Browsing by Author "Habiba, Nusrath"
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Item A Preliminary Look at the Effect of Light Exposure on Blood Glucose Levels of Overweight and Obese Teens(2018-03-14) Roane, Brandy; Fulda, Kimberly; Fernando, Shane; Shah, Deep; Habiba, Nusrath; Bowman, Paul; Shum, KathyPurpose: Teens experience a puberty-driven delay in their circadian clock due to a mismatch in their internal and social clocks that increases their risk of adverse health outcomes. Disruption to the circadian system from ill-timed light exposure before bedtime and reduced melatonin levels produces adverse changes in glucose control and increases Type 2 Diabetes Mellitus (T2DM) risk. As such, teens may be more susceptible to developing T2DM. This study sought to provide better insight into the relationship between light exposure around the sleep period and risk of developing T2DM in this vulnerable and understudied population. We proposed that light levels would be positively associated with HbA1c levels in teens during the two hours before bedtime and during the sleep period. Methods: Current analyses utilized baseline data from a 13-week pilot intervention study (PI: Roane) that examined the impact of a circadian-conscious intervention on T2DM risk. Teens and caregivers provided informed consent/assent. HbA1c levels (mmol/mol) were collected via finger prick. Teens followed a “typical” self-selected sleep schedule for 1-week while wearing a wrist actigraph (AMI MicroMotion Logger) to capture 24-hour sleep and light data. BMI %tile was calculated from in-lab measured height and weight. Mean lux, percent time above 20 lux, minimum lux, and maximum lux were calculated for the two hours pre-bedtime and during the sleep period. Correlation analyses were run to examine the association between light exposure and HbA1c due to small sample size. Results: Teens (n=7) were age 16 years, 57% female, and 57% Hispanic with low to moderate T2DM risk. Mean BMI %tile was 97th, HbA1c was 5.4, and 57% exhibited Acanthosis Nigricans. Mean sleep period duration was 496 minutes (mean sleep duration during this period = 410 minutes). Correlation analyses were not significant; however, visual inspection showed sex-differences in HbA1c levels and different patterns in how light exposure during these two crucial periods may relate to HbA1c. Conclusion: These pilot findings did not confirm an association between light exposure (lux) and HbA1c levels (mmol/mol) in obese and overweight teenagers. Findings were limited by a sample that was small in size and low in T2DM risk. Suggested sex differences in these data combined with documented sex differences in the literature support further examining sex differences in a larger sample with more diverse T2DM risk.Item Application of an Interprofessional Student Exercise to Improve Nutritional Wellness in a Pediatric Clinic(2018-03-14) Sembajwe-Reeves, Catherine; Dart, Lyn; Rew, Martha; Farmer, David; Habiba, Nusrath; Baker, BryanPurpose: Childhood obesity has become a significant problem in the state of Texas, especially in Tarrant County. To address the substantial nutritional education deficiency in the outpatient setting, faculty members of the UNTHSC pediatric clinic initiated a collaboration with the Interprofessional Education (IPE) department at UNTHSC. In collaboration with the dietetic departments at Texas Christian University and Texas Woman’s University, an outpatient internship was established for dietetic students at the UNTHSC pediatric clinic. A qualitative assessment was constructed to establish the success of the interns in the clinical environment and whether dietary information was delivered effectively to the patient and family. Methods: After the multi-faceted interprofessional team including a pediatrician, dietetic intern and medical/PA student concluded the visit with the patient, the patient’s parent received a short anonymous survey completed in the clinic. 4 questions assessed the quality and satisfaction of the visit using a 5-point Likert scale. Only families who had been consulted by the interprofessional team received the survey. Results: One hundred and twenty-one respondents filled out the survey, with 101 being parent/guardians, 17 patients 18+ years of age, and 3 other family members. 86% believed the addition of a dietitian improved the quality of the visit, and 90% were satisfied with the visit as a whole. The addition of the dietary information was viewed as very helpful with 87.6% of parents or patients pledging to apply this information in the near future. Conclusions: The addition of a dietary intern to supplement the dietary education during pediatric visits was well received by patients and parents. By incorporating an Interprofessional team in the patient care, patients can have more of their needs and concerns addressed by a specialist in that field. By working with other institutions, this model of Interprofessional care can be successfully utilized within other local clinics and further applied with other medical professional schools.Item Application of an Interprofessional Team in Pediatric Nutritional Wellness(2019-03-05) Baker, Bryan; Farmer, David; Rew, Martha; Habiba, Nusrath; Muqueet, SameeraPurpose: Childhood obesity poses a significant health risk to children in the United States and has been increasing in recent years. Childhood obesity is associated with increased risk of hyperlipidemia, diabetes, and hypertension manifesting later in life. Early intervention is crucial in preventing these health problems. Therefore, it is important that parents receive early education on nutritional wellness as well as the most accurate information possible. A team-based application of health care delivery is one possible way of achieving this patient education. This study aims to evaluate patient satisfaction with the use of an interprofessional healthcare team in delivering nutritional wellness information to parents in an outpatient pediatric clinic. Methods: Patients were seen by a three member interprofessional team consisting of a Physician or Physician Assistant (PA), medical student or PA student, and dietetic intern. At the end of the visit, patients were given a survey to assess their satisfaction with the visit. The survey evaluated patient satisfaction with the interprofessional team with, how helpful and how likely they were to use the nutritional advice given to them during the visit, and their perception on whether the interprofessional team improved the quality of their visit. Patients were asked to rank these factors on a scale of 1-5 with 1 being unsatisfied and a 5 being highly satisfied. Results: Out of 95 patients, 96.8% rated their happiness with the interprofessional team as a 5/5; 95.7% rated the helpfulness of the nutritional advice 5/5; 94.7% rated their likelihood of utilizing the nutritional advice 5/5; 94.7% rated the improvement in the quality of their visit 5/5. Conclusions: Overall, patients were satisfied with the nutritional information they received from the interprofessional team and viewed being seen by a team as an improvement in the quality of their visit. Utilizing an interprofessional team has the potential to be an efficacious method of delivery of nutritional information to patients and improve wellness and prevention. In future studies, the likelihood of patients to implement this nutritional advice will be tracked via EMR and compared to groups that were not seen by an interprofessional team in order to assess the efficacy of team-based healthcare.Item Assessing Body Image Perception among Children aged 10-14, and their Caregivers(2021) Desai, Shivani; Fernando, Shane; Habiba, Nusrath; Fulda, Kimberly; Bowman, WilliamPurpose: The incidence of Type 2 Diabetes Mellitus in children continues to rise in the country. According to the ADA, in 2011-2012, the annual incidence of diagnosed diabetes in youth was estimated at 5,300 with T2DM. Not only can T2DM be managed with appropriate measures but also be prevented if the risk factors are identified. Methods: 10-14 year-old children and their caregivers participated in a 2-hour research study in which questions about body silhouettes were asked. Child subjects identified which body silhouettes (gradient from 1: very thin to 9: obese) they currently looked like and the ones they wished to look like. Similarly, parents were asked to do the same for their child. Results: Male and female children wanted their desired silhouette number to be less than the number they picked for their current shape. The amount of male children who chose silhouette numbers 1-5 increased by 39% between their current and desired shape and for female children the increase was by 28%. For parents of male children, the increase was by 47% and for parents of female children, the increase was by 15%. Conclusion: This study suggests that the perception of desiring a thinner body were similar between male and female children and their parents. These body silhouettes may have potential as a screening tool for body image and healthy behaviors. Through this model, health care professionals can gauge their patient's perception on their body weight and help them facilitate conversation towards healthy behaviors.Item Assessing Body Image Perception among Children aged 10-14, and their Caregivers(2020) Fulda, Kimberly; Bowman, William; Habiba, Nusrath; Fernando, Shane; Desai, ShivaniPurpose: The incidence of Type 2 Diabetes Mellitus in children continues to rise in the country. According to the ADA, in 2011-2012, the annual incidence of diagnosed diabetes in youth was estimated at 5,300 with T2DM. Not only can T2DM be managed with appropriate measures but also be prevented if the risk factors are identified.Methods: 10-14 year-old children and their caregivers participated in a 2-hour research study in which questions about body silhouettes were asked. Child subjects identified which body silhouettes (a gradient from 1: very thin to 9: obese) they currently looked like and the ones they wished to look like. Similarly, parents were asked to do the same for their child. Results: Male and female children wanted their desired silhouette number to be less than the number they picked for their current shape. The amount of male children who chose silhouette numbers 1-5 increased by 39% between their current and desired shape and for female children the increase was by 28%. For parents of male children, the increase was by 47% and for parents of female children, the increase was by 15%. Conclusion: This study suggests that the perception of desiring a thinner body were similar between male and female children and their parents. These body silhouettes may have potential as a screening tool for body image and healthy behaviors. Through this model, health care professionals can gauge their patient's perception on their body weight and help them facilitate conversation towards healthy behaviors.Item Assessing elevated liver enzymes as a potential early screen for type II diabetes mellitus in children(2020) Bowman, William; Basha, Riyaz; Hamby, Tyler; Habiba, Nusrath; Das, SiddharthPurpose: As the rise of obesity tracks with the incidence of Type 2 Diabetes Mellitus (T2DM) and nonalcoholic fatty liver diseases (NAFLD), it suggests that metabolic changes in obesity give rise to a clinically significant association between insulin resistance and elevated liver enzymes. This is illustrated in recent adult studies showing a high prevalence of NAFLD in patients with T2DM. Considering the diagnosis of T2DM and NAFLD often occurs late into adulthood, assessing the validity of metabolic-based early screening protocols may identify high-risk individuals in the pediatric population. Our study assesses the prevalence of elevated liver enzymes in children and evaluates the association between elevated liver enzymes and noninvasive risk factors. Methods: Our study enrolled 151 nondiabetic children between the ages 10-14 at the pediatric outpatient clinic at UNTHSC. We recorded noninvasive risk factors and measured liver enzymes. The liver enzymes studied were alanine aminotransferase (ALT), alkaline phosphatase (ALP), and gamma-glutamyl transpeptidase (GGT). Results: Through chi-squared analysis, boys were shown to have a statistically significant relationship between increased BMI and elevated GGT as well a statistically significant relationship between presence of acanthosis nigricans and elevated GGT. It was also shown that young girls and African American children have a higher prevalence of ALP and GGT, respectively. Conclusions: There was significant association between elevated liver enzymes and specific noninvasive risk factors. Furthermore, this study noticed that gender and racial differences may play confounding roles suggesting there is variation within liver enzyme levels inherent in particular subpopulations.Item Assessment of health literacy and potential barriers regarding Human Papillomavirus (HPV) and the HPV vaccine among parents/guardians(2016-03-23) Fernando, Shane; Habiba, Nusrath; Magie, Richard; Bui, Priya; Rovner, GracePurpose: As the number of epidemics that are currently threatening the health of Americans and the associated health consequences continue to grow, protecting future generations from sexually infected viruses has become a concern. With the recent release of Human Papillomavirus (HPV) vaccines, children have the chance to be protected from some of the more common and symptomatic types of the virus. However, vaccine uptake has remained low, leaving many children and adolescents at risk for contracting HPV once they become sexually active. This research study aims at increasing the uptake of the HPV vaccine by identifying potential barriers in completing the three-dose regimen. Information gained will provide the basis for developing a new health literacy intervention within the department of Pediatrics at UNT Health Science Center (UNTHSC). Methods: Parents/guardians of pediatric patients at the department of Pediatrics at UNTHSC will be asked to participate in the study. There are two parts to this study: the initial interview used to establish a baseline, and a follow-up interview to estimate efficacy of the health literacy intervention. The multiple choice questionnaire evaluates the parent’s/guardian’s general perception of vaccinations, knowledge of HPV and the HPV vaccine, and potential obstacles that parents may face when obtaining immunizations for their child. After the initial interview, there will be a short 5 to 10 minute education session about HPV and the HPV vaccine, and the parent/guardian will be given a handout to take home. Additionally, a different questionnaire will be given to pediatricians to help assess their thoughts and perceptions behind the low uptake of the HPV vaccine among adolescents and recommendations of better ways to improve uptake of the vaccine. Projected goals/findings: The goal is to increase parent/guardian understanding about HPV and the HPV vaccine and to determine barriers to receiving the vaccination. By assessing parent/guardian retention of the information regarding HPV and the HPV vaccine and changes in their perception and/or opinions about HPV and the HPV vaccine, this project will gauge the effectiveness of the education session and handout method. If parents/guardians are made aware of HPV and the HPV vaccine, we predict that more children would receive the vaccine and complete all three doses of the vaccine. Moreover, since the population being evaluated in this study tends to have lower levels of education and income, identifying barriers will help increase our understanding of how to get the HPV vaccine to these individuals and be affordable for them. This project is ongoing and the protocol will be adjusted according to the study results.Item Association of Elevated Liver Enzymes with Non-Invasive Risk Factors for Type II Diabetes Mellitus in Children(2017-03-14) Habiba, Nusrath; Hamby, Tyler; Basha, Riyaz; Shah, Deep; Bowman, Paul; Chatrath, AmritpaulPurpose: The obesity epidemic has led to an increased incidence of type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) in children. This relationship is significant as the liver is intimately involved in blood glucose homeostasis as insulin resistance triggers glycogenolysis in the liver. However, there is limited research on the association between elevated liver enzymes and risk factors for T2DM in children. The purpose of this study was to assess the prevalence of elevated liver enzymes and their association with non-invasive risk factors for T2DM in non-diabetic children between the ages of 10-14 years without chronic diseases. The liver enzymes studied were alkaline phosphatase (ALP), alanine aminotransferase (ALT), and gamma-glutamyl transpeptidase (GGT). The non-invasive risk factors for T2DM are 1) Body Mass Index (BMI) [greater than] 85th percentile for age and gender, 2) blood pressure [greater than] 95th percentile for height and gender, 3) acanthosis nigricans, 4) race or ethnicity of high risk, and 5) history of T2DM in the family. A race or ethnicity of high risk includes African Americans, Hispanics, American Indians, and Asian/Pacific Islanders. Methods: Following IRB approval, the study was conducted at the outpatient clinics of the University of North Texas Health Science Center, Fort Worth. Children with elevated blood glucose levels, chronic medical conditions, or those who had received systemic corticosteroid therapy within the last year were excluded. Participation was voluntary and 151 children participated in the study who were from the representative races and ethnicities attending the clinics. Results: Results indicated that those with elevated GGT levels had marginally higher BMI (p=0.06) and were significantly more likely to have acanthosis nigricans (p Conclusions: These results suggest that there are meaningful relationships between elevated liver enzymes and non-invasive risk factors for T2DM.Item Asthma Care in an Academic Pediatric Primary Care Clinic: An Examination of Asthma Triggers(2020) Bui, Priya; Garcia, Joanna; Habiba, Nusrath; Guerra, AlejandroPurpose: The prevalence of asthma among pediatric populations is increasing: 8.4% of children (approximately 6.2 million) in the United States have asthma. It is the leading cause of chronic disease in children. It is hoped the implementation of asthma action plans will better help children (and their parents) manage their condition. A primary way in which asthma action plans are believed to assist their patients in understanding their condition is the identification of triggers for each patient's asthma. In pursuit of this goal, a local study of the asthmatic pediatric patient population at the UNTHSC Health Pavilion was carried out; specifically, research into the most prevalent asthma triggers within this population, as well as trigger exposures and disease severity. Methods: In order to craft a questionnaire designed to capture relevant information, PubMed was utilized to research pre-existing asthma action plans and questionnaires in order to create our own questionnaire for use at the Health Pavilion. This questionnaire was then used to attempt to contact 300 pediatric asthma patients currently being seen at the clinic and gather information on their asthma triggers and disease state, with data recorded in RedCap. Results: Data from 107 of these patients was recorded, which demonstrated a predominance of allergy-induced asthma, with exercise- and dust-induced asthma close behind. Conclusions: An emphasis on identifying prevalent asthma triggers can help pediatric patients and their parents better understand their disease. These triggers can also be focused on and worked into action plans in future patient care.Item A Case of Gitelman Syndrome with an Uncommon Presentation of Normomagnesemia(2024-03-21) Oyegoke, Sarah; Habiba, Nusrath; Gillespie, RobertBackground: Gitelman Syndrome (GS), also known as familial hypokalemia-hypomagnesemia, is an autosomal recessive renal tubular disorder that impacts sodium retention to electrolyte imbalance. It is a rare salt-losing tubulopathy that has a 1:40,000 prevalence. The disorder is mostly associated with symptoms including hypokalemic metabolic alkalosis with hypomagnesemia and low urinary calcium excretion. Case Information: An8-year-old female with a history of ADHD and bipolar disorder presents to her primary care clinic for initial concerns about low potassium and high cholesterol after getting routine lab work done outside of her primary care clinic. She had been receiving treatment at a mental health facility and had routine bloodwork done for her medications. The patient was referred to her primary care provider to follow up on the lab work. Her guardian had concerns about the child’s short stature and a bone age X-ray and labs were ordered. Her guardian also stated that her paternal grandmother had hypokalemia of unknown etiology. Her lab result showed hypokalemia (2.7 mmol/L) and hypercholesterolemia (192 mg/dL), so she was sent to a children’s hospital emergency room for immediate management. In the ER, the patient again had hypokalemia (2.5 mmol/L), elevated anion gap (21 mmol/L), and positive ketones. Her EKG showed prolonged QT interval and she was admitted to the hospital for further management. After receiving a potassium replacement, her EKG normalized, and the cardiologist cleared her for further follow-up. Genetic testing confirmed that she has Gitelman Syndrome, specifically a mutation in the SLC12A3 gene. Interestingly, Gitleman Syndrome usually presents with hypomagnesemia, but in this case, the patient only had hypokalemia and not hypomagnesemia. The patient was discharged with oral potassium and has been following up with a nephrologist on a regular basis. Conclusions: This case study showcases a rare case of Gitelman Syndrome with an unusual presentation of normomagnesemia. Future research should be conducted to solidify diagnostic criteria, evaluate abnormalities, and assess the long-term effects of the disease.Item Challenges in the management of obesity and comorbidities in an adolescent patient(2021) Pham, Jennifer; Motamedi, Shoaleh; Villarreal, Marcus; Habiba, NusrathBackground: Obesity is a common condition, especially among adolescents. In the United States, the Center of Disease Control states that as of 2019, 18.5% of adolescents are considered overweight. Case Information: 15-year-old female presents to a Weight Center for severe obesity. The patient had an uncomplicated gestation and was adopted at one month. No biological family history is available, except for a grandmother known to be overweight. Despite similar environmental factors, like dietary patterns and nutrition, her BMI at age 3 rose to the 97th percentile, unlike her siblings. After enrollment to a monthly weight control program, at age 8 on physical exam she appeared overweight with mild acanthosis nigricans of the neck. Upon a 15 kg weight increase from age 10 to 11, her pediatrician enrolled her in another weight control program. At age 13, she was diagnosed with obstructive sleep apnea and nocturnal somnambulation. At age 14, following menarche, she began to experience irregular menstrual cycles accompanied with worsening fatigue and rebound weight gain 20 kg. At age 15, severe acanthosis nigricans was noted on her neck and axillae with an android pattern hair growth. After numerous efforts and programs, a bariatric surgery was performed at 19 resulting in a 13 kg weight decrease and improvements of her acanthosis nigricans on her wrists and ankles, except for her neck. Conclusions: This case illustrates a unique presentation of severe pediatric obesity and the significant effect of biological determinants in comparison to developmental and environmental factors.Item Changes in Health Knowledge and Lifestyles After Participating in a Research Study.(2015-03) Resendes, Erica M.; Fulda, Kimberly; Habiba, NusrathBackground Clinical research plays an instrumental role in the advancement of health care by opening doors to new and improved treatments, prevention procedures, and methods of diagnoses. It is, therefore, important to tackle issues that may negatively impact the completion of a study. This includes problematic recruitment, which can result in costly economic consequences, inefficient collection of data, and even closure of a study. Research shows that the major driving force behind an individual’s decision to participate is due to the benefits received while enrolled in a study. These benefits are usually the primary aim of a study and include helping out future patients, receiving new/improved treatments and getting better care for various illnesses. The purpose of this study was to assess the participant’s self-reported benefits and/or lifestyle changes subsequent to participating in a research study. Methods A telephone survey was administered to parents/legal guardians of children who participated in two initial studies conducted at the UNT Health Science Center (UNTHSC). The survey assessed if the parents/legal guardians became more aware of their child’s health after participating and whether they made a change in the child’s lifestyle. Questions used in the initial study were re-administered in this study. In the initial study, children were sent a report characterizing the child’s lab results as normal or abnormal. Wilcoxon-Signed Rank test was used to compare means pre and post, and Fisher’s Exact Test was used to compare willingness to participate in future studies between parents of children who received normal and abnormal results. A total of 61 surveys were completed. Results Since completing the study, 55.7% of the parents/legal guardians reported a change in their child’s diet, while 70.5% reported a change in their child’s physical activity. Parents/legal guardians of children who received both normal and abnormal results were more likely to report making their child eat healthy and exercise regularly as well as describe their child as not being overweight during the follow-up data collection as compared to the original study (Abnormal p Discussion/Conclusion By highlighting such benefits, the public’s perceptions of clinical research can be broadened, encouraging more individuals to consider participating. The goal was to show that by participating in research, individuals can learn more about their own health, or more importantly, their child’s health. This knowledge can then translate to lifestyle changes beyond the scope of a study.Item COMPARISON OF BODY MASS INDEX PERCENTILE AND PERCENT BODY FAT ON RISK FACTORS FOR TYPE 2 DIABETES MELLITUS IN CHILDREN AGED 10-14(2014-03) Fernando, Shane I.; Fulda, Kimberly; Franks, Susan; Bowman, W. Paul; Shah, Deep; Proffitt-Leyva, Randi; Bawa, Binky; Habiba, NusrathThe growing rate of type 2 diabetes mellitus (T2DM) in children presents a critical public health problem for the future. However, assessment of T2DM risk among children can be challenging. Therefore, to improve assessment of risk, we examined the association between BMIP (body mass index percentile, a traditional indicator) with risk, compared to the association of percent body fat (PBF) with risk. Methods: Data were obtained from 290 10-14 year old adolescents who were patients in the pediatrics department of the University of North Texas Health Science Center, patients at Seminary Clinic in Fort Worth and recruited from community events. During study visits, subjects’ BMI percentile and percent body fat were obtained using standard height/weight measurements as well as through the use of a Tanita body composition device. Associations were then assessed using statistical regression models. Results: Among 290 subjects, 78.2% were of Hispanic origin, with approximately 13.4% being Black. Approximately 51% of subjects were female, while age distribution was evenly spread across 10-14. Logistic regression models found that both PBF and BMIP were significantly associated with Acanthosis nigricans (PBF: Sβ 0.584 vs. BMIP: Sβ 0.489), average systolic BP above 95th percentile (PBF: Sβ 0.219 vs. BMIP: Sβ 0.124), family history of T2DM (PBF: Sβ 0.189 vs. BMIP: Sβ 0.172), and high blood sugar test (PBF: Sβ 0.152 vs. BMIP: Sβ 0.119). Conclusions: The data from this study provides evidence that PBF may be a better measurement of T2DM risk among children compared to BMIP. It may be beneficial for pediatric and family physicians to measure PBF alongside BMIP to better ascertain a particular pediatric patient’s risk of T2DM. Purpose (a): The growing rate of type 2 diabetes mellitus (T2DM) in children presents a critical public health problem for the future. However, assessment of T2DM risk among children can be challenging. Therefore, to improve assessment of risk, we examined the association between BMIP (body mass index percentile, a traditional indicator) with risk, compared to the association of percent body fat (PBF) with risk. Methods (b): Data were obtained from 290 10-14 year olds in North Central Texas participating in a study examining risk for T2DM. During study visits, subjects’ BMI percentile and percent body fat were obtained using a Tanita body composition device. Associations were then assessed using logistic regression models against four of the five critical risk factors for T2DM: Average blood pressure (BP) above 95th percentile or History of high BP, family history of type 2 diabetes mellitus, positive sign of Acanthosis nigricans and a high blood sugar test. Results (c): Among 290 subjects, 78.2% were of Hispanic origin, with approximately 13.4% being Black. Approximately 51% of subjects were female, while age distribution was evenly spread across 10-14. Logistic regression models found that both PBF and BMIP were significantly associated with Acanthosis nigricans (PBF: Sβ 0.584 vs. BMIP: Sβ 0.489), average systolic BP above 95th percentile (PBF: Sβ 0.219 vs. BMIP: Sβ 0.124), family history of T2DM (PBF: Sβ 0.189 vs. BMIP: Sβ 0.172), and high blood sugar test (PBF: Sβ 0.152 vs. BMIP: Sβ 0.119). Conclusions (d): The data from this study provides evidence that PBF may be a better measurement of T2DM risk among children compared to BMIP. It may be beneficial for pediatric and family physicians to measure PBF alongside BMIP to better ascertain a particular pediatric patient’s risk of T2DM.Item How often parents make decisions with their children is associated with obesity(BioMed Central Ltd., 2018-09-25) Rahman, Adrita; Fulda, Kimberly G.; Franks, Susan F.; Fernando, Shane I.; Habiba, Nusrath; Muzaffar, OmairBackground: Evidence supports that better parental involvement and communication are related to reduced obesity in children. Parent-child collaborative decision-making is associated with lower BMI among children; while child-unilateral and parent-unilateral decision-making are associated with overweight children. However, little is known about associations between joint decision-making and obesity among Hispanic youth. The purpose of this analysis was to determine the relationship between parent-child decision making and obesity in a sample of predominantly Hispanic adolescents. Methods: Data from two studies focused on risk for type II diabetes were analyzed. A total of 298 adolescents 10-14 years of age and their parent/legal guardian were included. Parents completed questionnaires related to psychosocial, family functioning, and environmental factors. Multiple logistic regression was used to determine the association between obesity (≥ 95th percentile for age and gender), the dependent variable, and how often the parent felt they made decisions together with their child (rarely/never, sometimes, usually, always), the primary independent variable. Covariates included gender, age, ethnicity, total family income, and days participated in a physical activity for at least 20 min. ORs and 95% CIs were calculated. Results: Adolescent participants were predominantly Hispanic n = 233 (78.2%), and approximately half n = 150 (50.3%) were female. In multivariate analyses, adolescents who rarely/never made decisions together with their family had significantly higher odds (OR = 3.50; 95% CI [1.25-9.83]) of being obese than those who always did. No association was observed between either those who sometimes make decisions together or those who usually did and those that always did. Conclusions: Parents and children not making decisions together, an essential aspect of parent-child communication, is associated with increased childhood obesity. The results of our study contribute to evidence of parental involvement in decision-making as an important determinant of adolescent health. Further studies should explore temporal relationships between parenting or communication style and obesity.Item Internalizing Behaviors in Hispanic Boys Predict Overweight/Obese Status(2016-03-23) Franks, Susan; Fulda, Kimberly; Habiba, Nusrath; Namuduri, AnuradhaBackground: Obesity has been a troubling trend among Hispanic youth. Emotional eating has been described as the consumption of comfort food to cope with negative emotions, which in turn can contribute to weight gain. Negative emotions can lead to internalizing (feeling worthless, sad, withdrawn) and externalizing (bullying, arguing, disobeying, stubbornness) behaviors. Studies suggest these may precede obesity in children with poor socioeconomic status. The aim of this study was to examine these behaviors in relation to weight in under served Hispanic children. Hypotheses: Overweight children (OW) will have higher internalizing or externalizing behaviors as compared to normal weight children (NW). Methods: Subjects included Hispanic youths (117 males, 116 females) ages 10-14. Subjects were classified into NW (n=85) and OW (n=148) based on BMI percentile. Parents completed a 1-5 Likert scale survey of social-emotional behaviors. Responses were summed to arrive at scores for Internalizing (INT) and Externalizing (EXT) behaviors. Relationships between INT, EXT, age, and BMI percentile were examined for boys and girls separately using Spearman correlation. Logistic regressions were conducted to ascertain the effects of significantly associated variables on the likelihood that subjects would be OW. Results: For boys, BMI percentile was associated with INT (rs=.180, p=.053) and age (rs=.215, p=.020). Girls showed no significant correlations. Logistic regression for boys using INT and age was significant (X2=10.570, p=.005). Increasing age in boys was significantly associated with an increased likelihood of being OW (OR= 1.439, CI=1.056 – 1.961). The Wald criterion indicated that increases in INT approached significance in predicting OW (p=.069). EXT was not significant for boys. Regression models for girls were not significant. Conclusion: Internalizing behaviors increased for boys who were overweight or obese, especially with increasing age. This trend was not significant in girls. These data contradict previous literature suggesting Hispanic girls are at higher risk for obesity due to increased internalizing behaviors. Future research should broaden the scope of internalizing behaviors that may place children at risk for obesity. Acknowledgments: This study was supported by intramural grants, and the study was approved by the IRB at the University of North Texas Health Science Center.Item Parental Ideology of Diet and Exercise and Associated Risk of T2DM in Children(2015-03) Bauman, Thomas R.; Fernando, Shane I.; Fulda, Kimberly; Franks, Susan; Habiba, NusrathBackground: Type 2 diabetes mellitus (T2DM) in children is a major public health issue. This study examined parental ideology of diet and exercise and the associated risk of T2DM in children. Methods: Data were obtained from 10-14 year old children in North Central Texas participating in a study examining risk for T2DM. Questions on parental ideology were measured using three questions, including “Making my child eat a healthy diet and exercise regularly would be pleasant,” “I intend to make my child eat a healthy diet and exercise regularly” and “Making my child eat healthy and exercise regularly will reduce their risk of developing diabetes”. Associations were assessed using logistic regression models controlled for race, gender, SES, neighborhood safety and age. Results: Among 290 subjects, 5.7% were Caucasian, 15.4% were African-American, and 78.9% were Hispanic. Mean age was 11.87±1.4, while 50.3% of subjects were female. Increased pleasant perception of exercise and diet had decreased odds of being high risk for T2DM (0.916 OR, 95% CI: 0.901-1.124). Increased intention to make their child eat healthily and exercise had slightly increased odds of being high risk for T2DM (1.01 OR, 95% CI: 1.007-1.631). Finally, belief in healthy diet and exercise reducing risk for T2DM had decreased odds of being high risk for T2DM (0.969 OR, 95% CI: 0.591-0.997). Conclusion: Results from this study suggest that parental ideology of diet and exercise is associated with a child’s risk for T2DM. Improving parents’ positive ideology of exercise and diet may reduce children’s risk of T2DM.Item Potential Developmental Impacts of the Lysine N-Methyltransferase 5B Mutation: A Case Report(2024-03-21) Lin, Spencer; Habiba, NusrathBackground: Lysine N-Methyltransferases (KMTs) play a crucial role in regulating chromatin modification. Specifically, deleterious heterozygous variants in Lysine N-Methyltransferase 5B (KMT5B) are linked to intellectual disability (ID) and/or autism spectrum disorder (ASD). Pathogenic variants in several of these genes have been identified in autosomal- dominant or X- linked neurodevelopmental disorders. Additional symptoms include seizures, crossed eyes, flexible joints, and low muscle tone. However, little is known about the effects of the KMT5B mutation on other organ systems as there are fewer than 50 reported cases in the literature. Case Information: This case report follows a 4-year-old male patient seen in the pediatric clinic for a well child visit. Data obtained from the electronic medical records through authorized providers showed the patient was previously diagnosed with a 17p12 deletion, hereditary neuropathy with pressure palsies (HNPP), and KMT5B de Novo mutation. During infancy, the patient had a history of staring off and eye rolling. Developmental delays prompted a genetic evaluation which revealed a maternally inherited 17p12 deletion involving the PMP22 gene, predisposing the patient to hereditary neuropathy with liability to pressure palsies and a de novo pathogenic variant in the KMT5B gene. The KMT5B mutation predisposed the patient to ID and ASD which manifested as missed developmental milestones. At 33 months, the patient began walking and at 36 months the patient exhibited limited speech (only 7-8 words). Additionally, the patient has a history of possible seizure activity, macrocephaly, hypotonia, and possible craniosynostosis although his last head CT scan did not confirm it. Currently, the patient has bilateral eustachian tube dysfunction requiring tympanostomy tube placement, pes planus requiring ankle foot orthotics, and recurrent croup infections with 6 episodes in the last 2 years. The patient is currently monitored by neurology, ENT, physical therapy, and speech therapy and attends special education at his public school. We are in the process of acquiring the patient's follow-up records from the specialty clinic to evaluate the ongoing status of the patient. Conclusions: The influence of the KMT5B mutation on human embryonic development beyond the brain remains poorly understood, as the existing studies emphasize its impact on intellectual disability. Mouse studies of the mutation have implicated its involvement in the embryonic development of organs such as the lungs, liver, heart, skin, and bone. The recurrent croup infections and eustachian tube dysfunction in our patient emphasizes the need to investigate potential developmental consequences in humans. Recurrent croup infections often stem from secondary causes such as congenital and acquired airway abnormalities. We propose that the KMT5B mutation may have contributed to our patient's eustachian tube dysfunction and potentially caused a congenital airway abnormality, increasing susceptibility to croup infections. This case offers unique insights into the potential association of airway and eustachian tube dysfunction with the KMT5B mutation, which is not previously documented. Given the limited number of reported cases and the demonstrated impact on the embryonic development of various organs in mice, further investigation is warranted to comprehensively assess potential complications associated with the KMT5B mutation in humans.Item Prevalence of Specific Mental Health Issues in Families that have Family Meals(2022) Fairchild, Ashlyn; Fernando, Shane; Asfoor, Naser; Habiba, Nusrath; Fulda, KimberlyPurpose: Anxiety, depression, and Attention-deficit/hyperactivity disorder (ADHD) are some of the most prevalent mental health issues in the U.S. These mental health issues have seen an increase in diagnosis over the past few decades. A simple intervention, family meals, could be associated with improved mental health of children. This study assesses the effect family meals could have on the mental health of children aged 10-14. Methods: This cross-sectional study will examine the potential associations between parental mental health, child mental health and frequency of family meals to understand how common mental issues such as ADHD, depression, and anxiety could be mediated. Data comes from an IRB-approved dataset collected from 10 to 14-year-old patients attending an outpatient pediatric clinic in Fort Worth, Texas. Univariate and regression models were performed on the variables of interest. Results: Out of 152 surveys, 21 adults had above average depression scores, 32 children had above average depression scores, 19 children had ADHD, and 7 children had anxiety. There was a 12.4% reduction in adult depression scores and a 15% reduction in childhood depression scores with an increased frequency of meals eaten together. Neither ADHD nor anxiety had a significant association with frequency of meals. Conclusion: Increased frequency of family meals could be a mediating factor for both adult and childhood depression. However, this data did not show a significant association between increased family meals and childhood anxiety or ADHD. Future studies should look further into the impact of family meals on the mental health of both adults and children.Item The Association between Child Health Status and Family Functioning with Risk for Type 2 Diabetes among 10-14 Year Olds(2016-03-23) Fulda, Kimberly; Franks, Susan; Fernando, Shane; Habiba, Nusrath; Chen, PengThe Association between Child Health Status and Family Functioning with Risk for Type 2 Diabetes among 10-14 Year Olds Authors: Peng Chen – School of Public Health; Kimberly G Fulda, DrPH, Department of Family Medicine, Texas College of Osteopathic Medicine; Susan Franks, PhD, Department of Family Medicine, Texas College of Osteopathic Medicine; Shane Fernando, PhD, Department of Pediatrics, Texas College of Osteopathic Medicine; Nusrath Habiba, MD, Department of Pediatrics, Texas College of Osteopathic Medicine IRB # 2012-151 Abstract Introduction: Obesity is a risk factor for type 2 diabetes (DM2), and family environment stressors can increase risk of obesity among children and adolescents. Family factors such as parental divorce, cohabitation, and remarried family relationships are among these stressors. For example, living in a single-parent family is positively associated with BMI and greater risk of obesity. Poor family functioning has also been linked to overweight and obesity in children. Research, however, has not assessed associations between these stressors and risk for DM2. The purpose of this study was to assess whether child health status and family functioning are associated with being high risk for DM2 among Mexican American children aged 10-14 years. Methods: This cross-sectional study included 298 children and a parent/caregiver. High risk for DM2 was determined by having ≥ 3 of these 5 risk factors: first or second degree relative with DM2, BMI ≥ 95th percentile, blood pressure ≥ 95th percentile, elevated glucose, positive for Acanthosis Nigricans. Logistic regression was used to estimate odds ratio (ORs) and 95% confidence intervals (CIs) for the association between child’s health status and family functioning with being high risk for DM2. Multiple regression controlled for child factors (age, ethnicity, gender), parent/legal guardian’s factors (marital status, health status, relationship to child), and household factors (primary language spoken in the household and highest household education). Results: Of 298 children, 91 (31%) were high risk for DM2. Parents rated the child’s health as poor/fair/good for 105 (35%) of child participants. Children with poor/fair/good health status were over 5 times (OR: 5.37; 95% CI: 2.84-10.14) more likely to be high risk for DM2 compared to children with very good/excellent health status. None of the family functioning predictors (sharing ideas about things that matter, relationship to child, making decisions together, and coping with demands of parenting) were significantly associated with being high risk for DM2. Conclusions: Our research shows that a parent’s assessment of their child’s health predicts risk for DM2. This may be important for clinical visits, such as well child visits, or for programs aimed at reducing DM2 in children. While our research did not demonstrate an association between family functioning and risk for DM2, these factors should be explored further with questions obtained from validated measures.Item The Baby Bites Text Messaging Project with randomized controlled trial: texting to improve infant feeding practices(AME Publishing Company, 2023-04-24) Davis, Kathleen E.; Klingenberg, Adyson; Massey-Stokes, Marilyn; Habiba, Nusrath; Gautam, Rupali; Warren, Cynthia; Yeatts, PaulBACKGROUND: Rapid weight gain and overweight in infancy are associated with childhood obesity. Thus, effective, accessible interventions to promote healthy infant feeding practices to prevent early obesity are essential. METHODS: This mixed-methods study involved diverse parents of infants in an urban, low-income pediatric clinic. Qualitative interviews explored parental attitudes towards feeding, early obesity, and communication with the pediatrician. A pilot, randomized controlled trial (RCT) informed by feedback provided by clinic parents compared text messages delivered for 12 months promoting healthy feeding practices to usual care to prevent early pediatric obesity. A computer-generated randomization schedule with balanced distribution for sex was used to place infants into groups. Weight-for-length percentiles and z-scores and feeding practices were measured at 0-2 weeks (baseline), 2-4 months, 6-9 months, and 12 months. Interviews were recorded, transcribed, and coded using thematic analysis. Weight for length percentile, Weight for length z scores, and feeding practices were compared between groups using repeated measures mixed analysis of variance (ANOVA). RESULTS: Participants in the interviews were 15 parents of infants less than 1 month old. RCT participants were 38 parents of newborns (17 control; 21 intervention). Most parents in the qualitative evaluation viewed breastfeeding positively but also discussed barriers. Most also wanted practical information regarding infant feeding. There were no differences in weight-for-length percentile (F=0.52; P=0.60) or z-scores (F=0.7922; P=0.79), breastfeeding persistence chi(2)[1] =1.45, P=0.23, or age of introduction of solids in the intervention (statistical analysis not possible due to low counts) compared to the control group; however, low response to surveys limited the study's power. CONCLUSIONS: Text messaging has potential to extend the healthcare provider's communication beyond clinic. However, texting interventions should be flexible to mitigate barriers such as loss of phone service and challenges customizing messages to parent needs.