Abstract: Publication date: Available online 5 November 2019Source: Academic PediatricsAuthor(s): Elise M. Fallucco, Madeline M. Joseph, Kitty Leung, Carmen Smotherman, Emma Robertson Blackmore
Abstract: Publication date: Available online 5 November 2019Source: Academic PediatricsAuthor(s): Amy J. Houtrow, Adam Carle, James M. Perrin, Ruth E.K. SteinABSTRACTObjectiveThe Supplemental Security Income (SSI) program for children with disabilities has come under recent public and political scrutiny. We sought to determine if children with special health care needs (CSHCN) on Medicaid/SCHIP who receive SSI for disability were more severely impacted by their health conditions compared to other CSHCN on Medicaid/SCHIP by comparing their health service utilization, markers of quality health care, and family impacts.MethodsUsing the 2009-10 National Survey of CSHCN, we divided the population of CSHCN on Medicaid/SCHIP into two groups: CSHCN on SSI for disability and other CSHCN. We compared these two groups on measures of health condition severity, health service need and unmet need, health system quality measures, and family impact.ResultsCSHCN on SSI had significantly higher adjusted odds of being affected by their health conditions, aOR=4.33 (3.33-5.9) and having two or more functional difficulties, AOR=3.38 (2.83-4.03). CSHCN on SSI had significantly higher health care needs but not higher unmet needs. The families of CSHCN on SSI experienced more work loss, aOR=3.01 (2.52-3.59) and more financial problems, aOR=1.68 (1.38-2.04).ConclusionThis study indicates higher severity and extensive health service needs among CSHCN receiving SSI, compared to other low income children. CSHCN receiving SSI experience substantially more difficulty related to their health conditions and their conditions have considerably more impact on the daily lives of their parents.
Abstract: Publication date: November–December 2019Source: Academic Pediatrics, Volume 19, Issue 8Author(s): Stephanie M. Reich, Wendy Ochoa, Amy Gaona, Yesenia Salcedo, Georgina Espino Bardales, Veronica Newhart, Joyce Lin, Guadalupe Díaz ObjectiveTo understand the experiences of diverse families when taking their young children to the dentist and to document their prevalence.MethodsAn exploratory sequential design was used. First, 4 focus groups (N = 33) comprised of low-income female caregivers of children under 6 years of age were conducted in English and Spanish. Discussions centered around facilitators and barriers to taking children to the dentist. Themes derived from the groups were then used to create a survey that was given to 1184 caregivers in English, Spanish, or Vietnamese.ResultsThematic coding of focus groups found little support for typically reported barriers to pediatric oral health care utilization (eg, transportation, cost, knowledge); instead, caregivers reported negative experiences (eg, restraint, separation) as barriers. In the surveys, 66% of caregivers reported being separated from their children, 25% reported that their children were restrained (53.7% for cleanings), 26% of children were given sedating medication for cleanings, and 22% of the caregivers reported experiences that made them not want to return to the dentist. The prevalence of these experiences differed significantly among Latino, Asian, and Caucasian families and for annual incomes under or above $50,000.ConclusionsFamilies with lower incomes and/or from ethnic and linguistic minority groups were more likely to report negative experiences at the dentist than higher income and Caucasian families. These data document the high prevalence of negative experiences and suggest ethnic, financial, and linguistic disparities in the quality of experiences. More research is needed on the role of dentists in facilitating or hindering oral health care utilization among diverse families.
Abstract: Publication date: November–December 2019Source: Academic Pediatrics, Volume 19, Issue 8Author(s): Sriram Ramgopal, Jane Soung, Raymond D Pitetti ObjectiveTo identify the proportion of patients previously diagnosed with apparent life-threatening events (ALTE) who would meet criteria for brief resolved unexplained events (BRUE) and to identify rates of adverse outcomes in subgroups: ALTE not meeting criteria for BRUE, lower-risk BRUE, and higher-risk ALTE.MethodsWe performed a secondary analysis of a single-center prospective registry of patients diagnosed with ALTE in a tertiary care emergency department from March 1, 1997 to October 31, 2007. We identified the proportion of patients meeting criteria for BRUE, and the proportion of patients with BRUE meeting lower-risk criteria. We assessed outcomes of patients in subgroups.ResultsSeven hundred and sixty-two patients were included. Adverse outcomes included recurrent ALTE (n = 49), aspiration (n = 9), trauma (n = 8), and death (n = 4). Three hundred and twenty-six of 762 (42.8%) met criteria for BRUE. Seventy of 326 (21.5%) met criteria for lower-risk BRUE. Adverse outcomes occurred in 40 of 436 (9.2%) with ALTE not meeting criteria for BRUE, 2 of 70 (2.9%) with lower-risk BRUE, and 23 of 256 (9.0%) with higher-risk BRUE. Of 4 patients who died, 1 had an ALTE not meeting criteria for BRUE and 3 had non–lower-risk BRUE. The BRUE risk criteria identified all BRUE patients that died or had substantial morbidity as higher-risk.ConclusionsLess than half of patients with ALTE meet criteria for BRUE. Of those who do, one-fifth is lower-risk. In this series, the risk-stratification in the BRUE criteria identified those patients at highest risk of adverse outcomes. Further research is required to risk-stratify patients with BRUE.
Abstract: Publication date: November–December 2019Source: Academic Pediatrics, Volume 19, Issue 8Author(s): Emily A. Hartford, Andrea P. Anderson, Eileen J. Klein, Derya Caglar, Kristy Carlin, K. Casey Lion Background and ObjectivePatients with limited English proficiency (LEP) experience worse health care outcomes compared to English proficient (EP) patients, and professional interpretation is underutilized in clinical settings. The objectives of this study were to describe patterns of interpreter use in a pediatric emergency department (ED), to determine factors associated with its use, and to examine differences in outcomes between EP families and those with LEP.MethodsED encounters for LEP and EP patients were reviewed in a retrospective cohort study design over a 15 month period. Generalized estimating equations were used to compare patient encounters and factors associated with interpreter use.ResultsInterpreter use for families who preferred a non-English language was 45.4%. Use of interpretation was less likely during busier times of day (odds ratio [OR] 0.85, confidence interval [CI] 0.78–0.93), with a lower triage acuity (OR 0.66, CI 0.62–0.70), and with each increasing year of patient age (OR 0.97, CI 0.96–0.98). LEP patients who did not receive interpretation were less likely to be admitted than EP patients (OR 0.69, 0.62–0.78). Patients of LEP families, with or without interpretation, were more likely to be transferred to the ICU within 24 hours of admission than patients of EP families (OR 1.76, 1.07–2.90; 1.85, 1.08–3.18) suggesting that an aspect of clinical severity may have been missed in the ED.ConclusionsProfessional interpretation is currently underutilized in this ED for patients with LEP, and important differences in outcomes exist between LEP and EP patients. Factors associated with interpreter use will inform ongoing improvement efforts.
Abstract: Publication date: November–December 2019Source: Academic Pediatrics, Volume 19, Issue 8Author(s): Valerie S. Harder, Sara E. Barry, Sarah French, Alyssa B. Consigli, Barbara L. Frankowski ObjectiveDepression among adolescents is a leading public health problem. Although screening for adolescent depression in primary care is strongly recommended, screening rates remain low. Effective quality improvement (QI) initiatives can facilitate change. This study aims to assess the impact of a QI learning collaborative on adolescent depression screening and initial plans of care in primary care.MethodsSeventeen pediatric-serving practices in Vermont participated in a QI learning collaborative aimed at improving practitioner knowledge and office systems around adolescent depression screening. Monthly medical record reviews provided monitoring of adolescent depression screening and initial plans of care over 7 months for QI. Randomly sampled annual medical record review data allowed comparison of screening and initial plans of care after the QI learning collaborative between participating and 21 control practices.ResultsAs practices improved their office systems around adolescent depression screening and initial plans of care, data showed marked improvement in depression screening at all 17 practices, from 34% to 97% over 7 months. Adolescents at participating practices had 3.5 times greater odds (95% confidence interval [CI], 1.14–10.98, P = .03) of being screened for depression and 37.5 times greater odds (95% CI, 7.67–183.48, P < .0005) of being screened with a validated tool than adolescents at control practices, accounting for patient characteristics.ConclusionsThere were significant within practice increases in adolescent depression screening after a QI learning collaborative, as well as in comparison with control practices 1 year later.
Abstract: Publication date: November–December 2019Source: Academic Pediatrics, Volume 19, Issue 8Author(s): Megan Quist, Niko Kaciroti, Julie Poehlmann-Tynan, Heidi M. Weeks, Katharine Asta, Priya Singh, Prachi E. Shah ObjectiveTo examine the interactive effects of gestational age and infant fussiness on the risk of maternal depressive symptoms in a nationally representative sample.MethodsOur sample included 8200 children from the Early Childhood Longitudinal Study, Birth Cohort. Gestational age categories were very preterm (VPT, 24–31 weeks), moderate/late preterm (MLPT, 32–36 weeks) and full term (FT, 37–41 weeks). Maternal depressive symptoms (categorized as nondepressed/mild/moderate-severe), from the modified Center for Epidemiological Studies Depression Questionnaire, and infant fussiness (categorized as fussy/not fussy) were assessed at 9 months from parent-report questionnaires. We examined the interactive effects of infant fussiness and gestational age categories and estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of maternal depressive symptoms using multinomial logistic regression.ResultsInfant fussiness interacted with gestational age categories in predicting maternal depressive symptoms (P = .04), with severity varying by gestational age and infant fussiness. Compared with mothers of VPT infants without fussiness, mothers of VPT infants with fussiness had greater odds of mild depressive symptoms (aOR, 2.32; 95% CI, 1.19–4.53). Similarly, compared with mothers of MLPT and FT infants without fussiness, mothers of fussy MLPT and FT infants had greater odds of moderate-severe symptoms (aOR, 2.30; 95% CI, 1.40–3.80, and aOR, 1.74; 95% CI, 1.40–2.16, respectively).ConclusionsMothers of MLPT and FT infants with fussiness had increased odds of moderate-severe depressive symptoms, and mothers of VPT infants with fussiness had increased risk of mild symptoms. Early screening for infant fussiness in preterm and FT may help identify mothers with depressive symptoms in need of support.
Abstract: Publication date: November–December 2019Source: Academic Pediatrics, Volume 19, Issue 8Author(s): Eric J. Lammers, Joseph S. Zickafoose, G. Greg Peterson, Laura Blue, Kate A. Stewart, Keith Kranker ObjectiveNearly 10% of all hospitalized children have a primary behavioral health diagnosis, but the effectiveness of treatment can be limited by caregivers’ challenges navigating the behavioral health system. In this study, we assessed a novel peer-support intervention (“parent partners”) designed for the caregivers of children admitted to an inpatient psychiatric unit.MethodsWe used a mixed-methods approach including 1) document review and interviews to assess implementation and 2) a difference-in-differences analysis using claims for Medicaid-enrolled children admitted to the intervention inpatient psychiatric unit and matched comparison children admitted to other inpatient psychiatric units to assess the impacts on health care use after discharge.ResultsNinety-six percent of caregivers who were offered the intervention engaged with a parent partner. The primary challenges to implementation were accommodating the needs of parent partners to address behavioral health crises among their own children and initial limited engagement from behavioral health clinicians. The intervention leaders reported success in addressing these through adjustments to staffing policies, training parent partners in engagement with clinicians, and incorporating parent partners into team rounds. We did not find a statistically significant difference in follow-up outpatient behavioral health visits (adjusted treatment to comparison difference +3% [90% CI = −2%, +9%]), readmissions (+5% [−33%, +43%]), or behavioral health ED visits (−15% [−44%, +14%]).ConclusionsThis novel intervention was implemented successfully, and although our study did not find statistically significant impacts on health care use after discharge, the findings for ED visits are suggestive of benefits. Parent peer support in inpatient settings warrants additional investigation.
Abstract: Publication date: November–December 2019Source: Academic Pediatrics, Volume 19, Issue 8Author(s): Clement J. Bottino, Eric W. Fleegler, Joanne E. Cox, Erinn T. Rhodes ObjectiveTo examine associations between housing instability and poor diet quality in a sample of urban parents and children.MethodsCross-sectional study of 340 parent/guardian–child dyads visiting a pediatric primary care center in Boston, Massachusetts. The parent/guardian (hereafter, parent) completed 2 Harvard Service Food Frequency Questionnaires, one regarding their own dietary intake and one regarding their child's intake, and an assessment of health-related social needs. Diet quality was measured using the Healthy Eating Index-2010 (HEI-2010; score range 0–100). Housing instability was defined as: 1) homeless or in sheltered housing, 2) doubled up with another family, 3) utilities threatened or shut off, or 4) concerned about eviction. Multivariable logistic regression was used to measure associations between unstable housing and lowest-quartile HEI-2010 scores, adjusting for parent age, race/ethnicity, education, income, and child age.ResultsMedian (interquartile range) parent and child HEI-2010 scores were 63.8 (56.3–70.8) and 59.0 (54.2–64.7), respectively. Housing instability was found in 136 dyads (40%). In multivariable analysis, it was associated with increased odds of lowest-quartile total parent HEI-2010 scores (adjusted odds ratio [aOR], 1.9; 95% confidence interval [95% CI], 1.1–3.5) but not child scores (aOR, 1.4; 95% CI, 0.8–2.5). It also was associated with increased odds of lowest-quartile parent HEI-2010 dietary component scores for Total vegetables and Greens and beans (aOR, 2.0; 95% CI, 1.1–3.7 and aOR, 2.5; 95% CI, 1.3–4.8, respectively).ConclusionsIn this urban primary care population, housing instability is associated with lower diet quality scores for parents but not children. Lower vegetable consumption appears to drive this association.
Abstract: Publication date: November–December 2019Source: Academic Pediatrics, Volume 19, Issue 8Author(s): Marcia A. Morgenlander, Hollyce Tyrrell, Lynn C. Garfunkel, Janet R. Serwint, Michael J. Steiner, Samantha Schilling ObjectiveDescribe current practices in systematic screening for social determinants of health (SDH) in pediatric resident clinics enrolled in the Continuity Research Network (CORNET).MethodsCORNET clinic directors were surveyed on demographics, barriers to screening, and screening practices for 15 SDH, including the screen source, timing of screening, process of administering the screen, and personnel involved in screening. Incidence rate ratios were tabulated to investigate relationships among screening practices and clinic staff composition.ResultsClinic response rate was 41% (65/158). Clinics reported screening for between 0 and 15 SDH (median, 7). Maternal depression (86%), child educational problems (84%), and food insecurity (71%) were the items most commonly screened. Immigration status (17%), parental health literacy (19%), and parental incarceration (21%) were least commonly screened. Within 3 years, clinics plan to screen for 25% of SDH not currently being screened. Barriers to screening included lack of time (63%), resources (50%), and training (46%).ConclusionsScreening for SDH in our study population of CORNET clinics is common but has not been universally implemented. Screening practices are variable and reflect the complex nature of screening, including the heterogeneity of the patient populations, the clinic staff composition, and the SDH encountered.
Abstract: Publication date: November–December 2019Source: Academic Pediatrics, Volume 19, Issue 8Author(s): Erika L. Abramson, Monique M. Naifeh, Michelle D. Stevenson, Su-Ting T. Li Mentorship can be one of the most important factors in helping faculty members successfully advance academic careers. Finding effective mentorship, however, is extremely challenging and lack of mentorship may negatively impact productivity, promotion, and retention. Women, in particular, identify lack of mentorship as a major factor inhibiting career advancement, which in turn may be one element contributing to the significant gender gaps existing in academic medicine. Here, we describe a model of mentoring drawn from our personal experiences as 4 female faculty that has resulted in a successful collaboration spanning nearly a decade. This model combines different elements of mentoring models previously described in the literature into a single model of network mentoring. Our model aims to promote longitudinal, collaborative scholarship around a broad common research theme, provide long-term mentorship focused on successfully navigating personal and academic hurdles, and create a forum of mentorship for faculty at all academic ranks. Keys to the success of our model, The Accelerate Scholarship through Personal Engagement with a Collaborative Team (ASPECT) Model, are: 1) a shared overarching research goal that allows for multiple projects to be worked on over time; 2) regular, structured meetings; 3) a collaborative yet flexible arrangement with “group accountability”; and 4) a focus on the human connection. Our goal in writing this paper is to describe, in detail, lessons learned from our experiences and reflect on why and how this model may be effective in addressing mentoring gaps many faculty members, particularly women, experience.
Abstract: Publication date: November–December 2019Source: Academic Pediatrics, Volume 19, Issue 8Author(s): James M. Perrin, Gerry Fairbrother, Jean L. Raphael
Abstract: Publication date: November–December 2019Source: Academic Pediatrics, Volume 19, Issue 8Author(s): Gunjan Tiyyagura, Andrea G. Asnes, John M. Leventhal, Amy Shah, Trisha Calabrese, Linda Radecki, Gloria Jeter, Marc Auerbach
Abstract: Publication date: Available online 21 October 2019Source: Academic PediatricsAuthor(s): Mersine A Bryan, Yolanda Evans, Carlie Morishita, Nikita Midamba, Megan Moreno Objective1) To evaluate differences in how parents use the internet and social media for health information by child age 2) To examine parental perceptions of health information on social mediaMethodsWe conducted a cross-sectional survey of parents of children 0-18 years seen in clinics and an inpatient medical unit. Survey questions focused on: patterns of internet and social media use, for what topics, and parental ratings of the accuracy, reliability and appeal of information from social media. Parents’ responses were categorized by age of their youngest child in years (0-4, 5-11, 12-18).Results258 parents completed the survey. The mean age was 39.8 years, 83% were female, 59% were white. The most common topics parents read about online were: sleep, mental health and car safety. Nearly all parents (96%) used social media, with 68% using social media for health information. There were no significant differences in the proportion of parents who reported using social media for health information by child age. Only half of parents discussed information from social media with their physician. Parents of children age≥5 years rated health information on social media as significantly more accurate than parents of younger children. There were no significant differences in ratings of reliability and appeal by child age.ConclusionsParents of children of all ages use social media for a variety of important topics related to child health. As many parents do not discuss it with their physician, there are missed opportunities for pediatricians to provide high quality information.
Abstract: Publication date: Available online 21 October 2019Source: Academic PediatricsAuthor(s): Kira L. Ryskina, Linda Dynan, Rebecca Stein, Evan Fieldston, Deepak Palakshappa ObjectiveOveruse of diagnostic tests is of particular concern for pediatric academic medical centers. Our objective was to measure variation in testing based on proportion of hospitalization during the day versus night and the association between attending in-house coverage on the teaching service and test utilization for hospitalized pediatric patients.MethodsElectronic health record data from 11,567 hospitalizations to a large, Northeastern, academic pediatric hospital were collected between January 2007 and December 2010. The patient-level dataset included orders for laboratory and imaging tests, information about who placed the order, and the timing of the order. Using a cross-sectional effect modification analysis, we estimated the difference in test utilization attributable to attending in-house coverage.ResultsWe found that admission to the teaching service was independently associated with higher utilization of laboratory and imaging tests. However, the number of orders was 0.76 lower (95% CI -1.31 to -0.21, p=0.006) per 10% increase in the proportion in the share of the hospitalization that occurred during daytime hours on the teaching services, which is attributable to direct attending supervision.ConclusionsDirect attending care of hospitalized pediatric patients at night was associated with slightly lower diagnostic test utilization.
Abstract: Publication date: Available online 17 October 2019Source: Academic PediatricsAuthor(s): Krishna K. Upadhya, Kevin J. Psoter, Katherine A. Connor, Kamila B. Mistry, Daniel J. Levy, Tina L. Cheng ObjectiveRecognizing that pediatric primary care focuses on family health and is an important location of contact for women of childbearing age, this project assessed the effectiveness of a pre/interconception women's health intervention delivered during pediatric primary care using a cluster randomized trial.MethodsPediatric clinicians were randomized to a screening and brief educational intervention group or usual care comparison group. Intervention group clinicians received training on pre/interconception care, including recommended counseling and referral resources for needs identified. Women presenting to primary care with their child ≤12 months were enrolled and assigned to the group corresponding to the assignment of their child's clinician. Mothers seen by clinicians in the intervention group completed a pre/interconception health screening tool and discussed results with their child's clinician during the visit. These mothers were compared to mothers seen by comparison group clinicians who did not receive the screening tool or clinician discussion. All enrolled mothers (Intervention and Comparison) received written preconception health information and a 90 day supply of multivitamins. Primary outcomes at 6 and 12 months post enrollment included contraception use, pregnancy, and access to and use of preventive health care. Secondary outcomes included daily folic acid supplementation, smoking and substance use.Results415 women were enrolled and those who had at least one follow-up assessment were included in the analysis (n= 383). There was no significant effect of the intervention on contraceptive use, pregnancy incidence, or use of preventive care. Assignment to the intervention increased the odds of daily folic acid use [OR 1.82, 95% CI 1.25, 2.63] during follow-up. Intervention mothers were less likely to smoke at 6, but not 12 months.ConclusionsPediatric visits are an opportune location for addressing maternal health and this intervention demonstrated feasibility and improved outcomes for some but not all outcomes Attention to maternal health needs across pediatric visits during infancy may be important for maintaining positive pre/interconception health behaviors.
Abstract: Publication date: Available online 16 October 2019Source: Academic PediatricsAuthor(s): Melora Wiley, Alysse Schultheis, Brianna Francis, Gunjan Tiyyagura, John M Leventhal, Helena JV Rutherford, Linda C Mayes, Kirsten Bechtel ObjectiveInfant crying can lead to parental frustration and is the most common trigger for abusive head trauma (AHT). We used qualitative methodology with an activating stimulus (an audiotape of an infant crying) to prime the participants to engage in open dialogue for the purpose of understanding their perceptions of infant crying and its association with AHT, with the aim that information from these interviews and the impact of hearing the activating stimulus could be used to inform interventions to prevent AHT that would resonate with parents.MethodsWe conducted 25 initial qualitative interviews and 16 subsequent interviews with mothers and fathers of newborns. Before the initial interview, parents listened to a 1-minute audio clip of a crying infant, followed by a preventive message regarding AHT. The transcribed data were analyzed, and themes were developed using the constant comparative method of grounded theory. Data collection and analysis continued past the point of thematic saturation.ResultsFour themes emerged from the initial interviews: (1) previous experience is helpful to manage infant crying; (2) babies cry for a reason; (3) shaking an infant is incomprehensible to parents; and (4) the role of safety planning to manage frustration with crying. Analysis of the subsequent interviews revealed two additional themes: (1) use of supports for infant crying (e.g., technology and physician advice) and (2) effects of the audio clip on caregiving practices.ConclusionPrevious experiences and beliefs about crying affect parents’ perceptions of infant crying and AHT. After discharge, parents reported using technology for information and support and thinking about the audio clip when caring for their infant. These experiences, beliefs and practices may aid in shaping effective prevention strategies to prevent AHT.
Abstract: Publication date: Available online 16 October 2019Source: Academic PediatricsAuthor(s): Steven C. Marek, Sandra Cuzzi, Priti Bhansali Background and ObjectivesThe role of a hospitalist differs in a community hospital (CH) compared to a university/children's hospital. Residents are required to practice in a variety of relevant clinical settings, but little is known about current trends regarding pediatric resident training in different hospital settings. This study explores CH rotations including their value for resident training, characteristics, benefits, and drawbacks. This study also seeks to define “community hospital.”Methods Authors conducted an online cross-sectional survey of pediatric residency program directors distributed by the Association of Pediatric Program Directors. The survey was developed and revised based on review of the literature and iterative input from experts in pediatric resident training and CH medicine. It assessed residency program demographics, availability of CH rotations, value of CH rotations, and their characteristics including benefits and drawbacks.ResultsResponse rate was 56%. CH rotations were required at 24% of residency programs, available as an elective at 46% of programs, and unavailable at 48% of programs. Residency program directors viewed these rotations as valuable for resident training. CH rotations were found to have multiple benefits and drawbacks. Definitions of “community hospital” varied and can be categorized according to positive or negative characteristics.ConclusionsResident rotations at a CH provide valuable learning opportunities with multiple potential benefits that should be weighed against drawbacks in the context of a residency program's curriculum. There are many characteristics that potentially distinguish CH from university/children's hospitals.
Abstract: Publication date: Available online 16 October 2019Source: Academic PediatricsAuthor(s): Lori Uscher-Pines, Bonnie Ghosh-Dastidar, Debra L. Bogen, Kristin N. Ray, Jill R. Demirci, Ateev Mehrotra, Kandice A. Kapinos ObjectiveTo evaluate the feasibility and impact of telelactation via personal electronic devices on breastfeeding duration and exclusivity among rural women.MethodsThe Tele-MILC trial, a pragmatic, parallel design trial, recruited 203 women during their postpartum hospitalization in a critical access hospital in Pennsylvania and randomized them to receive telelactation (n=102) or usual care (n=101). We used intent-to-treat (ITT) and instrumental variable (IV) approaches to analyze study data for the 187 participants who completed follow-up. The primary outcomes were any breastfeeding and exclusive breastfeeding at 12 weeks postpartum.ResultsAmong participants in the telelactation arm, 50% (47/94) reported participating in video calls. At 12 weeks, 71% of participants in the telelactation arm vs. 68% of control participants were breastfeeding in the ITT model (3% difference, p=0.73), whereas 73% of participants in the telelactation arm vs. 68% of control participants were breastfeeding in the IV model (5% difference, p=0.74). Among participants who were still breastfeeding at 12 weeks, 51% participants in the telelactation arm were breastfeeding exclusively vs. 46% of control participants in the ITT model (5% difference, p=0.47), whereas 56% of participants in the telelactation arm were breastfeeding exclusively vs. 45% of control participants in the IV model (11% difference, p=0.48). In all models, participants in the telelactation arm were breastfeeding at higher rates; however, differences were not statistically significant.ConclusionsThis trial demonstrated that telelactation can be implemented with a rural underserved population. Though this trial was not powered to detect differences in breastfeeding duration and exclusivity, and none were observed, telelactation remains a promising approach for further investigation. ClinicalTrials.gov Identifier: NCT02870413
Abstract: Publication date: Available online 15 October 2019Source: Academic PediatricsAuthor(s): Sandra F. Braganza, Hollyce Tyrrell, Carolyn Rosen, Leora Mogilner, Ann Phillips, Sara Slovin, Iman SharifABSTRACTObjectiveUnderstanding differences between trainee and faculty experience with and confidence caring for children with special health care needs (CSHCN) can inform pediatric resident education.MethodsResidents and faculty across the Continuity Research Network (CORNET) reported on a consecutive series of 5 primary care encounters. Respondents answered questions about visit characteristics, patient demographics, and applied the CSHCN Screener. Respondents also reported on how confident they felt addressing the patient's healthcare needs over time. We dichotomized confidence at “very confident” vs. all other values. We used logistic regression to describe the correlates of provider confidence managing the patient's care.ResultsWe collected data on 381 (74%) resident-patient and 137 (26%) attending-patient encounters. A higher proportion of attending encounters compared to resident encounters were with CSHCN (49% vs. 39%, p
Abstract: Publication date: Available online 14 October 2019Source: Academic PediatricsAuthor(s): Colleen E. Bennett, Joanne N. Wood, Philip V. Scribano ObjectiveTo utilize hospital EMR data for children placed in foster care (FC) and a matched control group to compare: 1) healthcare utilization rates for primary care, subspecialty care, emergency department (ED) visits, and hospitalizations; 2) overall charges per patient-year; and, 3) prevalence of complex chronic conditions (CCC) and their effect on utilization.MethodsChildren ≤18 years old with a designation of FC placement and controls matched on age, race/ethnicity, gender, and zip code who had an encounter at an urban pediatric health system between 7/1/11-6/30/12 were identified in the EMR. Data on outpatient, ED, and inpatient encounters and charges for 7/1/12-6/30/13 were obtained. A general linear mixed effects model was applied to estimate means and rates for each group. Analyses were repeated among the subpopulations of children with and without CCCs.Results1,156 FC cases were matched to 4,062 controls (mean=3.5 controls/case). FC cases had significantly higher rates (per 100 patient-years) of hospitalizations (18.5 vs. 12.7, p=0.005), and subspecialty visits (173.3 vs. 113.6; p
Abstract: Publication date: Available online 13 October 2019Source: Academic PediatricsAuthor(s): Orly N. Bell, Michael K. Hole, Karl Johnson, Lucy E. Marcil, Barry S Solomon, Adam SchickedanzABSTRACTFinancial stress is the root cause of many adverse health outcomes among poor and low-income children and their families, yet few clinical interventions have been developed to improve health by directly addressing patient and family finances. Medical-Financial Partnerships (MFPs) are novel cross-sector collaborations in which health care systems and financial service organizations work collaboratively to improve health by reducing patient financial stress, primarily in low-income communities. Financial services provided by MFPs include individually tailored financial coaching, free tax preparation, budgeting, debt reduction, savings support, and job assistance, among others. MFPs have been shown to improve finances and, in the few existing studies available, health outcomes. We describe the rationale for MFPs and examine eight established MFPs providing financial services under 1 of 3 models: full-scope on-site service partnerships; targeted on-site service partnerships; and partnerships facilitating referral to off-site financial services. The services MFPs provide complement clinical social risk screening and navigation programs by preventing or repairing common financial problems that would otherwise lead to poverty-related social needs, such as food and housing insecurity. We identify common themes, as well as unique strengths and solutions to a variety of implementation challenges MFPs commonly encounter. Given that the financial circumstances and health outcomes of socially marginalized patients and families are closely linked, MFPs represent a promising and feasible cross-sector service delivery approach and a new model for upstream health care to promote synergistic financial well-being and health improvement.
Abstract: Publication date: Available online 28 September 2019Source: Academic PediatricsAuthor(s): Jin Russell, Cameron C. Grant, Susan M.B. MortonABSTRACTObjectiveIn contrast with multimorbidity during adulthood, the relationship of childhood multimorbidity with socioeconomic position (SEP) is poorly understood. We aimed to describe early childhood multimorbidity and investigate the relationship of this with SEP.MethodsWithin a diverse prospective child cohort study we determined associations of SEP with multimorbidity (defined as the presence of two or more chronic conditions) at age 2 years. Maternal SEP was ranked into five categories using an index constructed from variables collected antenatally describing maternal education, employment, financial stress, beneficiary status, housing tenure, overcrowding and residential mobility. Missing values were handled using multiple imputation with chained equations. Independent associations of SEP with multimorbidity were described using adjusted odds ratios (OR) and 95% confidence intervals (CI).ResultsOf the 6822 women and 6853 children who were enrolled into the cohort study, 5737 (84%) mother-child dyads had complete antenatal data and were interviewed at age 2 years. Of these 5737, for 3826 (67%) dyads there was complete data for all variables. Multimorbidity was present in 374/3838 (9.7%) of the cohort children. After multiple imputation; and adjustment for maternal ethnicity, smoking, poor health, depressive symptoms, and child gender; the odds of multimorbidity being present were increased for children of mothers in the most (OR 1.74, 95%CI 1.16-2.59) and second most (OR 1.43, 1.00-2.04) versus the least disadvantaged group.ConclusionThe odds of multimorbidity are increased for children whose mothers have lower SEP. Cumulative socioeconomic disadvantage increases the potential for a chronic illness trajectory to develop in early childhood.
Abstract: Publication date: Available online 24 September 2019Source: Academic PediatricsAuthor(s): Deborah J Rinehart, Sarah Leslie, M Joshua Durfee, Melanie Stowell, Matthew Cox-Martin, Tara Thomas-Gale, Judith C Shlay, Edward P Havranek ObjectiveTo evaluate the feasibility, acceptability and initial efficacy of a pilot texting intervention (“t4she”) in primary care designed to increase sexual health knowledge and promote dual protection strategies to reduce unintended pregnancies and sexually transmitted infections among adolescent females.MethodsParticipants were recruited from 2 federally qualified health centers. Eligibility included: being 13-18 years of age; assigned female at birth; English-speaking; not currently pregnant and/or intending to become pregnant; and having texting capabilities. A randomized controlled trial assessed between-group differences at 3 and 6-months on knowledge, Health Belief Model constructs, and sexual behaviors. Input on intervention acceptability was obtained at 3 months.ResultsAmong 244 participants enrolled and randomized, the average age was 16 (±1.6), 80% were Hispanic/Latina, 53% had ever had vaginal sex, and 50% had used prescription birth control with 24% currently using a long-acting reversible method. Among those sexually active, 29% reported consistent condom use and 24% reported engaging in dual protection behaviors at last sex. Among participants with all follow-up data (N=136), intervention participants had significant increases in sexual health knowledge and reported more prescription birth control use at follow-up than control participants. No significant outcome differences were found for condom use or dual protection behaviors. Intervention participants reported receiving messages, being introduced to new information, and reading and sharing the messages.ConclusionsThe pilot t4she sexual health intervention significantly improved knowledge and use of short-acting prescription birth control among young females in primary care and was acceptable by youth and feasible to implement.
Abstract: Publication date: Available online 18 September 2019Source: Academic PediatricsAuthor(s): Margot N. Tang, Stephanie Ettinger de Cuba, Sharon M. Coleman, Timothy Heeran, Megan Sandel, Mariana Chilton, Deborah A. Frank, Susanna Y. Huh ObjectivesAmong US-born children of Latina US (USB) and Latina foreign-born mothers (FBM), to determine whether 1) household and child characteristics differ; 2) child health outcomes differ; 3) these differences diminish for children of FBM with longer duration of residence (DOR) in the US; and 4) these differences can be explained by food insecurity (FI) or by Supplemental Nutrition Assistance Program (SNAP) participation.MethodsCross-sectional survey of 2,145 Latina mothers of publicly insured US born children 0-48 months old in a Boston emergency department (ED) 2004-2013. Predictors were FBM vs USBM and duration of residence in the US. Outcomes were mothers’ report of child health, history of hospitalization, developmental risk, hospital admission on the day of ED visit. Multivariable logistic regression adjusted for potential confounders and effect modification.ResultsFBM versus USBM households had more household (31% vs 26%) and child (19% vs 11%) FI and lower SNAP participation (44% vs 67%). Children of FBM versus USBM were more likely to be reported in fair/poor vs good/excellent health (AOR 1.9, 95% CI [1.4, 2.6]), with highest odds for children of FBM with shortest DOR, and to be admitted to the hospital on the day of the ED visit (AOR 1.7, 95% CI [1.3, 2.2]). SNAP and FI did not fully explain these outcomes.ConclusionWhen providing care and creating public policies, clinicians and policymakers should consider higher rates of food insecurity, lower SNAP participation, and risk for poor health outcomes in Latinx children of FBM.
Abstract: Publication date: Available online 12 September 2019Source: Academic PediatricsAuthor(s): Kathleen Huth, Tobey Audcent, Sara Long-Gagne, Anne Marie Sbrocchi, Natalie Weiser, Doug Miller, Danielle Arje, Derek Stephens, Nathalie Major, Kheirie Issa, Eyal Cohen, Julia OrkinABSTRACTObjectiveChildren with medical complexity (CMC) are a growing population, yet training in complex care varies across pediatric residency programs. The purpose of this study was 1) to evaluate the effectiveness of a curriculum for pediatric residents in improving performance in a simulated clinical scenario; and 2) to explore residents’ perceived self-efficacy in caring for CMC.MethodsA randomized controlled trial was conducted supplemented by qualitative inquiry. Pediatric residents from two residency programs were randomly assigned to participate in interactive modules on: (a) clinical assessment, care planning and technological dependency or (b) non-complex care topics. The primary outcome was mean score on an Observed Structured Clinical Examination (OSCE) of tracheostomy care. Semi-structured interviews were conducted post-intervention and analyzed using qualitative content analysis.ResultsNinety-four eligible residents were randomized. Residents who attended all modules and the OSCE and consented to participate [intervention (n=20) and control (n=24)] were included in the final analysis. At baseline, few (9%) reported being comfortable caring for CMC. There was no significant difference in mean OSCE score between intervention and control groups (39.0±1.1 vs. 38.0±1.0, p=0.48). Qualitative analysis revealed three emerging themes related to resident self-efficacy: building a system of care, navigating uncertainty and professional identity formation.ConclusionA standardized complex care curriculum delivered in a classroom setting did not lead to improved performance in an OSCE station despite increased resident-reported self-efficacy in approaching care for CMC. These findings highlight the need for multidimensional educational interventions and assessments in complex care.
Abstract: Publication date: Available online 12 September 2019Source: Academic PediatricsAuthor(s): Jean L. Raphael, Lee S. Beers, James M. Perrin, Arvin Garg
Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Kelsey A. Miller, Michael C. Monuteaux, Christopher Roussin, Joshua Nagler Background and ObjectiveSupervisors’ decisions regarding procedural readiness are influenced by resident confidence. Confidence is a valuable metric if we understand how it correlates with trainee characteristics and procedural competence. Our objective was to evaluate the relationship between self-reported confidence in endotracheal intubation (ETI) and pediatric interns’ characteristics (gender, prior intubation experience) and performance (airway management knowledge, demonstrated skills on airway trainers).MethodsThis was a secondary analysis of a randomized, controlled trial of an airway management curriculum. Gender and prior intubation experience were reported on a preparticipation questionnaire. Interns’ performance was measured 1) using a 14-item knowledge-based assessment of airway management and 2) as time to successful intubation across 4 simulated intubation scenarios. After completing the curriculum and assessment, interns reported retrospective precurriculum and current postcurriculum confidence with ETI using a 10-point Likert scale.ResultsForty-nine interns participated, of whom 16 (33%) were male. Eleven (22%) had ≥1 previous successful intubation. Median [interquartile range] pre- and postcurriculum confidence scores were 3 [2, 5] and 6 [5, 8], respectively. Male interns reported higher precurriculum confidence than females (median difference: 2.0; 95% confidence interval: 0.1, 3.9); postcurriculum confidence among males was also higher but not statistically significant. There was no correlation between self-reported precurriculum confidence and prior experience. There was no correlation between pre- or postcurriculum self-reported confidence and performance on the knowledge-based assessment or time to successful intubation on airway trainers.ConclusionsMale pediatric interns self-report higher initial confidence in ETI compared to females. Self-reported confidence did not correlate with prior experience, airway management knowledge, or intubation performance on airway trainers.
Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Maheswari Ekambaram, Matilde M. Irigoyen, Andrew Paoletti, Iqra Siddiqui ObjectivePacifier use decreases the risk of sudden infant death syndrome, but its impact on breastfeeding remains controversial. We evaluated the impact of a pacifier policy aligned with the World Health Organization and United Nations Children's Fund Baby-Friendly Hospital Initiative on subsequent pacifier use and breastfeeding at 1 month of age.MethodsWe conducted a prospective 2-stage (pre- and post-implementation) cohort study of newborns at a birth hospital before and after implementation of a Baby-Friendly–aligned pacifier policy. Consecutive mothers of newborns admitted to the nursery participated in a telephone survey when the infants were 1 month of age.ResultsIn total, 342 mothers participated (190 before and 152 after implementation of the policy). Pacifier adoption was delayed in the post-implementation group, but pacifier use by 1 month of age was comparable (78.9% pre-implementation vs 77.6% post-implementation; P = .793). In the pre-implementation group, female and male infants used pacifiers at comparable rates; however, in the post-implementation group, females were significantly less likely to use a pacifier compared to males after controlling for insurance, race, parity, and delivery mode (adjusted odds ratio, 0.35; 95% confidence interval, 0.15–0.83; P = .02). In the post-implementation group, exclusive breastfeeding rates at discharge increased significantly (from 40% to 51.3%; P = .04), but rates were not different at 1 month (23.7% pre-implementation vs 24.3% post-implementation; P = .89).ConclusionA Baby-Friendly–aligned pacifier policy delayed pacifier adoption but did not impact overall pacifier use or breastfeeding rates at 1 month of age. The finding of lower pacifier use rates among female infants post-intervention requires verification in other populations before evaluating public heath relevance.
Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Jaspreet Loyal, Theresa R. Weiss, Jessica H. Cheng, Laura R. Kair, Eve Colson ObjectiveDespite American Academy of Pediatrics recommendations, some parents refuse intramuscular (IM) vitamin K as prophylaxis against vitamin K deficiency bleeding for their newborns. The purpose of our study was to describe attitudes and perceptions of parents who choose to defer IM vitamin K for their newborns.MethodsUsing qualitative methodology, we conducted in-depth semi-structured interviews with parents of newborns in 3 hospitals in Connecticut and California. We used the grounded theory approach and the constant comparative method until saturation was reached.ResultsNineteen participants (17 mothers and 2 fathers) of 17 newborns were interviewed; 14 newborns did not receive IM vitamin K due to refusal by the parents, and for 3 newborns IM vitamin K administration was delayed due to initial hesitation by the parents. Four major themes emerged: 1) risk-to-benefit ratio, where parents refused IM vitamin K due to a perceived risk to their newborn from preservatives, for example; 2) “natural” approaches, which led to seeking oral vitamin K or increasing the mother's own prenatal dietary vitamin K intake; 3) placement of trust and mistrust, which involved mistrust of the medical and pharmaceutical community with overlapping concerns about vaccines and trust of self, like-minded allopathic and non-allopathic health care providers, the social circle, the internet, and social media; and 4) informed by experiences, reflecting hospital experiences with prior pregnancies and communication with health care providers.ConclusionsParents’ perception of risk, preference for alternative options, trust, and communication with health care providers were pivotal factors when making decisions about IM vitamin K.
Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Nisha Dalvie, Victoria Nguyen, Eve Colson, Jaspreet Loyal ObjectiveDue to increasing popularity, our hospital began considering distributing cardboard boxes combined with safe sleep education to new mothers. As a first step in studying the impact of this intervention on bedsharing in our community, we sought to understand mothers’ perceptions of the cardboard box.MethodsWe recruited primarily low-income, English- or Spanish-speaking mothers of infants aged 2 to 16 weeks during routine primary care visits. Participants responding to a cross-sectional survey about infant sleep practices were invited to participate in in-depth interviews about the cardboard box. We used a grounded theory approach and the constant comparative method until saturation was reached.ResultsOf 120 participants in the survey, 50 (42%) participated in the qualitative study. Participants were mothers of infants aged ≤4 weeks (46%), 4 to 8 weeks (32%), and 16 weeks (22%). Of 50 participants, 52% said they would use the cardboard box for their infant to sleep in, if provided, compared with 42% who said they would not and 6% were unsure. Three themes emerged from the data: (1) safety of the cardboard box; (2) appearance, and (3) variation in planned use. Some participants planned to place the cardboard box in their bed.ConclusionsParticipants in our study were divided about whether they would use the cardboard box for their infant to sleep in. If distributed, hospital staff should advise families to not place the cardboard box in their bed. Next steps include determining bedsharing frequency among parents who choose to use the cardboard box for their infant.
Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Elizabeth E. Halvorson, Thomas Curley, Mariah Wright, Joseph A. Skelton ObjectiveWeight bias can influence medical care but has not been studied in the pediatric inpatient setting. We will quantify implicit and explicit weight bias of pediatric inpatient providers and qualitatively explore providers’ attitudes toward children with obesity and patient/family perceptions of weight bias in the hospital.MethodsWe performed a mixed-methods study including semistructured key informant interviews and validated tests for implicit (Implicit Association Test) and explicit (Crandall's Anti-Fat Attitudes Questionnaire) bias with pediatric hospitalists, residents, and acute care nurses. We performed semistructured key informant interviews with pediatric inpatients aged 7 to 17 years and the patient's parent(s) or guardian(s). Interviews were coded using an inductive approach to identify recurrent themes.ResultsWe enrolled 28 pediatric providers, 12 patients, and 12 parents/guardians. In total, 71% of providers exhibited moderate or strong implicit weight bias, with generally lower scores for explicit bias. Qualitative analysis identified seven themes: the existence of weight bias, shared responsibility for a child's obesity, a potential for provider bias toward the parents of pediatric patients with obesity, possible effects of patient weight on inpatient care, importance of terminology in addressing obesity, and the possibility of addressing obesity inpatient but a preference for obesity to be addressed in the outpatient setting.ConclusionsHealth care providers, patients, and families in the pediatric inpatient setting identified multiple ways that obesity could impact care, including provider weight bias.
Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Olivier Drouin, Mona Sharifi, Monica Gerber, Christine Horan, E. John Orav, Richard Marshall, Elsie M. Taveras ObjectiveTo examine parents’ interest in continuing and willingness to pay (WTP) for 2 pediatric weight management programs following their participation.MethodsParticipants were parents of 2- to 12-year-old children with body mass index ≥ 85th percentile who participated in the Connect for Health trial. One group received enhanced primary care (EPC) and the other received EPC plus individualized coaching (EPC+C). At 1 year, we assessed parents’ self-reported WTP for a similar program and the maximum amount ($/month) they would pay. We used multivariable regression to examine differences in WTP and WTP amount by intervention arm and by individual and family-level factors.ResultsOf 638 parents who completed the survey, 85% were interested in continuing and 38% of those parents were willing to pay (31% in the EPC group and 45% in the EPC+C group). The median amount parents were willing to pay was $25/month (interquartile range, $15–$50). In multivariable models, the EPC+C parents were more likely to endorse WTP than the EPC parents (odds ratio, 1.53; 95% confidence interval, 1.05–2.22). Parents of children with Hispanic/Latino versus white ethnicity and those reporting higher satisfaction with the program were also more likely to endorse WTP.ConclusionsMost parents of children in a weight management program were interested in continuing it after it ended, but fewer were willing to pay out of pocket for it. A greater proportion of parents were willing to pay if the program included individualized health coaching.
Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Ruth S. Faircloth, Daniel I. Brooks, Karen S. Vogt, Jill E. Emerick ObjectiveDetermine parent preferences when discussing their child's weight with regard to weight-based terms, terms that are the most motivating, preferred setting, and whether or not awareness of their child's weight status impact these preferences.MethodsParents of children ages 3 to 17 years (N = 349) presenting for health supervision visits completed a survey to assess the degree of offensiveness and motivation for change of commonly used weight-based terminology, as well as the preferred setting for discussion of weight. Parents were asked to assess their child's weight status using recommended terminology (“obese,” “overweight,” “healthy weight,” “underweight”), and their responses were compared to the children's objective body mass index (BMI) percentile.ResultsThe children had a median age of 10.3 years; 47.3% were female, 15.8% had overweight (85th–94th percentile BMI), and 11.5% had obesity (≥95th percentile BMI). Of children with overweight/obesity, 84.2% of parents underestimated their child's weight status. The least offensive terms were “at-risk weight,” “BMI is high,” “BMI is above 95%,” and “unhealthy weight.” The more offensive terms (P < .001) were “overweight” and “obese.” The parent's perception of their child's weight did not affect offensiveness ratings. “Obese” was the strongest motivator for change (P < .001), and “unhealthy weight” was next. Well visits were preferred for discussing weight (P < .001). Most parents preferred to have the child remain in the room (P
Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Kayla Morel, Kelsey Nichols, Yvonne Nong, Nalini Charles, Sarah Price, Elsie Taveras, Roberta Goldman, Jennifer A. Woo BaidalABSTRACTBackgroundNovel approaches to reduce sugar-sweetened beverage (SSB) consumption during the first 1000 days—pregnancy through age 2 years—are urgently needed.ObjectiveTo examine perceptions of SSB consumption and acceptability of potential intervention strategies to promote SSB avoidance in low-income families in the first 1000 days.MethodsIn this qualitative research, we performed semistructured, in-depth interviews of 25 women and 7 nutrition/health care providers. Eligible women were Women, Infants, and Children program-enrolled and pregnant or had an infant younger than age 2 years. Eligible providers cared for families during the first 1000 days. Using immersion-crystallization techniques, we examined perceptions, barriers, and facilitators related to avoidance of SSB consumption; acceptability of messages framed as positive gains or negative losses; and perceived influence on SSB consumption of various intervention modalities.ResultsThemes related to SSB consumption included parental confusion about healthy beverage recommendations and maternal feelings of lack of control over beverage choices due to pregnancy cravings and infant tastes. Themes surrounding message frames included negative health consequences of sugary drink consumption are strong motivators for behavior change; and savings and cost count, but are not top priority. Highly acceptable intervention strategies included use of images showing health consequences of SSB consumption, illustrations of sugar content at the point of purchase, and multimodal delivery of messages.ConclusionsMessages focused on infant health consequences and parental empowerment to evaluate and select healthier beverages based on sugar content should be tested in interventions to reduce SSB consumption in the first 1000 days.
Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Alexander Rakowsky, Carl Backes, John D. Mahan, Kimberly Wolf, Elizabeth Zmuda It is clear that graduates of osteopathic medical schools desire to maintain their Osteopathic Manipulative Medicine (OMM) and Osteopathic Principles and Practice (OPP) skills and mindset of their professional identity. In a recent survey, 68% of 1,523 third year osteopathic medical students indicated that it would be more appealing to attend a residency with osteopathic recognition, with more than half indicating this would play an important role in how they made their rank list. There are currently few options available to DO students that would like to maintain their OMM and OPP skills during pediatric residency programs, and with an increasing number of DO graduates each year, there may be a need to provide more opportunities for them. In this article we describe our pediatric Osteopathic Recognition Track, which has the goal of providing an appropriate level of osteopathic focused training to our small number of residents in the track (4 annually) while incorporating them fully into a large and very busy pediatric program. We use Bloom's taxonomy as the framework upon which to provide details about our approach.
Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Judith A. Groner, Lisa Nicholson, Hong Huang, John Anthony Bauer BackgroundAdequate sleep during childhood is an important component of overall health and wellbeing for children. Secondhand smoke (SHS) exposure has been linked to a greater risk of sleep-disordered breathing.ObjectiveOur objective was to investigate relationships between SHS exposure and sleep-related breathing problems in healthy toddlers aged 2 to 5 years. We hypothesized that there is an independent relationship between objectively measured SHS exposure and presence of sleep-related breathing problems by parental report.MethodsA convenience sample of 149 healthy children ages 2 to 5 years was recruited from an academic pediatric primary care center for this cross-sectional study; 138 had complete data that were analyzed. Current SHS exposure was determined by hair nicotine level. Presence of sleep-related breathing problems was assessed by 1 survey item. Inflammation was determined by serum C-reactive protein (CRP) level. Analysis in Stata 15 included a series of multivariate logistic regression models, controlling for individual-level demographics and body mass index z scores according to mediation analysis procedures for dichotomous outcomes.ResultsApproximately 24% of parents reported their child snored, gasped, or had difficulty breathing at night sometimes, most of the time, or almost always. Regression models with mediation analysis indicate that SHS exposure significantly increased the odds of reporting the child had sleep-related breathing problems, and 18% of this relationship is explained by log serum CRP levels.ConclusionsAlthough the cross-sectional nature of this study limits causality, evidence suggests a relationship exists between SHS exposure, as measured by log hair nicotine and sleep-related breathing problems at night.
Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Matthew W. Zackoff, Francis J. Real, Bradley Cruse, David Davis, Melissa Klein
Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Katherine M. Richardson, Sarah D. Fouquet, Ellen Kerns, Russell J. McCulloh ObjectiveTo evaluate the individual-level impact of an electronic clinical decision support (ECDS) tool, PedsGuide, on febrile infant clinical decision making and cognitive load.MethodsA counterbalanced, prospective, crossover simulation study was performed among attending and trainee physicians. Participants performed simulated febrile infant cases with use of PedsGuide and with standard reference text. Cognitive load was assessed using the NASA-Task Load Index (NASA-TLX), which determines mental, physical, temporal demand, effort, frustration, and performance. Usability was assessed with the System Usability Scale (SUS). Scores on cases and NASA-TLX scores were compared between condition states.ResultsA total of 32 participants completed the study. Scores on febrile infant cases using PedsGuide were greater compared with standard reference text (89% vs 72%, P = .001). NASA-TLX scores were lower (ie, more optimal) with use of PedsGuide versus control (mental 6.34 vs 11.8, P < .001; physical 2.6 vs 6.1, P = .001; temporal demand 4.6 vs 8.0, P = .003; performance 4.5 vs 8.3, P < .001; effort 5.8 vs 10.7, P < .001; frustration 3.9 vs 10, P < .001). The SUS had an overall score of 88 of 100 with rating of acceptable on the acceptability scale.ConclusionsUse of PedsGuide led to increased adherence to guidelines and decreased cognitive load in febrile infant management when compared with the use of a standard reference tool. This study employs a rarely used method of assessing ECDS tools using a multifaceted approach (medical decision-making, assessing usability, and cognitive workload,) that may be used to assess other ECDS tools in the future.
Abstract: Publication date: Available online 22 August 2019Source: Academic PediatricsAuthor(s): Irene Kocolas, Wendy Hobson, Ameet Daftary, Marta King, James F. Bale
Abstract: Publication date: Available online 21 August 2019Source: Academic PediatricsAuthor(s): Elyse Olshen Kharbanda, Stephen E. Asche, Alan Sinaiko, James D. Nordin, Heidi L. Ekstrom, Steven P. Dehmer, Dani Bredeson, Patrick J. O'Connor
Abstract: Publication date: Available online 16 August 2019Source: Academic PediatricsAuthor(s): Chelsea Anne Young, Honora Burnett, Alexandra Ballinger, Gloria Castro, Shay Steinberg, Melissa Nau, E. Hayes Bakken, Melanie Thomas, Amy L. Beck ObjectiveThe American Academy of Pediatrics recommends screening parents for postpartum depression during pediatric primary care visits. Unfortunately, many women who screen positive do not obtain treatment. Providing mental health services for women in the same location as their children's primary care may facilitate treatment, but few such clinics exist. We designed a qualitative study to evaluate women's perceptions and experiences with receiving mental health services from psychiatrists embedded in a safety-net pediatric primary care clinic.MethodsSemi-structured interviews were conducted with women receiving mental health care from embedded psychiatrists in a safety-net pediatric clinic. Data were analyzed using an inductive approach.Results20 women participated. Five major themes emerged: (1) Barriers to maternal mental health care, including psychiatric symptoms impairing access, stigma, and fear of Child Protective Services; (2) Benefits of embedded care, including convenience, low barrier to entry and trust; (3) Motherhood as facilitator to care, with early motherhood described as a time of vulnerability to relapse; 4) Focus on parenting, including appreciation for parenting skills and normalization of the mothering experience; (5) Treatment modality preferences, including concerns about medications and a preference for psychotherapy.ConclusionsPostpartum women face many barriers to psychiatric care. Mental health care embedded within the pediatric setting lowers barriers to care during this critical period. These insights should inform further collaboration between adult psychiatrists and pediatric care providers.
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