11 Clinician Management of Childhood Dyslipidemia in the Community Setting
Bibliographic record
Abstract
Abstract Background Childhood dyslipidemia is a known risk factor for the development of cardiovascular disease (CVD) in adulthood. Although adverse health outcomes of dyslipidemias are rare in childhood, the atherosclerotic process begins in early life. An overlooked lifelong progression of disease may result in myocardial infarction and stroke in later life. There are currently no Canadian paediatric guidelines for lipid screening. Despite dyslipidemia identification, early treatment or management may not be initiated. Primary care providers (PCP) are well positioned to advise and reinforce cardiovascular health behaviours to minimize the risk of CVD and promote lifelong cardiovascular health. Objectives To describe clinician practice patterns associated with childhood dyslipidemia management in the community setting. Design/Methods A retrospective chart review was conducted for children 2 to 10 years of age with abnormal lipid profiles. Participants were recruited from a practice-based research network. Non-fasting blood samples were obtained. The primary study outcome was the proportion of physicians engaging in each step of management practice. R version 3.6.2 (R Foundation for Statistical Computing, Vienna, Austria) was used for statistical analysis. Results Among 462 children identified with dyslipidemia, all were seen by PCP at their next follow-up visit. PCP rarely informed families about abnormal lipid profiles. PCP frequently counselled on diet and eating habits (n=424, 95.1%), but less often on physical activity (n=154, 34.5%), screen time (n=24, 5.4%), and sleep (n=1, 0.2%). Family history of CVD, diabetes, high cholesterol, or hypertension was infrequently discussed (n=5, 1.1%). PCP repeated fasting lipid profiles uncommonly (n=20, 4.5%). Management plans for abnormal lipid profiles were not documented. Only one participant had a follow-up visit (n=1, 0.2%). Referrals were rarely made to dieticians (n=2, 0.4%) and were not in response to abnormal lipid levels. Conclusion Dyslipidemia in childhood is a risk factor for the development of adult cardiovascular disease. Among children with abnormal lipid profiles, our study showed PCP rarely identified and initiated early management for abnormal lipid levels. Our results may inform the need for paediatric lipid screening and management guidelines to develop best clinical practice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".