerosis begins during adolescence has led to the belief that primary prevention of cardiovascular disease (CHD) should commence in childhood. Although several national guidelines have been issued for the detection and treatment of CHD risk factors in children, concerns continue to be expressed regarding what constitutes appropriate measures and when to institute such measures in children. A 1988 national survey of primary care physicians revealed variation in the management of CHD risk factors in children by physician categories, which suggested the underlying quandary among physicians regarding CHD risk factors in children. OBJECTIVE:To assess current clinical management of pediatric CHD risk factors in the primary care setting and also to evaluate time trends between the current and 1988 surveys. METHODS:A 25-minute telephone survey was conducted with 1036 of eligible physicians (ie, >20 hours per week direct patient care including at least five pediatric patient contacts) selected from a national probability sample in three practice categories (family practitioners, pediatricians, and general practitioners). The questionnaire assessed the current practice of these physicians in the primary care setting regarding cholesterol and blood pressure (BP) screening and treatment, both nonpharmacologic and pharmacologic, and physician attitude and knowledge. RESULTS:Cholesterol screening in children was performed by 75.7% of all physicians. Nonscreening was highest among general practitioners (38%) and lowest among pediatricians (12%). BP was measured by almost all physicians. The majority of physicians (71%) prescribed diet as the first cholesterol-lowering step, but approximately 16% also used pharmacologic therapy. Cholesterol synthesis inhibitors and bile acid sequestrants were the drugs used most commonly. Approximately 25% of physicians have used drugs in children to treat high BP. Diuretics and beta-blockers were used most frequently. More than one fourth of the physicians had some concern about identifying and treating children for CHD risk factors. There was slightly less cholesterol measurement in 1995 compared with 1988, and no notable increase in the knowledge regarding major CHD risk factors. CONCLUSION:The results of the second National Heart, Lung, and Blood Institute survey of primary care physicians suggest that additional inroads need to be made in the dissemination of the national guidelines for the management of CHD risk factors in children, including appropriate use of pharmacologic agents.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Kimm SY,Payne GH,Stylianou MP,Waclawiw MA,Lichtenstein C

doi

10.1542/peds.102.5.e50

subject

Has Abstract

pub_date

1998-11-01 00:00:00

pages

E50

issue

5

eissn

0031-4005

issn

1098-4275

journal_volume

102

pub_type

杂志文章
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    abstract:OBJECTIVES:To study the efficacy of otoacoustic emissions (OAEs) as a screening test for hearing impairment in children with acute bacterial meningitis. Hearing tests were performed before discharge from the hospital in an attempt to improve coverage and avoid delays in the diagnosis of postmeningitic hearing loss. ME...

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    pub_type: 杂志文章,随机对照试验

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  • Intranasal Dexmedetomidine for Procedural Distress in Children: A Systematic Review.

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    journal_title:Pediatrics

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1542/peds.101.5.831

    authors: Clark NM,Gong M,Schork MA,Evans D,Roloff D,Hurwitz M,Maiman L,Mellins RB

    更新日期:1998-05-01 00:00:00

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    pub_type: 杂志文章,随机对照试验

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    更新日期:2008-07-01 00:00:00

  • Mental Health and Timing of Gender-Affirming Care.

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    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:10.1542/peds.2016-1039

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    更新日期:2016-12-01 00:00:00

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    pub_type: 杂志文章

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    pub_type: 临床试验,杂志文章,随机对照试验

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    pub_type: 杂志文章

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    pub_type: 临床试验,杂志文章,随机对照试验

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    更新日期:1998-04-01 00:00:00

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    pub_type: 杂志文章

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    更新日期:1987-06-01 00:00:00

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    pub_type: 杂志文章

    doi:

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    更新日期:1984-12-01 00:00:00

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    pub_type: 杂志文章,评审

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    doi:

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    pub_type: 杂志文章

    doi:

    authors: Chafee-Bahamon C,Lovejoy FH Jr

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