Journal Club

January 1, 2009

Asthma investigators identified evidence-based clinical process measures that are appropriate, feasible, and reliable for assessing the quality of care provided to children hospitalized with asthma exacerbations.

Hospitalized children's asthma care can be better

Asthma investigators identified evidence-based clinical process measures that are appropriate, feasible, and reliable for assessing the quality of care provided to children hospitalized with asthma exacerbations. A literature review of existing asthma care evidence, and input from a consensus panel of pediatric hospitalists and a pediatric pulmonologist, determined measures' appropriateness, while manual chart review evaluated their feasibility and reliability. To assess provider compliance with nine identified measures, investigators conducted a retrospective manual chart review of records for children with asthma exacerbations who were admitted to a tertiary care children's hospital in Salt Lake City in 2005.

Investigators identified the following clinical process measures as appropriate, feasible, and reliable:

Commentary

The authors had two goals in this study: to establish measures of quality of inpatient pediatric asthma care, and to measure their own practices against these standards. The latter goal reflects only local practice. But the former has potential national implications. Can we all agree on some evidence-based measures of our asthma care? We should try-better that than having regulatory agencies, insurers, and others decide for us.

Are childhood sleep duration and adult BMI connected?

According to a new study from New Zealand, childhood sleep duration and adult body mass index (BMI) are inversely related. Investigators followed a birth cohort of more than 1,000 individuals up to the age of 32. They obtained sleep information from parents when the children were 5, 7, 9, and 11 years of age, and from the study participants themselves when they reached the age of 32, at which time BMI measurements were obtained.

Analysis showed that shorter childhood sleep times were significantly associated with higher adult BMI values. This association remained after adjustment for potential confounding effects, including early childhood BMI (participants' BMI were also determined when they were 5 years old), childhood socioeconomic status, parental BMIs, child and adult television viewing, adult physical activity, and adult smoking. In contrast, sleep time at 32 years of age was not associated with adult BMI.

Short sleepers were defined as children who spent a mean of up to 11 hours in bed between ages 5 and 11 years. Moderate sleepers were in bed between 11 and 11.5 hours, and long sleepers for more than 11.5 hours. At 7 years and older, the BMIs for short childhood sleepers were consistently higher than those for moderate and long sleepers. No consistent differences in BMIs were seen between moderate and long sleepers (Landhuis CE et al: Pediatrics 2008;122:955).

Commentary

Proposed mechanisms for this association include sleep effect on appetite-altering hormones like ghrelin and leptin, and the association of sleep with decreased fatigue, increased physical activity, and less awake time with access to food. Whatever the mechanism, this observation generated from 32 years of data is fascinating. It also says something about New Zealand that at the end of 32 years, investigators were able to contact 96% of living study participants and more than 70% of their parents.