Faculty Bibliography

The current study describes the development of a short pre-clinic survey that helped multidiscipline providers to elicit patient perspective on barriers to HIV primary care. The survey was piloted with 318 patients returning to care after being lost to care for at least 12 months. Reasons for breaks in care were dependent on age, gender, and race. Concerns about confidentiality in care were more commonly reported by African-American, Latino, and younger patients, while concerns relating to acceptance of diagnosis and side effects were greater for women, African-American, and Latino participants. Further, Intimate Partner Violence (IPV) and transportation were greater concerns for women and younger patients in the sample.

PURPOSE: This study aimed to determine the changes in diagnosis that occur in making the transition from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria in an adolescent medicine eating disorder program. METHODS: During the months of September 2011 through December 2012, a data sheet was completed at the end of each new outpatient eating disorder evaluation listing the patient's gender, age, ethnicity, weight, height, DSM-IV diagnosis, and proposed DSM-5 diagnosis. Distributions were calculated using the Mann-Whitney and Wilcoxon rank sum analyses to determine differences between diagnostic groups. RESULTS: There were 309 patients evaluated during the 16-month period. DSM-IV diagnoses were as follows: anorexia nervosa, 81 patients (26.2%); bulimia nervosa, 29 patients (9.4%); binge eating disorder, 1 patient (0.3%); and eating disorder not otherwise specified (EDNOS), 198 patients (64.6%). By contrast, DSM-5 diagnoses were as follows: anorexia nervosa, 100 patients; atypical anorexia nervosa, 93 patients; avoidant/restrictive food intake disorder, 60 patients; bulimia nervosa, 29 patients; purging disorder, 18 patients; unspecified feeding or eating disorder, 4 patients; subthreshold bulimia nervosa, 2 patients; subthreshold binge eating disorder, 2 patients; and binge eating disorder, 1 patient. CONCLUSION: Almost two thirds (64.6%) of the 309 patients had a diagnosis of EDNOS based on the DSM-IV criteria. By contrast, only four patients had a diagnosis of unspecified feeding or eating disorder based on the DSM-5 criteria. These data demonstrate that the goal of providing more specific diagnoses for patients with eating disorders has been accomplished very successfully by the new DSM-5 criteria.

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, middle school in New York City. The school is located in the borough of Manhattan, but includes youngsters from all five boroughs of the city. The questions were grouped and analyzed according to "5-2-1-0" categories. Surveys were scored, and the association between targeted questionnaire items and demographic variables (i.e., sex and grade) was examined. RESULTS: All 140 students completed the survey, and there was great variability in their responses to both the nutrition and physical activity questions. Of all students, 65% reported eating one cup or more of fruit daily, and 38% reported eating one cup or more of vegetables daily. There was no statistically significant difference reported in consumption of fruits or vegetables by gender or grade. Over 60% of students indicated <2 h of DVD/video or computer/video game time per day, while 10% indicated more than 3 h per day for each. A significant difference existed in the screen time reported between grades (more screen time by the older students) and a statistically significant difference also existed in the amount of physical activity reported by gender and grade (more physical activity by males and younger students). There was no difference in the reported consumption of sugar-sweetened beverages by gender or grade. CONCLUSION: In a cohort of middle school students in New York City, there was great variability in compliance with the principles represented by the "5-2-1-0" concept. Changes in health behaviors were noted as students went from 6th to 7th to 8th grade, with physical activity decreasing and screen time increasing. Consequently, health curriculum topics for middle school students should focus on physical activity and screen time, while continuing to emphasize the need for proper nutrition.

A 13-year-old girl presented to our Division of Adolescent Medicine for evaluation of ongoing fatigue. She and her mother reported that 15 months earlier, when the patient was in the 7th grade, she started to be tired and "sleep all the time." They do not remember her being ill at that time; a test for mononucleosis was reportedly positive, but Epstein-Barr virus titers showed "old disease." She remained fatigued throughout 7th grade but attended school without falling asleep; however, she was too tired to do her work and had to attend summer school. The patient received home instruction in 8th grade and reported that on weekdays she slept from 1 AM to 11 AM with a nap from 4 to 8 PM and on weekends she slept from 3 AM to 1 PM without a nap.