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Publisher: Elsevier   (Total: 3161 journals)

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Showing 1 - 200 of 3161 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 9)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 33, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 23, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 94, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 34, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 411, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 10, SJR: 0.18, CiteScore: 1)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.128, CiteScore: 0)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 250, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 27, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 6, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 14, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 16, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 8, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 9, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 147, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 12, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 31, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 8, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 3)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 9)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 24)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 28, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 44, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 56, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 16, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 8, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 12, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 23)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 17, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 10)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 9)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 397, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 10, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 31, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 47, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 341, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 11, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 446, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 17, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 32, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 44, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 2)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 57, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 9)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 50, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 54, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 45, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 34, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 28, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 34, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 46)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 205, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 62, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 38, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 62, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 17, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 43, SJR: 1.512, CiteScore: 5)
Analytical Biochemistry     Hybrid Journal   (Followers: 177, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 11, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 190, SJR: 1.58, CiteScore: 3)

        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Journal Cover
Ambulatory Pediatrics
Number of Followers: 6  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1530-1567 - ISSN (Online) 1539-4409
Published by Elsevier Homepage  [3161 journals]
  • Vision for Our Journal
    • Authors: Peter G. Szilagyi
      Pages: 343 - 344
      Abstract: Publication date: November–December 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 6
      Author(s): Peter G. Szilagyi


      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.acap.2008.10.002
       
  • The Making and the Being of an Academic (Ambulatory) Pediatrician
    • Authors: John M. Leventhal
      Pages: 345 - 348
      Abstract: Publication date: November–December 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 6
      Author(s): John M. Leventhal


      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.07.008
       
  • A Tribute to Julius B. Richmond, MD
    • Authors: Jonathan P. Winickoff; James M. Perrin
      Pages: 349 - 350
      Abstract: Publication date: November–December 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 6
      Author(s): Jonathan P. Winickoff, James M. Perrin


      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.acap.2008.10.003
       
  • Use of a Web-Based Game to Teach Pediatric Content to Medical Students
    • Authors: Katherine A. Sward; Stephanie Richardson; Jeremy Kendrick; Chris Maloney
      Pages: 354 - 359
      Abstract: Publication date: November–December 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 6
      Author(s): Katherine A. Sward, Stephanie Richardson, Jeremy Kendrick, Chris Maloney
      Objective The aim of this study was to assess, using a Web-based format, third-year medical students’ pediatric knowledge and perceptions of game playing with faculty facilitation compared with self-study computerized flash cards. Methods This study used a repeated-measures experimental design with random assignment to a game group or self-study group. Pediatric knowledge was tested using multiple choice exams at baseline, week 6 of the clerkship following a 4-week intervention, and 6 weeks later. Perceptions about game playing and self-study were evaluated using a questionnaire at week 6. Results The groups did not differ on content mastery, perceptions about content, or time involved in game playing or self-study. Perceptions about game playing versus self-study as a pedagogical method appeared to favor game playing in understanding content (P < .001), perceived help with learning (P < .05), and enjoyment of learning (P < .008). An important difference was increased game group willingness to continue participating in the intervention. Conclusions Games can be an enjoyable and motivating method for learning pediatric content, enhanced by group interactions, competition, and fun. Computerized, Web-based tools can facilitate access to educational resources and are feasible to apply as an adjunct to teaching clinical medicine.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.07.007
       
  • Why Do Parents Bring Children to the Emergency Department for Nonurgent
           Conditions' A Qualitative Study
    • Authors: Anne Berry; David Brousseau; Jane M. Brotanek; Sandra Tomany-Korman; Glenn Flores
      Pages: 360 - 367
      Abstract: Publication date: November–December 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 6
      Author(s): Anne Berry, David Brousseau, Jane M. Brotanek, Sandra Tomany-Korman, Glenn Flores
      Objective Nonurgent conditions account for 58% to 82% of pediatric emergency department (ED) visits, but only 1 preliminary qualitative study has examined reasons why parents bring children to the ED for nonurgent care. The aim of this study was to identify parents’ reasons for choosing the ED over their primary care provider (PCP) for nonurgent pediatric care. Methods Audiotaped ethnographic interviews in English and Spanish were conducted of parents of children presenting for nonurgent care on weekdays from 8 AM to 4 PM at a children's hospital ED over a 4-week period. Results For the 31 families interviewed, the mean parental age was 28 years, and mean child age, 3 years. Reasons cited by caregivers for choosing the ED over their child's PCP were long appointment waits, dissatisfaction with the PCP, communication problems (accents and unhelpful staff at PCP), health care provider referral, efficiency, ED resources, convenience, quality of care, and ED expertise with children. Some parents said they would like education on the urgency of pediatric problems. Conclusions Parents bring their children to the ED for nonurgent care because of problems with their PCP, PCP referral, and perceived advantages to ED care. Although parents report that education on the urgency of pediatric conditions would be helpful, substantial reduction of pediatric nonurgent ED use may require improvements in families’ PCP office access, efficiency, experiences, and appointment scheduling.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.07.001
       
  • Discussion of Maternal Stress During Pediatric Primary Care Visits
    • Authors: Jonathan D. Brown; Lawrence S. Wissow
      Pages: 368 - 374
      Abstract: Publication date: November–December 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 6
      Author(s): Jonathan D. Brown, Lawrence S. Wissow
      Objective To determine whether the discussion of maternal stress in pediatric primary care is associated with the mother's satisfaction with her child's provider. Methods Children ages 5–16 and their mothers (N = 747) were recruited from the waiting rooms of 13 geographically diverse pediatric primary care sites from 2002 to 2005. Directly after the visit, the mother reported her satisfaction with the attention that the provider gave to her and her child's problems and also reported whether the provider understood the problems that she wanted to discuss during the visit. The mother also reported whether the visit included discussion of her “stresses and strains” and the discussion of child mood or behavior. Results Thirty-five percent of mothers discussed their stresses and strains with their child's provider. The mother was more likely to be “completely” satisfied with the attention that she and her child received from the provider (odds ratio [OR] 2.43, 95% confidence interval [95% CI], 1.43–4.11) and to agree “strongly” that the provider understood the problems she wanted to discuss (OR 1.95, 95% CI, 1.32–2.93) when the visit included the discussion of maternal stress after controlling for the reason for the visit, number of previous visits, provider specialty (family practice or pediatrics), youth mental health status, whether the visit included the discussion of child mood or behavior, and maternal distress measured with a standard screening tool. Conclusions The mother was more satisfied with her child's primary care provider when maternal stress was discussed during the visit. This finding should somewhat alleviate fears that mothers will react negatively to discussion of their stress during pediatric visits.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.08.004
       
  • Feasibility of Using a Tablet Computer Survey for Parental Assessment of
           Resident Communication Skills
    • Authors: John Patrick T. Co; Hodon Mohamed; Mary Louise Kelleher; Susan Edgman-Levitan; James M. Perrin
      Pages: 375 - 378
      Abstract: Publication date: November–December 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 6
      Author(s): John Patrick T. Co, Hodon Mohamed, Mary Louise Kelleher, Susan Edgman-Levitan, James M. Perrin
      Background The Accreditation Council for Graduate Medical Education recommends using patient surveys for assessing resident competency in interpersonal and communication skills. Despite the existence of several validated patient surveys for communication assessment, no system has been developed for their sustained use in resident assessment. Methods We developed and pilot tested a system to collect surveys from parents of hospitalized children on the day of discharge. We used a 28-item, tablet computer–based survey that measures individual provider and team communication. The computer displays resident photographs to ensure accurate identification and offers the survey in multiple languages. We assessed parental acceptance of the system by analyzing response rate, as well as reasons for response and nonresponse. Results Of the 98 eligible parents that were approached, 62 (63%) completed the survey. Only 2 (2%) of the eligible families refused to participate, and only 5 (5%) refused participation because of the survey not being available in a language they were familiar with. Conclusions Use of a tablet computer parent survey for resident assessment is feasible, with response rates comparable to those of mailed surveys. The low rate of parental refusal indicates our system could be used to attain sufficient numbers of survey responses to help validly measure resident communication skills.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.07.002
       
  • Comparison of Severe Injuries Between Powered and Nonpowered Scooters
           Among Children Aged 2 to 12 in the United States
    • Authors: Russell Griffin; Chris T. Parks; Loring W. Rue; Gerald McGwin
      Pages: 379 - 382
      Abstract: Publication date: November–December 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 6
      Author(s): Russell Griffin, Chris T. Parks, Loring W. Rue, Gerald McGwin
      Objective A substantial increase in the number of nonpowered and powered scooter injuries since 2000 has occurred in the United States. Because of differences in weight and operational speed between scooter types, it is possible that the type and severity of injuries may differ. The purpose of the current study is to compare demographics and injury characteristics between scooter types, focusing on differences in injury severity. Methods The 2002–2006 National Electronic Injury Surveillance System provided information about individuals aged 2 to 12 years who sought treatment at an emergency department due to powered or nonpowered scooter–related injury in the United States. We defined severe injury as an injury resulting in the hospitalization, staying in the hospital for observation, or transfer of the injured patient. Logistic regression analysis, adjusted for sex, age, and geographic location in which the injury occurred, estimated odds ratios (ORs) and 95% confidence intervals (CI) for the association between scooter type and severe injury. Results There were an estimated 15 752 and 185 007 injuries related to powered and nonpowered scooters, respectively. Powered scooter–related injuries were over 3 times as likely to be severe (OR 3.57, 95% CI, 1.91–6.65). This association was more prominent among females (OR 5.80, 95% CI, 2.02–16.63) than males (OR 2.90, 95% CI, 1.44–5.82). Conclusion Data suggest that, compared with nonpowered scooter–related injuries, powered scooter–related injuries are more often severe. This association is stronger among females than males. The higher risk of severe injury due to powered scooter use could result from increases in concussions and hip and lower extremity injuries.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.08.002
       
  • Assisting Primary Care Practices in Using Office Systems to Promote Early
           Childhood Development
    • Authors: Peter A. Margolis; Kathryn Taaffe McLearn; Marian F. Earls; Paula Duncan; Annette Rexroad; Colleen Peck Reuland; Sandra Fuller; Kimberly Paul; Brian Neelon; Tara E. Bristol; Pamela J. Schoettker
      Pages: 383 - 387
      Abstract: Publication date: November–December 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 6
      Author(s): Peter A. Margolis, Kathryn Taaffe McLearn, Marian F. Earls, Paula Duncan, Annette Rexroad, Colleen Peck Reuland, Sandra Fuller, Kimberly Paul, Brian Neelon, Tara E. Bristol, Pamela J. Schoettker
      Objective The aim of this study was to use family-centered measures to estimate the effect of a collaborative quality improvement program designed to help practices implement systems to promote early childhood development services. Methods A cohort study was conducted in pediatric and family practices in Vermont and North Carolina. Eighteen collaborative education practices and 17 comparison practices participated in a 12-month program to assist practices in implementing improved systems to provide anticipatory guidance and parental education. The main outcome measures were change over time in parent-reported measures of whether children received each of 4 aspects of recommended care, documentation of developmental and psychosocial screening, and practice-reported care delivery systems. Results The number of care delivery systems increased from a mean of 12.9 to 19.4 of 27 in collaborative practices and remained the same in comparison practices (P = .0002). The proportion of children with documented developmental and psychosocial screening among intervention practices increased from 78% to 88% (P < .001) and from 22% to 29% (P = .002), respectively. Compared with control practices, there was a trend toward improvement in the proportion of parents who reported receiving at least 3 of 4 areas of care. Conclusion The learning collaborative was associated with an increase in the number of practice-based systems and tools designed to elicit and address parents’ concerns about their child's behavior and development and a modest improvement in parent-reported measures of the quality of care.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.06.007
       
  • Development and Validation of a Self-Administered Questionnaire to Measure
           Water Exposures in Children
    • Authors: Marc H. Gorelick; Duke Wagner; Sandra L. McLellan
      Pages: 388 - 391
      Abstract: Publication date: November–December 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 6
      Author(s): Marc H. Gorelick, Duke Wagner, Sandra L. McLellan
      Objective To develop and validate a questionnaire to measure water exposures in children. Methods Caregivers of children younger than 18 years old evaluated in a pediatric emergency department completed a self-administered questionnaire with items about the child's exposure to water for drinking (15 items), hygiene (4 items), and recreation (5 items); other beverages (11 items); and other risk factors (11 items). Test-retest reliability was measured by administering the questionnaire to the same respondent within 48 hours. Concurrent validity was measured by having a second caregiver, when available, complete the same questionnaire independently. Agreement of paired responses was calculated by kappa (κ) for categorical variables or Spearman rho (ρ) correlation coefficient along with percentage mean difference for continuous variables. Results Ninety-four initial surveys were completed (45 subjects with diarrhea). All 94 completed retesting, while 23 had a second independently completed survey. Test-retest reliability (κ or ρ > 0.6) was acceptable for 84% of items, and concurrent agreement was acceptable (κ or ρ > 0.5) for 91% of items. Conclusions This questionnaire has excellent test-retest and concurrent validity in measuring water exposures and other risk factors for gastrointestinal illness in children.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.07.004
       
  • Association of Bicycling and Childhood Overweight Status
    • Authors: Robert A. Dudas; Michael Crocetti
      Pages: 392 - 395
      Abstract: Publication date: November–December 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 6
      Author(s): Robert A. Dudas, Michael Crocetti
      Objectives Obesity is the most common chronic disease of childhood. Although it is accepted that diet and exercise practices are important, there is little data to discern the contributions of specific activities toward a healthy body weight. We sought to identify associations between bicycling and overweight status and to compare this with other physical activities and dietary practices thought to be protective against overweight status. Methods We constructed a survey to gather dietary and activity practices in a cross-sectional, convenience sample of 100 children presenting to an urban hospital setting in Baltimore, Maryland. We chose to emphasize bicycling because it is a widely available activity that requires a sustained level of moderate energy expenditure, yet little is known about the relationship of this particular activity with childhood overweight status. Results The mean age of our population was 11.8 years and 56% were overweight (body mass index >85 percentile). Most (96%) knew how to ride a bike and 80% reported owning a bike. Children who rode a bike just once a week or less were the most likely to be overweight (multivariate-adjusted odds ratio 6.6, 95% confidence interval, 2.1–21). This association was stronger than for all other dietary and activity practices. We found that approximately half of our participants do not eat breakfast, fruits, or vegetables regularly. More than half never ride a bike to school, walk to school, or participate in any organized sport. Conclusions Riding a bicycle at least 2 or more days during the week is associated with a decreased likelihood of being overweight during childhood.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.08.001
       
  • Prevention and Chronic Health Conditions Among Children and Adolescents
    • Authors: James M. Perrin
      Pages: 271 - 272
      Abstract: Publication date: September–October 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 5
      Author(s): James M. Perrin


      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.08.003
       
  • Academic Pediatric Association (APA) Presidential Address: Changing the
           World for Children
    • Authors: Peter G. Szilagyi
      Pages: 273 - 278
      Abstract: Publication date: September–October 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 5
      Author(s): Peter G. Szilagyi


      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.07.005
       
  • I Had a Gun in My Purse
    • Authors: William Marshall
      Pages: 279 - 280
      Abstract: Publication date: September–October 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 5
      Author(s): William Marshall


      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.07.006
       
  • Risk Factors for Repeat Adverse Asthma Events in Children After Visiting
           an Emergency Department
    • Authors: Teresa To; Chengning Wang; Sharon Dell; Bonnie Fleming-Carroll; Patricia Parkin; Dennis Scolnik; Wendy Ungar
      Pages: 281 - 287
      Abstract: Publication date: September–October 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 5
      Author(s): Teresa To, Chengning Wang, Sharon Dell, Bonnie Fleming-Carroll, Patricia Parkin, Dennis Scolnik, Wendy Ungar
      Objective The aim of this study was to identify risk factors for long-term adverse outcomes in children with asthma after visiting the emergency department (ED). Methods A prospective observational study was conducted at the ED of a pediatric tertiary hospital in Ontario, Canada. Patient outcomes (ie, acute asthma episodes and ED visits) were measured at baseline and at 1- and 6-months post-ED discharge. Time trends in outcomes were assessed using the generalized estimating equations method. Multiple conditional logistic regressions were used to model outcomes at 6 months and examine the impact of drug insurance coverage while adjusting for confounders. Results Of the 269 children recruited, 81.8% completed both follow-ups. ED use significantly reduced from 39.4% at baseline to 26.8% at 6 months (P < .001), whereas the level of acute asthma episodes remained unchanged. Children with drug insurance coverage were less likely to have acute asthma episodes (adjusted odds ratio [AOR] = 0.36; 95% CI, 0.15–0.85; P < .02) or repeat ED visits (AOR = 0.45; 95% CI, 0.20–0.99; P < .05) at 6 months. Other risk factors for adverse outcomes included previous adverse asthma events and certain asthma triggers (eg, cold/sinus infection). Washing bed linens in hot water weekly was protective against subsequent acute asthma episodes. Conclusions Our study demonstrated significant improvements in long-term outcomes in children seeking acute care for asthma in the ED. Future efforts remain in targeting the sustainability of improved outcomes beyond 6 months. Risk factors identified can help target vulnerable populations for proper interventions, which may include efforts to maximize insurance coverage for asthma medications and strategies to improve asthma self-management through patient and provider education.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.04.008
       
  • Environmental Tobacco Smoke and Behaviors of Inner-City Children With
           Asthma
    • Authors: Maria Fagnano; Kelly M. Conn; Jill S. Halterman
      Pages: 288 - 293
      Abstract: Publication date: September–October 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 5
      Author(s): Maria Fagnano, Kelly M. Conn, Jill S. Halterman
      Objective To explore the relationship between environmental tobacco smoke (ETS) exposure and behavior among inner-city children with significant asthma. Methods We analyzed baseline data for 200 children 4 to 10 years old who were enrolled in an asthma program. Environmental tobacco smoke exposure was measured by the child's salivary cotinine level. Caregivers completed the 28-item Behavior Problem Index (BPI). Positive responses were summed for a total BPI score, and children with scores >14 were considered to have significant behavior problems. We conducted Student t tests and multivariate regression analyses to determine the association of children's cotinine levels with BPI scores. Results Overall, 56% of children were male, 65% were black, and 72% had Medicaid. Mean cotinine level was 1.47 ng/mL. Overall, 30% of children had total BPI scores >14. Children with cotinine values >1.47 ng/mL had significantly higher scores compared with children with lower cotinine values on total BPI (12.5 vs 10.2), as well as externalizing (9.0 vs 7.2), antisocial (2.3 vs 1.7), and immature (2.1 vs 1.6) subscales. In a multivariate model, log cotinine remained independently associated with externalizing (P = .04), headstrong (P = .04), and antisocial behavior (P = .04). Conclusions Cotinine levels are independently associated with problem behaviors among this sample of urban children with asthma.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.04.002
       
  • Physician Perspectives Regarding Annual Influenza Vaccination Among
           Children With Asthma
    • Authors: Kevin J. Dombkowski; Sonia W. Leung; Sarah J. Clark
      Pages: 294 - 299
      Abstract: Publication date: September–October 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 5
      Author(s): Kevin J. Dombkowski, Sonia W. Leung, Sarah J. Clark
      Objective National guidelines have historically varied for influenza vaccination of children with asthma, depending on asthma severity. This study aims to explore perspectives of primary care physicians regarding influenza vaccination practices for children with persistent versus intermittent asthma. Methods A cross-sectional survey was mailed to general pediatricians (n = 300) and family physicians (n = 300) in primary care offices in Michigan in 2006. The main outcome measures included physicians’ influenza vaccination recommendations and reasons for nonadministration of influenza vaccine to children with asthma for the 2005–2006 influenza season. Results Ninety-six percent of respondents (N = 320) reported routinely recommending influenza vaccination for children with persistent asthma; fewer (82%) reported routinely recommending influenza vaccination for those with intermittent asthma. The adjusted odds of recommending influenza vaccination for intermittent asthma patients was significantly higher among pediatricians versus family physicians (adjusted odds ratio 3.49, 95% confidence interval, 1.68–7.22), controlling for other practice characteristics. Regardless of specialty, physicians with more than 25 asthma patients were more likely than those with fewer asthma patients to routinely recommend influenza vaccination. Physicians who do not routinely recommend influenza vaccination to children with intermittent asthma were more likely to cite overlooking discussion of influenza vaccine during the visit (50% vs 13%, respectively; P < .0001) as a reason for lack of vaccination. Conclusions Influenza vaccination practices of primary care physicians reflect the inconsistencies historically found in national recommendations. Further research is warranted to determine whether the recent clarification of recommendations of the National Asthma Education and Prevention Program (NAEPP) to remove distinctions by asthma severity is associated with a reduction in missed opportunities to vaccinate.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.06.005
       
  • Effect of WHO Newborn Care Training on Neonatal Mortality by Education
    • Authors: Elwyn Chomba; Elizabeth M. McClure; Linda L. Wright; Waldemar A. Carlo; Hrishikesh Chakraborty; Hillary Harris
      Pages: 300 - 304
      Abstract: Publication date: September–October 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 5
      Author(s): Elwyn Chomba, Elizabeth M. McClure, Linda L. Wright, Waldemar A. Carlo, Hrishikesh Chakraborty, Hillary Harris
      Background Ninety-nine percent of the 4 million neonatal deaths per year occur in developing countries. The World Health Organization (WHO) Essential Newborn Care (ENC) course sets the minimum accepted standard for training midwives on aspects of infant care (neonatal resuscitation, breastfeeding, kangaroo care, small baby care, and thermoregulation), many of which are provided by the mother. Objective The aim of this study was to determine the association of ENC with all-cause 7-day (early) neonatal mortality among infants of less educated mothers compared with those of mothers with more education. Methods Protocol- and ENC-certified research nurses trained all 123 college-educated midwives from 18 low-risk, first-level urban community health centers (Zambia) in data collection (1 week) and ENC (1 week) as part of a controlled study to test the clinical impact of ENC implementation. The mothers were categorized into 2 groups, those who had completed 7 years of school education (primary education) and those with 8 or more years of education. Results ENC training is associated with decreases in early neonatal mortality; rates decreased from 11.2 per 1000 live births pre-ENC to 6.2 per 1000 following ENC implementation (P < .001). Prenatal care, birth weight, race, and gender did not differ between the groups. Mortality for infants of mothers with 7 years of education decreased from 12.4 to 6.0 per 1000 (P < .0001) but did not change significantly for those with 8 or more years of education (8.7 to 6.3 per 1000, P = .14). Conclusions ENC training decreases early neonatal mortality, and the impact is larger in infants of mothers without secondary education. The impact of ENC may be optimized by training health care workers who treat women with less formal education.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.04.006
       
  • Preventive Care Utilization Among Children With and Without Special Health
           Care Needs: Associations With Unmet Need
    • Authors: Jeanne Van Cleave; Matthew M. Davis
      Pages: 305 - 311
      Abstract: Publication date: September–October 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 5
      Author(s): Jeanne Van Cleave, Matthew M. Davis
      Objective To compare attendance at preventive medical and dental visits for children with special health care needs (CSHCN) and children without special health care needs, and associations between attending visits and unmet need. Methods We analyzed data on 102 353 children aged 0 to 17 years from the National Survey of Children's Health. We examined associations between attending preventive medical or dental visits and CSHCN status, and unmet need for medical or preventive dental care and attending preventive medical or dental visits. Results Medical care–CSHCN were more likely than other children to attend a well-child visit (odds ratio [95% confidence interval], 1.45 [1.12–1.93] for 0 to 5 years, 1.99 [1.74–2.28] for 6 to 11 years, 1.84 [1.64–2.06] for 12 to 17 years). CSHCN aged 12 to 17 years attending a well-child visit had lower odds of unmet medical need (0.48 [0.27–0.85]) than CSHCN not attending visits; well-child visits and unmet need were not associated for younger age groups. Dental care–CSHCN aged 3 to 5 years were more likely than other children of similar ages to attend a preventive dental visit (1.26 [1.04–1.52]). CSHCN attending a preventive dental visit had lower odds of unmet preventive dental needs than CSHCN not attending visits (0.52 [0.28–0.93] for 3 to 5 years, 0.18 [0.12–0.28] for 6 to 11 years, 0.12 [0.08–0.17] for 12 to 17 years). Conclusions CSHCN attend preventive medical and dental visits at similar or higher rates than other children. CSHCN who attend visits are less likely to have unmet needs. Further research should examine differences in visit content for CSHCN and mechanisms whereby preventive care may reduce unmet need.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.04.003
       
  • Parental Perceptions of Dental/Oral Health Among Children With and Without
           Special Health Care Needs
    • Authors: Mary Kay Kenney; Michael D. Kogan; James J. Crall
      Pages: 312 - 320
      Abstract: Publication date: September–October 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 5
      Author(s): Mary Kay Kenney, Michael D. Kogan, James J. Crall
      Objectives The aims of this study were to determine the prevalence of parent-reported preventive dental care and better dental health in children with special health care needs (CSHCN) and to identify parent-reported dental problems, reasons for lack of preventive dental care, and factors associated with receiving preventive care and having better perceived dental health in CSHCN. A comparison group of children without special needs (CWOSN) was included. Methods We analyzed the 2003 National Survey of Children's Health by using a sample of 17 001 CSHCN and a comparison group of CWOSN. Descriptive and between-group chi-square statistics were used to analyze child characteristics, parent-perceived dental problems, and reasons for lack of preventive dental care. Factors associated with receipt of preventive dental care and better reported dental health were examined using logistic regression. Results Approximately 80% of CSHCN and 72% of CWOSN received preventive dental care. CSHCN parents reported more dental problems and fewer described their children as having good to excellent dental health compared to CWOSN, despite greater odds of having dental coverage and receiving preventive dental care. Disparities were evident in preventive dental care and dental health based on income, education, and insurance coverage. Conclusions Most parents of CSHCN and CWOSN report that their children receive preventive dental care and have good to excellent dental health; however, disparities in dental health and receipt of preventive dental care exist. Accessing care coordination by using the medical/dental home model, particularly for CSHCN, may alleviate the situation in which some of the most vulnerable children are experiencing the worst dental health.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.04.005
       
  • The Impact of Insurance Instability on Children's Access, Utilization, and
           Satisfaction with Health Care
    • Authors: Amy Cassedy; Gerry Fairbrother; Paul W. Newacheck
      Pages: 321 - 328
      Abstract: Publication date: September–October 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 5
      Author(s): Amy Cassedy, Gerry Fairbrother, Paul W. Newacheck
      Objectives We describe instability of health insurance coverage for children aged 2 to 17 years and relate insurance instability to access, utilization and satisfaction. Methods Three 2-year panels of the Medical Expenditure Panel Survey were used to measure insurance instability and its relationship to access, utilization, and problems with medical care. Results Over a 2-year period, 53% of children were continuously insured with private coverage, 19% had continuous public insurance, 20% had a single gap in coverage, 2% had multiple gaps, and 6% were continuously uninsured. Compared with children continuously insured through private coverage, children with single or multiple gaps or who were continuously uninsured were significantly more likely to lack a usual source of care (adjusted odds ratios [AORs] = 2.3, 3.5, and 4.5, respectively), to have no well-child visits (AORs = 1.2, 2.2 and 2.4, respectively), and to have unmet medical or prescription drug needs (AORs = 4.5, 4.2 and 3.4, respectively). There were no significant differences between children continuously insured through private coverage and children with single or multiple gaps or continuously uninsured and having at least 1 problem with medical care (AORs = 0.8, 1.3, and 1.4, respectively). While there were no differences between children continuously insured through private coverage and children with multiple gaps or continuously uninsured, children with single gap in coverage were significantly more likely to report having at least one problem with medical care (AOR = 1.5). Conclusions Compared with those with continuous coverage, children with gaps in coverage—especially those with multiple gaps—are less likely to have a usual source of care and receive well-child care. The national debate should incorporate discussions of policies to promote not only expansions of coverage, but also initiatives to eliminate gaps in coverage.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.04.007
       
  • Impact of a Patient-Centered Technology on Medication Errors During
           Pediatric Emergency Care
    • Authors: Stephen C. Porter; Rainu Kaushal; Peter W. Forbes; Donald Goldmann; Leslie A. Kalish
      Pages: 329 - 335
      Abstract: Publication date: September–October 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 5
      Author(s): Stephen C. Porter, Rainu Kaushal, Peter W. Forbes, Donald Goldmann, Leslie A. Kalish
      Objective The aim of this study was to determine the impact of a patient-centered health information technology (HIT) on the error rate for ordering and prescribing of medications during emergency pediatric care. Methods We conducted a quasi-experimental intervention study by using control and intervention periods to evaluate the effect on medication ordering and prescribing from a patient-centered HIT designed to enhance communication between parents and emergency clinicians during emergency care. Parent-child dyads presenting to 2 emergency department (ED) sites with complaints of fever, asthma, head trauma, otalgia, and dysuria were eligible. During intervention periods, parents used the HIT to enter data on symptoms and medication-related history; a printout provided recommendations to clinicians. Data on errors/adverse drug events were collected via record reviews and phone interviews with parents. The primary outcome was the number of medication errors in orders or prescriptions for drugs targeted by the HIT. Results Of 2002 parent-child dyads screened, 1810 (90%) were eligible, 1411 of 1810 (78%) were enrolled, and 1410 analyzed; 1097 subjects had a total of 2234 orders or prescriptions written. Of these events, 1289 of 2234 (58%) were associated with at least 1 error. Of the 1755 errors discovered, 232 errors were serious and preventable. Among 654 patients exposed to medications targeted by the HIT, the number of errors per 100 patients during control versus intervention periods was not significantly different (173 vs 134 with both sites combined; P = .35.) Conclusion The patient-centered HIT demonstrated minimal impact on medication errors during ED care.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.06.003
       
  • Economic Evaluation of a Primary Care Trial to Reduce Weight Gain in
           Overweight/Obese Children: The LEAP Trial
    • Authors: Melissa Wake; Lisa Gold; Zoë McCallum; Bibi Gerner; Elizabeth Waters
      Pages: 336 - 341
      Abstract: Publication date: September–October 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 5
      Author(s): Melissa Wake, Lisa Gold, Zoë McCallum, Bibi Gerner, Elizabeth Waters
      Background A common policy response to the childhood obesity epidemic is to recommend that primary care physicians screen for and offer counseling to the overweight/obese. As the literature suggests, this approach may be ineffective; it is important to document the opportunity costs incurred by brief primary care obesity interventions that ultimately may not alter body mass index (BMI) trajectory. Methods Live, Eat and Play (LEAP) was a randomized controlled trial of a brief secondary prevention intervention delivered by family physicians in 2002–2003 that targeted overweight/mildly obese children aged 5 to 9 years. Primary care utilization was prospectively audited via medical records, and parents reported family resource use by written questionnaire. Outcome measures were BMI (primary) and parent-reported physical activity and dietary habits (secondary) in intervention compared with control children. Results The cost of LEAP per intervention family was AU $4094 greater than for control families, mainly due to increased family resources devoted to child physical activity. Total health sector costs were AU $873 per intervention family and AU $64 per control, a difference of AU $809 (P < .001). At 15 months, intervention children did not differ significantly in adjusted BMI or daily physical activity scores compared with the control group, but dietary habits had improved. Conclusions This brief intervention resulted in higher costs to families and the health care sector, which could have been devoted to other uses that do create benefits to health and/or family well-being. This has implications for countries such as the United States, the United Kingdom, and Australia, whose current guidelines recommend routine surveillance and counseling for high child BMI in the primary care sector.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.06.006
       
  • Textbook of Pediatric Emergency Procedures
    • Authors: Deanna Dahl-Grove
      First page: 342
      Abstract: Publication date: September–October 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 5
      Author(s): Deanna Dahl-Grove


      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.06.001
       
  • Ambulatory Pediatrics to Academic Pediatrics: Coming Changes at the
           Journal
    • Authors: James M. Perrin
      First page: 215
      Abstract: Publication date: July–August 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 4
      Author(s): James M. Perrin


      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.06.004
       
  • Mentoring Between Continents: A Conversation
    • Authors: Malini B. DeSilva; Philip R. Fischer
      Pages: 216 - 218
      Abstract: Publication date: July–August 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 4
      Author(s): Malini B. DeSilva, Philip R. Fischer


      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.06.002
       
  • Annual Report on Health Care for Children and Youth in the United States:
           
    • Authors: Pamela L. Owens; Marc W. Zodet; Terceira Berdahl; Denise Dougherty; Marie C. McCormick; Lisa A. Simpson
      Pages: 219 - 240.e17
      Abstract: Publication date: July–August 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 4
      Author(s): Pamela L. Owens, Marc W. Zodet, Terceira Berdahl, Denise Dougherty, Marie C. McCormick, Lisa A. Simpson
      Objective To examine state differences in children's utilization of injury-related emergency department (ED) care across 14 states, benchmarking aggregate state estimates against national expenditure estimates for outpatient injury-related ED care. Methods A retrospective analysis was performed using the 2003 State Emergency Department Databases and State Inpatient Databases from the Healthcare Cost and Utilization Project and data from the Medical Expenditure Panel Survey. Pediatric ED visits with any injury International Classification of Diseases Ninth Version Clinical Modification (ICD-9-CM) diagnosis code were selected. The Barell Injury Diagnosis Matrix, ICDMAP-90 software, and the Trauma Information Exchange Program data were used to classify injuries, produce injury severity scores, and examine utilization in trauma centers. Aggregate and state-specific descriptive analyses compared differences in patient and injury characteristics and admission status by age, severity of injury, and expected payer. Results Over 1.5 million or nearly one-third of ED visits were for pediatric injuries in the 14 states studied. Nationally, 5.4% of children had an injury-related ED visit, and approximately $2.3 billion was spent on outpatient injury-related ED visits in 2003. The pattern of injury-related ED visit care varied considerably by state. For example, injury-related ED visit rates ranged from 63.3 to 164.4 per 1000 children. Infants, adolescents, children from very low income communities, and children from nonmetropolitan and nonmicropolitan areas were more likely to have an injury-related ED visit than their peers. Although patient characteristics were fairly consistent across states, admission rates and expected source of payment for injury-related ED visits varied considerably by state. Hospital admission rates ranged from 1.5% to 4.4% of injury-related ED visits and expected payer estimates ranged from 37.1% to 71.0% of visits billed to private insurance, 17.9% to 47.0% billed to Medicaid, and 2.1% to 10.4% billed as uninsured. Conclusions This study suggests that injuries account for a significant portion of pediatric ED visits. There is substantial variation in ED use and hospital admissions for injured children across states and payers. This variation suggests that there are several opportunities for improvement in emergency care for children. To better understand the underlying reason for the variation, multivariate and hypothesis-driven research should focus on the nature and outcomes of injury-related ED care in the context of small area practice patterns and state programs, policies, and care system characteristics.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.03.032
       
  • Improvements in Health-Related Quality of Life Among School-Based Health
           Center Users in Elementary and Middle School
    • Authors: Terrance J. Wade; Mona E. Mansour; Kristin Line; Tracy Huentelman; Kathryn N. Keller
      Pages: 241 - 249
      Abstract: Publication date: July–August 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 4
      Author(s): Terrance J. Wade, Mona E. Mansour, Kristin Line, Tracy Huentelman, Kathryn N. Keller
      Objective To examine the role of school-based health centers (SBHCs) on changes in student health-related quality of life (HRQOL) over a 3-year period among elementary and middle school students. Methods Design: Three-year longitudinal prospective study. Setting: Four elementary schools with newly implemented SBHCs and 4 elementary comparison schools matched for rural/urban and state, percentage of nonwhite students, and percentage of free or reduced-price lunch–eligible students. Participants: Randomly selected student-parent dyads (n = 579) who responded in all 3 years from 4 intervention schools and 4 comparison schools randomly selected from school enrollment lists. Students in intervention schools were further divided into SBHC users and nonusers. Intervention: SBHC. Measures: The outcome, HRQOL, was measured annually by student self-reported and parent proxy-reported scores using the PedsQL 4.0. School covariates included region and state; individual covariates included child age, gender, race, health insurance, chronic health conditions, family income, and parental marital status. Results Adjusting for school- and individual-level covariates, there was a significant improvement in student-reported HRQOL over the 3 years for the SBHC user group compared with the comparison school group. Other significant predictors of student-reported HRQOL included student age, gender, health insurance, and household income. There were no differences across groups by using parent proxy reports of HRQOL. Conclusions The SBHC model of health care delivery improves student-reported HRQOL among younger, elementary, and middle school children. Moreover, it appears to have more influence on those children that generally have impeded access to care and who can most benefit from it, specifically those without private health insurance and with lower income levels.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.02.004
       
  • Criteria-Based Diagnosis and Antibiotic Overuse for Upper Respiratory
           Infections
    • Authors: Elizabeth D. Cox; Saurabh Saluja
      Pages: 250 - 254
      Abstract: Publication date: July–August 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 4
      Author(s): Elizabeth D. Cox, Saurabh Saluja
      Objective Studies of antibiotic overuse often rely on physicians' reports of diagnoses, which can overestimate bacterial illness. To assess potential overdiagnosis, we determine bacterial upper respiratory infection diagnoses by direct observation of visit videotapes. Design From an observational study of videotaped visits for upper respiratory symptoms (N = 66), coders assessed diagnostic criteria (symptoms, physician description of physical examination findings, and diagnostic tests), physician diagnosis, and prescribing. Survey data included patient demographics and health care utilization as well as physician/practice characteristics (n = 15). Outcomes Criteria-based diagnoses were determined from coded diagnostic criteria. Interrater reliabilities were determined for 33% (n = 22) of visits. Chi-square tests assessed concordance between the physician's diagnosis and the criteria-based diagnosis and compared rates of antibiotic overuse as determined from physician and criteria-based diagnoses. Results The criteria-based diagnosis agreed with 100% of physicians' diagnoses of streptococcal pharyngitis and 73% of physicians' acute otitis media diagnoses but with only 17% of physicians' sinusitis diagnoses. Antibiotic overuse occurred in 11% of visits based on physicians' diagnoses but in 32% of visits when criteria-based diagnoses were considered, a difference of 21% (95% confidence interval, 2%-38%; P < 0.05). Conclusions Criteria-based diagnoses revealed that antibiotic overuse occurred 3 times more frequently than suggested by physician diagnoses. Concordance between physician and criteria-based diagnoses was lowest for sinusitis. Future studies should consider the contribution of overdiagnosis to antibiotic overuse and target this practice to further reduce overuse.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.02.005
       
  • Comparison of 3 Data Collection Methods for Gathering Sensitive and Less
           Sensitive Information
    • Authors: Jeongeun Kim; Howard Dubowitz; Elizabeth Hudson-Martin; Wendy Lane
      Pages: 255 - 260
      Abstract: Publication date: July–August 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 4
      Author(s): Jeongeun Kim, Howard Dubowitz, Elizabeth Hudson-Martin, Wendy Lane
      Objective When gathering sensitive information about personal experiences such as child abuse, drug and alcohol use, and intimate partner violence (IPV), it is especially important for both research and clinical purposes to use optimal methods to limit socially desirable responses. The purpose of this paper is to determine which of the following 3 methods is optimal for gathering data: 1) face-to-face interviews, 2) self-administered paper and pencil questionnaires, or 3) audio computer-assisted self-interviews (ACASI). Methods The sample consisted of 514 parents bringing their preschoolers (0–5 years) to a pediatric primary care clinic for a checkup. The parent screening questionnaire (PSQ) addressing psychosocial problems was completed by participants themselves. Participants completed the PSQ in 1 of 3 ways: paper and pencil, face-to-face interview, or directly onto a computer (ACASI). Results In general, ACASI yielded the highest rates for sensitive problems such as social isolation and parental stress, with face-to-face interviews occupying an intermediate position. The differences between ACASI and self-administered paper and pencil questionnaires were significant for many items. The differences between ACASI and face-to-face interviews, however, were modest. There were no significant group differences among the 3 methods in the prevalence rates of the neutral, less sensitive items. Conclusion ACASI resulted in greater disclosure of sensitive information than did a paper and pencil approach. No significant differences were observed between the computer-assisted interview and the face-to-face interview, both done in a research setting. The 3 methods appeared similar when gathering less sensitive data.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.03.033
       
  • Development of a Caregiver Gastroenteritis Knowledge Questionnaire
    • Authors: Stephen B. Freedman; Samir Deiratany; Ran D. Goldman; Susa Benseler
      Pages: 261 - 265
      Abstract: Publication date: July–August 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 4
      Author(s): Stephen B. Freedman, Samir Deiratany, Ran D. Goldman, Susa Benseler
      Objective Because caregiver knowledge deficiencies are associated with the development of dehydration and nonurgent emergency department visits, we sought to develop and describe the characteristics of a Caregiver Gastroenteritis Knowledge Questionnaire. Methods We conducted a cross-sectional, associational analysis with a questionnaire consisting of 38 true/false questions covering signs of dehydration, indications to see a physician, oral rehydration therapy, solid intake and refeeding, medication use, and disease transmission. After completing initial validation procedures, 80 caregivers of children with gastroenteritis, 25 nurses, and 22 pediatric emergency medicine physicians completed the questionnaire. Results Content validity was confirmed qualitatively. Construct validity was demonstrated by incremental increases (P < .001) in mean total scores from caregivers to nurses to physicians. Multiple regression analysis revealed the reported number of prior visits for gastroenteritis was inversely associated with overall caregiver score (beta coefficient, −0.26; 95% confidence interval, −3.04, −0.28; P = .02). Internal consistency was demonstrated with a Cronbach's α of 0.67 at time 0. Conclusions The Caregiver Gastroenteritis Knowledge Questionnaire may have application in identifying knowledge gaps in gastroenteritis management and measuring improvement following educational interventions. Future uses may focus on individual knowledge deficits or serve to document larger community educational needs.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.02.003
       
  • Development of a Brief Questionnaire to Identify Families in Need of Legal
           Advocacy to Improve Child Health
    • Authors: David Keller; Nathan Jones; Judith A. Savageau; Suzanne B. Cashman
      Pages: 266 - 269
      Abstract: Publication date: July–August 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 4
      Author(s): David Keller, Nathan Jones, Judith A. Savageau, Suzanne B. Cashman
      Objective To determine whether the medical-legal advocacy screening questionnaire (MASQ), a simple 10-item questionnaire, is able to screen families in a primary care setting for possible referral to legal services more effectively than the clinical interview alone. Methods Family Advocates of Central Massachusetts (FACM) is a medical-legal collaboration that assists low-income families with legal issues that affect child health. A convenience sample of parents seen at each of 5 medical practices associated with FACM was recruited to complete the MASQ prior to a routine child health care visit. Physicians blinded to the result assessed family need for referral to FACM after their usual clinical encounter. The sensitivity and specificity of both the MASQ and provider assessment were calculated. Results Two hundred fifty-five parents from 5 practices participated in the study. The MASQ identified 85 patients in need of legal services. Prior to reviewing the MASQ, the primary care providers identified 35 families in need of referral to the FACM. After completion of both the MASQ and the medical encounter, 37 families agreed to referral. The MASQ had sensitivity of 0.81 and specificity of 0.75 in predicting program referral. Provider assessment had sensitivity of 0.65 and specificity of 0.95 of predicting program referral. Conclusions Routine use of the MASQ would likely identify more patients in pediatric practices who would accept referral to legal assistance than reliance on provider impression alone after a routine clinical encounter.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.04.004
       
  • Getting the Evidence Needed: A Recent Report from the Institute of
           Medicine
    • Authors: Lisa A. Simpson; Richard Marshall
      Pages: 147 - 149
      Abstract: Publication date: May–June 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 3
      Author(s): Lisa A. Simpson, Richard Marshall


      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.04.001
       
  • Uncharted
    • Authors: Anjali Jain
      Pages: 150 - 151
      Abstract: Publication date: May–June 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 3
      Author(s): Anjali Jain


      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.03.030
       
  • Children's Cognitive-Behavioral Functioning at Age 6 and 7: Prenatal Drug
           Exposure and Caregiving Environment
    • Authors: Prasanna Nair; Maureen M. Black; John P. Ackerman; Maureen E. Schuler; Virginia A. Keane
      Pages: 154 - 162
      Abstract: Publication date: May–June 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 3
      Author(s): Prasanna Nair, Maureen M. Black, John P. Ackerman, Maureen E. Schuler, Virginia A. Keane
      Objective The aim of this study was to examine how prenatal drug exposure (PDE) and caregiving environment relate to cognitive, academic, and behavioral performance at ages 6 and 7. Methods A longitudinal follow-up was conducted of 111 children with PDE and a community cohort of 62 non–drug-exposed children (N = 173). Children completed standardized tests of cognition (Stanford-Binet Intelligence Scales, Fourth Edition [SB-IV]) and academic performance (Wide Range Achievement Test 3). Caregivers completed ratings of child behavior problems (Child Behavior Checklist [CBCL]). Multivariate analyses were conducted, adjusting for gender, prenatal tobacco exposure, number of caregiver placement changes, and 3 caregiver variables assessed at age 7, including depressive symptoms, employment status, and public assistance status. Results After adjusting for perinatal and environmental variables, there were no significant exposure-group differences in cognition, academic performance, or behavior problems. In comparison with males, females had higher scores on overall IQ and 4 of 8 SB-IV subtests, fewer caregiver-reported attention and aggression problems, and higher reading achievement scores. There were no significant gender-by-group interactions. Conclusion When analyses were adjusted for perinatal and environmental variables, most associations between PDE and cognitive-behavioral functioning were attenuated. Regardless of drug exposure history, males performed more poorly than females on multiple cognitive-behavioral indices. Both exposed and nonexposed children were from low-income families and obtained scores substantially below normative expectations.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.02.002
       
  • Learning Difficulties Among Children Separated From a Parent
    • Authors: Sandra H. Jee; Kelly M. Conn; Wendy J. Nilsen; Moira A. Szilagyi; Emma Forbes-Jones; Jill S. Halterman
      Pages: 163 - 168
      Abstract: Publication date: May–June 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 3
      Author(s): Sandra H. Jee, Kelly M. Conn, Wendy J. Nilsen, Moira A. Szilagyi, Emma Forbes-Jones, Jill S. Halterman
      Objective To study the relationship between experiencing separation from parents and having learning difficulties among children in a community-based sample. Methods In 2003, parents of children entering kindergarten in the city of Rochester completed a survey assessing the child's social background, medical history, and behavioral profile. Children separated from parents for >1 month were compared with those who had never been away for >1 month on 4 validated developmental measures (range, 1–4): a learning scale, an expressive language scale, a preliteracy scale, and a speech scale. Bivariate analyses and multivariate logistic regression analyses were used to determine associations between separation from parents and learning difficulties. Results Among the 1619 children, 18% had been separated from a parent for >1 month at least once (11% once, 7% ≥2 times). Separated children scored worse compared with those without separations on learning (3.14 vs 3.28, P = .001) and preliteracy (2.21 vs 2.35, P = .03). Higher rates of learning difficulties (26.7% vs 16.7%, P < .001) and preliteracy problems (25.9% vs 18.7%, P = .01) were noted among those who had been separated versus those who had not. In multivariable modeling, separation was associated with learning problems (adjusted odds ratio, 1.71; 95% confidence interval, 1.18–2.49) and preliteracy problems (adjusted odds ratio, 1.46; 95% confidence interval, 1.04–2.05) when adjusted for demographic, medical, and social factors. Conclusions Urban children who have experienced separation from a parent may have more learning difficulties at entrance to kindergarten. Screening and intervention practices to remedy these challenges may better equip such young children to succeed when they enter school.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.02.001
       
  • Mothers' Expectations for Shared Reading After Delivery: Implications for
           Reading Activities at 6 Months
    • Authors: Samantha B. Berkule; Benard P. Dreyer; Perri E. Klass; Harris S. Huberman; Hsiang S. Yin; Alan L. Mendelsohn
      Pages: 169 - 174
      Abstract: Publication date: May–June 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 3
      Author(s): Samantha B. Berkule, Benard P. Dreyer, Perri E. Klass, Harris S. Huberman, Hsiang S. Yin, Alan L. Mendelsohn
      Objective To determine whether mothers with plans related to shared reading and baby books in the home at the time of delivery of their newborns would be more likely to engage in shared reading behaviors at age 6 months. Methods This was a cohort study with enrollment after birth and follow-up at 6 months in an urban public hospital. Predictors included mothers' attitudes and resources related to shared reading during the postpartum period. Outcomes included mothers' shared reading activities and resources at 6 months, as assessed by the StimQ-READ measure. Results A total of 173 mother-infant dyads were assessed. In multiple regression analyses adjusting for sociodemographics and maternal depression and literacy, StimQ-READ score at 6 months was increased in association with all 3 postpartum predictors: plans for reading as a strategy for school success (adjusted mean 1.7-point increase in 6-month score; 95% confidence interval [95% CI], 0.3–3.0), plans to read in infancy (3.1-point increase; 95% CI, 1.6–4.6), and having baby books in the home (2.3-point increase; 95% CI, 0.9–3.6). In multiple logistic regression analysis, mothers with 2 or more attitudes and resources had an adjusted odds ratio of 6.2 (95% CI, 2.0–18.9) for having initiated reading at 6 months. Conclusions Maternal attitudes and resources in early infancy related to shared reading are important predictors of reading behaviors by 6 months. Cumulative postnatal attitudes and resources are the strongest predictors of later behaviors. Additional research is needed regarding whether guidance about shared reading in early infancy or pregnancy would enhance programs such as Reach Out and Read.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.01.002
       
  • Child Characteristics and Receipt of Stimulant Medications: A
           Population-Based Study
    • Authors: Anton R. Miller; Dafna Kohen; Charlotte Johnston
      Pages: 175 - 181
      Abstract: Publication date: May–June 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 3
      Author(s): Anton R. Miller, Dafna Kohen, Charlotte Johnston
      Objective Predictive factors associated with prescription of psychostimulant drugs to children remain poorly understood. We aimed to identify child-related factors that predict receipt of methylphenidate (MPH: Ritalin) by children in a large population-based study. Methods With data from time 1 (1994–1995) and time 2 (1996–1997) of the National Longitudinal Survey of Children and Youth, we analyzed the role of child background, and behavioral and functional characteristics, all measured at time 1, in predicting receipt of MPH at time 2 in a series of logistic regression models. Results Parent- and teacher-reported attention-deficit/hyperactivity disorder (ADHD) symptoms were consistent and significant predictors of receipt of MPH (odds ratios [ORs] ranging from 5.3–7.0, and from 3.2–4.1, respectively), particularly when concordant. Parent-reported aggressive behaviors (OR 1.91, 95% confidence interval [CI], 1.24–2.96) and teacher-reported internalizing symptoms (OR 3.01, 95% CI, 1.74–5.54) also predicted receipt of MPH, whereas higher levels of academic functioning predicted lower likelihood of receiving MPH (OR 0.54, 95% CI, 0.34–0.85), even after controlling for child background characteristics, ADHD symptoms, and prior receipt of MPH. Across models, male gender predicted a higher likelihood of receiving MPH (ORs ranging from 3.5–4.5) over and above ADHD and other behavioral symptoms. The strongest predictor of MPH receipt across models was prior receipt of MPH (ORs ranging from 83.7–128.3). Conclusions Child characteristics and behavioral symptoms other than ADHD symptoms predict prescription and uptake of MPH, possibly attributable to their serving as clinically convenient indicators of impairment. Gender effects in receipt of stimulant medications among children with ADHD symptoms warrant further investigation.

      PubDate: 2017-12-13T11:59:55Z
      DOI: 10.1016/j.ambp.2008.01.009
       
  • Arrival
    • Authors: George Estreich
      Abstract: Publication date: November–December 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 6
      Author(s): George Estreich


      PubDate: 2017-12-13T11:59:55Z
       
  • Do You Google'
    • Authors: John Andrews
      Abstract: Publication date: May–June 2008
      Source:Ambulatory Pediatrics, Volume 8, Issue 3
      Author(s): John S. Andrews


      PubDate: 2017-12-13T11:59:55Z
       
 
 
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