PUBLIC HEALTH

Comprehensive, School-based Cardiovascular Screening Is Feasible, Effective

Comprehensive screening for cardiovascular risk, including testing for cholesterol and diabetes, is feasible in middle schools, according to a small study published in the Journal of Pediatrics. Furthermore, screening in some school settings has a high yield of abnormal test results.

While The American Academy of Pediatrics, the American Heart Association, and the American Diabetes Association recommend screening older, school-age children for weight status, hypertension, lipid abnormalities, and diabetes, it is known that the majority of children are not being screened in primary care offices.

Researchers from Cincinnati Children’s conducted a pilot to assess the feasibility of universal screening for diabetes, lipid abnormalities, and hypertension in the middle-school setting. Diabetes screening (hemoglobin A1c [HbA1c] testing) was offered to all participating students, since medical histories were not available. Only one mailing requesting consent was mailed to families.

Of the 290 seventh and eighth grade students, 16 percent of parents consented at Northwood Middle School, located in a city of 20,000 people without a pediatric practice in its city limit. Screening was conducted during two 4-hour morning sessions. A letter was sent home with the screening results and suggestions for follow-up, if needed, with a primary care provider or an appropriate pediatric subspecialist, if indicated. Guardians of children with critical screening values were called and appropriate follow-up was arranged.

Of 45 children screened, more than one-third of children (34.8 percent) had lipid or hbA1c abnormalities. Two students had HbA1c values in the diabetes range, while two students had a cholesterol level above 200 mg/dL with a calculated low-density lipoprotein greater than 140 mg/dL. Three additional students had a total cholesterol between 169 and 200 mg/dL with normal calculated low-density lipoprotein values. Of the two students with HbA1c above 5.6, both were asymptomatic and referred to a pediatric endocrinologist for evaluation where one was diagnosed with maturity onset diabetes of youth type 1 and the other girl was diagnosed as with type 2 diabetes.

“We were shocked with the diabetes screening results,” said lead author Robert Siegel, M.D., in a statement. “Most studies show that around 20 percent of kids will have abnormalities, so we weren’t too surprised by the results of the lipid screening. Our message is to get screened.”

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