Abstract: Publication date: Available online 21 January 2020Source: Academic PediatricsAuthor(s): Suzanne Reed, Richard Mink, Su-Ting T. LiAbstractBackgroundThe Accreditation Council for Graduate Medical Education recently made available final residency Milestones for first-year fellows to fellowship program directors (FPDs). Usefulness of residency Milestones for fellows are unknown.ObjectivesDetermine how many pediatric FPDs downloaded final residency Milestones for their first-year fellows and FPD perspectives about usefulness of residency Milestones.MethodsMixed methods survey of pediatric FPDs, assessing FPD use of residency Milestones for first-year fellows, and FPD opinions about utility of residency Milestones for fellowship, including during fellow recruitment. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using content analysis.ResultsThe response rate was 67.8% (544/802). Only 39.3% (209/532) of FPDs downloaded final residency Milestones for their first-year fellows. Twenty-four percent (129/532) of all FPDs thought residency Milestones were useful. Forty-one percent (218/532) thought residency Milestones would be useful during recruitment; others believed this may harm applicants. Of FPDs that downloaded and reviewed residency Milestones, 27% (50/185) used them for individualized education. FPDs felt residency Milestones might allow for identification of trainee needs and baseline assessments, but thought that residency Milestones had limited usefulness during fellowship due to concerns about lack of validity evidence, relevance, and how Milestones are assessed and reported.ConclusionsMost FPDs find residency Milestones to be of limited utility for their fellows and do not use residency Milestones to tailor education for their first-year fellows. Improving relevance of residency Milestones to fellowship training, validity, and how Milestones are assessed and reported may improve their usefulness for fellow training.
Abstract: Publication date: Available online 16 January 2020Source: Academic PediatricsAuthor(s): Alexander F. Glick, Jonathan S. Farkas, Rebecca E. Rosenberg, Alan L. Mendelsohn, Suzy Tomopoulos, Arthur H. Fierman, Benard P. Dreyer, Michael Migotsky, Jennifer Melgar, H. Shonna YinAbstractObjectiveInpatient discharge education is often suboptimal. Measures of parents’ perceived comprehension of discharge instructions are included in national metrics given linkage to morbidity; few studies compare parents’ perceived and actual comprehension. We (1) compared parent perceived and actual comprehension of discharge instructions and (2) assessed associations between plan complexity and parent health literacy with overestimation of comprehension (perceive comprehension but lack actual comprehension).MethodsProspective cohort study of English/Spanish-speaking parents (n=192) of inpatients ≤12 years old and discharged on ≥1 daily medication from an urban public hospital. We used McNemar's tests to compare parent perceived (agree/strongly agree on 5-point Likert scale) and actual comprehension (concordance of parent report with medical record) of instructions (domains: medications, appointments, return precautions, and restrictions). Generalized estimating equations were performed to assess associations between low parent health literacy (Newest Vital Sign score ≤3) and plan complexity with overestimation of comprehension.ResultsMedication side effects were the domain with lowest perceived comprehension (80%), while>95% of parents perceived comprehension for other domains. Actual comprehension varied by domain (41-87%) and was lower than perceived comprehension. Most (84%) parents overestimated comprehension in ≥1 domain. Plan complexity (adjusted odds ratio [aOR] 3.6 [95% CI 2.9–4.7]) and low health literacy (aOR 1.9 [1.3–2.6]) were associated with overestimation of comprehension.ConclusionsParental perceived comprehension of discharge instructions overestimated actual comprehension in most domains. Plan complexity and low health literacy were associated with overestimation of comprehension. Future interventions should incorporate assessment of actual comprehension and standardization of discharge instructions.
Abstract: Publication date: Available online 3 January 2020Source: Academic PediatricsAuthor(s): Maura R. Reilly, Kate Perkins, Savanna L. Carson, Su-Ting T. Li
Abstract: Publication date: January–February 2020Source: Academic Pediatrics, Volume 20, Issue 1Author(s): Nicole Meyers, Alexander F. Glick, Alan L. Mendelsohn, Ruth M. Parker, Lee M. Sanders, Michael S. Wolf, Stacy Bailey, Benard P. Dreyer, Jessica J. Velazquez, H. Shonna YinAbstractObjectiveParent use of technology to manage child health issues has the potential to improve access and health outcomes. Few studies have examined how parent health literacy affects usage of Internet and cell phone technologies for health management.MethodsCross-sectional analysis of data collected as part of a randomized controlled experiment in 3 urban pediatric clinics. English- and Spanish-speaking parents (n = 858) of children ≤8 years answered questions regarding use of and preferences related to Internet and cell phone technologies. Parent health literacy was measured using the Newest Vital Sign.ResultsThe majority of parents were high Internet (70.2%) and cell phone (85.1%) users (multiple times a day). A total of 75.1% had limited health literacy (32.1% low, 43.0% marginal). Parents with higher health literacy levels had greater Internet and cell phone use (adequate vs low: adjusted odds ratio [AOR], 1.7 [confidence interval, 1.2–2.5]) and were more likely to use them for health management (AOR, 1.5 [confidence interval, 1.2–1.8]); those with higher health literacy levels were more likely to use the Internet for provider communication (adequate vs marginal vs low: 25.0% vs 18.0% vs 12.0%, P = .001) and health-related cell phone apps (40.6% vs 29.7% vs 16.4%, P < .001). Overall preference for using technology for provider communication was high (∼70%) and did not differ by health literacy, although Internet and cell phone apps were preferred by higher literacy parents; no differences were seen for texting.ConclusionsHealth literacy–associated disparities in parent use of Internet and cell phone technologies exist, but parents’ desire for use of these technologies for provider communication was overall high and did not differ by health literacy.
Abstract: Publication date: January–February 2020Source: Academic Pediatrics, Volume 20, Issue 1Author(s): Dorene F. Balmer, Rachel J. Gottlieb-Smith, Patricia M. Hobday, Michele Long, Carol Carraccio, James F. Bale, J Lindsey Lane, the EPAC Study GroupAbstractObjectiveResearch on how medical students choose a career in pediatrics is either dated or conflated with primary care career choice. Capitalizing on student participation in an innovative, time-variable, competency based pathway program, Education in Pediatrics Across the Continuum (EPAC), the authors explored the process of career decision-making in students at 5 medical schools (including 4 EPAC sites) who begin medical school with an interest in pediatrics.MethodsIndividual, semistructured interviews were conducted with students in 5 groups: Group 1: accepted into EPAC, n = 8; Group 2: accepted into EPAC, opted-out, n = 4; Group 3 applied to EPAC, not accepted, pursued pediatrics, n = 4; Group 4: applied to EPAC, not accepted, did not pursue pediatrics, n = 3; Group 5: pursued pediatrics at a non-EPAC site, n = 6. Data collection and analysis occurred iteratively, with inductive coding of data revealing patterns in data explored in subsequent interviews and refined in the final analysis.ResultsAll students described intrinsic guiding principles, that is, “doing what you love,” that attracted them to pediatrics. They described extrinsic, phase-specific experiences before medical school, before clerkship, and in clerkship that shaped their perceptions of a career in pediatrics and shed light on collective values of different specialties. Student's assessment of how their guiding principles aligned with the collective values of pediatrics, which students encountered in the clerkship phase, was a key to making career decisions.ConclusionsIntrinsic and extrinsic factors do not act alone but interact in clerkships, and influence career choice of students who enter medical school with an interest in pediatrics.
Abstract: Publication date: January–February 2020Source: Academic Pediatrics, Volume 20, Issue 1Author(s): Kelsey A. Miller, Beatriz Collada, Destiny Tolliver, Zeena Audi, Amy Cohen, Catherine Michelson, Lori R. NewmanAbstractBackgroundConsensus about behaviors that define effective supervision by residents of more junior trainees on pediatric inpatient rounds is lacking.ObjectiveUse modified Delphi method to develop a checklist of essential supervisory behaviors pediatric residents demonstrate while leading inpatient, non-ICU, nonspecialty teaching rounds and pilot the checklist.Design/MethodsOne hundred and forty-one initial candidate behaviors were identified through literature review and narrowed by local stakeholders. Forty-one behaviors were submitted to national experts identified through purposive sampling to be refined using the modified Delphi method. Participants indicated agreement with behaviors’ inclusion in the checklist and whether any were nonobservable. Measures of central tendency and dispersion were used to identify consensus with a behavior's inclusion in the next cycle. A criterion was eliminated if>25% of experts felt it was not observable. Cycles continued until consensus was reached on ≤20 behaviors. The resulting checklist was piloted at 2 hospitals.ResultsAfter 2 modified Delphi cycles, consensus was obtained on 18 behaviors for inclusion in the final checklist. These were spread across 3 subcategories: teaching, leadership, and patient safety. In the pilot, the checklist of behaviors discriminated between residents with differing levels of competency in supervising trainees on inpatient rounds. For residents who had the checklist completed by 2 faculties, there was 75% agreement in behaviors observed.Conclusion(s)Based on literature review, local stakeholder input, and consensus of national experts through the modified Delphi method, we created and piloted a checklist of observable behaviors characteristic of effective clinical supervision by pediatric residents leading trainee teams on inpatient, non-ICU, nonspecialty rounds.
Abstract: Publication date: January–February 2020Source: Academic Pediatrics, Volume 20, Issue 1Author(s): Amy Trowbridge, Tara Bamat, Heather Griffis, Eric McConathey, Chris Feudtner, Jennifer K. WalterAbstractObjectivePediatric residents are expected to be competent in end-of-life (EOL) care. We aimed to quantify pediatric resident exposure to patient deaths, and the context of these exposures.MethodsRetrospective chart review of all deceased patients at one children's hospital over 3 years collected patient demographics, time, and location of death. Mode of death was determined after chart review. Each death was cross-referenced with pediatric resident call schedules to determine residents involved within 48 hours of death. Descriptive statistics are presented.ResultsOf 579 patients who died during the study period, 46% had resident involvement. Most deaths occurred in the NICU (30% of all deaths); however, resident exposure to EOL care most commonly occurred in the PICU (52% of resident exposures) and were after withdrawals of life-sustaining therapy (41%), followed by nonescalation (31%) and failed resuscitation (15%). During their postgraduate year (PGY)-1,
Abstract: Publication date: January–February 2020Source: Academic Pediatrics, Volume 20, Issue 1Author(s): Sean M. Frey, Nicolas P.N. Goldstein, Maria Fagnano, Reynaldo S. Tajon, Jill S. HaltermanAbstractObjectiveIt is unclear whether research participation effects contribute to an improvement in asthma symptoms during clinical trials in the absence of any active intervention. We examined the impact of additional follow-up surveys on caregiver-reported symptoms among control subjects in a series of randomized controlled asthma trials.MethodsWe analyzed baseline and follow-up data for children (3–10 years) with poorly controlled persistent asthma that participated as control subjects in 1 of 3 randomized trials of urban school-based asthma care (study duration: 7–10 months). We compared mean symptom-free days (SFD) per 2 weeks between baseline and final follow-up; performed bivariate regressions to explore associations between demographics and changes in SFD; and performed multivariate random-effects generalized least square regression to examine the relationship between number of follow-ups beyond baseline (range: 1–10) and changes in SFD over time.ResultsFive hundred and sixteen children were enrolled as controls across the 3 trials (mean age 7.5 years, 61% Black, 28% Hispanic, 81% Medicaid). Mean SFDs increased significantly from baseline to final follow-up (7.8–11.4 days, P < .001). In adjusted analyses, significant improvements in SFD were observed with all follow-up contacts in comparison with baseline. Symptom improvement showed a dose-response relationship with the number of follow-up assessments completed (1, 2–3, 4–5, and 6–10 assessments).ConclusionsChildren with uncontrolled asthma who participate as controls in clinical trials experience a significant increase in SFD with additional follow-up assessments. This improvement should be considered when designing/analyzing asthma interventions, and may help guide clinical outreach efforts for underserved children with persistent asthma.
Abstract: Publication date: January–February 2020Source: Academic Pediatrics, Volume 20, Issue 1Author(s): Staci R. Eisenberg, Elissa Jelalian, Michael Farrow, Sheryl J. Kopel, Nico Vehse, Patricia Mitchell, Shira Dunsiger, Daphne Koinis-MitchellAbstractBackgroundGiven the high prevalence of asthma and obesity in minority children, there is a need to identify targets for intervention to decrease the impact of these conditions on children's functioning in this high-risk group.ObjectiveTo examine in urban children with persistent asthma, 1) differences in asthma indicators (eg, FEV1% predicted) by weight status, and by ethnic group/weight status, 2) caregivers’ fears about their child's asthma by weight status, and by ethnic group/weight status, and 3) the proportion of children who qualified for exercise-induced bronchospasm (EIB) via exercise challenge test among those whose caregivers endorse exercise as a trigger for asthma.MethodsIn this sample of urban children (aged 7–9; N = 147), subjective measures included child/caregiver daily report of asthma symptoms and caregiver fears about their child's asthma. Objective lung function was measured twice daily via handheld spirometer and EIB was confirmed via exercise challenge test.ResultsIn the overall sample, a greater proportion of normal-weight children reported asthma symptoms compared to overweight/obese children. Caregiver fears about asthma were more prevalent among Latino caregivers. Non-Latino White children whose caregivers were afraid their child may die when having asthma reported more days with asthma symptoms. Very few children had confirmed EIB compared to the proportion of caregivers who endorsed exercise as a dangerous trigger for asthma.ConclusionsCaregiver fear about asthma and misperceptions of exercise as a dangerous trigger for asthma should be addressed during health care visits with families of children with asthma and interventions including urban children with asthma.
Abstract: Publication date: January–February 2020Source: Academic Pediatrics, Volume 20, Issue 1Author(s): Kristine A. Campbell, Amyanne Wuthrich, Chuck NorlinAbstractObjectiveA child protective services (CPS) investigation for maltreatment signals risk for childhood toxic stress and poor health outcomes. Despite this, communication between child welfare and health care professionals is rare. We present a qualitative exploration of experiences with, barriers to, and hopes for cross-sector collaboration for children with suspected maltreatment.MethodsWe conducted focus groups with child welfare and health care professionals participating in a cross-sector learning collaborative to improve care for children at high risk for toxic stress. Participants were asked to describe 2 phenomena: identifying and responding to childhood adversities in their professional settings and cross-sector collaboration in cases of suspected maltreatment. Analysis included an iterative process of reading, coding and comparing themes across groups.ResultsHealth care professionals shared positive experiences in screening for social risks in clinic, while child welfare professionals expressed mixed attitudes toward social risk screening during CPS investigations. Consistent with prior research, health care professionals reported limited communication with CPS caseworkers about patients but suggested that relationships with child welfare professionals might reduce these barriers. Child welfare professionals described the poor quality of information provided in referrals from medical settings. Caseworkers also recognized that improved communication could support better understanding of maltreatment concerns and sharing of outcomes of CPS investigation.ConclusionsOur project extends previously published research by describing potential benefits of child welfare and child health care collaboration in cases of suspected maltreatment. Lack of effective cross-sector communication and concerns about confidentiality present significant barriers to uptake of these collaborative practices.
Abstract: Publication date: January–February 2020Source: Academic Pediatrics, Volume 20, Issue 1Author(s): Natalie Stavas, Christine Paine, Lihai Song, Justine Shults, Joanne WoodAbstractObjectiveWe sought: 1) to examine the association between the presence of a child abuse pathway and the odds of skeletal survey performance in infants with injuries associated with high risk of abuse and 2) to determine whether pathway presence decreased disparities in skeletal survey performance.MethodsIn this retrospective study of children
Abstract: Publication date: January–February 2020Source: Academic Pediatrics, Volume 20, Issue 1Author(s): Brooke S.G. Molina, Heidi L. Kipp, Heather M. Joseph, Stacey A. Engster, Seth C. Harty, Montaya Dawkins, Rachel A. Lindstrom, Daniel J. Bauer, Srihari S. BangaloreAbstractObjectiveTo address increasing rates of stimulant misuse in college students, this study developed an evidence-based, brief clinical practice intervention for primary care providers (PCPs) to reduce stimulant medication diversion among young adults with attention-deficit/hyperactivity disorder (ADHD).MethodsCollege students (N-114; 18–25 years; 68% attending universities; 24% attending community college) treated for ADHD with a stimulant and their PCPs across six practices participated in this initial, uncontrolled study of pre- to post-intervention change. An educational workshop providing strategies aimed at reducing stimulant diversion was developed and delivered to providers and staff across all practices (50% pediatric; 50% family medicine). Patients and providers completed baseline and post intervention surveys.ResultsDiversion was relatively infrequent, 16.7% at baseline and 14.9% post-intervention, respectively. Statistically significant decreases from baseline to post-intervention were found for three diversion risk factors: (1) number of times approached to divert, (2) intent to share, sell, or trade stimulants, and (3) disclosure of stimulant use. Providers and staff reported mostly high satisfaction with the training.ConclusionsThis study provides initial evidence for a PCP-delivered intervention to reduce stimulant diversion. Research is needed on the efficacy of targeting college students directly, working with pharmacies and student health centers, and preventing misuse among teenagers.
Abstract: Publication date: January–February 2020Source: Academic Pediatrics, Volume 20, Issue 1Author(s): Kristin N. Ray, Jeremy M. KahnAbstractNearly a quarter of families of children with need of subspecialty care report difficulty accessing that care. Telehealth is a method to overcome barriers to subspecialty care. However, improving access to subspecialty care through telehealth requires granular identification of specific subspecialty barriers and recognition of the strengths and limitations of each telehealth strategy for addressing identified barriers. Focusing on each sequential step in subspecialty referrals and potential associated barriers, we summarize specific telehealth and technology-enabled strategies to improve access to subspecialty care, including electronic consultations, live interactive telemedicine, store-and-forward telemedicine, tele-mentoring, patient portals, and remote patient monitoring. Intentionally selecting telehealth strategies to target specific subspecialty referral barriers may avoid risks from misapplication of telehealth, may more clearly elevate equitable access as an essential goal within telehealth initiatives, and may also lead to synergistic use of strategies that overcome sequential barriers.
Abstract: Publication date: January–February 2020Source: Academic Pediatrics, Volume 20, Issue 1Author(s): Suzanne Reed, Ariel Frey-Vogel, Mackenzie FrostAbstractObjectiveTo determine current practices for communication skills curriculum and assessment in pediatric residency programs and to identify programs’ greatest needs regarding communication curricula and assessment.MethodsWe surveyed pediatric residency program directors about their programs’ approach to teaching and assessing residents’ communication skills and how satisfied they were with their curricula and assessment of competence. Respondents were asked about their programs’ greatest needs for teaching and assessing communication skills.ResultsResponse rate was 41% (82/202). Most programs did teach communication skills to residents; only 14% provided no formal training. Programs identified various 1) educational formats for teaching communication skills, 2) curricular content, and 3) assessment methods for determining competence. Many programs were less than satisfied with their curriculum and the accuracy of their assessments. The greatest programmatic need regarding curricula was time, while the greatest need for assessment was a tool.ConclusionsWhile teaching and assessment of communication skills is common in pediatric residency programs, it is inconsistent and variable, and many programs are not satisfied with their current communication training. There is need for development of and access to appropriate and useful curricula as well as a practical tool for assessment which has been evaluated for validity evidence.
Abstract: Publication date: January–February 2020Source: Academic Pediatrics, Volume 20, Issue 1Author(s): Jean L. Raphael, Lee S. Beers, James M. Perrin, Arvin Garg
Abstract: Publication date: January–February 2020Source: Academic Pediatrics, Volume 20, Issue 1Author(s): Auden C. McClure, Joy Gabrielli, Samantha Cukier, Kristina M. Jackson, Zoe L.B. Brennan, Susanne E. TanskiAbstractObjectiveEvidence suggests that adolescents are exposed to alcohol marketing in digital media. We aimed to assess recall of Internet alcohol marketing and its association with underage drinking.MethodsNew England adolescents age 12 to 17 years (N = 202) were recruited from a pediatric clinic. Subjects completed an online survey assessing: 1) general simple recall of Internet alcohol marketing and 2) image-prompted recall of specific Internet alcohol marketing channels (display ads, commercials, brand websites, and brand social media pages). Cross-sectional associations between recall (simple and image-prompted) and ever-drinking were each assessed in regression analysis adjusting for age, gender, race, parent education, ever-smoking, media use, sensation-seeking, peer/parent drinking, parent monitoring/responsiveness, and parent Internet monitoring.ResultsIn this sample (Mage = 14.5 years; 55% female; 89% white; high parent education), 20% reported ever-drinking and 87% recalled Internet alcohol marketing. Of the latter, 67% recalled display ads, 67% Internet commercials, 5% websites, and 5% social media pages. In logistic regression, higher simple Internet alcohol advertising recall was independently associated with higher odds of ever-drinking for simple (adjusted odds ratio: 2.66 [1.04,6.83]) but not for image-prompted recall.ConclusionsDespite controlling for potential confounders, simple recall of Internet alcohol marketing was significantly associated with underage drinking whereas image-prompted recall was significant only in bivariate analysis, likely due to small sample and a more limited range of specific channels assessed than those accessed by adolescents. Further longitudinal studies using image-prompted recall and capturing a broader range of internet platforms could be used to better understand adolescent engagement with alcohol marketing and guide policy and prevention efforts.
Abstract: Publication date: January–February 2020Source: Academic Pediatrics, Volume 20, Issue 1Author(s): Kathleen H. Timme, Janet P. Hafler, John Encandela, Eve R. Colson, Stuart A. Weinzimer, Andrea Asnes, Julie R. Gaither, Julie Guest, Tanya D. Murtha, Pnina WeissWhat's NewFellows as Medical Educators (FAME) is the first department-wide curriculum for pediatric subspecialty fellows that includes experiential learning activities, faculty and peer coaching and self-reflection through journaling. Fellows who participated in the pilot curriculum demonstrated an improvement in objective teaching skills and self-efficacy.
Abstract: Publication date: January–February 2020Source: Academic Pediatrics, Volume 20, Issue 1Author(s): Sarah Webber, Stephanie M. Lauden, Philip R. Fischer, Larissa Beyerlein, Charles Schubert, Midwest Consortium of Global Child Health Educators S-PACK WorkgroupMidwest Consortium of Global Child Health Educators S-PACK Workgroup: Denise Bothe, University Hospitals Rainbow Babies & Children's Hospital; Sabrina Butteris, University of Wisconsin School of Medicine and Public Health; Carmen Cobb, Medical College of Wisconsin; Emilia Connolly, Cincinnati Children's Hospital Medical Center; James Conway, University of Wisconsin School of Medicine and Public Health; Elizabeth Groothuis; Lurie Children's; Laura Houser, University of Wisconsin School of Medicine and Public Health; Andrea Jones, University of Wisconsin School of Medicine and Public Health; Caitlin Kaeppler, Medical College of Wisconsin; Kathleen Miller University of Minnesota; Ifelayo Ojo, University of Minnesota; Jane Rosenman, Mayo Clinic; Amy Rule. Cincinnati Children's Hospital Medical Center; Chelsea Schaack, University of Wisconsin School of Medicine and Public Health; Tasa Seibert, University Hospitals Rainbow Babies & Children's Hospital; Tina Slusher, University of Minnesota; Kristin Van Genderen, Lurie Children's; Michael B. Pitt, University of Minnesota; Nicole E. St Clair, University of Wisconsin School of Medicine and Public Health; Stephen Warrick, Cincinnati Children's Hospital Medical Center; Bethany Weinert, Medical College of Wisconsin; Jameel Winter, University of Minnesota.
Abstract: Publication date: Available online 30 December 2019Source: Academic PediatricsAuthor(s): John D. Melville, Daniel M. LindbergBackground and ObjectiveChild abuse pediatricians (CAPs) are often asked to determine the likelihood that a particular child has been sexually abused. These determinations affect medical and legal interventions, and are important for multi-site research. No widely accepted scale is available to communicate perceived sexual abuse likelihood. In this study, we measure intra- and inter-rater reliability of a 5-point scale to communicate child sexual abuse likelihood.MethodsWe developed a 5-point scale of perceived likelihood of child sexual abuse with example cases and medical-legal language for each risk category. We then surveyed CAPs who regularly perform sexual abuse evaluations using the abstracted facts of 15 actual cases with concern for sexual abuse. A subset of participants rated the same vignettes again, one month later.ResultsOf 512 invited participants, 240 (46.7%) responded, with 145 (28.3%) indicating that they regularly perform sexual abuse evaluations, 116 initially completing all 15 vignettes, and 36 completing repeat ratings at least one month later. The scale showed consistent stepwise increase in mean perceived likelihood of abuse and intention to report for each increase in scale rating. Inter-rater agreement was substantial (Fleiss’ weighted kappa 0.64) and test-retest reliability among 36 participants was almost perfect (Cohen's kappa = 0.81).ConclusionsWe introduce a scale of perceived sexual abuse likelihood that appears to reflect CAPs’ perceptions and intention to report. This scale may be a reasonable metric for use in multi-center studies. CAPs demonstrated substantial inter- and intra-rater reliability when evaluating sexual abuse likelihood in case vignettes. While this scale may improve communication of sexual abuse likelihood among experts, its examples should not be used as a legal standard or a clinical criterion for sexual abuse diagnosis.
Abstract: Publication date: Available online 20 December 2019Source: Academic PediatricsAuthor(s): Natalie Nardone, Shonul Jain, Newton Addo, Gideon St. Helen, Peyton Jacob, Neal L. BenowitzAbstractObjectiveIn an urban adolescent population, we evaluated sources of exposure to secondhand tobacco smoke (SHS), examined differences in exposure by race/ethnicity, age and sex, and determined the relationship between exposure source(s) and the biomarkers cotinine and NNAL.MethodsParticipants were recruited from a public hospital-based outpatient clinic in San Francisco, CA, USA.ResultsOf a sample of N=298 adolescents screened, 235 were biologically confirmed to be exposed to tobacco smoke. Of those, N=16 were active smokers and N=219 were exposed to SHS; 91(39%) were heavily SHS exposed (median cotinine=0.76 ng/mL) and 128 (54%) had light SHS exposure (median cotinine=0.11ng/mL). Within those SHS exposed, the most common source of exposure was in a public area. No significant racial/ethnic differences were found, although African American adolescents were more likely to live in a home that allowed smoking. Older adolescents were more likely to be exposed across several difference sources, and females more likely to be exposed in a car and in public areas. Past 7-day exposure in the home, in a car, and current blunt use were significantly related to biomarkers of exposure.ConclusionsUrban adolescents are exposed to SHS across a variety of sources. Although exposure in a public area is most common, exposure in the home and in cars significantly influences tobacco biomarker levels. Interventions to reduce exposure would have the greatest impact in this population if they focused on reducing exposure in the home and in cars. History of blunt use is a strong determinant of tobacco exposure.
Abstract: Publication date: Available online 17 December 2019Source: Academic PediatricsAuthor(s): Erika L. Abramson, Monique M. Naifeh, Michelle D. Stevenson, Shari Clifton, Su-Ting T. Li
Abstract: Publication date: Available online 17 December 2019Source: Academic PediatricsAuthor(s): Maya I. Ragavan, Kevin N. Griffith, John D. Cowden, Jeffrey D. Colvin, Megan Bair-MerrittAbstractObjectivesIncorporating culturally-sensitive care into well-child visits may help address pediatric preventive care disparities faced by racial and ethnic minorities, families with limited English proficiency, and immigrants. We explored parents’ perspectives about the extent to which their children's pediatric care is culturally-sensitive and potential associations between culturally-sensitive care and well-child visit quality.MethodsWe conducted cross-sectional surveys with parents attending a well-child visit for a child ages 3-48 months. To measure culturally-sensitive care, we created a composite score by averaging 8 subscales from an adapted version of the Clinicians’ Cultural Sensitivity Survey. We assessed well-child visit quality through the Promoting Healthy Development Survey. Multivariate linear regression was used to understand associations between demographic characteristics and parent-reported culturally-sensitive care. We used multivariate logistic regression to examine associations between culturally-sensitive care and well-child visit quality.Results212 parents (71% of those approached) completed the survey. Parents born abroad, compared with those born in the US, reported significantly higher culturally-sensitive care scores (+0.21; CI: 0.004, 0.43). Haitian parents reported significantly lower culturally-sensitive care scores compared with non-Hispanic white parents (-0.49; CI: -0.89, -0.09). Parent- reported culturally-sensitive care was significantly associated with higher odds of well-child visit quality including receipt of anticipatory guidance (aOR: 2.68; CI: 1.62, 4.62) and overall well-child visit quality (aOR: 2.54; CI: 1.59, 4.22).ConclusionConsistent with prior research of adult patients, this study demonstrates an association between parent-reported culturally-sensitive care and well-child visit quality. Future research should explore best practices to integrating culturally-sensitive care in pediatric preventive healthcare settings.
Abstract: Publication date: Available online 16 December 2019Source: Academic PediatricsAuthor(s): Christopher H. Kim, Kevin A. Gee, Robert S. ByrdABSTRACTBACKGROUND AND OBJECTIVESPrevious studies of asthma-related school absenteeism have reported absenteeism dichotomously (i.e., any school days missed versus none). However, schools use higher thresholds to identify and intervene for students at risk of chronic absenteeism (18 days or ≥10% schoolyear missed), which is associated with negative health and educational outcomes. We sought to identify factors associated with excessive absenteeism (EA) due to asthma (≥9 days missed), a threshold based on a convention defined by Attendance Works for absenteeism risk, and is linked to decreased academic performance and increased risk of chronic absenteeism.METHODSWe examined responses for asthma-related absenteeism from the 2011-2014 California Health Interview Survey for children ages 5-11. Multivariate logistic regression modeled odds ratios of EA for demographic, healthcare utilization, and asthma-related factors. Sensitivity analysis was performed modeling a ≥1 threshold (any absenteeism).RESULTS715 respondents represent an estimated 314,200 California schoolchildren with asthma. 50.3% of students missed ≥1 day, and 11.7% missed ≥9 days of school due to asthma. Odds of EA were significantly higher for younger children, lower-income families, and rural students, but not significant for any absenteeism. Indicators of greater asthma severity and poorer control were significantly associated with both EA and any absenteeism.CONCLUSIONSThis study identified factors significantly associated with EA that were not significant for lower absence thresholds. This may help direct school-based asthma interventions for which limited resources must target students at higher risk of chronic absenteeism.
Abstract: Publication date: Available online 12 December 2019Source: Academic PediatricsAuthor(s): James M. Perrin, Michael C. Lu, Amy Geller, Jennifer E. DeVoe
Abstract: Publication date: Available online 11 December 2019Source: Academic PediatricsAuthor(s): Meredith O'Connor, Natalie Slopen, Laia Becares, David Burgner, David R. Williams, Naomi PriestABSTRACTObjectiveExposure to early adversity carries long term harmful consequences for children's health and development. This study aims to 1) estimate the prevalence of childhood adversity for Australian children from infancy to 10-11 years, and 2) document inequalities in the distribution of adversity according to socioeconomic position (SEP), Indigenous status, and ethnicity.MethodsAdversity was assessed every two years from 0-1 to 10-11 years in the nationally representative birth cohort of the Longitudinal Study of Australian Children (N=5,107). Adversity included legal problems; family violence; household mental illness; household substance abuse; harsh parenting; parental separation/divorce; unsafe neighborhood; family member death; and bullying (from 4-5 years). Adversities were examined individually and summed for a measure of multiple adversity (2+ adverse experiences).ResultsBy 10-11 years, 52.8% (95% CI 51.0-54.7) of children had been exposed to two or more adversities. When combined with low SEP, children from ethnic minority and from Indigenous backgrounds had four to eight times the odds of exposure to two or more adversities than children from higher SEP Anglo-Euro backgrounds, respectively (OR 4.3, 95% CI 2.8-6.6 and OR 8.1, 95% CI 4.4-14.8). Ethnic minority and Indigenous children from higher SEP backgrounds had increased odds of exposure to multiple adversity than similarly advantaged Anglo-Euro children (OR 1.8, 95% CI 1.4-2.3 and OR 2.3, 95% CI 1.3-4.3, respectively).ConclusionsAddressing early adversity is a significant opportunity to promote health over the life course, and reduce health inequalities experienced by marginalized groups of children.
Abstract: Publication date: Available online 6 December 2019Source: Academic PediatricsAuthor(s): Beth D. Harper, Waceke Nganga, Robert Armstrong, Kevin D. Forsyth, Hazen P. Ham, Julie Vincuilla, William J. Keenan, Judith S. Palfrey, Christiana M. RussAbstractObjectiveA comprehensive, well-trained pediatric workforce is needed to ensure high-quality child health interventions around the globe. Further understanding of pediatric workforce training capacity would assist planning at the global and country level. The purpose of this study was to better understand the availability and process of training programs for pediatricians and pediatric subspecialists worldwide, as well as in-country presence of subspecialists.MethodsA survey was developed and distributed by email to national pediatric leaders across the globe. The survey asked about the number of pediatric training programs, duration and logistics of training, and whether practicing pediatric subspecialists and subspecialty training programs were available in their country.ResultsWe received responses from 121 of the 166 countries contacted (73%). Of these, 108 countries reported the presence of one or more general pediatric post-graduate training programs, ranging from 1 to 500 programs per country. The number of training programs did not vary significantly by GDP but did vary by region, with the fewest in Africa (p
Abstract: Publication date: Available online 4 December 2019Source: Academic PediatricsAuthor(s): Rebecca Seltzer, Jessica C. Raisanen, Trisha da Silva, Pamela K. Donohue, Erin P. Williams, Jennifer Shepard, Renee D. BossAbstractObjectiveTo explore how medical decision-making for children with medical complexity (CMC) occurs in the context of foster care (FC).MethodsTogether with a medical FC agency, we identified 15 CMC in medical FC and recruited eligible care team members (biological and foster parents, medical FC nurses, caseworkers in medical FC/ child welfare, and pediatricians) for each child. Semi-structured interviews were conducted, and conventional content analysis was applied to transcripts.Results58 interviews were completed with 2-5 care team members/child. Serious decision-making related to surgeries and medical technology was common. Themes regarding medical decision-making for CMC in FC emerged: 1) Protocol: decision-making authority is dictated by court order and seriousness of decision, 2) Process: decision-making is dispersed among many team members, 3) Representing the child's interests: the majority of respondents stated that the foster parent represents the child's best interests, while the child welfare agency should have legal decision-making authority, and 4) Perceived barriers: serious medical decision-making authority is often given to individuals who spend little time with the child.ConclusionMedical decisions for CMC can have uncertain risk/benefit ratios. For CMC in FC, many individuals have roles in these nuanced decisions; those with ultimate decision-making authority may have minimal interaction with the child. Pediatricians can assist by clarifying who has legal decision-making authority, facilitating team communication to promote truly informed consent, and serving as a resource to decision-makers. Further research should explore how to adapt the traditional model of shared decision-making to meet the needs of this population.
Abstract: Publication date: Available online 4 December 2019Source: Academic PediatricsAuthor(s): Mark Connelly, Jennifer BickelAbstractObjectiveTo evaluate whether primary care provider (PCP) access to an online decision support tool is associated with a change in evidence-based primary care medical management of pediatric migraine.MethodsIn this prospective observational study, PCPs serving a target community were educated on the availability and use of an online clinical decision support tool that was developed to inform treatment of pediatric migraine. For 9 months before and after implementation of the decision tool, the proportions of children with migraine prescribed evidence-based and contraindicated medications by PCPs in the target region were monitored using electronic medical record query and statistically compared to these same proportions for patients in surrounding (control) regions. Rates of visits to the emergency department for migraine also were tracked pre- and post-implementation as an indirect measure of impact of the decision tool. Provider usage of the decision tool was monitored and summarized using web analytics.ResultsApproximately half (56%) of target region PCPs used the online tool at least once over the project period. Relative to control regions and baseline trends, the proportion of children residing in the target region who were prescribed recommended abortive and preventive medications for treating migraine was statistically significantly higher following implementation of the tool. No significant changes to frequency of emergency care visits for migraine by youth in the target region were observed.ConclusionsAvailability to PCPs of an online decision support tool for pediatric migraine is associated with a modest change in some aspects of evidence-based medical care.
Abstract: Publication date: Available online 27 November 2019Source: Academic PediatricsAuthor(s): Taryn W. Morrissey, Daniel P. MillerAbstractObjectiveTo examine the impact of increased Supplemental Nutrition Assistance Program (SNAP) benefit levels as provided by the American Recovery and Reinvestment Act (ARRA) beginning in April 2009 on the health care use and health care needs of participating children.MethodsDifference-in-differences analysis compared changes in health care use and needs between children in SNAP-eligible households and those in low-income but SNAP-ineligible households before and after ARRA's implementation, using data from the nationally representative National Health Interview Survey (NHIS). Survey respondents reported on children's health care use and outstanding health care needs. Our sample included approximately 38,500 children in low-income households who completed the core NHIS, and a subsample of 15,000 sample children who reported additional information.ResultsApproximately 6% of low-income children had delayed care due to cost. 3% and 4% of children in low-income households and low-income single-parent households, respectively, reported needing health care but not being able to afford it. The increase in SNAP benefits was associated with a 65% reduction in outstanding medication needs due to affordability among SNAP-eligible children, relative to low-income, ineligible children. There was also a reduction in the likelihood that children had seen a general doctor in the last year. Among children in single-parent households, SNAP benefit expansion was associated with a 3.2 percentage point decrease in needing but not being able to afford health care.ConclusionsFindings suggest that even a small increase in household resources leads to reductions in outstanding health care needs due to affordability, particularly among children.
Abstract: Publication date: Available online 27 November 2019Source: Academic PediatricsAuthor(s): Geena Zhou, LR Thompson, Frances Barry, J Flores-Vazquez, Chloe Holifield, B Ravandi, TP Chang, JS Halterman, PG Szilagyi, SO OkeloAbstractObjectiveWhile a number asthma questionnaires have been validated, most have not been used in an emergency department (ED) setting, nor evaluated patient feedback or clinical benefit. We sought to evaluate parent feedback on an asthma questionnaire used in an ED setting.MethodsWe recruited parents of children 2-17 years old presenting to a tertiary pediatric ED for asthma care. Parents first completed, then rated the Pediatric Asthma Control and Communication Instrument (PACCI-ED).Results174 parents (84%) completed surveys. Approximately two-thirds were Latinx, and 82% completed high school. 93% of children had uncontrolled asthma. Parents endorsed the PACCI-ED: as easy to answer (94%); useful in understanding their child's asthma (83%); used the right words to describe their child's condition (95%); and would help the ED physician (93%) and primary care provider (PCP) (89%) better understand their child's asthma. 11% reported that the PACCI-ED interfered with ED care. Parents with lower health literacy were more likely to agree the PACCI-ED asked more complete questions about their child's asthma than the ED physician (64% vs. 45%, p=0.02). Parents of children with uncontrolled asthma were more likely to agree that the PACCI-ED should become part of regular ED care (88% vs. 62%, p=0.02). Parents were more likely to agree that the PACCI-ED would help their PCP understand their child's asthma if they had a lower income (92% vs. 50%, p
Abstract: Publication date: Available online 26 November 2019Source: Academic PediatricsAuthor(s): Nora Bismar, Sarah E. Barlow, Tammy M. Brady, Christy B. TurerABSTRACTObjectiveDespite recognition that hypertension is associated with childhood obesity, data suggest that high blood pressure (BP) is infrequently diagnosed in children. This study sought to examine provider communication with overweight school-age children regarding BP measurements that were high at well-child visits.MethodsCross-sectional mixed-methods analysis of audio-recorded communication from well-child visits with overweight 6-12-year-olds. Data from the subset of children with elevated BPs were used for this study. Three BP measures obtained at the audio-recorded visit were averaged, paired with historical BPs stored in the health record, and compared to contemporary/Fourth-Report thresholds to determine if children had elevated/hypertensive BPs only at the audio-recorded visit or met hypertension-diagnostic criteria (hypertension-level BP ≥3 separate visits). Two reviewers used visit transcripts to categorize communication about BP as "absent," "unclear," or "direct." Provider use of a billing diagnosis for elevated BP/hypertension in visits with direct-BP-communication was explored.ResultsIn 36 of 126 (29%) visit-audio-recordings, children had elevated/hypertensive BPs. Thirty-three of the 36 eligible (92%) had intelligible audio-recordings. Of these, nine (25%) had overweight and 24 (75%), obesity. Seventeen (52%) had elevated BPs, and 16 (48%), hypertensive BPs. Ten (30%) met criteria for hypertension diagnosis. BP communication was absent in 20 visits (61%), unclear in eight (24%), and direct in five visits (15%). Billing diagnoses for elevated BP/hypertension were entered at four of five (80%) visits with direct-BP communication.ConclusionsMost overweight children with elevated BPs do not receive communication that BP is high at well-child visits. Relevant billing diagnoses may indicate direct-BP communication.
Abstract: Publication date: Available online 26 November 2019Source: Academic PediatricsAuthor(s): Margeaux A Naughton, Shaili Rajput, Andrew N Hashikawa, Charles A Mouch, Jessica S Roche, Jason E Goldstick, Rebecca M Cunningham, Patrick M Carter
Abstract: Publication date: Available online 26 November 2019Source: Academic PediatricsAuthor(s): Katherine Abowd Johnson, Jessica Jones-Smith, Frank C. Curriero, Lawrence J. Cheskin, Sara E. Benjamin-Neelon, Jamie Perin, Mariana Rincon Caicedo, Rachel L.J. ThorntonABSTRACTBackgroundHigh obesity rates among young black and Hispanic children place them at a higher risk for adult obesity and its co-morbidities. Neighborhoods with predominately racial and ethnic minority residents have fewer healthful food options, which may contribute to obesity disparities. Yet few studies have assessed the relationship between neighborhood food environments and obesity in this population.MethodsElectronic health records from two pediatric primary care clinics serving predominately low-income, black and Hispanic children were used to create a cohort of 3,724 2-5 year-olds, encompassing 7,256 visits from 2007 to 2012 (mean 1.9 visits per patient, range: 1-5 visits per child). Longitudinal regression was used to model the association of mean body mass index z-score (BMI-z) over time and 3 measures of the neighborhood food environment: healthful food availability, availability of stores accepting the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) benefits, and fast food availability.ResultsCompared to peers in neighborhoods with no or few stores accepting WIC, children in neighborhoods with many WIC stores had higher BMI-z at age 2 years (average difference of 0.272 95% CI 0.041 – 0.503; p=0.021). No relationship was found for healthful food or fast food availability. Although children in neighborhoods with low fast food availability did not have statistically significantly different BMI-z at age 2 as compared to children in areas with high fast food availability, they did have a statistically significantly higher change in average BMI-z over time (0.006 per month, 0.000 – 0.012, p=0.024).ConclusionsAccess to WIC stores was associated with lower obesity rates and more healthful average BMI-z over time and represents a potentially important neighborhood food environment characteristic influencing racial/ethnic disparities in childhood obesity among young black and Hispanic children. More studies are needed to assess what aspects of WIC stores may underlie the observed association.
Abstract: Publication date: Available online 21 November 2019Source: Academic PediatricsAuthor(s): James P. Marcin, Patrick S. Romano, Parul Dayal, Madan Dharmar, James M. Chamberlain, Nanette Dudley, Charles G. Macias, Lise E. Nigrovic, Elizabeth C. Powell, Alexander J. Rogers, Meridith Sonnett, Leah Tzimenatos, Elizabeth R. Alpern, Rebecca Andrews-Dickert, Dominic A. Borgialli, Erika Sidney, T. Charles Casper, Nathan Kuppermann, for the Pediatric Emergency Care Applied Research NetworkABSTRACTObjectiveDifferences in the quality of emergency department (ED) care are often attributed to non-clinical factors such as variations in the structure, systems and processes of care. Few studies have examined these associations among children. We aimed to determine whether process measures of quality of care delivered to patients receiving care in children's hospital EDs were associated with physician-level or hospital-level factors.MethodsWe included children (
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 DíazAbstractObjectiveTo 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 PitettiAbstractObjectiveTo 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 LionAbstractBackground 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. FrankowskiAbstractObjectiveDepression 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. ShahAbstractObjectiveTo 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 KrankerAbstractObjectiveNearly 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. RhodesAbstractObjectiveTo 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 SchillingAbstractObjectiveDescribe 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. LiAbstractMentorship 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 MorenoAbstractObjective1) 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 22 August 2019Source: Academic PediatricsAuthor(s): Irene Kocolas, Wendy Hobson, Ameet Daftary, Marta King, James F. Bale
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. BeckAbstractObjectiveThe 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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