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Articles by A Gebremariam
Total Records ( 2 ) for A Gebremariam
  J. M Lee , A Gebremariam , P Card Higginson , J. L Shaw , J. W Thompson and M. M. Davis

Objective  To evaluate the test performance of specific body mass index (BMI) percentile cutoffs for detecting children/adolescents with hypercholesterolemia.

Design  Cross-sectional analysis.

Setting  National Health and Nutrition Examination Survey 1999-2004.

Participants  Population-based sample of children (aged 3-18 years) with nonfasting total cholesterol (TC) and high-density lipoprotein (HDL) cholesterol levels and adolescents (aged 12-18 years) with fasting low-density lipoprotein (LDL) cholesterol and triglyceride (TG) levels.

Main Outcome Measures  Individuals were classified as having hypercholesterolemia if they had a TC level greater than 200 mg/dL, HDL cholesterol level less than 35 mg/dL, LDL cholesterol level greater than 130 mg/dL, or TG level greater than 150 mg/dL, and sensitivity, specificity, and likelihood ratios were calculated for specific BMI percentiles. Receiver operating characteristic curves were constructed and area under the curve (AUC) was calculated.

Results  Receiver operating characteristic curves using BMI percentiles to predict abnormal levels of TC and LDL cholesterol had AUC values (0.60 for TC level and 0.63 for LDL cholesterol level) that were less than the threshold of acceptable discrimination (between 0.7-0.8). Body mass index percentiles provided better discrimination for detecting children with abnormal HDL cholesterol and TG levels, with AUC values approaching levels of acceptable discrimination (0.69 and 0.72, respectively), although there are no specific guidelines regarding management of children with these abnormalities.

Conclusions  According to the American Academy of Pediatrics guidelines, abnormal levels of LDL cholesterol are used to determine which children require nutritional and pharmacologic therapy. Because BMI percentiles did not adequately identify children and adolescents with abnormal TC and LDL cholesterol levels, the new recommendations for targeted screening of obese children and adolescents may require further consideration.

  S. J Woolford , S. J Clark , A Gebremariam , M. M Davis and G. L. Freed

Objective: To identify factors that might influence physicians’ referrals of obese adolescents to pediatric multidisciplinary weight management (PMWM) programs. Design/methods: Survey of a national sample of 375 pediatricians (PDs) and 375 family physicians (FPs) explored program availability, referral history, desired services, and when in the course of treatment physicians would refer. Differences were examined via 2 tests. Results: Response rate was 67%. More PDs than FPs reported having a PMWM program available (46% vs 10%, P < .01). More PDs (PD 83% vs FP 53%, P < .01) and female physicians (88% vs 65%, P < .01) reported having made a referral. Most physicians wanted coordinated diet, activity, and behavioral therapy (79%). Almost all physicians indicated they would refer when unsure of what else to do, or if requested by the patient/parent. Conclusions: PMWM program referrals appear limited by availability. These data also suggest physicians may be reticent to refer. Further work should examine whether this affects patient outcomes.

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