Feasibility and Acceptability in a Community-Partnered Implementation of CenteringParenting for Group Well-Child Care

Background

In a community-academic partnership, we implemented a group-based model for well-child care (WCC) (CenteringParenting) and conducted a pilot test for feasibility and acceptability among families at a federally qualified health center (FQHC).

Emergency room visits and readmissions after pediatric urologic surgery

ObjectiveReducing readmissions has become a focal point to increase quality of care while reducing costs. We report all-cause unplanned return visits following urologic surgery in children at our institution.Materials and methodsChildren undergoing urology procedures with returns within 30 days of surgery were identified. Patient demographics, insurance status, type of surgery, and reason for return were assessed.ResultsFour thousand and ninety-seven pediatric urology surgeries were performed at our institution during 2012, with 106 documented unplanned returns (2.59%). Mean time from discharge to return was 5.9 ± 4.9 days (range, 0.3–24.8 days). Returns were classified by chief complaint, including pain (32), infection (30), volume status (14), bleeding (11), catheter concern (8), and other (11). Circumcision, hypospadias repair, and inguinal/scrotal procedures led to the majority of return visits, accounting for 21.7%, 20.7%, and 18.9% of returns, respectively. Twenty-two returns (20.75%) resulted in hospital readmission and five (4.72%) required a secondary procedure. Overall readmission rate was 0.54%, with a reoperation rate of 0.12%.ConclusionsThe rate of unplanned postoperative returns in the pediatric population undergoing urologic surgery is low, further strengthening the argument that readmission rates in children are not necessarily a productive focal point for financial savings or quality control.     

Group visits in the pediatric heart transplant outpatient clinic

The “GVM” has emerged as an alternative to traditional individualized appointments in the ambulatory care setting. We hypothesized that group visits could successfully be utilized in a PHtx clinic. Seven patients, ages 1–18 yr old, and their families participated in a total of 11 group visits in lieu of individualized appointments. Patients were divided into two groups based on whether they were greater or less than one yr post‐transplant. Patient/provider satisfaction, medication adherence, and content retention were ascertained via questionnaires and free‐response tests. Total clinic throughput time, including per‐patient clinic utilization time, was compared to historical data. Six of seven patients completed the study with one dropout. Overall satisfaction ratings were 3.98 of 4 with all patients reporting that they would “strongly recommend” group visits to others. Health information retention tests demonstrated improvement between pre‐ and post‐tests in eight of nine (89%) of the group visits. Overall clinic utilization decreased by nearly 50% while providing 70 min of face‐to‐face time with the provider. Medication adherence neared 100% for all patients. The GVM can be successfully applied to the PHtx population with high patient and provider satisfaction, more face‐to‐face time, excellent content retention, and greatly improved clinic efficiency.     

Constipation-Related Emergency Department Use,and Associated Office Visits and Payments Among Commercially Insured Children

Objective

Pediatric constipation is common, costly, and often managed in the Emergency Department (ED). The objectives of this study were to determine the frequency of constipation-related ED visits in a large commercially insured population, the frequency of an office visit in the month before and after these visits, demographic characteristics associated with these office visits, and the ED-associated payments.

Lower rates of emergency department injury visits among Latino children in the USA: no association with health insurance.

BACKGROUND AND OBJECTIVE: Latino children have lower rates of injury visits to emergency departments (EDs) than non-Latino white and African American children. This study tests the hypothesis that this difference reflects health insurance status. DESIGN: Secondary analysis. Patients/ SETTING: Children under 19 years of age visiting EDs in the USA, sampled in the National Hospital Ambulatory Medical Care Survey of EDs (NHAMCS-ED) from 1997 to 2001. MAIN OUTCOME MEASURES: Rates of ED injury visits; ED injury visit rates by race/ethnicity stratified by health insurance and adjusted for other covariates; subtypes of injury visits; and procedures and hospital admissions by race/ethnicity. RESULTS: Injuries accounted for >56 million, or 40.5%, of total ED visits among pediatric patients. Injury visits occurred at lower rates for Latino children (9.9 per 100 person years) than non-Latino white and African American children (16.2 and 18.3, respectively), although total ED visit rates were similar. Regardless of health insurance status, Latino children had lower rates of injury visits than non-Latino white and African American children. Latino children had lower rates of the three major subtypes of injury visits (sports, accidental falls, struck by/between objects). Latino children had similar rates of procedures and hospital admissions to non-Latino white children. CONCLUSIONS: Irrespective of their insurance status, Latino children have lower rates of ED injury visits in the USA than non-Latino white children. Possible reasons for this difference include different healthcare seeking behavior or different injury patterns by race/ethnicity, but not differences in health insurance status or barriers to accessing ED care.     

The burden of asthma as reflected by the prevalence defined by doctor's diagnosis and the use of healthcare services by preschool children in a Swedish region

Aim : Epidemiological data and reports on the prevalence and burden of preschool asthma are mainly based on questionnaires and generally give a prevalence of above 6% in Sweden. In this study we used other ways of studying the prevalence, risk factors and the use of healthcare services in a defined region. Methods : The catchment area included 9410 children aged 0-6 y. All outpatient clinics had computerized records of patients and visits to the outpatient clinic could be studied as well as admissions to hospital for asthma between 1988 and 1998. Results : According to patients'record data, the prevalence of doctor-diagnosed asthma was 4.5% in 1998. Seventy-nine percent of recorded patients are seen outside the hospital, thus the burden of asthma for the health system is mainly on the outpatient clinics. Admissions and especially readmissions to the hospital have decreased during the past decade. One-third of the children with newly diagnosed asthma had recurring exacerbations and risk for persistent asthma.
Conclusions : The prevalence of doctor-diagnosed asthma as measured by total mapping in a region is lower than that reported from questionnaire-based studies. Hospital admissions for preschool asthma have decreased possibly as a result of improved medical care in the paediatric outpatient clinics where asthma is a dominating diagnose. In one-third of identified new asthmatics, there is a high risk of developing persistent asthma.     

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??Abstract??The long-term and preventive efficacies of ASIT have been paid great attention recently. To target the efficacy of ASIT??we may focus on??the standardizations of the treatment??patient selection??standardized allergen vaccines??management of adverse reactions??patient education?? documentations and management of follow-up visits.     

Chinese,Vietnamese, and Asian Indian Parents' Perspectives About Well-Child Visits: A Qualitative Analysis

Objectives

Well-child visits are a critical component of pediatric health care; however, disparities in attendance and quality of care exist for Asian children. Limited research has explored Asian immigrant parents' perspectives about their well-child visit experience.

Maternal biosocial factors affecting low birth weight

The causes of low birth weight (LBW) are multifactoral with genetic, placental, fetal and maternal factors interplaying with each other. To assess the influence of some of the maternal bio-social factors on the variance of birth weight, this study was undertaken. A total of 984 consecutive live births delivered at an urban hospital were analysed. The rate of LBW was 28.3% and preterms accounted for 3.2%. A strong correlation existed between birth weight and maternal height, weight, age, ANC visits and risk status at pregnancy. A short, malnourished, young, unregistered or primiparous mother was associated with a higher rate of LBW. On multiple regression analysis it was noted that maternal weight, parity and ANC visits independently affected the birthweight of the new born. Therefore emphasis needs to be given to maternal biosocial factors which are amenable to improvement to reduce the incidence of LBW. This can be done by selectively targeting interventions to improve nutrition, and curtailing parity and promoting contraception.     

Test performance of two-question screening for postpartum depressive symptoms

Background:  The Edinburgh Postnatal Depression Scale (EPDS) is commonly used to screen for postpartum depression, but it is difficult to consistently administer it to all mothers during busy well-child visits owing to the fact that it is time-consuming. The purpose of the present paper was to evaluate the performance of a concise, two-question screening tool in the detection of mothers with postpartum depressive symptoms who had a high EPDS score.
Methods:  The study involved 103 mothers attending a single hospital for 1 month well-child visits. The primary outcome measure was the detection of mothers with postpartum depressive symptoms, using the EPDS score as the reference standard. Visiting mothers were asked to complete both the EPDS questionnaire and a two-question questionnaire covering depressive mood and anhedonia while in the hospital waiting room. The sensitivity, specificity, predictive value, and likelihood ratio of the two-question instrument was evaluated using the EPDS as standard.
Results:  Taking EPDS as standard, sensitivity of the two-question instrument was 88% (95% confidence interval [CI]: 64−99%), specificity was 76% (95%CI: 65−84%), positive predictive value was 42% (95%CI: 26−59%), and negative predictive value was 97% (95%CI: 90−100%). The stratified likelihood ratios of each of the two-question instrument test scores 0, 1, and 2 were 0.2 (95%CI: 0.04−0.6), 3.4 (95%CI: 1.8−6.2) and 4.2 (95%CI: 1.5−12.3), respectively.
Conclusions:  With the cut-off point set at 1, the two-question instrument had high sensitivity in detecting postpartum depressive symptoms at 1 month well-child visits. In primary care setting, negative result with the two-question instrument may be a good indicator of no need for further evaluation for postpartum depression.     

儿童呼吸道过敏疾病特异性免疫治疗及随访管理

规范特异性免疫治疗相关要素、加强规范化患者选择、应用标准化疫苗、对不良反应安全管理、对患者和监护人教育以及建立脱敏档案和随访等,以达到治疗过敏性疾病预期目标。     

Associations Between Sleep Duration and Positive Mental Health Screens During Adolescent Preventive Visits in Primary Care

ObjectiveThe purpose of this paper was to understand associations between low sleep duration (<8.ßhours) and positive mental health screens among adolescents (ages 13...18) seen for preventive visits in primary care.MethodsData were from two randomized controlled trials testing the efficacy of an electronic health risk behavior screening and feedback tool for adolescent preventive visits. Participants (n.ß=.ß601) completed screeners at baseline, 3 months, and 6 months which included sleep duration in hours and the Patient Health Questionnaire 9 and Generalized Anxiety Disorder 7 screeners for depression and anxiety, respectively. Main analyses included adjusted logistic regressions testing associations between low sleep duration and positive mental health screens.ResultsAdjusted models showed that low sleep duration was associated with significantly greater odds of a positive depression screen (OR.ß=.ß1.58, 95% CI: 1.06...2.37) but not with a positive anxiety screen or co-occurring positive depression and anxiety screens. However, follow-up analyses indicated an interaction between sleep duration and anxiety in the association with a positive depression screen, such that the association between low sleep and a positive depression screen was driven by those who did not screen positive for anxiety.ConclusionsAs pediatric primary care guidelines for sleep continue to evolve, further research, training, and support for sleep screening are warranted to ensure effective early intervention for sleep and mental health problems during adolescence.     

RELATIONSHIP OF MATERNAL SMOKING TO MORBIDITY AND MORTALITY OF THE CHILD UP TO THE AGE OF FIVE

ABSTRACT. The effect of maternal smoking during pregnancy on the morbidity and mortality of the child up to the age of five was studied in 12068 births. The children of the smokers were compared with those of controls of similar age, parity, marital status and place of residence. Perinatal mortality was no higher among the smokers, but postneonatal mortality from 28 days to 5 years was almost significantly ( p <0.05) higher. The children of the smokers were highly significantly ( p <0.001) more often hospitalized in pediatric departments, the difference being clearest below the age of one. The average duration of hospital admissions was longer among the children of the smokers, and similarly the numbers of visits to the doctor and hospital admissions to any hospital under the age of one were more frequent among the children of the smokers. Respiratory diseases caused highly significantly more hospitalizations among these children.