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Publisher: Elsevier   (Total: 3031 journals)

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Showing 1 - 200 of 3031 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 16, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 79, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 22, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 302, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription  
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 195, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 21, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 5, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 4)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 119, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 24, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 21, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 8, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 39, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 38, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 41, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 14)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 18, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 33, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 4)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 7, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 5, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 6, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 20, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 14)
Advances in Pharmacology     Full-text available via subscription   (Followers: 13, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 17, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 56)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 1, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 332, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 7)
Advances in Surgery     Full-text available via subscription   (Followers: 6, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 28, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 14)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 12)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 42, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 303, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 4, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 7, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 389, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 29, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 36, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 48, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 3, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 5)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 7, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 6, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 45, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 45, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 47, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 34, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 25, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 48, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 173, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 51, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 2)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 22, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 23, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 32, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 13, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 52, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 3)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 152, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 7, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 10)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 21, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 141, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover Academic Pediatrics
  [SJR: 1.402]   [H-I: 51]   [20 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1876-2859
   Published by Elsevier Homepage  [3031 journals]
  • Getting the Word Out: Disseminating Scholarly Work in the Technology Age
    • Authors: Margaret J. Trost; Emily C. Webber; Karen M. Wilson
      Pages: 223 - 224
      Abstract: Publication date: April 2017
      Source:Academic Pediatrics, Volume 17, Issue 3
      Author(s): Margaret J. Trost, Emily C. Webber, Karen M. Wilson

      PubDate: 2017-04-09T12:53:33Z
      DOI: 10.1016/j.acap.2017.01.007
  • Treating the Pain
    • Authors: Ann S. Botash
      Pages: 225 - 227
      Abstract: Publication date: April 2017
      Source:Academic Pediatrics, Volume 17, Issue 3
      Author(s): Ann S. Botash

      PubDate: 2017-04-09T12:53:33Z
      DOI: 10.1016/j.acap.2017.01.003
  • Location, Location, Location: Teaching About Neighborhoods in Pediatrics
    • Authors: Francis J. Real; Catherine D. Michelson; Andrew F. Beck; Melissa D. Klein
      Pages: 228 - 232
      Abstract: Publication date: April 2017
      Source:Academic Pediatrics, Volume 17, Issue 3
      Author(s): Francis J. Real, Catherine D. Michelson, Andrew F. Beck, Melissa D. Klein

      PubDate: 2017-04-09T12:53:33Z
      DOI: 10.1016/j.acap.2016.12.007
  • Tobacco Control and Treatment for the Pediatric Clinician: Practice,
           Policy, and Research Updates
    • Authors: Brian P. Jenssen; Karen M. Wilson
      Pages: 233 - 242
      Abstract: Publication date: April 2017
      Source:Academic Pediatrics, Volume 17, Issue 3
      Author(s): Brian P. Jenssen, Karen M. Wilson
      Tobacco use is the leading cause of preventable death in the United States, and exposure to tobacco smoke harms children from conception forward. There is no safe level of tobacco exposure. Although overall smoking rates have declined, the advent of new products, such as electronic cigarettes, threatens to perpetuate nicotine addiction without clear health benefits. In addition to reviewing traditional and new tobacco products, we discuss the unique role that pediatricians should play in tobacco treatment and control efforts. New policies and technologies can empower pediatric clinicians and pediatric health care systems to help parent smokers quit, and new policies outside of the health care setting might help prevent smoking initiation as well as improve cessation treatments. Future research is needed to continue to study the consequences of tobacco use exposure as well as the best ways to help patients and parents stop tobacco use.

      PubDate: 2017-04-09T12:53:33Z
      DOI: 10.1016/j.acap.2016.12.010
  • Expert Perspectives on Time Sensitivity and a Related Metric for Children
           Involved in Motor Vehicle Crashes
    • Authors: Andrea N. Doud; Samantha L. Schoell; Ashley A. Weaver; Jennifer W. Talton; Ryan T. Barnard; John K. Petty; J. Wayne Meredith; Joel D. Stitzel
      Pages: 243 - 250
      Abstract: Publication date: April 2017
      Source:Academic Pediatrics, Volume 17, Issue 3
      Author(s): Andrea N. Doud, Samantha L. Schoell, Ashley A. Weaver, Jennifer W. Talton, Ryan T. Barnard, John K. Petty, J. Wayne Meredith, Joel D. Stitzel
      Objective Advanced Automatic Crash Notification (AACN) uses vehicle telemetry data to predict risk of serious injury among motor vehicle crash occupants and can thus improve the accuracy with which injured children are triaged by first responders. To better define serious injury for AACN systems (which typically use Abbreviated Injury Scale [AIS] metrics), an age-specific approach evaluating severity, time sensitivity (TS), and predictability of injury has been developed. This study outlines the development of the TS score. Methods The 95% most frequent AIS 2+ injuries in a national motor vehicle crash data set spanning 2000 to 2011 were determined for the following age groups: 0 to 4, 5 to 9, 10 to 14, and 15 to 18 years. For each age-specific injury, clinicians with pediatric trauma expertise were asked if treatment at a trauma center was required and were asked about the urgency of treatment. A TS score (range 0–1) was calculated by combining the mean trauma center decision and urgency scores. Results A total of 30 to 32 responses were obtained for each age-specific injury. The most frequent motor vehicle crash–induced injuries in the younger groups received significantly higher scores than those in the older groups (median TS score 0 to 4 years: 0.89, 5–9 years: 0.87, 10–14 years: 0.82, 15–18 years: 0.72, P < .001). Large variations in TS existed within each AIS severity level; for example, scores among AIS 2 injuries in 0- to 4-year-olds ranged from 0.12 to 0.98. Conclusions The TS of common pediatric injuries varies on the basis of age and may not be accurately reflected by AIS metrics. AIS may not capture all aspects of injury that should be considered by AACN systems.

      PubDate: 2017-04-09T12:53:33Z
      DOI: 10.1016/j.acap.2016.10.009
  • Predicting Subsequent High-Frequency, Low-Acuity Utilization of the
           Pediatric Emergency Department
    • Authors: Margaret E. Samuels-Kalow; Matthew W. Bryan; Kathy N. Shaw
      Pages: 256 - 260
      Abstract: Publication date: April 2017
      Source:Academic Pediatrics, Volume 17, Issue 3
      Author(s): Margaret E. Samuels-Kalow, Matthew W. Bryan, Kathy N. Shaw
      Objective To derive and test a predictive model for high-frequency (4 or more visits per year), low-acuity (emergency severity index 4 or 5) utilization of the pediatric emergency department. Methods The study sample used 3 years of data (2012–2014) from a single tertiary-care children's hospital for patients <21 years of age. Utilization in 2013 defined the index visit; prior utilization was drawn from 2012; and 2014 was used for outcome measurement. Candidate predictor variables were those that would be available at the time of triage. Data were split into derivation and test sets randomly; variables with a significant univariate association in the derivation set were included for multivariable modeling. The final model from the derivation set was then tested in the validation set, with calculation of a receiver operating characteristic curve. Results There were 90,972 visits in 2013, of which 61,430 were first (index) visits. A total of 590 (1%) had 4 or more triage level 4 or 5 visits in the following year (2014). The final model included site of primary care, age, acuity, previous utilization, race, and insurance, and had an area under the receiver operating characteristic curve of 0.84. Conclusions Data available to the emergency department provider at the time of initial visit triage can predict utilization for low-acuity complaints in the subsequent year. Future work should focus on validation and refinement of the model in additional settings, and electronic calculation of risk status for targeted intervention to improve appropriate utilization of health care services.

      PubDate: 2017-04-09T12:53:33Z
      DOI: 10.1016/j.acap.2016.11.008
  • A Clinical Score to Predict Appendicitis in Older Male Children
    • Authors: Anupam B. Kharbanda; Michael C. Monuteaux; Richard G. Bachur; Nanette C. Dudley; Lalit Bajaj; Michelle D. Stevenson; Charles G. Macias; Manoj K. Mittal; Jonathan E. Bennett; Kelly Sinclair; Peter S. Dayan
      Pages: 261 - 266
      Abstract: Publication date: April 2017
      Source:Academic Pediatrics, Volume 17, Issue 3
      Author(s): Anupam B. Kharbanda, Michael C. Monuteaux, Richard G. Bachur, Nanette C. Dudley, Lalit Bajaj, Michelle D. Stevenson, Charles G. Macias, Manoj K. Mittal, Jonathan E. Bennett, Kelly Sinclair, Peter S. Dayan
      Objective To develop a clinical score to predict appendicitis among older, male children who present to the emergency department with suspected appendicitis. Methods Patients with suspected appendicitis were prospectively enrolled at 9 pediatric emergency departments. A total of 2625 patients enrolled; a subset of 961 male patients, age 8–18 were analyzed in this secondary analysis. Outcomes were determined using pathology, operative reports, and follow-up calls. Clinical and laboratory predictors with <10% missing data and kappa > 0.4 were entered into a multivariable model. Resultant β-coefficients were used to develop a clinical score. Test performance was assessed by calculating the sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios. Results The mean age was 12.2 years; 49.9% (480) had appendicitis, 22.3% (107) had perforation, and the negative appendectomy rate was 3%. In patients with and without appendicitis, overall imaging rates were 68.6% (329) and 84.4% (406), respectively. Variables retained in the model included maximum tenderness in the right lower quadrant, pain with walking/coughing or hopping, and the absolute neutrophil count. A score ≥8.1 had a sensitivity of 25% (95% confidence interval [CI], 20%–29%), specificity of 98% (95% CI, 96%–99%), and positive predictive value of 93% (95% CI, 86%–97%) for ruling in appendicitis. Conclusions We developed an accurate scoring system for predicting appendicitis in older boys. If validated, the score might allow clinicians to manage a proportion of male patients without diagnostic imaging.

      PubDate: 2017-04-09T12:53:33Z
      DOI: 10.1016/j.acap.2016.11.014
  • Identifying Local Hot Spots of Pediatric Chronic Diseases Using Emergency
           Department Surveillance
    • Authors: David C. Lee; Stella S. Yi; Hiu-Fai Fong; Jessica K. Athens; Joseph E. Ravenell; Mary Ann Sevick; Stephen P. Wall; Brian Elbel
      Pages: 267 - 274
      Abstract: Publication date: April 2017
      Source:Academic Pediatrics, Volume 17, Issue 3
      Author(s): David C. Lee, Stella S. Yi, Hiu-Fai Fong, Jessica K. Athens, Joseph E. Ravenell, Mary Ann Sevick, Stephen P. Wall, Brian Elbel
      Objective To use novel geographic methods and large-scale claims data to identify the local distribution of pediatric chronic diseases in New York City. Methods Using a 2009 all-payer emergency claims database, we identified the proportion of unique children aged 0 to 17 with diagnosis codes for specific medical and psychiatric conditions. As a proof of concept, we compared these prevalence estimates to traditional health surveys and registry data using the most geographically granular data available. In addition, we used home addresses to map local variation in pediatric disease burden. Results We identified 549,547 New York City children who visited an emergency department at least once in 2009. Though our sample included more publicly insured and uninsured children, we found moderate to strong correlations of prevalence estimates when compared to health surveys and registry data at prespecified geographic levels. Strongest correlations were found for asthma and mental health conditions by county among younger children (0.88, P = .05 and 0.99, P < .01, respectively). Moderate correlations by neighborhood were identified for obesity and cancer (0.53 and 0.54, P < .01). Among adolescents, correlations by health districts were strong for obesity (0.95, P = .05), and depression estimates had a nonsignificant, but strong negative correlation with suicide attempts (−0.88, P = .12). Using SaTScan, we also identified local hot spots of pediatric chronic disease. Conclusions For conditions easily identified in claims data, emergency department surveillance may help estimate pediatric chronic disease prevalence with higher geographic resolution. More studies are needed to investigate limitations of these methods and assess reliability of local disease estimates.

      PubDate: 2017-04-09T12:53:33Z
      DOI: 10.1016/j.acap.2016.10.017
  • Identification and Validation of a Sickle Cell Disease Cohort Within
           Electronic Health Records
    • Authors: Daniel E. Michalik; Bradley W. Taylor; Julie A. Panepinto
      Pages: 283 - 287
      Abstract: Publication date: April 2017
      Source:Academic Pediatrics, Volume 17, Issue 3
      Author(s): Daniel E. Michalik, Bradley W. Taylor, Julie A. Panepinto
      Objective To develop and validate a computable phenotype algorithm for identifying patient populations with sickle cell disease. Methods In this retrospective study we used electronic health record data from the Children's Hospital of Wisconsin to develop a computable phenotype algorithm for sickle cell disease. The algorithm was on the basis of the International Classification of Diseases, Ninth Revision codes, number of visits, and hospital admissions for sickle cell disease. Using Informatics for Integrating Biology and the Bedside queries, the algorithm was refined in an iterative process. The final algorithm was verified using manual medical records review and by comparison with a gold standard set of confirmed sickle cell cases. The algorithm was then validated at Froedtert Hospital, a neighboring health system for adults. Results From the Children's Hospital of Wisconsin, our computable phenotype algorithm identified patients with confirmed sickle cell disease with a positive predictive value of 99.4% and a sensitivity of 99.4%. Additionally, using data from Froedtert, the computable phenotype algorithm identified patients with confirmed sickle cell disease with a positive predictive value of 95.8% and a sensitivity of 98.3%. Conclusions The computable phenotype algorithm developed in this study had a high sensitivity and positive predictive value when identifying patients with sickle cell disease in the electronic health records of the Children's Hospital of Wisconsin and Froedtert, a neighboring health system for adults. Our algorithm allows us to harness data provided by the electronic health record to rapidly and accurately identify patient with sickle cell disease and is a rich resource for future clinical trials.

      PubDate: 2017-04-09T12:53:33Z
      DOI: 10.1016/j.acap.2016.12.005
  • Personal Digital Assistant-Based Self-Work Sampling Study of Pediatric
           Interns Quantifies Workday and Educational Value
    • Authors: Joyce K. Campbell; Michael V. Ortiz; Mary C. Ottolini; Sarah Birch; Dewesh Agrawal
      Pages: 288 - 295
      Abstract: Publication date: April 2017
      Source:Academic Pediatrics, Volume 17, Issue 3
      Author(s): Joyce K. Campbell, Michael V. Ortiz, Mary C. Ottolini, Sarah Birch, Dewesh Agrawal
      Objective Optimizing clinical proficiency and education of residents has become more important with restricted residency duty hours. Our objective was to investigate how interns spend their time on inpatient rotations and the perceived educational value of workday activities. Methods We performed a descriptive self-work sampling study using a personal digital assistant (PDA) to randomly query interns on inpatient rotations in real time regarding their activity and the perceived educational value of that activity on a 4-point Likert scale. Results A total of 31 interns participated on 88 workdays over a 5-month period, generating 2082 samples from which the average workday was modeled. Time spent using the electronic health record (EHR) accounted for 33% of intern time, communicating with the health care team 23%, educational activities 17%, and time with patients and families 12%. Time with patients and families was perceived to be the most educational part of clinical service. Time spent using the EHR was perceived as the least educational. Interns perceived clinical service as excellent or good 37% of the time, while planned educational activities were perceived as excellent or good 81% of the time. Conclusions Interns spend the majority of their time using the EHR and communicating with the health care team. Interns perceive time spent in planned educational activities has more educational value than time spent in clinical service. The distribution of daily activities is discordant with the perceived educational value of those activities.

      PubDate: 2017-04-09T12:53:33Z
      DOI: 10.1016/j.acap.2016.12.001
  • What Do Pediatric Residents Gain From an Experience in Juvenile
           Justice' A Qualitative Analysis of Community-Based Learning
    • Authors: Elizabeth R. Hanson; Erin P. Finley; Jean A. Petershack
      Pages: 296 - 302
      Abstract: Publication date: April 2017
      Source:Academic Pediatrics, Volume 17, Issue 3
      Author(s): Elizabeth R. Hanson, Erin P. Finley, Jean A. Petershack
      Background Training in advocacy and community pediatrics often involves the use of community site visits. However, data on the specific knowledge, skills, and attitudes gained from these experiences are limited. In this study we used qualitative analysis of written narratives to explore the response of residents to a juvenile justice experience. Methods Pediatric residents participated in a week-long experience in the juvenile probation department and completed a written narrative. Narratives were analyzed using grounded theory to explore the effects of this experience on residents' views of youth in the juvenile justice system. Results Analysis of 29 narratives revealed 13 themes relating to 5 core concepts: social determinants of behavior, role of professionals and institutions, achieving future potential, resolving discrepancies, and distancing. A conceptual model was developed to explore the interactions of these concepts in the resident view of youth in the juvenile justice system. Of the themes only 3 (23%) were related to content explicitly covered in the assigned reading materials. Conclusions Several important concepts emerged as elements of this experience, many of which were not covered in the explicit curriculum. Variability in attitudinal response to the experience raised important questions about the influence of the ideological framework of the learner and the hidden curriculum on the learning that occurs in community settings. We propose a theoretical model that delineates the factors that influence learning in community settings to guide educators in planning these types of experiences.

      PubDate: 2017-04-09T12:53:33Z
      DOI: 10.1016/j.acap.2016.12.006
  • How Educators Conceptualize and Teach Reflective Practice: A Survey of
           North American Pediatric Medical Educators
    • Authors: Lavjay Butani; Susan L. Bannister; Allison Rubin; Karen L. Forbes
      Pages: 303 - 309
      Abstract: Publication date: April 2017
      Source:Academic Pediatrics, Volume 17, Issue 3
      Author(s): Lavjay Butani, Susan L. Bannister, Allison Rubin, Karen L. Forbes
      Objective The objectives of this study were to explore pediatric undergraduate medical educators' understanding of reflective practice, the barriers they face in teaching this, the curricular activities they use, and the value they assign to reflective practice. Methods Nine survey questions were sent to members of the Council on Medical Student Education in Pediatrics, an international pediatric undergraduate medical educator group. Quantitative data were analyzed using descriptive statistics. Open-ended responses were analyzed qualitatively through an iterative process to establish themes representing understanding of reflective practice and barriers in teaching this. Results Respondents representing 56% of all North American schools answered at least 1 survey question. Qualitative analysis of understanding of reflection revealed 11 themes spanning all components of reflective practice, albeit with a narrow view on triggers for reflection and a lower emphasis on understanding the why of things and on perspective-taking. The most frequent barriers in teaching this were the lack of skilled educators and limited time. Most respondents valued reflective skills but few reported confidence in their ability to teach reflection. Several curricular activities were used to teach reflection, the most common being narrative writing. Conclusions Pediatric undergraduate medical educators value reflection and endorse its teaching. However, many do not have a complete understanding of the construct and few report confidence in teaching this. Implementing longitudinal curricula in reflective practice may require a culture change; opportunities exist for faculty development about the meaning and value of reflective practice and how best to teach this.

      PubDate: 2017-04-09T12:53:33Z
      DOI: 10.1016/j.acap.2016.12.008
  • Total Breast-Feeding Duration and Dental Caries in Healthy Urban Children
    • Authors: Peter D. Wong; Catherine S. Birken; Patricia C. Parkin; Isvarya Venu; Yang Chen; Robert J. Schroth; Jonathon L. Maguire; Kawsari Abdullah; Laura N. Anderson; Catherine S. Birken; Cornelia M. Borkhoff; Sarah Carsley; Yang Chen; Mikael Katz-Lavigne; Kanthi Kavikondala; Grace Jieun Lee; Jonathon L. Maguire; Dalah Mason; Jessica Omand; Patricia C. Parkin; Navindra Persaud; Meta van den Heuvel; Weeda Zabih; Jillian Baker; Tony Barozzino; Joey Bonifacio; Douglas Campbell; Sohail Cheema; Brian Chisamore; Karoon Danayan; Paul Das; Mary Beth Derocher; Anh Do; Michael Dorey; Sloane Freeman; Keewai Fung; Charlie Guiang; Curtis Handford; Hailey Hatch; Sheila Jacobson; Tara Kiran; Holly Knowles; Bruce Kwok; Sheila Lakhoo; Margarita Lam-Antoniades; Eddy Lau; Fok-Han Leung; Jennifer Loo; Sarah Mahmoud; Rosemary Moodie; Julia Morinis; Sharon Naymark; Patricia Neelands; James Owen; Michael Peer; Marty Perlmutar; Navindra Persaud; Andrew Pinto; Michelle Porepa; Nasreen Ramji; Noor Ramji; Alana Rosenthal; Janet Saunderson; Rahul Saxena; Michael Sgro; Susan Shepherd; Barbara Smiltnieks; Carolyn Taylor; Thea Weisdors; Sheila Wijayasinghe; Peter Wong; Ethel Ying; Elizabeth Young
      Pages: 310 - 315
      Abstract: Publication date: April 2017
      Source:Academic Pediatrics, Volume 17, Issue 3
      Author(s): Peter D. Wong, Catherine S. Birken, Patricia C. Parkin, Isvarya Venu, Yang Chen, Robert J. Schroth, Jonathon L. Maguire
      Objective To determine if there is an association between longer breast-feeding duration and dental caries in healthy urban children. Methods We conducted a cross-sectional study of urban children aged 1 to 6 years recruited through The Applied Research Group for Kids (TARGet Kids!) practice-based research network between September 2011 and August 2013. The main outcome measure was parental report of dental caries. Results The adjusted predicted probability of dental caries was 7%, 8%, 11%, and 16% with total duration of breast-feeding duration of 12, 18, 24, and 36 months, respectively. In the adjusted logistic regression analyses, relative to breast-feeding 0 to 5 months, the odds of dental caries with total breast-feeding duration >24 months was 2.75 (95% confidence interval 1.61–4.72). Conclusions Among healthy urban children, longer breast-feeding duration was associated with higher odds of dental caries. These findings support heightened awareness and enhanced anticipatory guidance for preventive dental care, particularly among children who breast-feed beyond 2 years of age.

      PubDate: 2017-04-09T12:53:33Z
      DOI: 10.1016/j.acap.2016.10.021
  • Fluoride Supplementation Adherence and Barriers in a Community Without
           Water Fluoridation
    • Authors: Shannon Flood; Karin Asplund; Benjamin Hoffman; Allison Nye; Katharine E. Zuckerman
      Pages: 316 - 322
      Abstract: Publication date: April 2017
      Source:Academic Pediatrics, Volume 17, Issue 3
      Author(s): Shannon Flood, Karin Asplund, Benjamin Hoffman, Allison Nye, Katharine E. Zuckerman
      Background To prevent early childhood caries, the American Dental Association recommends oral fluoride supplementation for children in communities lacking water fluoridation who are at high caries risk. However, patient adherence to oral fluoride supplementation has not been studied in this population. This study assessed adherence to oral fluoride and barriers to adherence in a community lacking water fluoridation. Methods A self-administered survey was completed in a systematic sample of 209 parents of children aged 6 months to 4 years, during a primary care visit in an urban academic medical center. Participants reported frequency of administering oral fluoride to their children, as well as agreement or disagreement with proposed barriers to supplementation. Bivariate and multivariate analyses were used to assess adherence with oral supplementation and the association of barriers to supplementation and child receipt of fluoride on the day before. Results More than half of parents either had not or did not know if their child had received fluoride on the day before. Approximately 1 in 4 of parents had given fluoride in 0 of the previous 7 days. Difficulty remembering to give fluoride and agreeing that the child does not need extra fluoride were associated with not receiving fluoride on the day before. Conclusions Adherence to oral fluoride supplementation in the primary care setting is low. Difficulty remembering to give fluoride daily is the greatest barrier to adherence. Further research on interventions to reduce common barriers is needed to increase fluoride administration and reduce early childhood caries in communities lacking water fluoridation.

      PubDate: 2017-04-09T12:53:33Z
      DOI: 10.1016/j.acap.2016.11.009
  • Understanding the Financial Implications of Immunization Reminder/Recall
           in a Multipractice Pediatric Group
    • Authors: Leila C. Sahni; Monica R. Banes; Julie A. Boom
      Pages: 323 - 329
      Abstract: Publication date: April 2017
      Source:Academic Pediatrics, Volume 17, Issue 3
      Author(s): Leila C. Sahni, Monica R. Banes, Julie A. Boom
      Objective Immunization reminder/recall is widely recommended as an effective strategy for increasing vaccination rates. We examined the revenue generated from well-child visits scheduled as a result of reminder/recall activities implemented in a multipractice pediatric organization. Methods Patients aged 19 to 35 months who were due or overdue for vaccines were identified from participating practices and assigned to either standard or enhanced reminder/recall activities. Participants who received standard reminder/recall were observed for the 6-week study period, and the number of appointments in which vaccines were administered was tracked. Participants who received enhanced reminder/recall were contacted up to 3 times and received a letter followed by up to 2 phone calls. Financial information associated with appointments scheduled during the study period was obtained, and revenue was calculated for each dose of vaccine administered. Reminder/recall costs were calculated and overall revenue generated was calculated. Results We identified 3916 children who were potentially due or overdue for immunizations. After review and manual uploading of missing historical vaccines, a total of 1892 participants received the reminder/recall initiative; 942 received standard reminder/recall, and 950 received enhanced reminder/recall. One hundred eighty-two (19%) standard and 277 (29%) enhanced reminder/recall participants scheduled an appointment by the end of the study period (P < .001). After subtracting the cost of reminder/recall activities, an additional $20,066 and $20,235 were generated by standard and enhanced reminder/recall, respectively. Conclusions We show that conducting reminder/recall is at a minimum financially neutral, and might increase revenue generated by vaccine administration.

      PubDate: 2017-04-09T12:53:33Z
      DOI: 10.1016/j.acap.2016.03.002
  • Centralized Reminder/Recall to Increase Immunization Rates in Young
           Children: How Much Bang for the Buck'
    • Authors: Allison Kempe; Alison W. Saville; Brenda Beaty; L. Miriam Dickinson; Dennis Gurfinkel; Sheri Eisert; Heather Roth; Diana Herrero; Lynn Trefren; Rachel Herlihy
      Pages: 330 - 338
      Abstract: Publication date: April 2017
      Source:Academic Pediatrics, Volume 17, Issue 3
      Author(s): Allison Kempe, Alison W. Saville, Brenda Beaty, L. Miriam Dickinson, Dennis Gurfinkel, Sheri Eisert, Heather Roth, Diana Herrero, Lynn Trefren, Rachel Herlihy
      Objective We compared the effectiveness and cost-effectiveness of: 1) centralized reminder/recall (C-R/R) using the Colorado Immunization Information System (CIIS) versus practice-based reminder/recall (PB-R/R) approaches to increase immunization rates; 2) different levels of C-R/R intensity; and 3) C-R/R with versus without the name of the child's provider. Methods We conducted 3 sequential cluster-randomized trials involving children aged 19 to 25 months in 15 Colorado counties in March 2013 (trial 1), October 2013 (trial 2), and May 2014 (trial 3). In C-R/R counties, the intensity of the intervention decreased sequentially in trials 1 through 3, from 3 to 1 recall messages. In PB-R/R counties, practices were offered training using CIIS and financial support. The percentage of children with up-to-date (UTD) vaccinations was compared 6 months after recall. A mixed-effects model assessed the association between C-R/R versus PB-R/R and UTD rates. Results C-R/R was more effective in trials 1 to 3 (relative risk = 1.11; 95% confidence interval 1.01–1.20; P = .009). Effectiveness did not decrease with decreasing intervention intensity (P = .59). Costs decreased with decreasing intensity in the C-R/R arm, from $18.72 per child brought UTD in trial 1 to $10.11 in trial 3. Costs were higher and more variable in the PB-R/R arm, ranging from $20.63 to $237.81 per child brought UTD. C-R/R was significantly more effective if the child's practice name was included (P < .0001). Conclusions C-R/R was more effective and cost-effective than PB-R/R for increasing UTD rates in young children and was most effective if messages included the child's provider name. Three reminders were not more effective than one, which may be explained by the increasing accuracy of contact information in CIIS over the course of the trials.

      PubDate: 2017-04-09T12:53:33Z
      DOI: 10.1016/j.acap.2016.11.016
  • Integrating a Clinical Librarian to Increase Trainee Application of
           Evidence-Based Medicine on Patient Family-Centered Rounds
    • Authors: Lisa E. Herrmann; Jeffrey C. Winer; Jeremy Kern; Susan Keller; Padmaja Pavuluri
      Pages: 339 - 341
      Abstract: Publication date: April 2017
      Source:Academic Pediatrics, Volume 17, Issue 3
      Author(s): Lisa E. Herrmann, Jeffrey C. Winer, Jeremy Kern, Susan Keller, Padmaja Pavuluri

      PubDate: 2017-04-09T12:53:33Z
      DOI: 10.1016/j.acap.2016.11.005
  • The Role of the Peer Reviewer
    • Authors: Robert M. Jacobson; Gerry Fairbrother; R. Christopher Sheldrick; Peter G. Szilagyi
      Pages: 105 - 106
      Abstract: Publication date: March 2017
      Source:Academic Pediatrics, Volume 17, Issue 2
      Author(s): Robert M. Jacobson, Gerry Fairbrother, R. Christopher Sheldrick, Peter G. Szilagyi

      PubDate: 2017-03-08T01:55:16Z
      DOI: 10.1016/j.acap.2016.08.011
  • Using Your Personal Mission Statement to INSPIRE and Achieve Success
    • Authors: Su-Ting T. Li; John G. Frohna; Susan B. Bostwick
      Pages: 107 - 109
      Abstract: Publication date: March 2017
      Source:Academic Pediatrics, Volume 17, Issue 2
      Author(s): Su-Ting T. Li, John G. Frohna, Susan B. Bostwick

      PubDate: 2017-03-08T01:55:16Z
      DOI: 10.1016/j.acap.2016.11.010
  • The Role of Social-Emotional and Social Network Factors in The
           Relationship Between Academic Achievement and Risky Behaviors
    • Authors: Mitchell D. Wong; Danielle Strom; Lourdes R. Guerrero; Paul J. Chung; Desiree Lopez; Katherine Arellano; Rebecca Dudovitz
      Abstract: Publication date: Available online 18 April 2017
      Source:Academic Pediatrics
      Author(s): Mitchell D. Wong, Danielle Strom, Lourdes R. Guerrero, Paul J. Chung, Desiree Lopez, Katherine Arellano, Rebecca Dudovitz
      Purpose We examined whether standardized test scores and grades are related to risky behaviors among low-income minority adolescents and whether social networks and social-emotional factors explained those relationships. Methods We analyzed data from 929 high school students exposed by natural experiment to high- or low-performing academic environments in Los Angeles. We collected information on grade point average (GPA), substance use, sexual behaviors, participation in fights and carrying a weapon from face-to-face interviews and obtained California math and English standardized test (CST) results. Logistic regression and mediation analyses were used to examine the relationship between achievement and risky behaviors. Results Better GPA and CST scores were strongly associated with lower rates of substance use, high risk sexual behaviors and fighting. The unadjusted relative odds of monthly binge drinking was 0.72 (95%CI: 0.56-0.93) for 1 standard deviation increase in standardized test scores and 0.46 (0.29-0.74) for GPA of B minus or higher compared to C plus or lower. Most associations disappeared after controlling for social-emotional and social network factors. Averaged across the risky behaviors, mediation analysis revealed social-emotional factors accounted for 33% of the relationship between test scores and risky behaviors and 43% of the relationship between GPA with risky behaviors. Social network characteristics accounted for 31% and 38% of the relationship between behaviors with test scores and GPA, respectively. Demographic factors, parenting and school characteristics were less important explanatory factors. Conclusions Social-emotional factors and social network characteristics were the strongest explanatory factors of the achievement-risky behavior relationship and may be important to understanding the relationship between academic achievement and risky behaviors.

      PubDate: 2017-04-24T03:53:46Z
      DOI: 10.1016/j.acap.2017.04.009
  • Developing the PedsValue Modules - A National Pediatric High Value Care
    • Authors: Carolyn S. Avery; Jimmy Beck; Ryan Padrez; Lauren LaRue Walker; Lisa E. Herrmann; Suzanne Woods; Alan R. Schroeder; Adam Schickedanz
      Abstract: Publication date: Available online 18 April 2017
      Source:Academic Pediatrics
      Author(s): Carolyn S. Avery, Jimmy Beck, Ryan Padrez, Lauren LaRue Walker, Lisa E. Herrmann, Suzanne Woods, Alan R. Schroeder, Adam Schickedanz

      PubDate: 2017-04-24T03:53:46Z
      DOI: 10.1016/j.acap.2017.04.006
  • Care Coordination and Comprehensive Electronic Health Records are
           Associated with Increased Transition Planning Activities
    • Authors: Niraj Sharma; Kitty O’Hare; Karen G. O’Connor; Umbereen Nehal; Megumi J. Okumura
      Abstract: Publication date: Available online 18 April 2017
      Source:Academic Pediatrics
      Author(s): Niraj Sharma, Kitty O’Hare, Karen G. O’Connor, Umbereen Nehal, Megumi J. Okumura
      Objective Youth with Special Health Care Needs (YSHCN) require assistance from their pediatricians to transition to adult care. There is little data on what transition resources pediatricians have. This paper studies if care coordination and/or comprehensive electronic health record (CEHR) implementation are associated with improved transition processes. Methods Using AAP Periodic Survey #79, we report whether practices generated written transition plans, assisted in finding adult providers, and discussed confidentiality issues. Descriptive statistics and a logistic regression model were done to evaluate whether CEHR, care coordination, or practice and physician characteristics improve transition planning. Results Transition planning support in practices is low. Pediatricians with any care coordinator report more written transition plans for YSHCN (23% vs. 6%, p<0.001), assistance identifying adult providers (59% vs. 39%, p<0.001), and discussing confidentiality issues (50% vs. 33%, p<0.001). Pediatricians with a CEHR compared to those without are more likely to report written transition plans for YSHCN (24% vs. 12 % p<0.05) and discussing confidentiality issues (51% vs. 39%, p<0.05). In the logistic regression model, having care coordination (AOR 11.1, 95% CI 5.9-21.3) and CEHR (AOR 2.6, 95% CI 1.5-5.0) are independently associated with higher odds of having a written transition plan. Conclusions Only 1 in 5 pediatricians have a transition coordinator in their practice and just 15% have a CEHR, even as these resources are associated with improved transition processes for YSHCN. Policy decisions should be made to help practices with supports, such as care coordination and EHR implementation, in order to improve transitions to adulthood.

      PubDate: 2017-04-24T03:53:46Z
      DOI: 10.1016/j.acap.2017.04.005
  • Development of School-Based Asthma Management Programs in Rochester, NY
    • Authors: Jill S. Halterman; Reynaldo Tajon; Paul Tremblay; Maria Fagnano; Arlene Butz; Tamara Perry; Ken McConnochie
      Abstract: Publication date: Available online 18 April 2017
      Source:Academic Pediatrics
      Author(s): Jill S. Halterman, Reynaldo Tajon, Paul Tremblay, Maria Fagnano, Arlene Butz, Tamara Perry, Ken McConnochie
      Overview:In the spirit of Dr. Haggerty’s teachings, we present an overview of our work to improve care for children with asthma in the context of 3 lessons learned:1 1) The importance of providing integrated services across disciplinary boundaries for children with chronic illness, 2) The need to move from a care model focused only on the individual child to a model focused on the child, family, and community, and 3) The need to expand beyond the local community and take a broad perspective on improving health on a national level. The goal of our program is to develop sustainable models to overcome the multiple obstacles to effective preventive care for urban children with asthma. The primary intervention for our original School Based Asthma Therapy (SBAT) program was directly observed administration of preventive asthma medications in school (with dose adjustments based on NHLBI guidelines).2 We found that children who received preventive medications in school through directly observed therapy had improved outcomes across multiple outcome measures.3 Our subsequent asthma programs have focused on dissemination and sustainability, with the incorporation of communication technology to enhance the system of care. We are currently testing the ‘School-Based Telemedicine Enhanced Asthma Management’ (SB-TEAM) program, including 400 children with persistent asthma from the Rochester City School District. This program includes directly observed administration of preventive asthma medication at school, and school-based telemedicine to assure appropriate evaluation, preventive medication prescription, and follow-up care. It is designed to implement and sustain guideline-based asthma care through existing community infrastructure, and could serve as a model for the integration of services in both rural and urban communities.

      PubDate: 2017-04-24T03:53:46Z
      DOI: 10.1016/j.acap.2017.04.008
  • Parental Knowledge of Trampoline Safety in Children
    • Authors: Beno Ackery; Colaco Boutis
      Abstract: Publication date: Available online 14 April 2017
      Source:Academic Pediatrics
      Author(s): S. Beno, A. Ackery, K. Colaco, K. Boutis
      Objectives Recreational trampoline use is increasing in popularity, with a resulting increase in significant trampoline-related injuries in children. Parents are the best advocates for the safety of their children during recreational trampoline use. Our primary objective was to determine the proportion of parents who were aware of five key recommendations for safer recreational trampoline use in children. Methods This was a cross-sectional survey of parents whose children presented to a tertiary care pediatric emergency department (ED) with an extremity injury. Survey questions were derived and validated using expert opinion, available literature, and pre and pilot testing of questions on the target audience. Results Of the 1415 enrolled parents, 654 (46.2%) had regular access to a trampoline and 125 (8.8%) of their children had a history of trampoline injury. A total of 116 (8.2%; 95% CI 6.8 to 9.6) parents were aware of all five key safety recommendations for home trampoline use. Specifically, the proportion of parents who reported knowledge of the requirement for active supervision, regularly inspected safety equipment, avoiding stunts, multiple jumpers and use by children 6 years of age and older was 89.0%, 77.2%, 44.3%, 41.6%, and 18.3%, respectively. Conclusions Trampoline safety knowledge of the five key recommendations amongst parents was low, specifically with respect to recommended age, number of jumpers, and stunts. Since it is unlikely that use of recreational trampolines will decrease, a harm reduction approach that includes a public knowledge translation strategy of recommendations for safer home use of trampolines is necessary.

      PubDate: 2017-04-17T03:24:41Z
  • Parent Preferences and Perceptions of mLs and Teaspoons: Role of Health
           Literacy and Experience
    • Authors: Alejandro Torres; Ruth M. Parker; Lee M. Sanders; Michael S. Wolf; Stacy Bailey; Deesha A. Patel; Jessica J. Jimenez; Kwang-Youn A. Kim; Benard P. Dreyer; Alan Mendelsohn; H. Shonna Yin
      Abstract: Publication date: Available online 8 April 2017
      Source:Academic Pediatrics
      Author(s): Alejandro Torres, Ruth M. Parker, Lee M. Sanders, Michael S. Wolf, Stacy Bailey, Deesha A. Patel, Jessica J. Jimenez, Kwang-Youn A. Kim, Benard P. Dreyer, Alan Mendelsohn, H. Shonna Yin
      Background and Objectives A recent AAP policy statement recommends mL-exclusive dosing for pediatric liquid medications. Little is known about parent preferences regarding units, perceptions about moving to mL-only, and the role of health literacy and prior mL-dosing experience. Methods Cross-sectional analysis of data collected as part of a randomized controlled study in 3 urban pediatric clinics (SAFE-Rx for Kids study). English/Spanish-speaking parents (n=493) of children <8 years were randomized to 1 of 4 study arms and given labels/dosing tools which varied in label instruction format (text+pictogram, text-only) and units (mL-only, mL/tsp). Outcomes: teaspoon preference in dosing instructions, perceived difficulty with mL-only dosing. Predictor variable: health literacy (Newest Vital Sign; low[0-1], marginal[2-3], adequate[4-6]). Mediating variable: prior mL-dosing experience. Results Over two-thirds of parents had low or marginal health literacy. The majority (>70%) preferred to use mL, perceived mL-only dosing to be easy, and had prior mL-dosing experience; 11.5% had a teaspoon preference, 18.1% perceived mL-only dosing will be difficult, and 17.7% had no prior mL-dosing experience. Parents with lower health literacy had a higher odds of having a teaspoon preference (low vs. adequate: AOR=2.9[1.3-6.2]), and greater odds of perceiving difficulty with mL-only dosing (low vs. adequate: AOR=13.9[4.8-40.6]), marginal vs. adequate: AOR=7.1[2.5-20.4]). Lack of experience with mL-dosing partially mediated the impact of health literacy. Conclusions Most parents were comfortable with mL-only dosing. Parents with low health literacy were more likely to perceive mL-only dosing to be difficult; educational efforts will need to target this group to ensure safe medication use.

      PubDate: 2017-04-09T12:53:33Z
      DOI: 10.1016/j.acap.2017.04.001
  • Pediatrician Maintenance of Certification Using American Board of
           Pediatrics’ Performance Improvement Modules
    • Authors: Marina Arvanitis; Neal A. deJong; Laurel K. Leslie; Darren A. DeWalt; Gregory D. Randolph; Kori B. Flower
      Abstract: Publication date: Available online 2 April 2017
      Source:Academic Pediatrics
      Author(s): Marina Arvanitis, Neal A. deJong, Laurel K. Leslie, Darren A. DeWalt, Gregory D. Randolph, Kori B. Flower
      Background From 2010-2014, pediatricians completed Part 4 Maintenance of Certification (MOC) through practice- or organization-developed quality improvement (QI) activities approved by the American Board of Pediatrics (ABP). Organization-developed activities were online modules, such as the ABP’s Performance Improvement Modules (PIMs), through which pediatricians implemented QI strategies in practice, and reported quality measures. Objectives Aim 1) Assess the proportion of pediatricians who completed practice- vs organization-developed QI activities for Part 4 MOC, and test the relationship between activities and pediatrician demographics. Aim 2) Assess the relationship between PIM completion and improvement in care processes and outcomes as determined by PIM quality measures. Methods Aim 1) Using de-identified demographic data from the ABP, we summarized QI activity completion and performed bivariate testing by pediatrician demographics; Aim 2) Using de-identified parent and pediatrician-reported quality measures from the ADHD, Asthma, Hand Hygiene, and Influenza PIMs, we used two-sample tests of proportions to calculate pre-post changes in quality measures. Results Aim 1) Of 50,433 pediatricians who completed Part 4 MOC from 2010-2014, 22% completed practice-, and 78% organization-developed activities. More pediatricians completed organization-developed activities, regardless of age, gender, or subspecialty status. The majority (73%) of pediatricians who completed organization-developed activities completed ABP PIMs. Aim 2) PIM completion was associated with improvement on nearly all pediatrician and parent-reported quality measures. Conclusions At the outset of the Part 4 MOC system, pediatricians most commonly completed online, organization-developed activities. Pediatricians and parents reported improvements in care processes and outcomes associated with PIMs, suggesting PIMs can be an effective means of facilitating practice improvement.
      Teaser At the outset of Part 4 MOC, board-certified pediatricians completed organization-developed, online modules in higher frequencies than practice-developed QI activities. The most frequently completed online modules – ABP PIMs – were associated with improvements in nearly all parent- and pediatrician-reported quality measures.

      PubDate: 2017-04-02T21:29:10Z
      DOI: 10.1016/j.acap.2017.03.014
  • Development and Implementation of the Family Experiences with Coordination
           of Care Survey Quality Measures
    • Authors: Courtney Gidengil; Layla Parast; Q. Burkhart; Julie Brown; Marc N. Elliott; K. Casey Lion; Elizabeth A. McGlynn; Eric C. Schneider; Rita Mangione-Smith
      Abstract: Publication date: Available online 31 March 2017
      Source:Academic Pediatrics
      Author(s): Courtney Gidengil, Layla Parast, Q. Burkhart, Julie Brown, Marc N. Elliott, K. Casey Lion, Elizabeth A. McGlynn, Eric C. Schneider, Rita Mangione-Smith
      Objective Ensuring high quality care coordination for children with medical complexity (CMC) could yield significant health and economic benefits given that they account for one-third of pediatric healthcare expenditures. The objective of this study was to develop and field test the Family Experiences with Coordination of Care (FECC) survey which facilitates assessment of 20 new caregiver-reported quality measures for CMC. Methods We identified caregivers of Medicaid-insured CMC 0-17 years old in Minnesota and Washington State, categorized by the Pediatric Medical Complexity Algorithm as having complex chronic disease. Eligible caregivers had CMC with at least four visits to healthcare providers participating in Medicaid in 2012. Caregivers were randomized to telephone or mixed mode (mail with telephone follow-up). Survey administration and data were collected in 2013. Results 1209 caregivers responded to the FECC survey (response rate 41%; 36% by telephone only, 45% by mixed mode; p<0.001). Among CMC with a hospitalization, caregivers were invited to join hospital rounds in 51% of cases. Seventy-two percent of caregivers reported their child had a care coordinator; among these, 96% reported knowing how to access the care coordinator. Few children had written shared care plans (44%) or emergency care plans (20%). Only 10% of adolescents had a written transition care plan. Scores were lower from mixed mode respondents than from telephone-only respondents for some measures. Conclusions The FECC survey enables the evaluation of care coordination quality for CMC. Both survey modes were feasible to implement, but mixed mode administration produced a higher response rate.

      PubDate: 2017-04-02T21:29:10Z
      DOI: 10.1016/j.acap.2017.03.012
  • Family-Centered Care Measurement and Associations With Unmet Health Care
           Need Among US Children
    • Authors: Olivia J. Lindly; G. John Geldhof; Alan C. Acock; Kari-Lyn K. Sakuma; Katharine E. Zuckerman; Sheryl Thorburn
      Abstract: Publication date: Available online 30 March 2017
      Source:Academic Pediatrics
      Author(s): Olivia J. Lindly, G. John Geldhof, Alan C. Acock, Kari-Lyn K. Sakuma, Katharine E. Zuckerman, Sheryl Thorburn
      Objective Family-centered care (FCC), including shared decision making (SDM), has become increasingly emphasized in pediatric health care delivery. Past studies using national surveys have used different FCC measurement approaches without determining their validity. We, therefore, sought to develop an FCC measurement model with Medical Expenditure Panel Survey (MEPS) items previously used to assess FCC or SDM; and to determine temporal associations of FCC with unmet health care need. Methods Four longitudinal MEPS data files (2007–2011) were combined. The study sample included 15,764 US children aged 0 to 17 years. Eight items assessed FCC, and 5 items assessed unmet health care need. We performed exploratory factor analyses to develop an FCC measurement model and fit a cross-lagged structural equation model to determine temporal associations between FCC and unmet health care need. Results Results supported a 2-factor FCC model including family–provider communication and SDM. The family–provider communication factor was indicated by items reflecting general communication between the child's doctor and family. The SDM factor was indicated by items reflecting decision-making about the child's health care. Adjusted cross-lagged structural equation model results showed family–provider communication and SDM were associated with a reduced likelihood of unmet health care need the following year. Unmet health care need was not significantly associated with family–provider communication or SDM the subsequent year. Conclusions Study results support differentiating between family–provider communication and SDM as interrelated aspects of FCC in future pediatric health care quality measurement and improvement. Family–provider communication and SDM may reduce the likelihood of unmet health care need the following year among US children.

      PubDate: 2017-04-02T21:29:10Z
      DOI: 10.1016/j.acap.2016.10.018
  • Reasons for Non-Initiation and Non-Completion of HPV Vaccine among
           English- and Spanish-Speaking Parents of Adolescent Girls: A Qualitative
    • Authors: Karen Albright; Juliana Barnard; Sean O'Leary; Steven Lockhart; Andrea Jimenez-Zambrano; Shannon Stokley; Amanda Dempsey; Allison Kempe
      Abstract: Publication date: Available online 28 March 2017
      Source:Academic Pediatrics
      Author(s): Karen Albright, Juliana Barnard, Sean O'Leary, Steven Lockhart, Andrea Jimenez-Zambrano, Shannon Stokley, Amanda Dempsey, Allison Kempe
      Objective The Advisory Committee on Immunization Practices recommends routine human papillomavirus (HPV) vaccination for females aged 11-12 years, yet vaccination rates remain low. We conducted a qualitative study to understand English- and Spanish-speaking parents’ reasons for non-initiation or non-completion of the HPV vaccine series for their daughters. Methods Parents of females aged 12-15 years who had not initiated or not completed the HPV vaccine series were identified through administrative data in two large urban safety net health care systems in Colorado. Focus groups and in-depth interviews were conducted with English-speaking parents and in-depth interviews were conducted with Spanish-speaking parents. All data were recorded, transcribed, and analyzed for thematic content by experienced analysts using established qualitative content analysis techniques. Results Forty-one parents participated in the study. Thirty parents participated in individual interviews and 11 parents participated in one of two focus groups. The most common reasons for non-initiation and non-completion among English-speakers included a low perceived risk of HPV infection, vaccine safety concerns, and distrust of government and/or medicine. In contrast, Spanish-speaking parents most often reported that providers had either not encouraged initiation of the HPV vaccine series or had not explained the necessity of completing the series. Some non-initiating parents, particularly Spanish-speaking ones, also cited concerns that vaccination would encourage sexual activity. Conclusions The reasons for non-initiation and non-completion of the HPV vaccine series differed substantially between English- and Spanish-speaking parents. To maximize uptake of HPV vaccine, varying approaches may be needed to effectively target specific populations. What's New This is the first study to explore reasons for non-initiation and non-completion of the HPV vaccine series among English- and Spanish-speaking parents of adolescent girls. Substantial differences emerged by language preference, suggesting that varying approaches may be necessary to maximize uptake.

      PubDate: 2017-04-02T21:29:10Z
      DOI: 10.1016/j.acap.2017.03.013
  • Development and pilot implementation of a trauma-informed care curriculum
           for pediatric residents
    • Authors: Davida M. Schiff; Barry Zuckerman; Elizabeth Hutton; Carolyn Genatossio; Catherine Michelson; Megan Bair-Merritt
      Abstract: Publication date: Available online 28 March 2017
      Source:Academic Pediatrics
      Author(s): Davida M. Schiff, Barry Zuckerman, Elizabeth Hutton, Carolyn Genatossio, Catherine Michelson, Megan Bair-Merritt

      PubDate: 2017-04-02T21:29:10Z
      DOI: 10.1016/j.acap.2017.03.011
  • ACES and Child Health Policy: The Enduring Case for EPSDT
    • Authors: Sara Rosenbaum
      Abstract: Publication date: Available online 22 March 2017
      Source:Academic Pediatrics
      Author(s): Sara Rosenbaum

      PubDate: 2017-03-26T20:47:47Z
      DOI: 10.1016/j.acap.2017.03.010
  • Making a safe space possible
    • Authors: Amy E. Caruso Brown
      Abstract: Publication date: Available online 18 March 2017
      Source:Academic Pediatrics
      Author(s): Amy E. Caruso Brown

      PubDate: 2017-03-19T18:39:40Z
      DOI: 10.1016/j.acap.2017.03.009
  • Best Practices in Relational Skills Training for Medical Trainees and
           Providers: An Essential Element of Addressing ACEs and Promoting
    • Authors: Eran Magen; Horace M. DeLisser
      Abstract: Publication date: Available online 15 March 2017
      Source:Academic Pediatrics
      Author(s): Eran Magen, Horace M. DeLisser
      Medical providers' ability to form strong therapeutic alliances with patients is an essential clinical skill that is associated with a higher quality of care and improved provider well being. However, comparatively few medical providers exhibit adequate relational skills, which serve to convey respect, communicate caring, and build trust between the medical provider and the patient. A growing number of medical training programs and continuing medical education programs have begun to incorporate relational skills training, but the results have been highly variable in terms of training methods and impact. To support administrators who are considering the implementation (or improvement) of relational skills training in their organization, we provide a set of best practices for relational skills training, based on a review of the literature and on our experience as clinical educators, and demonstrate the application of these best practices through a case study. We conclude with a discussion of challenges for implementing high-quality relational skills training program, policy-level solutions for these challenges, and recommendations for future research.

      PubDate: 2017-03-19T18:39:40Z
      DOI: 10.1016/j.acap.2017.03.006
  • Predictors of Maternal Trust in Doctors about Advice on Infant Care
           Practices: The SAFE Study
    • Authors: Sunah S. Hwang; Denis V. Rybin; Stephen M. Kerr; Timothy C. Heeren; Eve R. Colson; Michael J. Corwin
      Abstract: Publication date: Available online 14 March 2017
      Source:Academic Pediatrics
      Author(s): Sunah S. Hwang, Denis V. Rybin, Stephen M. Kerr, Timothy C. Heeren, Eve R. Colson, Michael J. Corwin
      Objective To determine predictors of maternal trust in doctors about advice on infant care practices. Methods Using probability sampling methods, we recruited mothers from 32 U.S. maternity hospitals. Mothers completed a survey 2-6 months post-partum that included questions about maternal trust in doctors regarding six infant care practices and physician characteristics (doctor asked mother’s opinion, doctor is qualified, infant sees one main doctor who is/is not of the same ethnicity/race). Prevalence estimates and 95% CI were calculated for maternal trust in physician advice for each infant care practice. Multivariate logistic regression was used to calculate the independent association of maternal and physician characteristics and trust for each infant care practice, controlling for socio-demographic characteristics. Results Of the 3983 mothers enrolled from 01/2011–03/2014, 3297 (83%) completed the follow-up survey. Maternal trust in the doctor varied by infant care practice with highest trust for vaccination (89%) and lowest trust for pacifier use (56%). In the adjusted analyses, for all infant care practices, mothers were more likely to trust their doctors if they reported that the doctors were qualified (AOR >3.0 for all practices) or if the doctor had asked their opinion (AOR 1.76-2.43). For mothers who reported seeing one main doctor, white mothers were more likely to trust physicians for almost all infant care practices if they reported the doctor was the same race (AOR 1.54-2.19). Conclusions Physician characteristics and ways of communication were significantly associated with maternal trust in doctors about advice on infant care practices.

      PubDate: 2017-03-19T18:39:40Z
      DOI: 10.1016/j.acap.2017.03.005
  • Food Insecurity Screening in Pediatric Primary Care: Can Offering
           Referrals Help Identify Families in Need?
    • Authors: Clement J. Bottino; Erinn T. Rhodes; Catherine Kreatsoulas; Joanne E. Cox; Eric W. Fleegler
      Abstract: Publication date: Available online 13 March 2017
      Source:Academic Pediatrics
      Author(s): Clement J. Bottino, Erinn T. Rhodes, Catherine Kreatsoulas, Joanne E. Cox, Eric W. Fleegler
      Objective To describe a clinical approach for food insecurity screening incorporating a menu offering food-assistance referrals, and to examine relationships between food insecurity and referral selection. Methods Caregivers of 3- to 10-year-old children presenting for well-child care completed a self-administered questionnaire on a laptop computer. Items included the US Household Food Security Survey Module: 6-Item Short Form (food insecurity screen) and a referral menu offering assistance with: 1) finding a food pantry, 2) getting hot meals, 3) applying for Supplemental Nutrition Assistance Program (SNAP), and 4) applying for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Referrals were offered independent of food insecurity status or eligibility. We examined associations between food insecurity and referral selection using multiple logistic regression while adjusting for covariates. Results A total of 340 caregivers participated; 106 (31.2%) reported food insecurity, and 107 (31.5%) selected one or more referrals. Forty-nine caregivers (14.4%) reported food insecurity but selected no referrals; 50 caregivers (14.7%) selected one or more referrals but did not report food insecurity; and 57 caregivers (16.8%) both reported food insecurity and selected one or more referrals. After adjustment, caregivers who selected one or more referrals had greater odds of food insecurity compared to caregivers who selected no referrals (adjusted odds ratio 4.0; 95% confidence interval 2.4–7.0). Conclusions In this sample, there was incomplete overlap between food insecurity and referral selection. Offering referrals may be a helpful adjunct to standard screening for eliciting family preferences and identifying unmet social needs.

      PubDate: 2017-03-19T18:39:40Z
      DOI: 10.1016/j.acap.2016.10.006
  • The Cumulative Impact of Health Adversities on Children's Later Academic
    • Authors: Jon Quach; Cattram Nguyen; Meredith O’Connor; Melissa Wake
      Abstract: Publication date: Available online 12 March 2017
      Source:Academic Pediatrics
      Author(s): Jon Quach, Cattram Nguyen, Meredith O’Connor, Melissa Wake
      Objective We aimed to determine whether the accumulation of physical, psychosocial and combined health adversities measured at age 8-9 years predicts worsening of academic scores cross-sectionally at 8-9 and longitudinally at 10-11 years. Methods Design: Longitudinal data from Waves 3 and 4 in the Longitudinal Study of Australian Children (83% of 4983 retained). Exposures (8-9 years): Physical health adversities (yes/no; summed range 0-5): overweight, special health care needs, chronic illness, PedsQL Physical, global health. Psychosocial health adversities (yes/no; summed range 0-4): parent- and teacher-reported behavior, PedsQL Psychosocial, sleep problems. Combined health adversities (range 0-9). Outcomes (8-9, 10-11 years): National academic standardized test scores. Analysis: Generalized estimating equations, accounting for multiple academic domains in each year and socioeconomic position and cognition. Results At 8-9 years, 23.9%, 9.9% and 5.3% had 1, 2 or ≥3 physical health adversities, respectively, while 27.2%, 9.5% and 4.9% had 1, 2 or ≥3 psychosocial health adversities, respectively. For each additional health adversity at 8-9 years, academic scores fell incrementally in Year 3 and Year 5 (both p<0.001), with reductions of at least 0.4 standard deviations for ≥3 health adversities. Number was more important than type (physical, psychosocial) of adversity. Conclusion The accumulation of health adversities predicts poorer academic achievement up to 2 years later. Interventions may need to address multiple domains to improve child academic outcomes and delivered across the health-education interface.

      PubDate: 2017-03-12T19:36:58Z
      DOI: 10.1016/j.acap.2017.03.002
  • Five Steps for Success in Building Your Own Educational Website
    • Authors: Aarti Patel; Ndidi Unaka; Brad Sobolewski; Angela Statile
      Abstract: Publication date: Available online 12 March 2017
      Source:Academic Pediatrics
      Author(s): Aarti Patel, Ndidi Unaka, Brad Sobolewski, Angela Statile

      PubDate: 2017-03-12T19:36:58Z
      DOI: 10.1016/j.acap.2017.03.004
  • Health Conditions and Racial Differences Among Justice-Involved
           Adolescents, 2009-2014
    • Authors: Tyler N.A. Winkelman; Joseph W. Frank; Ingrid A. Binswanger; Debra A. Pinals
      Abstract: Publication date: Available online 12 March 2017
      Source:Academic Pediatrics
      Author(s): Tyler N.A. Winkelman, Joseph W. Frank, Ingrid A. Binswanger, Debra A. Pinals
      Objective Providers can optimize care for high-risk adolescents by understanding the health risks among the one million US adolescents who interact with the justice system each year. We compared the prevalence of physical health, substance use, and mood disorders among adolescents with and without justice involvement and analyzed differences by race/ethnicity. Methods Cross-sectional analysis using the 2009-2014 National Survey on Drug Use and Health (NSDUH). Prevalence data were adjusted for sociodemographic differences between adolescents with and without justice involvement. Justice-involved adolescents had a history of past year arrest, parole/probation, or juvenile detention. Results Our sample consisted of adolescents aged 12-17 with (n=5149) and without (n=97,976) past year justice involvement. In adjusted analyses, adolescents involved at any level of the justice system had a significantly higher prevalence of substance use disorders (P<.001), mood disorders (P<.001) and sexually transmitted infections (P<.01). Adolescents on parole/probation or in juvenile detention in the past year had a higher prevalence of asthma (P<.05) and hypertension (P<.05) compared to adolescents without justice involvement. Among justice-involved adolescents, African-Americans were significantly less likely to have a substance use disorder (P<.001) or mood disorder (P<.01) compared to whites or Hispanics, but had significantly higher prevalence of physical health disorders (P<.01). Conclusions Adolescents involved at all levels of the justice system have high-risk health profiles compared to the general adolescent population, though these risks differ across racial/ethnic groups. Policymakers and health care providers should ensure access to coordinated, high-quality health care for adolescents involved at all levels of the justice system.

      PubDate: 2017-03-12T19:36:58Z
      DOI: 10.1016/j.acap.2017.03.003
  • Refusal of Vitamin K by Parents of Newborns: A Survey of the Better
           Outcomes Through Research for Newborns Network
    • Authors: Jaspreet Loyal; James A. Taylor; Carrie A. Phillipi; Neera K. Goyal; Niramol Dhepyasuwan; Eugene D. Shapiro; Eve Colson
      Abstract: Publication date: Available online 9 March 2017
      Source:Academic Pediatrics
      Author(s): Jaspreet Loyal, James A. Taylor, Carrie A. Phillipi, Neera K. Goyal, Niramol Dhepyasuwan, Eugene D. Shapiro, Eve Colson
      Objective To survey newborn clinicians in the United States regarding the frequency of intramuscular (IM) vitamin K refusal by a parent, reasons for refusal, and approaches of clinicians to refusals. Methods An electronic survey was administered to the clinician site representative (nursery director or designee knowledgeable about site-specific nursery policies) at all newborn nurseries in the Better Outcomes through Research for Newborns (BORN) network of newborn nurseries. Results Of 92 BORN sites, 85 (92%) respondents completed the survey. Frequency of IM vitamin K refusal during the past 5 years was reported as increased by 52% of respondents, unchanged by 42%, and 6% did not know. Reported frequencies of refusal of IM vitamin K was weekly (9%), a few times a month (31%), once a month (13%), once every 3 to 4 months (20%), once or twice a year (26%), or never (1%). The overall distribution of the reported frequencies of refusal differed among regions in the United States (higher in the West and the South; P < .05). Reported reasons for refusal by parents included perceptions of parents that the injection was unnecessary, lack of knowledge about vitamin K deficiency bleeding, and concern about preservatives. Approaches to refusal included attempts to educate parents, enlisting support from community clinicians, a state mandate, and prescription of oral vitamin K. Conclusions Respondents from a national sample of newborn nursery clinicians reported an increase in refusal of IM vitamin K in the past 5 years with regional variation. Approaches to refusals need further investigation to determine effectiveness.

      PubDate: 2017-03-12T19:36:58Z
      DOI: 10.1016/j.acap.2016.10.012
  • Impact of Non-Medical Vaccine Exemption Policies on the Health and
           Economic Burden of Measles
    • Authors: Melanie D. Whittington; Allison Kempe; Amanda Dempsey; Rachel Herlihy; Jonathan D. Campbell
      Abstract: Publication date: Available online 9 March 2017
      Source:Academic Pediatrics
      Author(s): Melanie D. Whittington, Allison Kempe, Amanda Dempsey, Rachel Herlihy, Jonathan D. Campbell
      Objective Despite relatively high national vaccination coverage for measles, geographic vaccination variation exists resulting in clusters of susceptibility. A portion of this geographic variation can be explained by differences in state policies related to non-medical vaccine exemptions. The objective of this analysis was to determine the magnitude, likelihood, and cost of a measles outbreak under different non-medical vaccine exemption policies. Methods An agent-based transmission model simulated the likelihood and magnitude of a measles outbreak under different non-medical vaccine exemption policies, previously categorized as easy, medium, or difficult. The model accounted for measles herd immunity, infectiousness of the pathogen, vaccine efficacy, duration of incubation and communicable periods, acquired natural immunity, and the rate of recovery. Public health contact tracing was also modeled. Model outcomes, including the number of secondary cases, hospitalizations, and deaths, were monetized to determine the economic burden of the simulated outbreaks. Results A state with easy non-medical vaccine exemption policies is 140% and 190% more likely to experience a measles outbreak compared to states with medium or difficult policies, respectively. The magnitude of these outbreaks can be reduced by half by strengthening exemption policies. These declines are associated with significant cost reductions to public health, the healthcare system, and the individual. Conclusions Strengthening non-medical vaccine exemption policies is one mechanism to increase vaccination coverage to reduce the health and economic impact of a measles outbreak. States exploring options for decreasing their vulnerability to outbreaks of vaccine preventable diseases should consider more stringent requirements for non-medical vaccine exemptions.

      PubDate: 2017-03-12T19:36:58Z
      DOI: 10.1016/j.acap.2017.03.001
  • Quality of Primary Care for Children With Disabilities Enrolled in
    • Authors: Alyna T. Chien; Karen A. Kuhlthau; Sara L. Toomey; Jessica A. Quinn; Megumi J. Okumura; Dennis Z. Kuo; Amy J. Houtrow; Jeanne Van Cleave; Mary Beth Landrum; Jisun Jang; Isabel Janmey; Michael J. Furdyna; Mark A. Schuster
      Abstract: Publication date: Available online 9 March 2017
      Source:Academic Pediatrics
      Author(s): Alyna T. Chien, Karen A. Kuhlthau, Sara L. Toomey, Jessica A. Quinn, Megumi J. Okumura, Dennis Z. Kuo, Amy J. Houtrow, Jeanne Van Cleave, Mary Beth Landrum, Jisun Jang, Isabel Janmey, Michael J. Furdyna, Mark A. Schuster
      Objective The quality of primary care delivered to Medicaid-insured children with disabilities (CWD) is unknown. We used the newly validated CWD algorithm (CWDA) to examine CWD prevalence among Medicaid enrollees 1 to 18 years old, primary care quality for CWD, and differences in primary care quality for CWD and non-CWD. Methods Cross-sectional study using 2008 Medicaid Analytic eXtract claims data from 9 states, including children with at least 11 months of enrollment (N = 2,671,922 enrollees). We utilized CWDA to identify CWD and applied 12 validated or endorsed pediatric quality measures to assess preventive/screening, acute, and chronic disease care quality. We compared quality for CWD and non-CWD unmatched and matched on age, sex, and number of nondisabling chronic conditions and outpatient encounters. Results CWDA identified 5.3% (n = 141,384) of our study population as CWD. Care quality levels for CWD were below 50% on 8 of 12 quality measures (eg, adolescent well visits [44.9%], alcohol/drug treatment engagement [24.9%]). CWD care quality was significantly better than the general population of non-CWD by +0.9% to +15.6% on 9 measures, but significantly worse for 2 measures, chlamydia screening (−3.4%) and no emergency department visits for asthma (−5.0%; all P < .01 to .001). Differences in care quality between CWD and non-CWD were generally smaller or changed direction when CWD were compared to a general population or matched group of non-CWD. Conclusions One in 20 Medicaid-insured children is CWD, and the quality of primary care delivered to CWD is suboptimal. Areas needing improvement include preventive/screening, acute care, and chronic disease management.

      PubDate: 2017-03-12T19:36:58Z
      DOI: 10.1016/j.acap.2016.10.015
  • Is a positive developmental-behavioral screening score sufficient to
           justify referral? A review of evidence and theory
    • Authors: R. Christopher Sheldrick; Daryl Garfinkel
      Abstract: Publication date: Available online 7 March 2017
      Source:Academic Pediatrics
      Author(s): R. Christopher Sheldrick, Daryl Garfinkel
      In their recommendations on screening for autism and developmental disabilities, the American Academy of Pediatrics recommends referral subsequent to a positive screening result. In this paper, we argue that positive screening results are not always sufficient to justify a referral. We demonstrate that while positive predictive values are often low, they actually overstate the probability of having a disorder for many children who screen positive. Moreover, recommended screening thresholds are seldom set to ensure that the benefits of referral will equal or exceed the costs and risk of harm, which is a necessary condition for an optimal threshold in the field of decision analysis. Drawing on recent recommendations for the Institute of Medicine/National Academy of Medicine, we discuss the implications of this argument for pediatric policy, education, and practice. In particular, we recommend that screening policies be revised to ensure that the costs and benefits of actions recommended in the event of a positive screen are appropriate to the screening threshold. We recommend greater focus on clinical decision making in the education of physicians, including shared decision making with patients and their families. Finally, we recommend broadening the scope of screening research to encompass not only the accuracy of specific screening instruments, but also their ability to improve decision making in the context of systems of care.

      PubDate: 2017-03-08T01:55:16Z
      DOI: 10.1016/j.acap.2017.01.016
  • Special health care needs across the school and family contexts:
           Implications for service utilization
    • Authors: Meredith O’Connor; Stefanie Rosema; Jon Quach; Amanda Kvalsvig; Sharon Goldfeld
      Abstract: Publication date: Available online 7 March 2017
      Source:Academic Pediatrics
      Author(s): Meredith O’Connor, Stefanie Rosema, Jon Quach, Amanda Kvalsvig, Sharon Goldfeld
      Objectives A fifth of children enter school with special health care needs (SHCN), many of whom have difficulties that are milder or not yet formally diagnosed (emerging SHCN). This study aimed to investigate how differing perceptions of children’s emerging SHCN across the family and school contexts relates to service utilization. Method Sample: The nationally-representative birth cohort of the Longitudinal Study of Australian Children (LSAC), which includes parent reports on the abbreviated Children with Special Health Care Needs Screener (CSHCNS). For a subsample of 2,459 children teachers also completed the Australian Early Development Census, a measure of early childhood development at school entry that includes SHCN. Analysis: Logistic regression analyses were conducted adjusting for severity of condition, gender, language background, and disadvantage. Results Overall 24.1% of children were identified by their parent and/or teacher as experiencing emerging SHCN. Compared to those with consistent reports, children with parent-only identified needs had lower odds of accessing school services (OR .29 [95% CI .10, .81]). Similarly, children with parent-only (OR .39 [95% CI .20, .75]) and teacher-only (OR .25 [95% CI .14, .46]) identified needs had significantly lower odds of accessing services in the community. Conclusions When parent and teacher perceptions of children’s emerging SHCN were inconsistent, service use was lower at school and in the community. Further efforts are needed by health and education providers to ensure that common understandings about a child’s needs at school are established early in children’s educational careers.

      PubDate: 2017-03-08T01:55:16Z
      DOI: 10.1016/j.acap.2017.02.012
  • Which Pediatricians Comanage Mental Health Conditions?
    • Authors: Cori Green; Amy Storfer-Isser; Ruth E.K. Stein; Andrew S. Garner; Bonnie D. Kerker; Moira Szilagyi; Karen G. O'Connor; Kimberly E. Hoagwood; Sarah M. Horwitz
      Abstract: Publication date: Available online 6 March 2017
      Source:Academic Pediatrics
      Author(s): Cori Green, Amy Storfer-Isser, Ruth E.K. Stein, Andrew S. Garner, Bonnie D. Kerker, Moira Szilagyi, Karen G. O'Connor, Kimberly E. Hoagwood, Sarah M. Horwitz
      Objective Given the prevalence of mental health (MH) conditions (MHC) in children, pediatricians should initiate treatment alone or in collaboration with a specialist for children with MHC. However, the majority of pediatricians do not manage or comanage common MHC even with an on-site MH provider. We examined which physician, practice, and training characteristics are associated with pediatricians' comanaging at least half of their patients with MHC. Methods We analyzed responses of general pediatricians (n = 305) from the American Academy of Pediatrics 2013 Periodic Survey. Practice characteristics include presence of an on-site MH provider and perceived access to services. Independent variables included sociodemographics, training experiences, and interest in further training. The outcome was comanagement of ≥50% of patients with MHC. Weighted univariate, bivariate, and multivariable analyses were performed. Results Of the pediatricians who reported comanaging ≥50% of their patients with MHC, logistic regression analysis showed that pediatricians who completed ≥4 weeks of developmental behavioral pediatrics training had 1.8 increased odds (95% confidence interval 1.06, 3.08, P = .03) of comanagement, those very interested in further education in managing/treating MHC had 2.75 increased odds (95% confidence interval 1.63, 3.08, P < .001), and those with more training in MH treatment with medications had 1.4 increased odds (95% confidence interval 1.12, 1.75, P = .004) of comanaging children with MHC. Conclusions Specific educational experiences and interest in further education in managing or treating MHC were significantly associated with comanaging ≥50% of patients, suggesting that enhanced MH training among pediatricians could increase the comanagement of children with MHC.

      PubDate: 2017-03-08T01:55:16Z
      DOI: 10.1016/j.acap.2016.10.014
  • Parent-Reported Penicillin Allergy Symptoms in the Pediatric Emergency
    • Authors: David Vyles; Asriani Chiu; Pippa Simpson; Mark Nimmer; Juan Adams; David C. Brousseau
      Abstract: Publication date: Available online 6 March 2017
      Source:Academic Pediatrics
      Author(s): David Vyles, Asriani Chiu, Pippa Simpson, Mark Nimmer, Juan Adams, David C. Brousseau
      Objective Children often present to the pediatric emergency department (ED) with a reported penicillin allergy. The true incidence of pediatric penicillin allergy is low, and patients may be inappropriately denied first-line antibiotics. We hypothesized that more than 70% of reported penicillin allergies in the pediatric ED are low risk for true allergy. Methods Parents of children presenting to the pediatric ED with parent-reported penicillin allergy completed an allergy questionnaire. The questionnaire included age at allergy diagnosis, symptoms of allergy, and time to allergic reaction from first dose. The allergy symptoms were dichotomized into high and low risk in consultation with a pediatric allergist before questionnaire implementation. Results A total of 605 parents were approached; 500 (82.6%) completed the survey. The median (interquartile range) age of the children at diagnosis was 1 year (7 months, 2 years); 75% were diagnosed before their third birthday. Overall, 380 (76%) (95% confidence interval 72.3, 79.7) children had exclusively low-risk symptoms. The most commonly reported symptoms were rash (466, 92.8%) and itching (203, 40.6%). Of the 120 children with one or more high-risk symptom, facial swelling (50, 10%) was the most common. Overall, 354 children (71%) were diagnosed after their first exposure to penicillin. Symptom onset within 24 hours of medication administration occurred in 274 children (54.8%). Conclusions Seventy-six percent of patients with parent-reported penicillin allergy have symptoms unlikely to be consistent with true allergy. Determination of true penicillin allergy in patients with low-risk symptoms may permit the increased use of first-line penicillin antibiotics.

      PubDate: 2017-03-08T01:55:16Z
      DOI: 10.1016/j.acap.2016.11.004
  • Predicting Hypertension Among Children With Incident Elevated Blood
    • Authors: Matthew F. Daley; Liza M. Reifler; Eric S. Johnson; Alan R. Sinaiko; Karen L. Margolis; Emily D. Parker; Louise C. Greenspan; Joan C. Lo; Patrick J. O'Connor; David J. Magid
      Abstract: Publication date: Available online 21 February 2017
      Source:Academic Pediatrics
      Author(s): Matthew F. Daley, Liza M. Reifler, Eric S. Johnson, Alan R. Sinaiko, Karen L. Margolis, Emily D. Parker, Louise C. Greenspan, Joan C. Lo, Patrick J. O'Connor, David J. Magid
      Objective To develop a model to predict hypertension risk among children with incident elevated blood pressure (BP); to test the external validity of the model. Methods A retrospective cohort study was conducted in 3 organizations: Kaiser Permanente Colorado was the model derivation site; HealthPartners of Minnesota and Kaiser Permanente Northern California served as external validation sites. During study years 2006 through 2012, all children aged 3 through 17 years with incident elevated BP in an outpatient setting were identified. The predictor variables were demographic and clinical characteristics collected during routine care. Cox proportional hazards regression was used to predict subsequent hypertension, and diagnostic statistics were used to assess model performance. Results Among 5598 subjects at the derivation site with incident elevated BP, 160 (2.9%) developed hypertension during the study period. Eight characteristics were used to predict hypertension risk: age, sex, race, BP preceding incident elevated BP, body mass index percentile, systolic BP percentile, diastolic BP percentile, and clinical setting of the incident elevated BP. At the derivation site, the model discriminated well between those at higher versus lower risk of hypertension (c-statistic = 0.77). At external validation sites, the observed risk of hypertension was higher than the predicted risk, and the model showed poor discrimination (c-statistic ranged from 0.64 to 0.67). Conclusions Among children with incident elevated BP, a risk model demonstrated good internal validity with respect to predicting subsequent hypertension. However, the risk model did not perform well at 2 external validation sites, which might limit transportability to other settings.

      PubDate: 2017-02-21T15:28:47Z
      DOI: 10.1016/j.acap.2016.09.009
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