The medical home: relationships with family functioning for children with and without special health care needs

ObjectiveIn this study we tested the association of the medical home with family functioning for children without and with special health care needs (CSHCN).MethodsWe used data from the 2007 National Survey of Children’s Health to run multivariate logistic regressions to test the association between having a medical home and family functioning (difficulty with parental coping, parental aggravation, childcare/work issues, and missed school days). We further assessed interactions of CSHCN status with having a medical home.ResultsIn adjusted analysis, parents of children with a medical home were less likely to report difficulty with parental coping (odds ratio [OR] 0.26 [0.19–0.36]), parental aggravation (OR 0.54 [0.45–0.65]), childcare/work issues (OR 0.72 [0.61–0.84]), and missed school days (OR 0.87[0.78–0.97]) for their children than those without a medical home. Using interaction terms, we found that for most outcomes, the medical home had a greater association for CSHCN compared with healthy peers, with odds ratios ranging 0.40 (CI 0.22–0.56) for parental aggravation to 0.67 (CI0.52–0.86) for missed school days.ConclusionsWe show that the medical home is associated with better family functioning. All children may benefit from receiving care in a medical home, but CSHCN, who have greater needs, may particularly benefit from this enhanced model of care.     

Family Experience of Caregiver Burden and Health Care Usage in a Statewide Medical Home Program

ObjectiveTo evaluate family-reported caregiver experiences and health care utilization of patients enrolled in the Pennsylvania Medical Home Program (PA-MHP) statewide practice network and compare results to PA-MHP practices’ Medical Home Index (MHI) scores. We hypothesized families enrolled in higher-scoring patient-and-family-centered medical homes (PCMH) on completed MHIs would report decreased caregiver burden and improved health care utilization.MethodsWe analyzed surveys completed by families receiving care coordination services in PA-MHP's network and each practice's mean MHI score. A total of 3221 caregivers completed surveys evaluating hours spent coordinating care/week, missed school/workdays, sick visits, and emergency department (ED) visits. A total of 222 providers from 54 participating PA-MHP practices completed the nationally recognized MHI. Family/practice demographics were collected. We developed multivariate logistic regression models assessing independent associations among family survey outcomes and corresponding practices’ MHI scores.ResultsFamilies enrolled in high-scoring PCMHs had decreased odds of spending >1 h/wk coordinating care (odds ratio [OR] 0.82, adjusted OR [aOR]: 0.70, 95% confidence interval [CI] 0.55–0.90), missing workdays in the past 6 months (OR 0.82, aOR: 0.72, 95% CI 0.69–0.97), and ED visits in the past 12 months (OR 0.83, aOR: 0.81, 95% CI 0.65–0.99) in comparison to families enrolled in lower-scoring PCMHs. Families enrolled in higher-scoring PCMHs did not report fewer sick visits despite fewer ED visits, indicating more appropriate health care utilization. High-scoring PCMHs had lower percentages of publicly insured and low-income children.ConclusionsHigher-scoring PCMHs are associated with decreased caregiver burden and improved health care utilization across diverse PA practices. Future studies should evaluate interventions uniformly improving PCMH quality and equity.     

Underuse of controller medications among Medicaid-insured children with asthma

BACKGROUND: National guidelines recommend daily use of controller medications for children with persistent asthma. Although studies suggest low rates of controller use, little is known about predictors of underuse among low-income children in whom asthma morbidity is greatest. OBJECTIVES: To determine the frequency of underuse of controller medications among Medicaid-insured children in a variety of managed care arrangements, and to examine demographic factors and processes of asthma care associated with underuse. DESIGN: Cross-sectional telephone survey of parents of children and adolescents aged 2 to 16 years with asthma, insured by Medicaid, and enrolled in 1 of 5 managed care plans. The main outcome was parent-reported underuse of controllers among children with persistent asthma. Survey items included demographic factors and reports of specific processes of care. Current symptom level was determined by recall of the number of days with symptoms in the previous 14 and by the Physical Function Score of the American Academy of Pediatrics (AAP) Child Health Status Assessment for Asthma. Logistic regression was used to identify factors independently associated with underuse. RESULTS: The response rate was 66%, with 1648 children included in the analysis; 1083 were classified as having persistent asthma. Of these, 73% were underusers of controller therapy, with 49% reporting no controller use and 24% reporting less than daily use. A multivariate model that adjusted for age, managed health care organization, and AAP Physical Function Score found that black (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.2-2.4) or Latino (OR, 2.2; 95% CI, 1.3-3.8) race were associated with underuse and that parental education beyond high school was protective (OR, 0.6; 95% CI, 0.4-0.8). Having a primary care physician (OR, 0.4; 95% CI, 0.2-0.8), written action plan (OR, 0.5; 95% CI, 0.4-0.7), or a follow-up visit (OR, 0.5; 95% CI, 0.4-0.8) and having seen an asthma specialist (OR, 0.5; 95% CI, 0.4-0.7) were associated with lower rates of underuse. CONCLUSIONS: Underuse of controller medications among Medicaid-insured children is widespread. Racial minorities and children whose parents are less educated are at higher risk for underuse. Patients who have received action plans or had follow-up visits or specialty consultations are less likely to be symptomatic underusers of controller medications.     

Sunburn reduction through parental role modeling and sunscreen vigilance

OBJECTIVES: To identify characteristics associated with child sunburn experience and sun protection practices, including parent and child demographics, phenotype, and sun-related knowledge, attitudes, and behaviors. STUDY DESIGN: A nationally representative telephone survey conducted in 1999 with 651 parents of children 5 to 12 years of age to collect data relating to the sun-related knowledge, attitudes, and behaviors of the parent and child. RESULTS: Nearly half of parents (49%) and children (44%) were sunburnt during the previous summer. Parents who reported that they had been sunburnt were more likely to have children who had been sunburnt (OR = 2.9, 95% CI = 2.0, 4.2). Conversely, parents with a high level of sun protection behavior were less likely to report being sunburnt (OR = 0.6, 95% CI = 0.4, 0.9), and their children were more likely to have a high level of sun protection behavior (OR = 3.0, 95% CI = 2.0, 4.6) and sunscreen vigilance (OR = 2.7, 95% CI = 1.7, 4.5). High sunscreen vigilance was associated with a 60% reduction in child sunburning. CONCLUSIONS: The sunburn experience and sun protection practices of children (5-12 years of age) are closely linked to a number of modifiable attitudes and behaviors of their parents. Therefore the inclusion of parents and care givers in interventions targeting children may increase program efficacy.     

Influenza vaccination among children with asthma in medicaid managed care.

OBJECTIVE: To describe influenza vaccination rates and identify risk factors for missing vaccination among children with asthma in managed Medicaid. METHODS: As part of a longitudinal study of asthma care quality, parents of children aged 2-16 years with asthma enrolled in Medicaid managed care organizations in Massachusetts, Washington, and California were surveyed by telephone at baseline and 1 year. We evaluated influenza vaccination rates during the follow-up year. RESULTS: The study population included 1058 children with asthma. The influenza vaccination rate was 16% among all children with asthma and 21% among those with persistent asthma. Children with persistent asthma (odds ratio [OR] 0.53, 95% confidence interval [CI] 0.36-0.79) and those who had been hospitalized during the follow-up year (OR 0.29, 95% CI 0.11-0.76) were less likely to miss vaccination.Children older than 9 years (OR 1.66, 95% CI 1.13-2.46) and children of parents with less than a high school education (OR 2.29, 95% CI 1.05-5.03), compared with a college degree, were at risk for missing vaccination. Among children with persistent asthma, older children (OR 1.65, 95% CI 1.01-2.69) and children of parents with less than a high school education (OR 4.13, 95% CI 1.43-11.90) were more likely to miss influenza vaccination. CONCLUSIONS: Our findings suggest that interventions directed toward older children and families with lower educational levels may help improve influenza vaccination rates among this high-risk group. The low overall vaccination rate highlights the need for improvement in this important component of asthma care quality for all children with asthma.     

Parental Perceptions on Use of Artificial Intelligence in Pediatric Acute Care

BackgroundFamily engagement is critical in the implementation of artificial intelligence (AI)-based clinical decision support tools, which will play an increasing role in health care in the future. We sought to understand parental perceptions of computer-assisted health care of children in the emergency department (ED).MethodsWe conducted a population-weighted household panel survey of parents with minor children in their home in a large US city to evaluate perceptions of the use of computer programs for the care of children with respiratory illness. We identified demographics associated with discomfort with AI using survey-weighted logistic regression.ResultsSurveys were completed by 1620 parents (panel response rate = 49.7%). Most respondents were comfortable with the use of computer programs to determine the need for antibiotics (77.6%) or bloodwork (76.5%), and to interpret radiographs (77.5%). In multivariable analysis, Black non-Hispanic parents reported greater discomfort with AI relative to White non-Hispanic parents (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.03–2.70) as did younger parents (18–25 years) relative to parents ≥46 years (OR 2.48, 95% CI 1.31–4.67). The greatest perceived benefits of computer programs were finding something a human would miss (64.2%, 95% CI 60.9%–67.4%) and obtaining a more rapid diagnosis (59.6%; 56.2%–62.9%). Areas of greatest concern were diagnostic errors (63.0%, 95% CI 59.6%–66.4%), and recommending incorrect treatment (58.9%, 95% CI 55.5%–62.3%).ConclusionsParents were generally receptive to computer-assisted management of children with respiratory illnesses in the ED, though reservations emerged. Black non-Hispanic and younger parents were more likely to express discomfort about AI.     

Association of Primary and Behavioral Health Integrated Care Upon Pediatric Mental Disorder Treatment

ObjectiveThe objective of this study was to examine whether linkage with mental health (MH) treatment differed across 3 different integrated care arrangements (ICAs), following incident attention deficit hyperactive disorder (ADHD) and major depressive disorder (MDD) diagnoses given by primary care providers (PCPs) in the pediatric setting.MethodsUsing claims linking with multiple public data sources, we examined the treatment initiation among children receiving an incident diagnosis of ADHD or MDD from PCPs working in practices with various ICAs. ICAs were categorized as PCP practiced alone (non–co-located), PCP practiced with specialist outside the practice but co-located at the practice site (co-located), and employed specialists who were co-located (co-located and co-affiliated).ResultsA total of 4203 incident ADHD and 298 incident MDD cases diagnosed by PCPs were identified, of which 3123 (74%) with ADHD and 200 (67%) with MDD received treatment within 90 days since the diagnosis. Children diagnosed with ADHD by co-located and co-affiliated PCPs were twice as likely to receive treatment as those diagnosed by non–co-located PCPs (odds ratio [OR] = 1.93; 95% confidence interval [CI], 1.24–2.78). Of those treated, children diagnosed by co-located and co-affiliated PCPs were 2 times more likely to receive guideline recommended psychotherapy (OR = 2.15; 95% CI, 1.35–3.44). These patients were also more likely to be treated at the diagnosing site versus elsewhere. Similar beneficial effects were not observed in those first diagnosed by co-located but non-affiliated PCPs.ConclusionsService co-location between co-affiliated PCPs and MH specialists was associated with significant higher ADHD treatment rate and the receipt of guideline-recommended psychotherapy.     

Association of externalizing behavior disorder symptoms and injury among fifth graders

ObjectiveInjury is the leading cause of death among American youth, killing more 11-year-olds than all other causes combined. Children with symptoms of externalizing behavior disorders such as attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) may have increased risk. Our aims were to determine: (1) whether increasing symptoms of ADHD and CD associate positively with injuries among a community sample of fifth graders; and (2) whether symptoms of ADHD and CD have a multiplicative rather than additive association with injuries among the sample.MethodsData were collected from 4745 fifth graders and their primary caregivers participating in Healthy Passages, a multisite, community-based study of pediatric health risk behaviors and health outcomes. The primary outcome was injury frequency. Primary independent variables were ADHD and CD symptoms. Additional covariates included gender, race/ethnicity, and household income. Ordinal logistic regression examined correlates of injury frequency. The interaction between ADHD and CD symptoms also was examined.ResultsIn bivariate analyses, the odds of injury increased as ADHD symptoms (odds ratio [OR] 1.29; 95% confidence interval [95% CI] 1.18–1.41) and CD symptoms (OR 1.18; 95% CI 1.07–1.31) increased. However, in multivariate analysis, only ADHD symptoms were significantly associated with injury (OR 1.22; 95% CI 1.10–1.35). There was no statistically significant interaction between ADHD and CD symptoms.ConclusionsADHD symptoms are associated with increased odds of injury in fifth graders. Findings have implications for potential injury prevention strategies for mental health practitioners (for example, cognitive training with at-risk youth), pediatricians (ADHD screening), and parents (improved supervision).     

The Effect of Primary Care Interventions on Children's Media Viewing Habits and Exposure to Violence

ObjectiveTo determine if brief primary care interventions can affect children's media viewing habits and exposure to violence.MethodsEnglish- and Spanish-speaking parents of 2- to 12-year-old children presenting to a pediatric primary care clinic participated in a randomized controlled trial. There were 2 intervention groups; one group viewed 5 minutes from the Play Nicely program and another received a handout, "Pulling the Plug on TV Violence." There were 2 control groups; the primary control group received standard primary care, and the alternative control group viewed a program about obesity prevention. The outcome measure was parental report of changes in media viewing habits and changes in exposure to violence.ResultsA total of 312 of 443 parents who were randomized completed a 2-week follow-up survey. Compared with the primary control group, parents in the video intervention group were more likely to report a change in their children's media viewing habits (odds ratio [OR] 3.29; 95% confidence interval [CI] 1.66–6.51) and a change in their children's exposure to violence (OR 4.26; 95% CI 1.95–9.27). Compared with the primary control group, parents in the handout group were more likely to report a change in their children's media viewing habits (OR 4.35; 95% CI 2.20–8.60) and a change in their children's exposure to violence (OR 3.35; 95% CI 1.52–7.35).ConclusionsBrief primary care interventions can affect children's media viewing habits and children's exposure to violence. These results have implications for how to improve primary care services related to decreasing children's media exposure and violence prevention.     

Incidence of Enuresis and Encopresis Among Children With Attention-Deficit/Hyperactivity Disorder in a Population-Based Birth Cohort

ObjectiveThis study reports the incidence of enuresis and encopresis among children with attention-deficit/hyperactivity disorder (ADHD) versus those without ADHD.MethodsSubjects included 358 children (74.5% boys) with research-identified ADHD from a 1976 to 1982 population-based birth cohort (n = 5718) and 729 (75.2% boys) non-ADHD control subjects from the same birth cohort, matched by gender and age. All subjects were retrospectively followed from birth until a diagnosis of enuresis or encopresis was made or last follow-up before 18 years of age. The complete medical record for each subject was reviewed to obtain information on age of initial diagnosis of an elimination disorder, frequency and duration of symptoms, and identification of exclusionary criteria specified by DSM-IV, with confirmation of the diagnosis by expert consensus.ResultsChildren with ADHD were 2.1 (95% confidence interval [CI], 1.3–3.4; P = .002) times more likely to meet DSM-IV criteria for enuresis than non-ADHD controls; they were 1.8 (95% CI, 1.2–2.7; P = .006) times more likely to do so than non-ADHD controls when less stringent criteria for a diagnosis of enuresis were employed. Though not significant, children with ADHD were 1.8 (95% CI, 0.7–4.6; P = .23) times more likely to meet criteria for encopresis than non-ADHD controls. The relative risk was 2.0 (95% CI, 1.0–4.1; P = .05) when a less stringent definition for encopresis was utilized.ConclusionsChildren with ADHD are more likely than their peers without ADHD to develop enuresis with a similar trend for encopresis.     

The Relationship of Reported Neighborhood Conditions With Child Mental Health

ObjectiveAlthough in many studies authors have documented the relationship between neighborhood socioeconomic status and child mental health, few have examined the association between neighborhood conditions and mental health disorders. The objective of this study was to determine whether parent-reported neighborhood conditions are associated with common child mental health disorders.MethodsWe analyzed data on children ages 6 to 17 (N = 64,076) collected through the 2007 National Survey of Children's Health. Primary outcome variables were a child being reported to have a diagnosis of (1) anxiety and/or depression and (2) attention-deficit?hyperactivity disorder (ADHD) and/or disruptive behavior. Main independent variables were parent-reported neighborhood amenities (eg, recreation center), poor physical characteristics (eg, dilapidated housing), social support/trust, neighborhood safety, and school safety. Multivariate logistic regression analyses were conducted to examine associations between neighborhood conditions and (1) anxiety/depression and (2) ADHD/disruptive behavior.ResultsChildren living in a neighborhood with 3 poor physical characteristics had greater odds of anxiety/depression (adjusted odds ratio [AOR] 1.58, 95% confidence interval [95% CI] 1.01–2.46) and ADHD/disruptive behavior (AOR 1.44, 95% CI 1.04–1.99) compared with children living in a neighborhood with no poor physical characteristics. Children of parents who reported living in a neighborhood with low social support/trust had greater odds of depression/anxiety (AOR 1.71, 95% CI 1.28–2.30) and ADHD/disruptive behavior (AOR 1.47, 95% CI 1.19–1.81) than children living in a neighborhood with greater social support/trust.ConclusionsParent perception of neighborhood social support/trust and physical characteristics may be important to assess in clinical settings and should be examined in future study of child mental health burden.     

Epidemiology of allergic reactions to hymenoptera stings in Irish school children

Jennings A, Duggan E, Perry IJ, Hourihane JO’B. Epidemiology of allergic reactions to hymenoptera stings in Irish school children.
Pediatr Allergy Immunol 2010: 21: 1166–1170.
© 2010 John Wiley & Sons A/S The aim of this was to study generate the first epidemiological data regarding the prevalence of hymenoptera allergy among school children in Ireland. Questionnaires, including six sting‐specific questions ( 1 ), were distributed to the parents of primary school children aged 6–8 and 11–13, divided equally between rural and urban backgrounds. From 110 schools, 4112 questionnaires were returned. A total of 1544 (37.5%) children had been stung in their lifetime. Among the total, 5.8% of children stung experienced a large local reaction, 3.4% had a mild (cutaneous) systemic reaction (MSR) and 0.8% experienced a moderate/severe systemic reaction (SSR); these figures respectively represent 2.2%, 1.3% and 0.2% of the total study group. On logistic regression analysis, older children and rural children were at a higher risk of being stung (OR 1.7; 95% CI 1.4–2.; OR 1.6; 95% CI 1.4–1.8 respectively). Rural dwellers and asthma sufferers were more likely to experience an SSR (OR 4.3; 95% CI 1.4–13.5 and OR 2.8; 95% CI 1.8–4.3, respectively). Hymenoptera stings are more common in rural than urban dwelling Irish children. Asthma imparted a greater risk of SSR in this study population. Severe reactions are unusual overall, occurring in <1% of those stung, a lower prevalence than in Israeli teenagers but in keeping with other European reports relating to young children.     

Preventive Asthma Care Delivery in the Primary Care Office: Missed Opportunities for Children With Persistent Asthma Symptoms

ObjectiveTo describe which National Heart Lung and Blood Institute preventive actions are taken for children with persistent asthma symptoms at the time of a primary care visit and determine how care delivery varies by asthma symptom severity.MethodsWe approached children (2 to 12 years old) with asthma from Rochester, NY, in the waiting room at their doctor's office. Eligibility required current persistent symptoms. Caregivers were interviewed via telephone within 2 weeks after the visit regarding specific preventive care actions delivered. Bivariate and regression analyses assessed the relationship between asthma symptom severity and actions taken during the visit.ResultsWe identified 171 children with persistent asthma symptoms (34% black, 64% Medicaid) from October 2009 to January 2011 at 6 pediatric offices. Overall delivery of guideline-based preventive actions during visits was low. Children with mild persistent symptoms were least likely to receive preventive care. Regression analyses controlling for demographics and visit type (acute or follow-up asthma visit vs non-asthma-related visit) confirmed that children with mild persistent asthma symptoms were less likely than those with more severe asthma symptoms to receive preventive medication action (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.14–0.84), trigger reduction discussion (OR 0.39, 95% CI 0.19–0.82), recommendation of follow-up (OR 0.40, 95% CI 0.19–0.87), and receipt of action plan (OR 0.37, 95% CI 0.16–0.86).ConclusionsMany children with persistent asthma symptoms do not receive recommended preventive actions during office visits, and children with mild persistent symptoms are the least likely to receive care. Efforts to improve guideline-based asthma care are needed, and children with mild persistent asthma symptoms warrant further consideration.     

Nocturnal asthma in children affects school attendance, school performance, and parents' work attendance

CONTEXT: Asthma symptoms that occur at night may signal worse asthma control, but the nighttime occurrence may have additional clinical significance. To date, however, there have been few studies of the impact of nocturnal awakening from asthma on children with the disease, including problems with daytime functioning. OBJECTIVE: To determine if school absenteeism and school performance in children and work absenteeism in their parents are associated with nocturnal awakenings from asthma. DESIGN: Cross-sectional survey during the winter of 1997 through 1998. SETTING: Three managed care organizations in the United States. PARTICIPANTS: Parents of 438 children with asthma, aged 5 to 17 years, who were enrolled in managed care organizations. INTERVENTION: None. MAIN OUTCOME MEASURES: Parent's reports of number of days their child missed school and parent missed work and how often the child's education suffered because of asthma in the past 4 weeks. RESULTS: Overall, more than 40% of children had nocturnal awakenings from asthma in the past 4 weeks. Multivariate analyses were performed that adjusted for child age, race, overall symptom severity, and use of reliever medications. Compared with children who did not awaken from asthma, there were greater odds of missed school days in children who awakened 1 to 3 nights (odds ratio [OR], 3.6; 95% confidence interval [CI], 2.1-6.2), 4 to 7 nights (OR, 4.4; 95% CI, 2.0-10.0), and more than 7 nights (OR, 14.7; 95% CI, 5.9-37.0). Similarly, there were greater odds of education suffering in children who awakened 1 to 3 nights (OR, 2.3; 95% CI, 1.4-3.7), 4 to 7 nights (OR, 2.1; 95% CI, 0.9-4.6), and more than 7 nights (OR, 2.3; 95% CI, 1. 0-5.4), and parents missing work in children who awakened 1 to 3 nights (OR, 4.0; 95% CI, 2.2-7.1), 4 to 7 nights (OR, 6.5; 95% CI, 2.7-16), and more than 7 nights (OR, 3.2; 95% CI, 1.3-7.9). Greater overall symptom severity and high use of reliever mediation were also associated with missed school, education suffering, and parent absenteeism. CONCLUSIONS: Nighttime awakenings in children with asthma may affect school attendance and performance, as well as work attendance by parents. Nighttime symptoms have independent prognostic value, even when overall asthma symptom severity is accounted for. By addressing whether there are nighttime awakenings in children with asthma, clinicians may be able to tailor the therapeutic regimen to counter these symptoms.     

Prevalence of and factors associated with current asthma symptoms in school children aged 6–7 and 13–14 yr old in Bogotá, Colombia

This cross‐sectional study of children aged 6–7 years and adolescents aged 13–14 years in Bogotá, Colombia, assessed the prevalence of asthma symptoms and their associations with dietary, health, and behavioral habits. This study is part of the International Study of Asthma and Allergies in Childhood (ISAAC)‐phase III. Asthma prevalence among the children was assessed using a parental self‐administered written questionnaire (WQ), and among adolescents using a WQ together with a video questionnaire (VQ). Associations were estimated with bivariate and multivariate analysis. The study found that the 6–7 year age‐group were more likely to report current asthma symptoms than the 13–14 year age‐group (10.4% [WQ] vs. 8.6% [WQ] and 8.0% [VQ], respectively). Factors associated with current asthma symptoms among the 6–7 year age‐group included higher maternal education (OR = 1.7, [95% CI 1.2–2.6], p = 0.007), a cat in the home during the last year (OR = 1.5, [95% CI 1.0–2.3], p = 0.036), watching TV 1–2 hours/day (OR = 2.1, [95% CI 1.2–3.9], p = 0.013), and medication with acetaminophen in the first and most recent year of life (OR = 1.8, [95% CI 1.3–2.4], p < 0.001; OR = 2.2, [95% CI 1.7–2.8], p < 0.001, respectively) or antibiotics in the first year of life (OR = 1.9, [95% CI 1.4–2.5], p < 0.001). Among the 13–14 year age‐group, factors associated with current asthma symptoms included medication with acetaminophen during the last year (OR = 1.8, [95% CI 1.4–2.3], p < 0.001); cereal, milk, and fruit consumption 3 or more times weekly (OR = 1.5, [95% CI 1.1–1.9], p = 0.010; OR = 0.8, [95% CI 0.6–1.0], p = 0.046; OR = 0.6, [95% CI 0.4–1.0], p = 0.031, respectively). Overall, compared with that in other Latin American centers, asthma prevalence in Bogotá is close the lower estimates. However, associations with dietary, health, and behavioral habits need further study to assess their complex relationship with asthma.     

Performance limitations and participation restrictions among childhood cancer survivors treated with hematopoietic stem cell transplantation: the bone marrow transplant survivor study

BACKGROUND: Hematopoietic stem cell transplantation (HCT) may result in important disease- and treatment-related late effects. This study estimated physical, emotional, and educational limitations (performance limitations) and restrictions in the ability to perform personal care or routine daily activities (physical participation restrictions) and restrictions in the ability to participate in social roles (social participation restrictions) in a cohort of cancer survivors treated with HCT during childhood. METHODS: Study participants included 235 persons who had a malignancy or hematologic disorder, were treated with HCT before the age of 21 years, and survived at least 2 years after transplantation. A comparison group was recruited and frequency matched for age, sex, and ethnicity. Medical data were abstracted, and patients or parents (if <18 years at survey completion) completed a mailed 24-page questionnaire. RESULTS: Adult survivors of childhood cancer were more likely than the comparison group to report limitations in physical (prevalence odds ratio [OR], 2.2; 95% confidence interval [CI], 1.3-3.7) and emotional domains (OR, 2.9; 95% CI, 1.4-5.8) and to report physical participation restrictions (OR, 3.9; 95% CI, 1.9-8.2). Adult survivors were also less likely than the comparison group to be married (OR, 0.4; 95% CI, 0.2-0.6). Child survivors were more likely than similarly aged children to have participated in special education (OR, 3.0; 95% CI, 1.5-6.0), to report physical participation restrictions (OR, 10.8; 95% CI, 2.2-53.9), and to have behaviors that indicated impaired social competence (OR, 2.0; 95% CI, 0.9-4.2). CONCLUSION: This study demonstrated that persons treated with HCT as children were at increased risk for performance limitations that restricted participation in routine daily activities and interpersonal relationships.     

Influence of attendance at day care on the common cold from birth through 13 years of age

OBJECTIVE: To describe trends in the occurrence of the common cold during the first 13 years of life among children who attended different childcare settings early in life. DESIGN: The Tucson Children's Respiratory Study involves 1246 children enrolled at birth and followed up prospectively since May 1980 through October 1984. Children with data regarding day care use during the first 3 years of life were included in this investigation (n = 991). Parents reported the occurrence of frequent (> or = 4) colds during the past year by questionnaire when each child was 2, 3, 6, 8, 11, and 13 years of age. Child care at home (no unrelated children), at small day care (1-5 unrelated children), or at large day care (> or = 6 unrelated children) was reported retrospectively by parental questionnaire when the children were approximately 6 years old. RESULTS: After adjusting for potential confounding variables, compared with children at home those in large day care had more frequent colds at year 2 (odds ratio [OR], 1.9, 95% confidence interval [CI], 1.0-3.4; P =.04), less frequent colds at years 6 (OR, 0.3, 95% CI, 0.1-0.9; P =.02) through 11 (OR, 0.4, 95% CI, 0.1-1.2; P =.09), and the same odds of frequent colds at year 13 (OR,1.0, 95% CI, 0.3-3.8; P =.95). In addition, compared with children in large day care for 1 year or less those attending large day care for more than 2 years had more frequent colds at year 2 (OR, 1.7, 95% CI, 1.0-3.0; P =.04), less frequent colds at years 6 (OR, 0.5, 95% CI, 0.2-1.1; P =.08), 8 (OR, 0.2, 95% CI, 0.1-1.0; P =.04), and 11 (OR, 0.3, 95% CI, 0.1-1.0; P =.05); and the same odds of frequent colds at year 13 (OR, 0.9, 95% CI, 0.3-2.9; P =.80). CONCLUSIONS: Attendance at large day care was associated with more common colds during the preschool years. However, it was found to protect against the common cold during the early school years, presumably through acquired immunity. This protection waned by 13 years of age.     

Use of health care by young Asian New Zealanders: findings from a national youth health survey

Aim: To examine the use of health services and perceived barriers to accessing health care among young Asian New Zealanders. Methods: Secondary analysis of data from Youth2000, a cross‐sectional survey of secondary school students in New Zealand (NZ) conducted in 2001. Of the 9567 survey participants (aged 12–18 years), this study was restricted to students who identified with an ‘Asian’ ethnic category (n = 922). Results: Chinese and Indian students (the largest Asian ethnic groups in NZ) reported levels of overall health comparable to NZ European (NZE) students. However, relative to NZE students, Chinese students were more likely to report (i) not having a usual location for health care (adjusted OR 3.28; 95% CI: 2.51–4.43); and (ii) having problems getting health care when they needed it (adjusted OR 1.61; 95% CI: 1.32–1.96). Asian students who had been in NZ for 5 years or less (compared with NZ‐born students), as well as those who did not speak English at home (compared with those who did) were less likely to report having a usual source of health care, even after adjusting for their overall health (adjusted OR 2.13, 95% CI: 1.27–3.56; and adjusted OR 1.69, 95% CI: 1.11–2.56, respectively). Conclusion: Young Asian New Zealanders are less likely to access health care than their NZE counterparts. The perceived barriers require explicit attention within the broader platforms of health‐care quality, and professional and cultural competence of health‐care services.     

The Relationship Between Adverse Childhood Experiences and Weight-Related Health Behaviors in a National Sample of Children

ObjectiveTo examine how adverse childhood experiences (ACEs) relate to healthy weight behaviors in children.MethodsWe examined data from the 2016 National Survey of Children's Health. ACE scores were calculated from 6 measures of household dysfunction. Outcome measures included 5 healthy weight behaviors. Logistic regression models assessed associations between ACEs and healthy weight behaviors controlling for sociodemographic variables.ResultsChildren 6 to 17 years of age (n = 32,528) with 0 ACEs had increased odds of: watching 2 hours or less of television daily (6–12 years: odds ratio [OR] 1.46; 95% confidence interval [CI], 1.20–1.80, 13–17 years: OR 1.64; 95% CI, 1.39–1.94), using electronics for 2 hours or less daily (6–12 years: OR 1.44; 95% CI, 1.15–1.80, 13–17 years: OR 1.86; 95% CI, 1.60–2.16), sharing 4 or more family meals per week (6–12 years: OR 1.39; 95% CI, 1.17–1.66, 13–17 years: OR 1.68; 95% CI, 1.44–1.95), and getting adequate age-specific sleep (6–12 years: OR 1.50; 95% CI, 1.26–1.79, 13–17 years: OR 1.31; 95% CI, 1.11–1.55) when compared to children with one or more ACEs. Children 13 to 17 years of age with 0 ACEs had increased odds of exercising for 60 minutes daily (OR 1.27; 95% CI, 1.02–1.58) when compared to children with one or more ACEs. There was an overall gradient dose pattern; the odds of engaging in a healthy weight behavior decreased as the number of ACEs increased, with mixed significance levels.ConclusionsIn children, ACE exposure is associated with decreased healthy weight behaviors and behavior counseling alone may be insufficient. Trauma-informed care to address intra-familial adversity may be necessary.