Pediatrics Research at The Center for Health Research

Transcription

1 Pediatrics Research at The Center for Health Research OCTRI Pediatrics Research Retreat Mark C. Hornbrook, PhD Chief Scientist The Center for Health Research Northwest/Hawaii/Southeast May 22,

2 A Sweeping View 2

3 The Center for Health Research Newest applicant: Maccabi-Health, Israel 3

4 KPNW Pediatric Members, Girls = 64,688; Boys = 66, Yr. 2-5 Yrs Yrs Yrs Yrs. Girls Boys 4

5 Adolescent Smoking Teen REACH Jack Hollis, PhD Can pediatricians help teens quit smoking? Yes--largest, longest, and most successful teen stop-smoking study Only study that took place during routine pediatric visits Program using brief clinician advice, an interactive computer program, and two intervention phone calls Two-thirds of all teens approached participated We doubled the quit rate for smoking teens, ages 14-17, at the two-year follow-up from 11% to 24% Not successful in preventing nonsmoking teens from starting 5

6 Adolescent Smoking Teen Quitline Jack Hollis, PhD Will teen smokers use a free quit-help telephone line to stop smoking? No just offering help is ineffective No teachable moment Need greater intervention intensity, as with Teen REACH 6

7 Childhood Overweight Childhood Obesity and Metabolic Imprinting: What are the Ongoing Effects of Maternal Hyperglycemia? Teresa Hillier, MD, MS Overweight and obesity risk is increased nearly twofold in KPNW and KPH children age 5-7 if their mother had gestational diabetes (GDM) that was not treated In contrast, offspring of mothers who were treated for GDM had no difference in childhood overweight or obesity risk, suggesting GDM is a modifiable risk factor for childhood obesity 7

8 Type II Diabetes in Adolescents What are the risk factors for Type II diabetes in Native Hawaiians and Pacific Islanders? Teresa Hillier, MD, MS Obesity from diets high in saturated fats and high calories! 8

9 Pediatric Nutrition Research DISC Dietary Intervention Study in Children Vic Stevens, PhD Are low-fat diets safe for children? Yes, up to a point YOUTH Youth Osteoporosis Prevention Lynn DeBar, PhD, MPH Can teen girls improve their uptake of calcium and raise their bone mineral densities? Yes, in the short run 9

10 Vaccine Safety Datalink VSD Are childhood vaccines safe? Allison Naleway, PhD Risk of seizures, intussusception, autism, Yes, even MMR 10

11 Pediatric Mental Health Research ADEPT Adolescent Depression Education, Prevention, and Treatment Greg Clarke, PhD Can demoralized teens living in a household with a depressed parent be taught cognitive and behavioral skills to prevent depression episodes? Yes! Can depressed teens living in a household with a depressed parent be taught cognitive and behavioral skills to relieve their depression episodes? Perhaps right direction but not significant 11

12 Pediatric Mental Health Research PUP Psychotropic Use in Preschoolers Lynn DeBar, PhD, MPH What are the diagnoses, symptoms, and health care services associated with preschool children receiving psychotropic medications? Health Services Use by Children with ADHD Lynn DeBar, PhD, MPH, & Frances Lynch, PhD Does KPNW have higher or lower rates of psychotropic medication use by children with ADHD compared to fee-for-service populations? Lower rates 12

13 Ongoing Pediatrics Research at TCHR Vaccine Safety Datalink Allison Naleway, PhD Pharmacovigilance for pediatric vaccines SEARCH for Diabetes in Youth Teresa Hiller, MD, MS Recruiting all youth with diabetes age < 20 (prevalent, now incident cases) 13

14 Ongoing Pediatrics Research at CHR What costs do families incur for childhood mental health/developmental disorders? Frances Lynch, PhD SHINE--can obese teens lose weight? Lynn DeBar, PhD, MPH HEALTHY--can diabetes be prevented by helping obese teens lose weight? Lynn DeBar, PhD, MPH 14

15 Prior Pediatric Evidence Reviews at Oregon Evidence-based Practice Center Screening for speech and language delay in preschool children Screening children for family violence Screening for elevated lead levels in childhood and pregnancy Screening for developmental dysplasia of the hip Universal newborn hearing screening 15

16 Prior Pediatric Evidence Reviews at Oregon Evidence-based Practice Center Screening and interventions for childhood overweight Primary care counseling about motor vehicle occupant restraints and alcoholrelated driving to prevent injuries Screening for lipid disorders in children and adolescents Screening for child and adolescent depression in primary care settings 16

17 Germinating Opportunities 17

18 Oregon Evidence-based Practice Center Pediatricians needed to help prioritize topics for comparative clinical effectiveness, outcomes, and appropriateness of pharmaceuticals, devices, and health services Evelyn Whitlock, MD, MPH 18

19 Oregon Evidence-based Practice Center AHRQ's Effective Healthcare Program Relevant to Medicare, Medicaid, and SCHIP Forthcoming Evidence reviews (specifically for the USPSTF) Screening for Visual Impairment in Children Younger than 5 Years Screening for High Blood Pressure in Children and Adolescents Update on Universal Newborn Hearing Screening Update on Childhood Overweight Screening and Treatment 19

20 2008 Priority Pediatric Health Conditions for AHRQ EHC Program ADHD, developmental delays, autism Cancer Depression and other mood disorders Diabetes mellitus Obesity Pulmonary disease/asthma 20

21 Future Pediatrics Research Opportunities at TCHR Pediatrics coinvestigators needed for research on: Childhood overweight, diet, nutrition, exercise Pediatric pharmacovigilance Pediatric rare diseases Pediatric mental health More to come from Greg Clarke and Lynn DeBar 21

22 Future Pediatrics Research Opportunities at TCHR Pediatrics coinvestigators needed for research on: Childhood cancers Health systems research Comparative effectiveness research Pediatric health-related quality of life measurement 22

23 Starting Tomorrow 23

24 Translational Research Opportunities Can KPNW and OHSU collaborate to generate detectable improvements in the health of Oregon s children over the next 10 years? Can KPNW and OHSU collaborate to generate greater participation by Oregon s children in research to improve their health and well being? Can NWP and OHSU pediatricians create successful career models of practicebased research? 24

25 Questions? 25