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Ambul Pediatr 2008 Nov-Dec;8(6):392-5. Epub 2008 Oct 2.

Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University, and Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA.

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. Read More

Ambul Pediatr 2008 Nov-Dec;8(6):388-91. Epub 2008 Oct 2.

Children's Research Institute and Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53201-1991, USA.

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. Read More

Ambul Pediatr 2008 Nov-Dec;8(6):383-7. Epub 2008 Aug 22.

Center for Health Care Quality, Division of Health Policy and Clinical Effectiveness, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45299, USA.

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. Read More

Ambul Pediatr 2008 Nov-Dec;8(6):379-82. Epub 2008 Oct 15.

Center for Injury Sciences, University of Alabama at Birmingham, Department of Surgery, School of Medicine, Birmingham, AL 35294, USA.

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. Read More

Ambul Pediatr 2008 Nov-Dec;8(6):375-8. Epub 2008 Oct 2.

MGH Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, Boston, MA 02114, USA.

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. Read More

Ambul Pediatr 2008 Nov-Dec;8(6):368-74. Epub 2008 Oct 25.

Mathematica Policy Research Inc, Washington, DC 20024, USA.

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. Read More

Ambul Pediatr 2008 Nov-Dec;8(6):360-7. Epub 2008 Oct 5.

Pennsylvania State College of Medicine, Hershey, PA, USA.

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. Read More

Ambul Pediatr 2008 Nov-Dec;8(6):354-9. Epub 2008 Oct 5.

University of Utah College of Nursing, Department of Biomedical Informatics, Center for Teaching & Learning Excellence, School of Medicine, Salt Lake City, Utah 84112, USA.

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. Read More

Ambul Pediatr 2008 Nov-Dec;8(6):351-3. Epub 2008 Dec 2.

Ambul Pediatr 2008 Nov-Dec;8(6):349-50. Epub 2008 Dec 2.

MGH Center for Child and Adolescent Health Policy and Harvard Medical School, Boston, MA 02114, USA.

Ambul Pediatr 2008 Nov-Dec;8(6):345-8. Epub 2008 Oct 2.

Yale University School of Medicine, New Haven, CT 06520-8064, USA.

Ambul Pediatr 2008 Sep-Oct;8(5):336-41. Epub 2008 Aug 20.

Department of Pediatrics, Centre for Community Child Health, The University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia.

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. Read More

Ambul Pediatr 2008 Sep-Oct;8(5):329-35. Epub 2008 Jul 21.

Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts 02115, USA.

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. Read More

Ambul Pediatr 2008 Sep-Oct;8(5):321-8. Epub 2008 Jun 16.

Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 45229-3039, USA.

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. Read More

Ambul Pediatr 2008 Sep-Oct;8(5):312-20. Epub 2008 Jun 2.

US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland 20857, USA.

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. Read More

Ambul Pediatr 2008 Sep-Oct;8(5):305-11. Epub 2008 Jun 2.

Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, Boston, Mass., USA.

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. Read More

Ambul Pediatr 2008 Sep-Oct;8(5):300-4. Epub 2008 Jul 7.

Department of Paediatrics and Child Health, University of Zambia, Lusaka, Zambia.

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. Read More

Ambul Pediatr 2008 Sep-Oct;8(5):294-9. Epub 2008 Aug 20.

Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan 48109-0456, USA.

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. Read More

Ambul Pediatr 2008 Sep-Oct;8(5):288-93. Epub 2008 May 12.

Department of Pediatrics, University of Rochester School of Medicine and Dentistry, and Children's Hospital at Strong, Strong Memorial Hospital, Rochester, NY 14642, USA.

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. Read More

Ambul Pediatr 2008 Sep-Oct;8(5):281-7. Epub 2008 Jun 27.

Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.

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. Read More

Ambul Pediatr 2008 Sep-Oct;8(5):279-80. Epub 2008 Sep 19.

Department of Pediatrics, University of Arizona, Tucson, Arizona 85724-5073, USA.

Ambul Pediatr 2008 Sep-Oct;8(5):273-8. Epub 2008 Sep 19.

Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.

Ambul Pediatr 2008 Sep-Oct;8(5):271-2. Epub 2008 Sep 19.

Ambul Pediatr 2008 Jul-Aug;8(4):266-9. Epub 2008 May 27.

Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.

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. Read More

Ambul Pediatr 2008 Jul-Aug;8(4):261-5. Epub 2008 Apr 11.

Department of Pediatrics, Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

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. Read More

Ambul Pediatr 2008 Jul-Aug;8(4):255-60. Epub 2008 Jun 9.

Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.

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. Read More

Ambul Pediatr 2008 Jul-Aug;8(4):250-4. Epub 2008 Apr 28.

Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA.

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. Read More

Ambul Pediatr 2008 Jul-Aug;8(4):241-9. Epub 2008 Apr 8.

Department of Community Health Sciences and Child and Youth Studies, Brock University, St Catharines, Ontario, Canada.

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. Read More

Ambul Pediatr 2008 Jul-Aug;8(4):219-240.e17. Epub 2008 May 27.

Agency for Healthcare, Research and Quality, Department of Health and Human Services, Rockville, Maryland 20850, USA.

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. Read More

Ambul Pediatr 2008 Jul-Aug;8(4):216-8

Mayo Medical School, Mayo Clinic, Rochester, Minnesota 55905, USA.