Implementation of an Evidence-Based Childhood Obesity Toolkit in a Rural Pediatric Clinic in Cookeville, TN: A Quality Improvement Project Dawn G. Johnson, MSN, APRN, FNP-BC Tennessee Technological University Nursing 6802 – DNP Project Development Dr. Victoria Pope & Dr. Candice Short March 23, 2022 Author Note Dawn G. Johnson https://orcid.org/0000-0002-7090-8036 College of Nursing, Tennessee Technological University There are no conflicts of interest to disclose. Correspondence concerning this manuscript should be addressed to Dawn G. Johnson, Tennessee Technological University, 248 Haven Lane, Algood, TN 38506 Email: djohnson@tntech.edu Abstract Purpose: The purpose of this quality improvement project is to increase the early identification of overweight or obese children in the primary care setting and provide education through the implementation of an evidence-based childhood obesity toolkit. Aims: This project aims to implement the Healthy Care for Healthy Kids Physical Activity and Nutrition Survey Management Plan to educate patients and parents about childhood obesity. The Healthy Care for Healthy Kids Physical Activity and Nutrition Survey Management Plan is an evidence-based questionnaire and action plan used by healthcare providers in the prevention and treatment of childhood obesity. Processes: Nurses will provide the toolkit to children ages 5-18 who present to the clinic for well-child examinations and have a BMI classified as overweight or obese. Providers will then review the screening toolkit with the patient and family and make a corrective plan of action. The screening tool will then be signed by the patient, caregiver, and provider and placed in the child’s electronic medical record. Results: To be determined after project implementation is complete. Results are anticipated to be that more overweight and obese children are identified by the clinic and proper education is provided to the patient and family. Limitations: The study is limited to one location and only available to the providers who perform well-child examinations. Conclusions: Implementation of an evidence-based childhood obesity toolkit in the pediatric setting with increase the early identification of overweight and obese children. Keywords: childhood obesity, pediatric obesity, toolkit, obesity, overweight

Background: While the obesity epidemic is impacting children, survivors of childhood brain tumors (SCBT) are particularly vulnerable to obesity-driven cardiometabolic comorbidities. SCBT have excess body fat (adiposity) with similar body mass measures when compared to matched non-cancer controls. The effect of the built environment on the risk of obesity has received relatively limited attention in survivors. Aim & Methods: The aim of this project was to determine the impact of the built environment on body mass index (BMI) percentile, body fat percentage (BF%), waist-to-hip ratio (WHR), and waist-to-height-ratio (WHtR) in SCBT and non-cancer controls. The data for this secondary analysis were derived from participants in the Canadian Study of Determinants of Endometabolic Health in Children (CanDECIDE), a prospective cohort study based at McMaster Children’s Hospital, a tertiary pediatric academic center in Hamilton, Ontario, Canada. The Neighborhood Environment Walkability Scale (NEWS) was used to assess the built environment. Multivariable regression analyses were used to define the predictors of the association. Results: The built environment was not associated with BMI percentile in SCBT and non-cancer controls including residential density (B 0.276, p value 0.436), land use mix diversity (B -0.286, p value 0.301), land use mix access (B 0.004, p value 0.993), street connectivity (B 0.297, p value 0.431), walking/cycling facilities (B 0.185, p value 0.540), neighborhood aesthetics (B 0.270, p value 0.513), safety from traffic (B -0.368, p value 0.418), and safety from crime (B -0.074, p value 0.907). The built environment was also not associated with adiposity measures (BF%: residential density B 0.031, p value 0.851, land use mix diversity B -0.082, p value 0.513, land use mix access B -0.036, p value 0.861, street connectivity B 0.309, p value 0.055, walking/cycling facilities B 0.109, p 0.439, neighborhood aesthetics B 0.127, p value 0.503, safety from traffic B -0.047, p value 0.825, and safety from crime B -0.154, p value 0.601; WHR: residential density B -0.042, p value 0.362, land use mix diversity B 0.043, p value 0.131, land use mix access B -0.028, p value 0.558, street connectivity B -0.044, p value 0.252, walking/cycling facilities B 0.026, p value 0.476, neighborhood aesthetics B 0.062, p value 0.137, safety from traffic B -0.048, p value 0.336, and safety from crime B -0.083, p value 0.239; WHtR: residential density B 0.011, p value 0.865, land use mix diversity B 0.033, p value 0.462, land use mix access B -0.032, p value 0.662, street connectivity B 0.021, p value 0.720, walking/cycling facilities B 0.042, p value 0.493, neighborhood aesthetics B 0.018, p value 0.790, safety from traffic B -0.020, p value 0.789, and safety from crime B -0.086, p value 0.392). Conclusion: The results of this study suggest that the built environment has less of an impact than brain tumors and their treatments on driving body mass and fat mass changes in SCBT. The use of lifestyle interventions may need to be combined with pharmacotherapies in the treatment of obesity in SCBT. / Thesis / Master of Science (MSc) / Childhood obesity is a global epidemic. Survivors of childhood brain tumors (SCBT) are a subpopulation of childhood cancer survivors who exhibit numerous comorbidities including obesity. SCBT have increased amounts of adipose tissue compared to non-cancer controls at similar body mass. While tumor and treatment related drivers of obesity exist in this population, the impact of environmental factors on obesity and the fat mass are not well understood. In this cross-sectional study, we aimed to determine the association between the built environment and body mass in SCBT and non-cancer controls. There was no association between the built environment and body mass measures in survivors. This study suggests the disproportionate importance of the biological mechanisms including the original tumors and their treatments on body mass in SCBT. Interventions to mitigate obesity and cardiometabolic risk in survivors need to focus on addressing tumor and treatment impacts.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01

Background: While the obesity epidemic is impacting children, survivors of childhood brain tumors (SCBT) are particularly vulnerable to obesity-driven cardiometabolic comorbidities. SCBT have excess body fat (adiposity) with similar body mass measures when compared to matched non-cancer controls. The effect of the built environment on the risk of obesity has received relatively limited attention in survivors. Aim & Methods: The aim of this project was to determine the impact of the built environment on body mass index (BMI) percentile, body fat percentage (BF%), waist-to-hip ratio (WHR), and waist-to-height-ratio (WHtR) in SCBT and non-cancer controls. The data for this secondary analysis were derived from participants in the Canadian Study of Determinants of Endometabolic Health in Children (CanDECIDE), a prospective cohort study based at McMaster Children’s Hospital, a tertiary pediatric academic center in Hamilton, Ontario, Canada. The Neighborhood Environment Walkability Scale (NEWS) was used to assess the built environment. Multivariable regression analyses were used to define the predictors of the association. Results: The built environment was not associated with BMI percentile in SCBT and non-cancer controls including residential density (B 0.276, p value 0.436), land use mix diversity (B -0.286, p value 0.301), land use mix access (B 0.004, p value 0.993), street connectivity (B 0.297, p value 0.431), walking/cycling facilities (B 0.185, p value 0.540), neighborhood aesthetics (B 0.270, p value 0.513), safety from traffic (B -0.368, p value 0.418), and safety from crime (B -0.074, p value 0.907). The built environment was also not associated with adiposity measures (BF%: residential density B 0.031, p value 0.851, land use mix diversity B -0.082, p value 0.513, land use mix access B -0.036, p value 0.861, street connectivity B 0.309, p value 0.055, walking/cycling facilities B 0.109, p 0.439, neighborhood aesthetics B 0.127, p value 0.503, safety from traffic B -0.047, p value 0.825, and safety from crime B -0.154, p value 0.601; WHR: residential density B -0.042, p value 0.362, land use mix diversity B 0.043, p value 0.131, land use mix access B -0.028, p value 0.558, street connectivity B -0.044, p value 0.252, walking/cycling facilities B 0.026, p value 0.476, neighborhood aesthetics B 0.062, p value 0.137, safety from traffic B -0.048, p value 0.336, and safety from crime B -0.083, p value 0.239; WHtR: residential density B 0.011, p value 0.865, land use mix diversity B 0.033, p value 0.462, land use mix access B -0.032, p value 0.662, street connectivity B 0.021, p value 0.720, walking/cycling facilities B 0.042, p value 0.493, neighborhood aesthetics B 0.018, p value 0.790, safety from traffic B -0.020, p value 0.789, and safety from crime B -0.086, p value 0.392). Conclusion: The results of this study suggest that the built environment has less of an impact than brain tumors and their treatments on driving body mass and fat mass changes in SCBT. The use of lifestyle interventions may need to be combined with pharmacotherapies in the treatment of obesity in SCBT. / Thesis / Master of Science (MSc) / Childhood obesity is a global epidemic. Survivors of childhood brain tumors (SCBT) are a subpopulation of childhood cancer survivors who exhibit numerous comorbidities including obesity. SCBT have increased amounts of adipose tissue compared to non-cancer controls at similar body mass. While tumor and treatment related drivers of obesity exist in this population, the impact of environmental factors on obesity and the fat mass are not well understood. In this cross-sectional study, we aimed to determine the association between the built environment and body mass in SCBT and non-cancer controls. There was no association between the built environment and body mass measures in survivors. This study suggests the disproportionate importance of the biological mechanisms including the original tumors and their treatments on body mass in SCBT. Interventions to mitigate obesity and cardiometabolic risk in survivors need to focus on addressing tumor and treatment impacts.

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This study aimed to establish a better candidacy protocol for pediatric heart transplant patients at the University of Arizona Medical Center through a retrospective chart review of pediatric heart transplants held there between the years of 2004 -2009. Sequential patterns related to noncompliance investigated included patient and guardian demographics and past medical, familial, social and psychiatric history. Trends between gender and noncompliance were found as 5/5 noncompliant rejectors were male. Four out of the 5 were between the ages of 16.5 and 21 years old. Seventy percent of medication changes due to medication intolerance were associated with noncompliance. Patients with family members currently or previously suffering from life-threatening illnesses (7/16) had a greater likelihood of having subtherapeutic immunosuppressive trough levels. Of noncompliant rejectors, 4/5 (80%) had a duration of illness prior to transplant > than 6 months. Also, 4/4 patients with pre-transplant depression experienced rejection and 2/4 were noncompliant rejectors.

Purpose: The purpose of this study is to assess what training and motivational factors dental providers report in providing dental care to PSHCN (patients with special healthcare needs. Materials and Methods: An electronic questionnaire was sent to n=104 fourth year dental students, n=147 general dentists with a specific continuing education course pertaining to PSCHN, and n=140 pediatric dentists in Virginia. The questionnaire consisted of four sections including Demographics, Professional Attitudes, Special Needs Patients and Motivational Factors, and PSCHN Cases. Results: The overall response rate for our study was 21%. The response rates of dental students, general dentists, and pediatric dentists were 30%, 10%, and 25%, respectively. A statistically significant difference was found for 10 out 12 motivational factors. Conclusions: There is a difference in motivational factors among the three different types of dental providers.

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University