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1.

Introduction

This study examined postpartum depression, food insecurity, and underestimation of infant size as potential early life factors for overweight risk at 12 months among infants of Hispanic immigrant mothers.

Method

Weight-for-length (WFL) measurements and face-to-face interviews were completed during well child visits. Regression models estimated the impact of early life factors (0-6 months) on overweight risk at 1 year.

Results

WFL ≥ 85th percentile was found among 2.4% at birth and 42.7% at 1 year. Most mothers (78.6%) experienced food insecurity, a factor that increased the likelihood of infant overweight risk by 2.29 times (1.03–5.09). Maternal underestimation of infant size increased the likelihood of overweight risk 5.07 times (2.57–9.99). Postpartum depression risk did not contribute to infant weight status.

Discussion

Assessment for maternal food insecurity and underestimation of infant weight status during early infancy may help reduce overweight risk and subsequent obesity for this vulnerable population.  相似文献   

2.

Introduction

Sudden cardiac arrest continues to be the leading cause of death in young athletes despite preparticipation sports screening (PPS). The devastating loss of children to sudden cardiac arrest has led communities to demand more comprehensive heart screenings. The purpose of this study was to evaluate a community youth heart screening program in Minnesota.

Method

A retrospective chart review of 840 participants aged 14 to 18 years from August 2015 through March 2017 was conducted.

Results

Referrals were made for two abnormal electrocardiography results, 12 abnormal echocardiography results, and 59 elevated blood pressure readings. Cross-tabulations showed one participant with an abnormal electrocardiogram and six participants with abnormal echocardiograms who had no other abnormal findings at the screening. Findings were not statistically significant.

Discussion

It was clinically significant that six participants were found to have potentially lethal electrical or structural heart abnormalities who would have otherwise have remained unidentified with the standard preparticipation sports screening guidelines.  相似文献   

3.

Introduction

Children with special health care needs (CSHCN) have chronic conditions that generally are classified as developmental disabilities. Children with developmental disabilities are at high risk of malnutrition. Gastrostomy buttons are frequently used to provide enteral nutrition for children with developmental disabilities.

Objective

This study aimed to understand caregivers’ perceptions regarding gastrostomy button placement for CSHCN.

Methods

Caregivers (N?=?257) were recruited from CSHCN peer support groups to complete an online survey regarding perceptions of gastrostomy button placement. Kolmogorov–Smirnov testing found that results were not normally distributed. Nonparametric testing with Spearman rank correlation was used to determine the relationship between Overall Satisfaction With Choice and all other perception variables.

Results

The findings suggested overall satisfaction and willingness to accept gastrostomy button placement earlier.

Conclusion

Gastrostomy button placement has diverse effects for children with developmental disabilities and their families. Health care professionals must be knowledgeable about the positive and negative outcomes to effectively educate families as they consider gastrostomy placement.  相似文献   

4.

Introduction

Children with disabilities have significant health care needs, and receipt of care coordinator services may reduce caregiver burdens. The present study assessed caregivers’ experience and satisfaction with care coordination.

Method

Caregivers of Medicaid-enrolled children with disabilities (n?=?2,061) completed a survey (online or by telephone) collecting information on the caregivers’ experiences and satisfaction with care coordination using the Family Experiences with Coordination of Care questionnaire.

Results

Eighty percent of caregivers with a care coordinator reported receiving help making specialist appointments, and 71% reported help obtaining community services. Caregivers who reported that the care coordinator helped with specialist appointments or was knowledgeable, supportive, and advocating for children had increased odds of satisfaction (odds ratio?=?3.46, 95% confidence interval?=?[1.01, 11.77] and odds ratio?=?1.07, 95% confidence interval?=?[1.03, 1.11], respectively).

Discussion

Findings show opportunities for improving care coordination in Medicaid-enrolled children with disabilities and that some specific elements of care coordination may enhance caregiver satisfaction with care.  相似文献   

5.

Introduction

Because health care reimbursement is being linked to discharge quality and patient satisfaction, this quality improvement initiative reviewed the outcomes of embedding a pediatric nurse practitioner within the resident team at an academic medical facility.

Methods

The project was completed at a pediatric orthopedic unit at a large Southeastern U.S. academic medical facility. During the intervention, the pediatric nurse practitioner student completed daily rounds, communicated with the resident team, assessed readiness for discharge, provided patient education, and ensured that comprehensive discharge materials were completed.

Results

Analyses were completed for 219 patients (pre-intervention, n?=?116; post-intervention, n?=?103). Patient satisfaction was measured for provider communication and discharge. All areas experienced improvement, with provider communication benchmarks obtained. Ambulatory call volume decreased from 97 to 45 calls/100 patients.

Discussion

This study shows that embedding a pediatric nurse practitioner into the resident team helped improve patient satisfaction and reduce ambulatory workload by decreasing call volume.  相似文献   

6.

Introduction

Asthma is underdiagnosed, particularly for children younger than 5 years old. Clinical practice guidelines have been shown to improve asthma diagnosis and management, but are underutilized. This evidence-based practice project aimed to develop, implement, and evaluate a three-page decision support tool (DST) to improve the asthma diagnosis process among children younger than 5 years old.

Methods

This project used a pre-experimental design and was conducted in a pediatric primary care setting with a predominantly South Asian population. The authors analyzed the utilization of the DST as well as the end-users' perception of the tool.

Results

Despite above-average results in the end-users' usability scale, the DST had poor utilization.

Discussion

Implementation of the DST is recommended at similar pediatric primary care sites. The EBP Project team recommends translating the DST to the electronic health record and improving the roles of the champion.  相似文献   

7.

Objectives

The American Academy of Pediatrics (AAP) recommends an oral health risk assessment and referral to a dental home by a child's first birthday. We evaluated the adherence of primary care providers (PCPs) to AAP dental referral guidelines for children age <4 years and barriers to implementation of these guidelines.

Methods

A cross-sectional survey of PCPs randomly selected from the 435 practices in North Carolina identified as providing well-child visits for Medicaid children age <4 years was completed in 2013. The PCPs’ referral recommendations were assessed using 4 vignettes of 18-month-old children at various risk of dental caries (low, moderate, high, or highest) and different levels of dentist supply (adequate or inadequate). Barriers to guideline adherence specified in the Cabana framework were analyzed for their associations with PCP adherence, using logistic regression models stratified by caries risk and dentist supply.

Results

The survey yielded 219 (50%) usable responses from the sample of 435 PCPs. On average for all vignettes, 61% of providers chose a referral recommendation in agreement with guidelines. Underreferral averaged 40%. With adequate workforce, guideline-adherent responses varied from 26% for low-risk children to >90% for high-risk children. An inadequate workforce reduced adherence for most levels of risk. Generally, correct knowledge of risk status, barriers to risk assessment, and pediatric practice were associated with adherence, but not always in the hypothesized direction.

Conclusions

PCPs’ adherence to referral guidelines varies according to caries risk and dentist supply, but generally they underrefer low- to moderate-risk patients by a significant degree.  相似文献   

8.

Objective

This study examined whether components of resilience at the family or child level are associated with a decreased risk of obesity in children after accounting for community-, family-, and individual-level stressors associated with an increased risk of obesity.

Methods

Data are from the 2016 National Survey of Children's Health, using the subset of children 10 to 17 years of age with weight data. We examined whether or not components of family- or child-level resilience were associated with weight status. Community-, family-, and individual-level risk factors for obesity were examined within each income stratum. We used multinomial logistic regression to evaluate if components of resilience are associated with lower overweight or obesity.

Results

The sample included 24,405 10- to 17-year-old children. Child-level but not family-level resilience components were associated with a decreased risk of child obesity across income strata. Food security and adverse childhood experiences (ACEs) were only associated with obesity within higher income strata; bullying was consistently associated across strata. Physical activity was strongly associated with increased emotional resilience. The association between higher emotional resilience and lower obesity remained after adjusting for community-level factors (parks), family-level factors (ACEs), and individual-level factors (bullying). Better maternal health was associated with increased emotional resilience and lower risk of obesity.

Conclusions

Resilience, specifically emotional resilience, may be a protective factor against obesity in children regardless of income stratum. Physical activity of the child is associated with greater emotional resilience, and better maternal health may mediate the association between this component of resilience and weight.  相似文献   

9.

Introduction

Research suggests that diverse examples of adverse childhood experiences (ACEs) may link to health. This study examines relationships between conventional (abuse, neglect, household dysfunction) and expanded examples (bullying, safety perceptions) of ACEs and adolescent mental health among youth participating in a statewide school-based survey.

Methods

Logistic regression was used to determine whether 10 types of conventional ACEs and 11 types of additional ACEs were associated with the odds of youth meeting cutoff scores for a positive Patient Health Questionnaire–2 (PHQ-2) after adjustment for demographic covariates and known mental health problems.

Results

Individual and cumulative measures for conventional and expanded ACEs were significantly associated with youth odds of meeting criteria for a positive PHQ-2. Increasing frequency of bullying harassment was associated with a 1.5- to 5-fold increase in the odds of a positive PHQ-2.

Discussion

Findings support consideration of broad concepts for adversity as relevant for youth mental health.  相似文献   

10.

Introduction

Examining the impact of appropriate sleep evaluation on diagnosis of attention deficit disorders can improve the standard of care in pediatrics. This quality improvement project examined current practice and subsequent implementation of a validated standardized sleep evaluation tool in the assessment of children with symptoms of attention deficit.

Methods

Retrospective chart review and implementation of the Children's Sleep Habits Questionnaire (CSHQ) for children 6 to 14years old with attention deficit symptoms.

Measures

Rates of sleep screening, sleep referrals, diagnosis of sleep and attention deficit disorders, Vanderbilt scores, CSHQ scores.

Results

In the retrospective group (n?=?41), 76% of patients had attention deficit disorder/attention deficit hyperactivity disorder, 19.5% had sleeping disorders. There were significant provider differences in diagnosing sleep problems (p?=?.007). In the intervention group (n?=?5), 60% had abnormal CSHQ scores.

Discussion

There was considerable incidence of sleeping problems in children with symptoms of attention deficit and provider variation in sleep evaluation and diagnosis, with minimal referral to specialist care. Our findings support a more comprehensive and standardized evaluation of sleep when assessing for attention deficit disorders to improve appropriate referrals, diagnosis, and treatment in pediatrics.  相似文献   

11.

Objective

The objectives of this study were to examine differences in body mass index z-score (BMIZ) trajectory during early childhood among children with a younger sibling compared with those without and to test potential mediators.

Methods

This longitudinal cohort study included 6050 participants of the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B). Focal children's weight, height, sibship status, screen time, active play time, family dinner frequency, and diet quality were assessed at 9 months, 24 months, preschool, and kindergarten when available. A piecewise linear regression model was used to examine the association between sibling birth and focal child's subsequent BMIZ trajectory to kindergarten. Mediation by screen time, active play time, family dinner frequency, and diet quality was tested.

Results

BMIZ trajectory was lower among children who had a new sibling join the family before kindergarten compared to children who did not have a new sibling join the family by kindergarten. The association was strongest when new sibship occurred when the focal child was 48 to 66 months (b?=?–0.026, P?=?.044). The association was not mediated by screen time, active play time, family dinner frequency, or diet quality.

Conclusion

Among a nationally representative cohort of US children, new sibship before kindergarten was associated with a lower BMIZ trajectory. Several common obesogenic risk factors did not explain the association.  相似文献   

12.
13.

Introduction

Outpatient pediatric providers play a crucial role in the promotion of breastfeeding. We conducted a mixed methods study to measure provider knowledge, attitudes, and current practices around breastfeeding counseling.

Method

In New Mexico in 2016 and 2017, we conducted a knowledge, attitudes, and practice survey of outpatient pediatric providers (i.e., nurse practitioners, physicians, and physician assistants) and conducted focus groups with outpatient pediatric providers.

Results

Seventy-seven providers responded to the survey, and 17 participated in three focus groups. Fewer than half of providers surveyed reported asking how long mothers plan to breastfeed at initial well-baby examinations. One quarter of participants (28.2%) erroneously reported that hepatitis C was an absolute contraindication to breastfeeding. Just half of respondents had received continuing education within the past 3 years about managing common breastfeeding problems.

Discussion

We identified missed opportunities for outpatient pediatric providers to support breastfeeding and a need for continuing provider education.  相似文献   

14.

Background

Adults tend to underestimate their personal risk of disease, but little is known about parents’ perceptions of children's risk.

Methods

In total, 648 parents of children 0 to 18 years old attending 2 pediatric practices were surveyed about their children's exposure to smoking; 344 parents with children ≥2 years old also were asked about their children's sugar-sweetened beverage (SSB) consumption and physical activity. Children were categorized as “at risk” or “not at risk” for each factor. Parents estimated the risk of their child becoming a smoker or gaining excessive weight and were categorized as “optimistic” if they believed their children were less likely than others to use tobacco or gain weight.

Results

Overall, 92% of parents thought their children were at lower risk than average for tobacco use, and 86% believed their children were at lower risk for excessive weight gain. A high frequency of optimistic bias occurred even among parents with “at-risk” children, including parents with children exposed to tobacco use (70.4%), SSB consumption (77.6%), >2 hours of screen time (82.1%), and low physical activity (84.1%). In multivariable analyses, parents with children exposed to tobacco smoke (odds ratio?=?0.21, 95% confidence interval, 0.09–0.51); or who consumed SSBs daily (odds ratio?=?0.44, 95% confidence interval 0.20–0.97) were less likely to be optimistic about their child's future tobacco use and excessive weight gain, respectively.

Conclusions

Most parents believed their children were at lower risk than average for tobacco use or excessive weight gain. Eliciting parents’ optimistic biases might facilitate behavior change counseling in pediatric settings.  相似文献   

15.

Objective

To improve breastfeeding through home visiting.

Methods

From 2013 to 2016, the Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN) enrolled 15 home visiting agencies serving 1000 families in 7 states. Using the Breakthrough Series Collaborative model, HV CoIIN faculty taught a theory of change and continuous quality improvement (CQI) skills, as well as facilitating opportunities for networked learning.

Results

HV CoIIN improved home visitors’ breastfeeding competencies and use of data to inform practice. Breastfeeding initiation increased from 47% to 61%. Exclusive breastfeeding of 3-month-old babies increased from 10% to 13.5%, and for babies 6 months old it increased from 5% to 8%.

Conclusions

Home visiting programs can improve breastfeeding among participants with very low baseline breastfeeding rates. Continuous quality improvement and the Breakthrough Series Collaborative model can be used to improve home visiting services in ways that advance national public health priorities.  相似文献   

16.
17.

Objective

This study evaluates the impact of a coordinated effort by an urban pediatric hospital and its associated accountable care organization to reduce asthma-related emergency department (ED) and inpatient utilization by a large, countywide Medicaid patient population.

Methods

Multiple evidence-based interventions targeting general pediatric asthma care and high health care utilizers were implemented using standardized quality improvement methodologies. Annual asthma ED and inpatient utilization rates by 2- to 18-year-old members of an accountable care organization living in the surrounding county (>140,000 eligible members in 2016), adjusted per 1000 children from 2008 through 2016, were analyzed using Poisson regression. We compared these ED utilization rates to national rates from 2006 to 2014.

Results

Asthma ED utilization fell from 18.1 to 12.9 visits/1000 children from 2008 to 2016, representing a 28.7% reduction, with an average annual decrease of 3.9% (P < .001), during a time when national utilization was increasing. Asthma inpatient utilization did not change significantly during the study period.

Conclusions

Asthma-related ED utilization was significantly reduced in a large population of primarily urban, minority, Medicaid-insured children by implementing a multimodal asthma quality improvement program. With adequate support, a similar approach could be successful in other communities.  相似文献   

18.
19.

Objective

Medicaid and the Children's Health Insurance Program (CHIP) provide health insurance to 38% of all children in the United States. Uninsured rates continued to fall over the past decade, and citizen children in immigrant families experienced the most dramatic gains. Our objective is to test whether states have managed to close Medicaid enrollment gaps between US citizen children in native and immigrant families.

Methods

We use the 2008 to 2015 American Community Surveys to compare uninsured rates for 2.4million Medicaid-eligible citizen children in immigrant and native families. State fixed-effects probit models estimate the probability of children remaining uninsured when eligible for public coverage, excluding children covered by private insurance. We compare the states with the largest enrollment gains across differences in policies relevant to CHIP/Medicaid participation for all children, including CHIP Reauthorization Act (CHIPRA) enrollment simplification, Immigrant Children's Health Improvement Act, and Affordable Care Act (ACA) Medicaid expansion.

Results

Most states reduced their enrollment disparities by one half or even completely eliminated their enrollment differentials. However, the states with the largest gains did not adopt ACA and CHIPRA policy options that would have improved CHIP/Medicaid participation for children in their states–or implemented the policies long before the observed gains.

Conclusions

Rather than policy anchoring the gains, the improvements may be rooted in operational changes and outreach efforts during CHIPRA and ACA implementation. Absent a policy anchor, the large enrollment differentials of a decade ago may reappear for children in immigrant families, affect the wellbeing of children and their communities.  相似文献   

20.

Objective

To examine insurance-based disparities in provider-related barriers to care among children in California in the wake of changes to the insurance market resulting from the Affordable Care Act.

Methods

Our sample included 6514 children (ages 0 to 11 years) from the 2014–2016 California Health Interview Survey. We examined parent reports in the past year of 1) having trouble finding a general provider for the child, 2) the child not being accepted by a provider as a new patient, 3) the child's health insurance not being accepted by a provider, or 4) any of the above. Multivariable models estimated the associations of insurance type—Medi-Cal (Medicaid), employer-sponsored insurance, or privately purchased coverage—and parent reports of these problems.

Results

Approximately 8% of parents had encountered at least one of these problems. Compared with parents of children with employer-sponsored insurance, parents of children with Medi-Cal or privately purchased coverage had over twice the odds of experiencing at least one of the barriers. Parents of children with Medi-Cal had over twice the odds of being told a provider would not accept their children's coverage or having trouble finding a general provider and 3times the odds of being told a provider would not accept their children as new patients. Parents of children with privately purchased coverage had over 3times the odds of being told a provider would not accept their children's coverage.

Conclusions

Our study found significant disparities in provider-related barriers by insurance type among children in California.  相似文献   

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