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The West Virginia CARDIAC Project

The West Virginia CARDIAC Project. C oronary A rtery R isk D etection I n A ppalachian C ommunities. “To reduce cardiovascular disease mortality in West Virginia through research and intervention in children”. Health Care Professionals. Health Science Students. School Nurses.

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The West Virginia CARDIAC Project

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  1. The West Virginia CARDIAC Project • Coronary • Artery • Risk • Detection • In • Appalachian • Communities “To reduce cardiovascular disease mortality in West Virginia through research and intervention in children”

  2. Health Care Professionals Health Science Students School Nurses RHEP Coordinators School Principals and Teachers

  3. CARDIAC Project Year 1 1998 - 1999 Within 5 years, CARDIAC began operating in all WV counties! CARDIAC Project 2003 - present

  4. Percentage Of Youths < 18 Years Expected To Have Fh According To CholesterolLevels And Closest Relative With Fh Williams, RR. Am J Cardio 1993; 72: 171-76

  5. 20,266 Subjects Tested (5th Graders) 14,468 met NCEP screening Guidelines (71.4%) 5,798 did not meet NCEP Screening guidelines (28.6%) 170 warrant pharmacologic tx (1.2% of those who met NCEP guidelines) (1.7% of those who did not Meet NCEP guidelines) Universal versus Selective Screening:Testing Current NCEP Guidelines 98 warrant pharmacologic tx 98 warrant pharmacologic tx

  6. “Cholesterol Screens Miss Children, StudySays”By Ron Winslow • “Data from a school-based program in West Virginia found that national guidelines regarding cholesterol screening among children would miss 36% of those with seriously high LDL.”

  7. FH Family-based Study(2013) • Cascade screening of family members* • 50 FH probands in lipid clinics • 500 CARDIAC 5th graders LDL > 160mg/dl • 100 CARDIAC 5th graders LDL > 190mg/dl *Phenotypingand genotyping

  8. Prevalence Of Obesity Boys Girls

  9. CARDIAC Screening Results5th Grade (1998-2011) • 76,688 students screened since 2011 • 28.3% BMI > 95th percentile • 18.8% BMI 85-95th percentile • 23.6% hypertensive • 25.9% abnormal blood cholesterol • 5.3% have AcanthosisNigricans • 35.5% of AN students were hyperinsulinemic

  10. The West Virginia CARDIAC Project Coronary Artery Risk Detection In Appalachian Communities “To reduce cardiovascular disease, diabetes, and other chronic illnesses in West Virginia through research and intervention in children.”

  11. Exploring the Morbidly Obese Diagnosis * Ice et al., International Journal of Pediatric Obesity, 2009

  12. FAMILY 116-001 014 015 unk unk unk unk 008 017 012 016 unk nis 010 unk nis unk 011 021 019 unk 020 004 007 009 nis nis nis ↑001 003 002 005 006 022 013 nis nis nis 018 ↑ PROBAND (OO1) affected male affected female nis lipid profile known but not in sample unk lipid profiles unknown & not in sample

  13. Childhood Hypertension • Nearly always secondary to obesity • Refer to specialist if BP > 130/85 in normal weight child • Rare pathologic causes include: • Coarctation of aorta • Pheochromocytoma • Cushing Syndrome • Chronic kidney disease • Renal artery stenosis • Hyperthyroidism

  14. Childhood Hypertension • Normal values based on age, gender, height • 11 year olds • Boys > 95% 121/78 • Girls > 95% 120/77 • Use large cuff size • Diastolic pressure is K5 (disappearance of sound)

  15. School-basedHealth Promotion “School health education and promotion programs for children and young people constitute the most effective and feasible prevention approach that can be applied immediately in most countries.” World Health Organization Tech. Rep. 792, Pg 73, 1990

  16. CARDIAC InterventionsSchool-based Programs and Resources • Web-based Instructional Modules for the School Curriculum • Healthy Hearts 4 Kids • 35,743 students served • Take Charge! Be Healthy! • 7835 students served • Teacher Resources • Active Academics • Greenbrier CHOICES Project

  17. Web-based program that focuses on improving teen’s health through impacting knowledge, attitudes, and behaviors as they relate to physical activity, nutrition, and health.

  18. Student Pre/Post Knowledge N=2980 Paired t-test; t=-55.25; p<0.001 for overall and all three topics

  19. Web-based resource for PreK – 5th grade teachers that provides activity ideas to enhance the learning of math, reading, language arts, science, social studies, PE and health. Also provides ideas for energizers, recess and lunch breaks

  20. AAP 5-2-1-0 Campaign 5 2 0 1

  21. Obesity Prevention & Treatment:The Medical Home and Chronic Care Model Health Systems Organization and Health Care Community Resources and Policies Informed, Activated Patient Prepared, Proactive Practice Team Productive Interactions Improved Outcomes

  22. Population-based InterventionActiveWV 2015: The WV Physical Activity Plan

  23. The AIM of the WVPAP • To create a statewide culture that facilitates physically active lifestyles in every societal sector and in every region of the state, regardless of socio-demographic factors, or other barriers we may face Intended Outcomes • Buy-in and support from sector-specific leaders at both the state and local levels (short term) • Policy, environmental, and programming changes at the state and local levels (intermediate term) • Increase/maintain the physical activity levels of both children and adults to meet or exceed the national physical activity recommendations (long term)

  24. London Transport Workers(1950) Conductors outlive drivers

  25. Collaboration between Central WV Medical Society and Stonewall Resort

  26. Greenbrier CHOICES ProjectChildren’s Health Opportunities Involving Coordinated Efforts in Schools • Funded by a Carol M White Physical Education Program (PEP)Grant, US Dept of Education, (Awarded 9/29/2011, in Year 2) • 76 recipients nationwide • $890,000.00 over three years • Focus on making Greenbrier County (WV) youth healthier and more physically active! • Two middle schools – approx. 1200 students

  27. McDowell CHOICES ProjectChildren’s Health Opportunities Involving Coordinated Efforts in Schools • 6-month Planning Grant funded by the Highmark Foundation (Awarded 10/19/2012) • In Preparation for a two-year Intervention Grant, June 2013 • Focus on making McDowell County (WV) youth healthier and more physically active! • All 10 schools in McDowell County (PK-12) (programming, equipment, faculty development, after-school opportunities) • New Community Play Space • Community Programming and Joint Use Agreements for more availability of environments that promote PA

  28. Health Status of WV School Children is Improving* • 5th graders • Hypertension decreased from 23.9% to 20.3% • Obesity declined from 28.9% to 27.8% • Abn. cholesterol declined from 26.1% to 23.5% • Kindergarten • Obesity declined from 17.5% to 13.6% *2011-12 vs 2010-11

  29. Mean of non-HDL Year of screening

  30. HANCOCK RESA Regions BROOKE OHIO MARSHALL VI MONONGALIA WETZEL PRESTON MORGAN MARION VII TYLER BERKELEY PLEASANTS MINERAL HARRISON JEFFERSON TAYLOR HAMPSHIRE DODDRIDGE GRANT WOOD RITCHIE BARBOUR TUCKER LEWIS HARDY WIRT VIII GILMER CALHOUN JACKSON UPSHUR RANDOLPH ROANE V MASON BRAXTON PENDLETON PUTNAM WEBSTER CLAY CABELL KANAWHA III NICHOLAS POCAHONTAS LINCOLN WAYNE II FAYETTE GREENBRIER BOONE IV LOGAN RALEIGH MINGO I WYOMING MONROE SUMMERS MERCER MCDOWELL

  31. Coordinated School Wellness Programs

  32. HANCOCK CARDIAC 2012-2013 BROOKE Kathryn Greenlief - 304-276-4052 Program Manager - Northern kgreenlief@hsc.wvu.edu OHIO Dalena Riggs - 304-692-6741 driggs2@hsc.wvu.edu MARSHALL Robin VanFleet - 304-692-6743 rvanfleet@hsc.wvu.edu declined MONONGALIA WETZEL MORGAN MARION TYLER PRESTON BERKELEY 16+ PLEASANTS MINERAL HARRISON JEFFERSON TAYLOR HAMPSHIRE DODDRIDGE GRANT WOOD RITCHIE BARBOUR TUCKER LEWIS HARDY WIRT Tina Whitt - 304-593-4319 twhitt@hsc.wvu.edu GILMER CALHOUN JACKSON UPSHUR RANDOLPH ROANE MASON BRAXTON PENDLETON PUTNAM Valerie Minor - 304-457-6350 vminor@hsc.wvu.edu WEBSTER CLAY CABELL KANAWHA NICHOLAS POCAHONTAS LINCOLN WAYNE Tammy Pyle-Vicars - 304-812-4469 Program Manager - Southern tpyle@hsc.wvu.edu FAYETTE BOONE GREENBRIER LOGAN RALEIGH MINGO WYOMING Nahied Haidar - 304-293-4286 Greenbrier CHOICES Project nhaidar@hsc.wvu.edu MONROE SUMMERS MERCER Janetta Massie - 304-890-9490 jmassie@hsc.wvu.edu MCDOWELL

  33. RESA and CARDIAC Potential for collaboration • Health promotion (education) • Interventions • Facilitate Medical Home model

  34. CARDIAC Team

  35. CARDIAC and CPASS* • ActiveWV 2015 (WV PAP) • Rx for Health: A Healthcare and State Parks Collaborative • Greenbrier County CHOICES (USDE) • McDowell County CHOICES (Highmark Foundation) * WVU College of Physical Activity and Sports Science

  36. CPASS Colleagues Emily Jones Ph.D. Eloise Elliott PhD Sean Bulger ED.D

  37. School of Public Health Colleagues Alfgeir L. Kristjansson Ph.D. Christa Lilly Ph.D.

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