Survey suggests education objectives to improve practice activities

Article Abstract:

A recent survey described how primary care physicians identify and manage factors that increase the risk of cardiovascular disease in children. This national survey identified the need for education about cardiovascular risk factors and illustrated patterns of practice that could be used to plan continuing medical education programs. The findings can also be incorporated in planning undergraduate and medical residency education. A long-term goal of most pediatric primary care physicians is to prevent the early development of disease of the coronary arteries, the major blood vessels supplying the heart. Although it is universally accepted that cholesterol screening should be done on children whose first- or second-degree relatives have cardiovascular risk factors, family history alone is not adequate for identifying children at risk. The management of cardiovascular risk factors in children should involve effective nutritional and physical activity counseling. However, physicians are not adequately trained in the methods required to promote behavioral changes directed at health promotion and disease prevention activities. Hence, medical education programs should not only teach the benefits of good nutrition, physical activity, and nonsmoking, but also how to effect changes in behavior. The immediate goal of the primary care physician is to promote the development of healthy lifestyles. Although the routine measurement of blood pressure in children is beneficial, the effects of starting drug treatment to lower blood pressure or lipid levels may not be favorable. Instead, healthy lifestyles should be promoted in children with elevated cholesterol levels. Children with excessive blood levels of cholesterol may require drug therapy but, to avoid parental alarm, they should not be classified as hypercholesterolemic. (Consumer Summary produced by Reliance Medical Information, Inc.)

Study and teaching, Pediatric cardiology, editorial

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Poverty and cardiac disease in children

Article Abstract:

Congenital heart defects affect approximately one of every one thousand infants born each year. Coupled with acquired heart diseases, such as rheumatic fever, AIDS myocarditis (AIDS-related inflammation of the heart), arrythmias (abnormal heart rhythms), and cardiomyopathies (diseases of heart muscle), up to one-half million children may suffer some degree of cardiac impairment. Of this total, approximately one-third have the added burden of poverty. Each child will require frequent visits for medical treatment and follow-up care; some will require invasive diagnostic procedures, and about 40 percent will require reparative surgery. The risks attendant on children who live in poverty add to the burden. Environmental challenges, lack of participation in the support system, and inadequate insurance (including lack of insurance) further complicate the situation. The cardiac services needed by poor children with heart disease are difficult to acquire, because of parental ignorance or lack of insurance coverage. The age of the grown child with heart disease adds to the problem. The 21-year-old previously insured dependent who received Crippled Children's Services is unable to obtain insured care because of the 'pre-existing condition'. Care and treatment are expensive, usually beyond the financial reach of young parents who lack adequate resources. Without a compassionate system, physician, clinic or other resource, their children do not get the care they need. Health and educational services for children with heart disease need to be expanded and made more readily available. Prevention and intervention strategies should be developed. Pediatric cardiologists must be the voice for children with heart and they must speak out in the political arena. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Social aspects, Demographic aspects, Poor children, Child health services

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You are a preventive cardiologist: the scope of pediatric preventive cardiology

Article Abstract:

The historic role of the pediatrician is to serve the young and practice a form of preventive medicine. Pediatricians have a well-founded reputation for being concerned with good nutrition, and encouraging children to develop good health habits. They have led the fight against smoking and advocated physical activity. Increasingly, pediatricians are becoming involved in preventive cardiology. Although this focuses greater attention on a single organ system, it differs little from their traditional role. Pediatricians are now trying to identify children who are at high risk for developing coronary artery disease and high blood pressure (hypertension). Although nearly half of all children are at risk for future cardiovascular difficulties, primary prevention must be generally applied to the community-at-large. An effective approach is to pursue both the identification of high-risk individuals and community awareness. Cholesterol screening at the pediatrician's office is encouraged. This allows for generalized screening, and when children who have elevated cholesterol levels are identified, thorough assessments. Experience has also demonstrated that the parents of high-risk children also have elevated cholesterol levels. Cholesterol measurements and their interpretation also afford the pediatrician an excellent opportunity to discuss all elements of a prudent life-style, aimed at preventing cardiovascular problems, with parents and children. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Hypertension, Testing, Statistics, Children, Blood cholesterol, Preventive medicine, Medicine, Preventive

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