Dr. Renee L Davis

Prescribed burning, the intentional application of fire to landscapes, is a crucial tool for land management. It aids in forest rejuvenation and controls nuisance species. This study explores the perceptions of 19 rural leaders in the Ozark Mountains regarding private landowners' access to information and their involvement in decision-making about prescribed fires in the region. A qualitative descriptive approach was used. Interviews with rural leaders highlighted 3 main themes: structured efforts for community-based land management, capacity building partnerships, and smoke management safety. Our study's findings underscore the transformative potential of prescribed burn associations' structured efforts for community-based land management in bridging gaps between policy, and practice. Our study also reveals how collaborative networks enhance resource-sharing, and decision-making autonomy, thereby expanding prescribed burn access for Missouri's private landowners. Finally, persistent challenges, such as smoke management resource gaps, highlight the need for targeted investments in education and technology. While this research focuses on Mark Twain National Forest in south-central Missouri, its implications extend to other regions of the United States struggling with fragmented landownership and climate-driven wildfire risks, offering insights for scalable prescribed burn strategies.

Car safety seat laws and professional guidance, such as the American Academy of Pediatrics (AAP) Child Passenger Safety recommendations, are essential for parents and health care providers when choosing an appropriate car seat. This project reviewed car safety seat state laws for commonalities, variations, and themes. Car safety seat laws for all 50 states and the District of Columbia (N 1 / 4 51) were reviewed through electronic sources. Data collection focused on gathering common legislative language in each car safety seat grouping. All car safety seat laws were based on age, height, weight, manufacturer limit, any combination of these, or were not specified. The most common category result was "age only" except for rear-facing car safety seats, which was "not speci fied." Variations in clarity, terminology, and completeness were found. Owing to great variance in AAP and state laws, health care providers should use AAP guidelines, know their specific state's car safety seat laws, and advocate for legislation to meet or exceed AAP guidelines.

This integrative review found 7 professional clinical practice guidelines or recommendations for treating low vitamin D (LVD) or vitamin D deficiency (VDD) in infants, children, and adolescents. Treatment recommendation considerations varied by age group, severity, daily versus weekly dosing, treatment length, need for follow-up testing and maintenance therapy after treatment completion. These inconsistencies make treatment recommendations for health care providers difficult to navigate. Terminology variations for LVD or VDD are discussed. Results reviewed with the Appraisal of Guidelines, Research and Evaluation II process showed mixed results with the lowest scores in Rigor of Development and Applicability domains.
•There is a lack of consensus for vitamin D treatment recommendations for infants, children, and adolescents.•An integrative review found 7 professional clinical practice guidelines or recommendations for treating low vitamin D or vitamin D deficiency.•Variations of recommendations for treatment of vitamin D make it difficult for health care providers to provide therapeutic treatment.•Vitamin D treatment clinical practice guidelines and recommendations for infants, children, and adolescents show mixed results when evaluated using the Agree II process.

Aim To describe the experiences of weight stigma in adolescents with severe obesity and their parents. Design Qualitative descriptive secondary analysis. Methods A secondary analysis on 31 transcripts from a larger study of 46 transcripts conducted between February 2019 and June 2020. Semi-structured interviews were conducted with 19 parents (n = 17 mothers, n = 2 fathers) and 12 adolescents (n = 7 male, n = 5 female). Interviews were digitally audio recorded, transcribed and analysed using conventional content analysis. Results Four common themes were identified reflecting experiences of weight stigma: weight-based teasing and bullying, interactions with healthcare providers (HCPs), family interactions and blame. Subthemes were fairness and impact on mental health. Conclusion This secondary analysis adds to the sparse literature documenting the experiences of weight stigma from adolescents with severe obesity and their families. It is important to understand the experiences of weight stigma from the adolescent and parent perspective as it can inform healthcare, education and policies across communities and facilitate holistic health for this vulnerable population. Impact The need for research to better understand how experiences of weight stigma correlate with physiological and psychological outcomes and inform innovative interventions are critical to improve treatment of severe obesity. Healthcare providers across disciplines are in a strategic position to change the paradigm through which we provide care to youth with severe obesity and guide families in supporting their children's weight management efforts without contributing to weight stigma.

Introduction: Childhood obesity remains a serious public health problem affecting all ages of the pediatric life span. Despite increases in interventions and research, the prevalence of childhood obesity continues to rise. The National Center for Health Statistics 2015-2016 data report an overall childhood obesity rate of 18.5%, with variation between age groups: 13.9% among 2–5 years old, 18.4% among 6–11 years old, and 20.6% among 12–19 years old (Hales, Carroll, Fryar, & Ogden, 2017). For children with developmental and intellectual disabilities (e.g., autism spectrum disorder), estimates of obesity are as high as 29.7% and 30.4%, respectively (Fox, Witten, & Lullo, 2014). The comorbidities of adult obesity, including hyperlipidemia, hypercholesterolemia, hypertension, metabolic syndrome, nonalcoholic fatty liver disease, and type 2 diabetes, are now common in childhood (Center for Disease Control and Prevention, 2016; Kumar & Kelly, 2017). In addition, pediatric overweight and obesity have resulted in increased behavioral and mental health issues and often have long-term impacts on the developing child and adolescent (Center for Disease Control and Prevention, 2016).
Pediatric health care providers (PHCPs) are key to the assessment, treatment, and prevention of childhood overweight and obesity, but rates of obesity management in the primary care setting are low (Rhee, Kessl, Lindback, Littman, & El-Kareh, 2018). There are many quality tools and resources available that use evidence-based practices and multidisciplinary resources to assist providers in counseling families on improving health behaviors, parenting skills, and modifying environmental influences with families. Organizations such as the American Academy of Pediatrics (AAP) and the National Association of Pediatric Nurse Practitioners have provided sentinel guidelines related to childhood obesity management (Barlow & Expert Committee, 2007; National Association of Pediatric Nurse Associates & Practitioners, 2006). These guidelines titled (respectively) “Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report” and the “Healthy Eating and Activity Together (HEAT) Initiative” are well known and have proved to be very useful for the practicing clinician. Unfortunately, considerable time and energy are needed to maintain and update these resources, and they are becoming outdated. In addition, it can be difficult for PHCPs to find the time needed to gather and discern the quality of resources available then decide which should be used in the care of their patients and families. The purpose of Part Two of this review is to provide PHCPs with useful and evidenced-based information to aid in the prevention and management of the child with overweight and obesity in an easily retrievable format and to develop a Childhood Overweight and Obesity Evidence-Based Toolbox.

espite the focus on reducing childhood overweight and obesity in the United States over the past decade, recent reports indicate an increasing trend in prevalence among youth 2–19 years of age (Hales, Carroll, Fryar, & Ogden, 2017; Skinner, Ravanbakht, Skelton, Perrin, & Armstrong, 2018). The overall prevalence of childhood obesity in 2016 was 18.5%, with significantly higher prevalence among non-Hispanic black youth (22.0%) and Hispanic youth (25.8%; Hales et al., 2017). Particularly concerning is the latest obesity prevalence rate of 13.9% among children 2–5 years old, which increased 5% since 2014 (Hales et al., 2017; Skinner et al., 2018). Moreover, the risk of adolescent obesity is 1.4 times higher in those who are overweight or obese at 3 years of age (Geserick et al., 2018). Of further concern are the comorbidities of adult obesity, including hypertension, metabolic syndrome, non-alcoholic fatty liver disease, and type 2 diabetes, are now prevalent in childhood (Pulgarón, 2013).
Childhood overweight and obesity have become a primary public health concern, and the publications related to this topic have dramatically increased. Pediatric primary care providers (PCPs) working within the clinical environment recognize the importance of evidence-based practice. Barriers to implementing evidence-based practice can include the amount of evidence, the time needed to review, and the ability to discern the highest quality of evidence in an efficient manner (Tacia, Biskupski, Pheley, & Lehto, 2015). Randomized controlled trials provide the best evidence for the management and treatment of chronic conditions. However, the number of randomized controlled, longitudinal studies on effective interventions and treatments for childhood overweight and obesity is limited.
Consequently, pediatric PCPs have relied on clinical practice guidelines (CPGs) to provide evidence-based information concisely for the management of childhood overweight and obesity to improve patient care and overall child health outcomes (Pulgarón, 2013). Currently, there are many CPGs of variable strength and quality aimed at the management and treatment of childhood overweight and obesity. The purpose of this review was to conduct a comprehensive appraisal of evidence-based CPGs focused on the assessment, prevention, management, and treatment of childhood overweight and obesity and to present the information in a format to facilitate the work of the practicing provider.

Although vaccines are one of the greatest scientific innovations to prevent disease and promote well-being, 1 in 10 children is not being vaccinated. This has directly contributed to the rise in vaccine-preventable diseases. Because of the high contagiousness of measles, mumps, and pertussis, innovative efforts are paramount to prevent disease outbreaks in the United States and worldwide. This article reviews measles, mumps, and pertussis; explains the resurgence of these vaccine-preventable diseases; and offers evidence-based solutions for increasing vaccination rates.

Problem: No consensus on vitamin D deficiency (VDD) screening in children and adolescents exists. Early VDD detection can improve the health of children. VDD can cause bone mineralization diseases, such as rickets in children. The purpose of this review is to determine existing VDD screening recommendations or clinical practice guidelines in children and adolescents.
Eligibility criteria: Inclusion criteria were VDD screening 'guideline', 'clinical practice guideline', and 'recommendations' for children and adolescents in English, published 2001-2018.
Results: Eight current guidelines addressed VDD screening recommendations with the common recommendation results endorsing screening only for VDD in at-risk children and adolescents.
Conclusions: There is insufficient evidence for pediatric healthcare providers to recommend which VDD risk factors should be utilized for screening in children and adolescents. (C) 2019 Elsevier Inc. All rights reserved.