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Papers by ronald feinstein

AM:STARs: Case Studies in Adolescent Health, Vol. 23, No. 2, 2012

Current Problems in Pediatric and Adolescent Health Care, 2017

Current Opinion in Pediatrics, 2018

The purpose of this review is to provide an updated summary on the unique aspects of caring for f... more The purpose of this review is to provide an updated summary on the unique aspects of caring for female youth and adolescent athletes. Recent research on female athletes has led to a better understanding of injuries and conditions that are more likely to occur in female youth and adolescent athletes, including the frequency and severity of concussions, musculoskeletal injury such as involving the anterior cruciate ligament, and the female athlete triad. Social factors, such as the growing pressure to specialize in a sport particularly at an early age, also put young female athletes at risk for issues such as overuse injuries. Researchers continue to explore the benefits of athletic participation that extend beyond physical fitness. Female participation in youth sports has increased dramatically during the past 50 years. This has led to greater research on how to manage risks and maximize benefits for young female athletes, although there is still much to be learned. Providers should educate patients, parents, and coaches on both the increased risks for female athletes and ways to provide better support and accessibility of youth sports to all children.

Current Problems in Pediatric and Adolescent Health Care, 2018

Organized and recreational sports have been shown to be an important part of growth and developme... more Organized and recreational sports have been shown to be an important part of growth and development in children, adolescents and young adults. In addition to the health benefits of increased physical activity, sports also provide social benefits. Pediatricians play an important role in determining if young athletescan participate in various sports and the proper equipment or precautions that are necessary. This review provides information on sports participation for athletes with specific health considerations, such as: febrile illnesses, solitary organs, seizures, and skin infections.

Current Problems in Pediatric and Adolescent Health Care, 2018

Learning about concussion diagnosis and management is important for all individuals who will be t... more Learning about concussion diagnosis and management is important for all individuals who will be taking care of young athletes. There are about 1.7 million reported concussions per year, and, of these, about 20% are sports related. There are risks in all sports, but the highest rates of concussions are from football, rugby, and hockey, with soccer being the highest cause for girls. An on-field assessment includes evaluating airway, breathing, and circulation, followed by cervical spine assessment. Then, concussion evaluation tools can be used to aid in making the diagnosis. While concussion symptoms for the majority of youth resolve within a few weeks, some individuals may have persistence of symptoms for 3 months or more, referred to as postconcussive syndrome. Providers should consider ongoing symptoms in assessing when an athlete may safely return to sports and to learning. A major concern that has become more apparent in recent years is the possibility that concussions may have a longitudinal effect on health, such as in the development of chronic traumatic encephalopathy. Research has shown that there is an increase in the number of patients presenting to their primary care physician with concussions. Knowing how best to prevent, diagnose, and manage concussions will help to minimize risks to young athletes.

Journal of Adolescent Health, 2017

Methods: Fourteen subjects were recruited from within the United States who had a child diagnosed... more Methods: Fourteen subjects were recruited from within the United States who had a child diagnosed with an eating disorder before the age of 18. Qualitative research techniques were used to carry out semi-structured individual interviews. The transcriptions of the interviews were analyzed and coded for themes using the immersion-crystallization method. Topics covered during the interviews included treatment options, the subject's feelings throughout treatment, and aspects of treatment they found helpful or detrimental. Results: Four high level themes and ten sub-themes were identified: High level themes were difficulty with insurance coverage, selfreproach, negative treatment experience, and provider expertise. Difficulty with insurance coverage, self-reproach, desire for additional support services (sub-theme of negative treatment experience), and perceived lack of provider knowledge (sub-theme of provider expertise) were nearly universal. Some subjects conveyed perceived blame from providers, perceived lack of parental engagement in treatment and limited provider availability. However these themes were expressed by only a portion of subjects. Conclusions: This study provides the first qualitative study in the United States addressing parental needs in pediatric eating disorder treatment. It affirms what has been found regarding eating disorder treatment in terms of barriers accessing care and provider expertise. Other themes discussed, such as desire for more support services for the family, should urge clinicians to encourage the use of these services among families when possible, with the goal of maximizing parental support and empowerment. The nearly unanimous self-reproach in the light of a minority of subjects perceiving blame from a provider points to other sources of selfreproach that providers should address directly. Sources of Support: None.

Journal of Advanced Nutrition and Human Metabolism, 2016

Obesity continues to be a growing problem today. Specifically, childhood obesity has become one o... more Obesity continues to be a growing problem today. Specifically, childhood obesity has become one of the most critical public health challenges of this time. Increased weight and poor health lead to higher medical costs, thus, efforts must be made to deal with this problem. This research highlight discusses a study that assessed the nutrition knowledge of medical/osteopathic school graduates entering a pediatric residency program and compares it to the knowledge of previous medical graduates found in the literature. It is imperative that medical education continue to incorporate clinical nutrition education in medical school and beyond because it has been shown that the dedicated time has a beneficial effect on the nutrition knowledge of medical students.

Abnormal Female Puberty, 2016

Childhood and adolescent obesity is an ongoing epidemic in the United States and other industrial... more Childhood and adolescent obesity is an ongoing epidemic in the United States and other industrialized countries, with 16.9 % of children ages 2–19 years in the United States currently classified as obese. The causes for the high prevalence of obesity in America’s youth are multifactorial and include a combination of genetics, poor nutrition, sedentary lifestyle, and environmental and social factors. In addition to having numerous medical and psychosocial complications for teenagers, obesity in young girls also has an effect on puberty and normal reproductive development. Studies have demonstrated that obese girls are more likely to enter puberty earlier and experience menarche at a younger age than their normal weight peers. The earlier onset of puberty in young obese girls is due to a complex interplay of hormones with leptin, a hormone secreted by adipocytes, playing an essential role in the neuroendocrine events that initiate puberty. Early pubertal development carries multiple health risks for young females, including higher rates of depression, substance use, behavior issues, and promiscuity as teenagers and higher rates of type 2 diabetes, hypertension, breast cancer, and increased overall mortality as adults. Furthermore, obese girls are at higher risk for menstrual irregularities secondary to hyperandrogenism and polycystic ovary syndrome, a diagnosis that carries its own set of complications. Prevention and treatment of obesity remains at the forefront of our nation’s healthcare agenda and presents an ongoing challenge for healthcare practitioners.

International Journal of Adolescent Medicine and Health, 2016

Due to the growth of the epidemic of obesity and the association of obesity with both short-term ... more Due to the growth of the epidemic of obesity and the association of obesity with both short-term and long-term medical complications, many professional organizations have recommended performing laboratory testing as part of the initial evaluation of overweight and obese children and adolescents. We report on the results of laboratory testing performed on 110 patients (mean age 14.0 years, range 8–20 years) referred to our weight management program between 2011 and 2013. Our results showed mild abnormalities in levels of cholesterol, glucose, liver enzymes, and thyroid stimulating hormone (TSH) in fewer than 5% of patients for each test and no changes in management based on these results for any of the patients. We call for re-consideration of the recommendations for laboratory testing in children and adolescents being evaluated and treated for overweight and obesity.

Journal of Adolescent Health, 2016

Background: Concussions, a form of mild traumatic brain injury, are a current "hot topic" in spor... more Background: Concussions, a form of mild traumatic brain injury, are a current "hot topic" in sports and medicine, with current research focusing on diagnosis, treatment, and the long-term effects of repeated concussions on development of chronic traumatic encephalopathy. Concussions represent 8.9% of all high school athletic injuries, and pediatricians see many of these patients in their practices, however evolving guidelines and recommendations have resulted in varying practices among providers. Objective: To assess how local pediatricians in New York Chapter 2 of the American Academy of Pediatrics (AAP) diagnose and treat concussion patients, and to evaluate the need for continuing education in this area. Design and methods: Survey Monkey™ was used to query providers regarding their diagnosis and treatment of concussion patients. A total of three emails containing a link to the 22 question multiple-choice survey were sent to AAP Chapter 2 members between January 2015 and June 2015. The survey was adapted and modified with permission from one previously used by "Zonfrillo MR, Master CL, Grady MF, Winston FK, Callahan JM, Arbogast KB. Pediatric providers' self-reported knowledge, practices, and attitudes about concussion. Pediatrics. 2012;130:1120-5". Results: We received 115 responses from 1436 potential participants to whom the survey link was sent, resulting in an 8% response rate. We excluded subspecialists from our data analysis, resulting in data from 95 primary care pediatricians. Of the PCPs 98.7% reported seeing at least one child or adolescent with a concussion in the previous 12 months and 76.6% reported referring some or all of their concussion patients for ongoing management. The most common reason for referral was "I am not always comfortable with management" and the most common subspecialist referral was to a neurologist. Most providers reported that they did not use any guidelines for management (58.3%) and only 57.4% were familiar with the New York State Education Department concussion guidelines. Almost half reported inadequate training in performing neurocognitive assessments (48.6%). Most were comfortable educating families about the diagnosis of concussion (81.7%), as well as recommending the appropriate time to resume school (70.4%) and prescribing and monitoring a return to play protocol (62%). A total of 84.3% also responded, however, that they would be interested in a webinar for a continuing medical education(CME) credit focused on concussion diagnosis and management. Conclusions: Most pediatric providers care for patients who have suffered a concussion, however many identify barriers to diagnosis and treatment, which results in patients being referred to subspecialists for further management. Many providers are also unfamiliar with, or do not use, published concussion guidelines and report varying practices in treatment of concussion patients due to evolving recommendations. This study demonstrates that there is a need for further education for pediatric providers who see patients with concussion.

Journal of Adolescent Health, 2016

Purpose: To compare the nutritional intake of adolescents with eating disorders (EDs) to recommen... more Purpose: To compare the nutritional intake of adolescents with eating disorders (EDs) to recommended Daily Values of macronutrients and micronutrients, using the Nutrition Data Systems for Research (NDSR); to determine if nutritional content varied among the different sub-types of EDs; and to use the Healthy Eating Index 2010 (HEI-2010) as a measurement of diet quality in this population. Methods: Forty-six adolescents referred to an ED Program were recruited for inclusion in this study. A detailed 24-h dietary recall from each participant was obtained and a detailed nutritional analysis was generated, allowing for calculation of the HEI-2010. Descriptive statistics were calculated to determine baseline characteristics of the study population and to determine associations and differences between ED subtypes. Results: Average daily caloric intake was below recommended values in the study population. Despite this, the distribution of macronutrients was within the ranges recommended for older children and adolescents by the Dietary Guidelines for Americans, 2010. Micronutrient content varied considerably. The study population had a mean HEI-2010 score of 60.1, falling within the "needs improvement" category. A majority of the participants had insufficient caloric intake for the HEI to be applicable. Conclusion: Results suggest that adolescents with EDs have a surprisingly normal distribution of macronutrient intake. Although using a diet quality assessment tool such as the HEI-2010 has been helpful in analyzing overall diet quality in the general population, the restrictive caloric intake which characterizes the ED population prevents the utility of such a guide for most patients with EDs.

International Journal of Adolescent Medicine and Health, 2016

Objective: This study assesses the basic nutritional knowledge of fourth year medical/osteopathic... more Objective: This study assesses the basic nutritional knowledge of fourth year medical/osteopathic school graduates entering a pediatric residency program and compares the knowledge of the medical students to that of the patients and parents who completed the same survey previously. Methods: Medical and osteopathic school graduates entering a pediatric residency program completed an 18-question nutrition survey during resident orientation in June of 2011 and 2012. Results: The incoming interns averaged answering 52% of the questions correctly. Interns did better than both groups but the only statistically significant difference was between the interns and the non-eating disorder adolescents and their parents (p<0.001). Conclusion: Incoming residents to a pediatric residency program appear to be deficient in basic nutritional knowledge. With the ever increasing burden of obesity and its associated co-morbidities on society, it is imperative that medical education focuses on prepari...

Hospital Pediatrics, 2014

Objective: Overweight and obesity (OAO) are major problems among children and adolescents. Hospit... more Objective: Overweight and obesity (OAO) are major problems among children and adolescents. Hospitalization of pediatric patients provides an opportunity for physicians to initiate point-of-care services related to weight status. Our goal was to determine the prevalence of OAO among hospitalized pediatric patients and to assess the extent of documentation of OAO in their medical records. Methods: We conducted a retrospective chart review of 8- to 18-year-olds admitted to an inpatient pediatric unit during 6 months in 2012. Age, gender, height, weight, BMI, discharge diagnosis, and admitting specialty were extracted from electronic medical records. BMI percentile was calculated from Centers for Disease Control and Prevention growth charts. Prevalence of OAO was determined for medical and surgical subspecialties, and charts were queried for documentation of weight status. Results: The study included 603 patients. Approximately one-third (36.5%) of patients were either overweight or obe...

International Journal of Adolescent Medicine and Health, 2015

Anorexia nervosa is a medical and psychological disorder classically seen in young women who pres... more Anorexia nervosa is a medical and psychological disorder classically seen in young women who present with significant weight loss, a distorted body image, and an intense fear of gaining weight despite being underweight. A rare diagnosis that is also associated with weight loss is a trichobezoar, a collection of hair or hair-like fibers in the gastrointestinal tract, primarily in the stomach. In this report, we present the case of a 14.5-year-old girl with weight loss caused by a trichobezoar, initially thought to be due to anorexia nervosa, and we review the details of both disorders.

International Journal of Adolescent Medicine and Health, 2014

Although the vast majority of youths with an eating disorder (ED) are treated as outpatients, som... more Although the vast majority of youths with an eating disorder (ED) are treated as outpatients, some require treatment in an inpatient unit. The purpose of this study was to determine the attitudes of nurses and pediatric residents towards adolescents and young adults with ED. Methods: Nursing questionnaires were distributed through a nurse manager and resident questionnaires were distributed in coordination with the chief residents. Results: A total of 82 individuals (32 nurses and 50 pediatric residents) completed the survey. Only two nurses and six residents had not worked with a patient with an ED in the previous year. The vast majority of nurses and residents recognized that fear of gaining weight, refusal to maintain body weight and, disturbed body image were frequent signs occurring in patients with an ED. Both nurses and residents believed that emotional problems, influence of friends and family, family pressure, influence of the media, and being self-induced were the most lik...

International Journal of Adolescent Medicine and Health, 2014

Objective: This study aims to determine and compare the level of basic nutrition knowledge of ado... more Objective: This study aims to determine and compare the level of basic nutrition knowledge of adolescents with eating disorders and their parents to adolescents without eating disorders and their parents. Materials and methods: This six-month convenience based survey recruited a total of 182 adolescents with and without an eating disorder and their parents. The surveys were conducted in a suburban adolescent medicine office. Main outcome measures were based on the 18 basic nutrition questions, while means, standard deviations, Wilcoxon Rank Sum Test, and χ2 were all employed for the analysis. Results: None of the groups correctly answered more than half of the questions. In terms of the percentage of correct responses, there was a statistically significant difference between adolescents with eating disorders and their parents compared with adolescents without an eating disorder and their parents. Fewer than 16% of respondents in each group correctly answered the recommended daily ca...

Journal of Correctional Health Care, 2007

Abstract The number of children and adolescents who are overweight continues to increase rapidly ... more Abstract The number of children and adolescents who are overweight continues to increase rapidly in the United States, particularly among African American and Hispanic youth. The dramatic increase in the prevalence of childhood overweight and its resultant ...

International Journal of Adolescent Medicine and Health, 2015

Purpose: The threat of childhood obesity has never been greater. Behavior changes implemented dur... more Purpose: The threat of childhood obesity has never been greater. Behavior changes implemented during childhood and adolescence are believed to be the most successful means of thwarting the progression of this epidemic. The American Academy of Pediatrics has developed a public health campaign that promotes awareness of clinical guidelines for nutrition and physical activity. The campaign is based on a concept developed by the Maine Center for Public Health referred to as “5-2-1-0 Healthy”. The simple clear message of this concept outlines steps families can take to help prevent and treat childhood obesity. The purpose of the present study is to determine the current level of compliance and health education needs of a middle school population related to the “5-2-1-0” concept. Methods: A modified version of the 2010 National Youth Physical Activity and Nutrition Survey (developed by the Centers for Disease Control and Prevention) was distributed to students at a private, nonsectarian, ...

Journal of Adolescent Health Care, 1990

Appropriate screen'ng for cholesterol remains a controversial subject often confusing Practltlone... more Appropriate screen'ng for cholesterol remains a controversial subject often confusing Practltloners. particularly those treating adolescents. TO clarify this dilemma, this study evaluates the efficacy of che AAP's current recommendations for twgefed screening in teens. The results point out the Iimitat:ona of these recommendations. Oetalled information regarding risk factors for hyperChOlesterolemia was obtained from 1.001 adolescents or their parents et three urban teen clinics during routine healtt. assessments. In addition. serum cholesterol was meesured in all adolescents. The population under Study was 38.2% Hispanic. 33.5% White. 15.4% Black, and 11.3% Asian. with a mean age of 15.6 years (range: 12-21 years): 52% were female. Cased on the cholesterol valw~s, the study populetion was div:ded info LYO groups. GROUP I: Normal Cholesterol, < 200 mgfdl (N = 937. mean cholesterol a 157 mg/dl). GROUP II: Elevated cholesterol, 2 200 mgldl (N = 64, mean cholesterol = 228 slg,fdl. range-20.-366 mgldl). Significant differences In risk factors

AM:STARs: Case Studies in Adolescent Health, Vol. 23, No. 2, 2012

Current Problems in Pediatric and Adolescent Health Care, 2017

Current Opinion in Pediatrics, 2018

The purpose of this review is to provide an updated summary on the unique aspects of caring for f... more The purpose of this review is to provide an updated summary on the unique aspects of caring for female youth and adolescent athletes. Recent research on female athletes has led to a better understanding of injuries and conditions that are more likely to occur in female youth and adolescent athletes, including the frequency and severity of concussions, musculoskeletal injury such as involving the anterior cruciate ligament, and the female athlete triad. Social factors, such as the growing pressure to specialize in a sport particularly at an early age, also put young female athletes at risk for issues such as overuse injuries. Researchers continue to explore the benefits of athletic participation that extend beyond physical fitness. Female participation in youth sports has increased dramatically during the past 50 years. This has led to greater research on how to manage risks and maximize benefits for young female athletes, although there is still much to be learned. Providers should educate patients, parents, and coaches on both the increased risks for female athletes and ways to provide better support and accessibility of youth sports to all children.

Current Problems in Pediatric and Adolescent Health Care, 2018

Organized and recreational sports have been shown to be an important part of growth and developme... more Organized and recreational sports have been shown to be an important part of growth and development in children, adolescents and young adults. In addition to the health benefits of increased physical activity, sports also provide social benefits. Pediatricians play an important role in determining if young athletescan participate in various sports and the proper equipment or precautions that are necessary. This review provides information on sports participation for athletes with specific health considerations, such as: febrile illnesses, solitary organs, seizures, and skin infections.

Current Problems in Pediatric and Adolescent Health Care, 2018

Learning about concussion diagnosis and management is important for all individuals who will be t... more Learning about concussion diagnosis and management is important for all individuals who will be taking care of young athletes. There are about 1.7 million reported concussions per year, and, of these, about 20% are sports related. There are risks in all sports, but the highest rates of concussions are from football, rugby, and hockey, with soccer being the highest cause for girls. An on-field assessment includes evaluating airway, breathing, and circulation, followed by cervical spine assessment. Then, concussion evaluation tools can be used to aid in making the diagnosis. While concussion symptoms for the majority of youth resolve within a few weeks, some individuals may have persistence of symptoms for 3 months or more, referred to as postconcussive syndrome. Providers should consider ongoing symptoms in assessing when an athlete may safely return to sports and to learning. A major concern that has become more apparent in recent years is the possibility that concussions may have a longitudinal effect on health, such as in the development of chronic traumatic encephalopathy. Research has shown that there is an increase in the number of patients presenting to their primary care physician with concussions. Knowing how best to prevent, diagnose, and manage concussions will help to minimize risks to young athletes.

Journal of Adolescent Health, 2017

Methods: Fourteen subjects were recruited from within the United States who had a child diagnosed... more Methods: Fourteen subjects were recruited from within the United States who had a child diagnosed with an eating disorder before the age of 18. Qualitative research techniques were used to carry out semi-structured individual interviews. The transcriptions of the interviews were analyzed and coded for themes using the immersion-crystallization method. Topics covered during the interviews included treatment options, the subject's feelings throughout treatment, and aspects of treatment they found helpful or detrimental. Results: Four high level themes and ten sub-themes were identified: High level themes were difficulty with insurance coverage, selfreproach, negative treatment experience, and provider expertise. Difficulty with insurance coverage, self-reproach, desire for additional support services (sub-theme of negative treatment experience), and perceived lack of provider knowledge (sub-theme of provider expertise) were nearly universal. Some subjects conveyed perceived blame from providers, perceived lack of parental engagement in treatment and limited provider availability. However these themes were expressed by only a portion of subjects. Conclusions: This study provides the first qualitative study in the United States addressing parental needs in pediatric eating disorder treatment. It affirms what has been found regarding eating disorder treatment in terms of barriers accessing care and provider expertise. Other themes discussed, such as desire for more support services for the family, should urge clinicians to encourage the use of these services among families when possible, with the goal of maximizing parental support and empowerment. The nearly unanimous self-reproach in the light of a minority of subjects perceiving blame from a provider points to other sources of selfreproach that providers should address directly. Sources of Support: None.

Journal of Advanced Nutrition and Human Metabolism, 2016

Obesity continues to be a growing problem today. Specifically, childhood obesity has become one o... more Obesity continues to be a growing problem today. Specifically, childhood obesity has become one of the most critical public health challenges of this time. Increased weight and poor health lead to higher medical costs, thus, efforts must be made to deal with this problem. This research highlight discusses a study that assessed the nutrition knowledge of medical/osteopathic school graduates entering a pediatric residency program and compares it to the knowledge of previous medical graduates found in the literature. It is imperative that medical education continue to incorporate clinical nutrition education in medical school and beyond because it has been shown that the dedicated time has a beneficial effect on the nutrition knowledge of medical students.

Abnormal Female Puberty, 2016

Childhood and adolescent obesity is an ongoing epidemic in the United States and other industrial... more Childhood and adolescent obesity is an ongoing epidemic in the United States and other industrialized countries, with 16.9 % of children ages 2–19 years in the United States currently classified as obese. The causes for the high prevalence of obesity in America’s youth are multifactorial and include a combination of genetics, poor nutrition, sedentary lifestyle, and environmental and social factors. In addition to having numerous medical and psychosocial complications for teenagers, obesity in young girls also has an effect on puberty and normal reproductive development. Studies have demonstrated that obese girls are more likely to enter puberty earlier and experience menarche at a younger age than their normal weight peers. The earlier onset of puberty in young obese girls is due to a complex interplay of hormones with leptin, a hormone secreted by adipocytes, playing an essential role in the neuroendocrine events that initiate puberty. Early pubertal development carries multiple health risks for young females, including higher rates of depression, substance use, behavior issues, and promiscuity as teenagers and higher rates of type 2 diabetes, hypertension, breast cancer, and increased overall mortality as adults. Furthermore, obese girls are at higher risk for menstrual irregularities secondary to hyperandrogenism and polycystic ovary syndrome, a diagnosis that carries its own set of complications. Prevention and treatment of obesity remains at the forefront of our nation’s healthcare agenda and presents an ongoing challenge for healthcare practitioners.

International Journal of Adolescent Medicine and Health, 2016

Due to the growth of the epidemic of obesity and the association of obesity with both short-term ... more Due to the growth of the epidemic of obesity and the association of obesity with both short-term and long-term medical complications, many professional organizations have recommended performing laboratory testing as part of the initial evaluation of overweight and obese children and adolescents. We report on the results of laboratory testing performed on 110 patients (mean age 14.0 years, range 8–20 years) referred to our weight management program between 2011 and 2013. Our results showed mild abnormalities in levels of cholesterol, glucose, liver enzymes, and thyroid stimulating hormone (TSH) in fewer than 5% of patients for each test and no changes in management based on these results for any of the patients. We call for re-consideration of the recommendations for laboratory testing in children and adolescents being evaluated and treated for overweight and obesity.

Journal of Adolescent Health, 2016

Background: Concussions, a form of mild traumatic brain injury, are a current "hot topic" in spor... more Background: Concussions, a form of mild traumatic brain injury, are a current "hot topic" in sports and medicine, with current research focusing on diagnosis, treatment, and the long-term effects of repeated concussions on development of chronic traumatic encephalopathy. Concussions represent 8.9% of all high school athletic injuries, and pediatricians see many of these patients in their practices, however evolving guidelines and recommendations have resulted in varying practices among providers. Objective: To assess how local pediatricians in New York Chapter 2 of the American Academy of Pediatrics (AAP) diagnose and treat concussion patients, and to evaluate the need for continuing education in this area. Design and methods: Survey Monkey™ was used to query providers regarding their diagnosis and treatment of concussion patients. A total of three emails containing a link to the 22 question multiple-choice survey were sent to AAP Chapter 2 members between January 2015 and June 2015. The survey was adapted and modified with permission from one previously used by "Zonfrillo MR, Master CL, Grady MF, Winston FK, Callahan JM, Arbogast KB. Pediatric providers' self-reported knowledge, practices, and attitudes about concussion. Pediatrics. 2012;130:1120-5". Results: We received 115 responses from 1436 potential participants to whom the survey link was sent, resulting in an 8% response rate. We excluded subspecialists from our data analysis, resulting in data from 95 primary care pediatricians. Of the PCPs 98.7% reported seeing at least one child or adolescent with a concussion in the previous 12 months and 76.6% reported referring some or all of their concussion patients for ongoing management. The most common reason for referral was "I am not always comfortable with management" and the most common subspecialist referral was to a neurologist. Most providers reported that they did not use any guidelines for management (58.3%) and only 57.4% were familiar with the New York State Education Department concussion guidelines. Almost half reported inadequate training in performing neurocognitive assessments (48.6%). Most were comfortable educating families about the diagnosis of concussion (81.7%), as well as recommending the appropriate time to resume school (70.4%) and prescribing and monitoring a return to play protocol (62%). A total of 84.3% also responded, however, that they would be interested in a webinar for a continuing medical education(CME) credit focused on concussion diagnosis and management. Conclusions: Most pediatric providers care for patients who have suffered a concussion, however many identify barriers to diagnosis and treatment, which results in patients being referred to subspecialists for further management. Many providers are also unfamiliar with, or do not use, published concussion guidelines and report varying practices in treatment of concussion patients due to evolving recommendations. This study demonstrates that there is a need for further education for pediatric providers who see patients with concussion.

Journal of Adolescent Health, 2016

Purpose: To compare the nutritional intake of adolescents with eating disorders (EDs) to recommen... more Purpose: To compare the nutritional intake of adolescents with eating disorders (EDs) to recommended Daily Values of macronutrients and micronutrients, using the Nutrition Data Systems for Research (NDSR); to determine if nutritional content varied among the different sub-types of EDs; and to use the Healthy Eating Index 2010 (HEI-2010) as a measurement of diet quality in this population. Methods: Forty-six adolescents referred to an ED Program were recruited for inclusion in this study. A detailed 24-h dietary recall from each participant was obtained and a detailed nutritional analysis was generated, allowing for calculation of the HEI-2010. Descriptive statistics were calculated to determine baseline characteristics of the study population and to determine associations and differences between ED subtypes. Results: Average daily caloric intake was below recommended values in the study population. Despite this, the distribution of macronutrients was within the ranges recommended for older children and adolescents by the Dietary Guidelines for Americans, 2010. Micronutrient content varied considerably. The study population had a mean HEI-2010 score of 60.1, falling within the "needs improvement" category. A majority of the participants had insufficient caloric intake for the HEI to be applicable. Conclusion: Results suggest that adolescents with EDs have a surprisingly normal distribution of macronutrient intake. Although using a diet quality assessment tool such as the HEI-2010 has been helpful in analyzing overall diet quality in the general population, the restrictive caloric intake which characterizes the ED population prevents the utility of such a guide for most patients with EDs.

International Journal of Adolescent Medicine and Health, 2016

Objective: This study assesses the basic nutritional knowledge of fourth year medical/osteopathic... more Objective: This study assesses the basic nutritional knowledge of fourth year medical/osteopathic school graduates entering a pediatric residency program and compares the knowledge of the medical students to that of the patients and parents who completed the same survey previously. Methods: Medical and osteopathic school graduates entering a pediatric residency program completed an 18-question nutrition survey during resident orientation in June of 2011 and 2012. Results: The incoming interns averaged answering 52% of the questions correctly. Interns did better than both groups but the only statistically significant difference was between the interns and the non-eating disorder adolescents and their parents (p<0.001). Conclusion: Incoming residents to a pediatric residency program appear to be deficient in basic nutritional knowledge. With the ever increasing burden of obesity and its associated co-morbidities on society, it is imperative that medical education focuses on prepari...

Hospital Pediatrics, 2014

Objective: Overweight and obesity (OAO) are major problems among children and adolescents. Hospit... more Objective: Overweight and obesity (OAO) are major problems among children and adolescents. Hospitalization of pediatric patients provides an opportunity for physicians to initiate point-of-care services related to weight status. Our goal was to determine the prevalence of OAO among hospitalized pediatric patients and to assess the extent of documentation of OAO in their medical records. Methods: We conducted a retrospective chart review of 8- to 18-year-olds admitted to an inpatient pediatric unit during 6 months in 2012. Age, gender, height, weight, BMI, discharge diagnosis, and admitting specialty were extracted from electronic medical records. BMI percentile was calculated from Centers for Disease Control and Prevention growth charts. Prevalence of OAO was determined for medical and surgical subspecialties, and charts were queried for documentation of weight status. Results: The study included 603 patients. Approximately one-third (36.5%) of patients were either overweight or obe...

International Journal of Adolescent Medicine and Health, 2015

Anorexia nervosa is a medical and psychological disorder classically seen in young women who pres... more Anorexia nervosa is a medical and psychological disorder classically seen in young women who present with significant weight loss, a distorted body image, and an intense fear of gaining weight despite being underweight. A rare diagnosis that is also associated with weight loss is a trichobezoar, a collection of hair or hair-like fibers in the gastrointestinal tract, primarily in the stomach. In this report, we present the case of a 14.5-year-old girl with weight loss caused by a trichobezoar, initially thought to be due to anorexia nervosa, and we review the details of both disorders.

International Journal of Adolescent Medicine and Health, 2014

Although the vast majority of youths with an eating disorder (ED) are treated as outpatients, som... more Although the vast majority of youths with an eating disorder (ED) are treated as outpatients, some require treatment in an inpatient unit. The purpose of this study was to determine the attitudes of nurses and pediatric residents towards adolescents and young adults with ED. Methods: Nursing questionnaires were distributed through a nurse manager and resident questionnaires were distributed in coordination with the chief residents. Results: A total of 82 individuals (32 nurses and 50 pediatric residents) completed the survey. Only two nurses and six residents had not worked with a patient with an ED in the previous year. The vast majority of nurses and residents recognized that fear of gaining weight, refusal to maintain body weight and, disturbed body image were frequent signs occurring in patients with an ED. Both nurses and residents believed that emotional problems, influence of friends and family, family pressure, influence of the media, and being self-induced were the most lik...

International Journal of Adolescent Medicine and Health, 2014

Objective: This study aims to determine and compare the level of basic nutrition knowledge of ado... more Objective: This study aims to determine and compare the level of basic nutrition knowledge of adolescents with eating disorders and their parents to adolescents without eating disorders and their parents. Materials and methods: This six-month convenience based survey recruited a total of 182 adolescents with and without an eating disorder and their parents. The surveys were conducted in a suburban adolescent medicine office. Main outcome measures were based on the 18 basic nutrition questions, while means, standard deviations, Wilcoxon Rank Sum Test, and χ2 were all employed for the analysis. Results: None of the groups correctly answered more than half of the questions. In terms of the percentage of correct responses, there was a statistically significant difference between adolescents with eating disorders and their parents compared with adolescents without an eating disorder and their parents. Fewer than 16% of respondents in each group correctly answered the recommended daily ca...

Journal of Correctional Health Care, 2007

Abstract The number of children and adolescents who are overweight continues to increase rapidly ... more Abstract The number of children and adolescents who are overweight continues to increase rapidly in the United States, particularly among African American and Hispanic youth. The dramatic increase in the prevalence of childhood overweight and its resultant ...

International Journal of Adolescent Medicine and Health, 2015

Purpose: The threat of childhood obesity has never been greater. Behavior changes implemented dur... more Purpose: The threat of childhood obesity has never been greater. Behavior changes implemented during childhood and adolescence are believed to be the most successful means of thwarting the progression of this epidemic. The American Academy of Pediatrics has developed a public health campaign that promotes awareness of clinical guidelines for nutrition and physical activity. The campaign is based on a concept developed by the Maine Center for Public Health referred to as “5-2-1-0 Healthy”. The simple clear message of this concept outlines steps families can take to help prevent and treat childhood obesity. The purpose of the present study is to determine the current level of compliance and health education needs of a middle school population related to the “5-2-1-0” concept. Methods: A modified version of the 2010 National Youth Physical Activity and Nutrition Survey (developed by the Centers for Disease Control and Prevention) was distributed to students at a private, nonsectarian, ...

Journal of Adolescent Health Care, 1990

Appropriate screen'ng for cholesterol remains a controversial subject often confusing Practltlone... more Appropriate screen'ng for cholesterol remains a controversial subject often confusing Practltloners. particularly those treating adolescents. TO clarify this dilemma, this study evaluates the efficacy of che AAP's current recommendations for twgefed screening in teens. The results point out the Iimitat:ona of these recommendations. Oetalled information regarding risk factors for hyperChOlesterolemia was obtained from 1.001 adolescents or their parents et three urban teen clinics during routine healtt. assessments. In addition. serum cholesterol was meesured in all adolescents. The population under Study was 38.2% Hispanic. 33.5% White. 15.4% Black, and 11.3% Asian. with a mean age of 15.6 years (range: 12-21 years): 52% were female. Cased on the cholesterol valw~s, the study populetion was div:ded info LYO groups. GROUP I: Normal Cholesterol, < 200 mgfdl (N = 937. mean cholesterol a 157 mg/dl). GROUP II: Elevated cholesterol, 2 200 mgldl (N = 64, mean cholesterol = 228 slg,fdl. range-20.-366 mgldl). Significant differences In risk factors