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  • 1
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    Which Psychiatric Patients Board on the Medical Service?
    American Academy of Pediatrics (AAP) ; 2003
    In:  Pediatrics Vol. 111, No. 6 ( 2003-06-01), p. e693-e698
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 111, No. 6 ( 2003-06-01), p. e693-e698
    Abstract: Objectives. Patients who require psychiatric hospitalization may be admitted to a medical service only because there are no available inpatient psychiatric beds. These patients are psychiatric “boarders.” The goals of this study were to describe the extent of the boarder problem and to compare the characteristics of patients who are placed successfully into psychiatric facilities from the emergency department (ED) with those who require admission to the medical service as a boarder. Methods. A retrospective cohort study of a large pediatric ED was conducted. Included were patients who required inpatient psychiatric admission between July 1, 1999, and June 30, 2000. Patients were excluded when they needed inpatient medical treatment before psychiatric placement. The main outcome measured was placement into a psychiatric facility or boarding on medical service. Results. Of the 315 patients who presented to the ED and required psychiatric admission, 103 (33%) were boarded on the medical service. Multivariate logistic regression demonstrated an increased odds of boarding for age 10 to 13 years (adjusted odds ratio [AOR]: 3.5; 95% confidence interval [CI] : 1.8–6.6), black race (AOR: 2.3; 95% CI: 1.1–4.8), presenting on a weekend or holiday (AOR: 3.8; 95% CI: 1.6–8.8), and presenting from October to June (October–December 1999 [AOR: 4.7; 95% CI: 1.7–13.4], January–March 2000 [AOR: 14.5; 95% CI: 4.9–42.6] , and April–June 2000 [AOR: 10.4; 95% CI: 3.5–30.2]) but a decreased odds for 1 insurance company (AOR: 0.08; 95% CI: 0.02–0.4). There was a linear increase in odds of boarding as severity of homicidal ideation increased from none to mild (AOR: 1.5; 95% CI: 1.2–1.8) to moderate (AOR: 2.3; 95% CI: 2.0–2.6) to severe (AOR: 3.5; 95% CI: 3.2–3.8). Suicidal patients also had increased risk of boarding (AOR: 2.2; 95% CI: 1.2–4.3). Conclusions. Boarders are a problem in pediatrics, and this study identifies multiple characteristics that were associated with increasing a youth’s odds of becoming a boarder at this institution. The suicidal and homicidal symptom results suggest a reverse triage system in which sicker patients are not necessarily given priority by psychiatric facilities. These data highlight mental health practices that need to be reassessed to ensure optimal care for youths with acute mental illness.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.111.6.e693
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2003
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  • 2
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    Community Asthma Initiative: Evaluation of a Quality Improvement Program for Comprehensive Asthma Care
    American Academy of Pediatrics (AAP) ; 2012
    In:  Pediatrics Vol. 129, No. 3 ( 2012-03-01), p. 465-472
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 129, No. 3 ( 2012-03-01), p. 465-472
    Abstract: The objective of this study was to assess the cost-effectiveness of a quality improvement (QI) program in reducing asthma emergency department (ED) visits, hospitalizations, limitation of physical activity, patient missed school, and parent missed work. METHODS: Urban, low-income patients with asthma from 4 zip codes were identified through logs of ED visits or hospitalizations, and offered enhanced care including nurse case management and home visits. QI evaluation focused on parent-completed interviews at enrollment, and at 6- and 12-month contacts. Hospital administrative data were used to assess ED visits and hospitalizations at enrollment, and 1 and 2 years after enrollment. Hospital costs of the program were compared with the hospital costs of a neighboring community with similar demographics. RESULTS: The program provided services to 283 children. Participants were 55.1% male; 39.6% African American, 52.3% Latino; 72.7% had Medicaid; 70.8% had a household income & lt;$25 000. Twelve-month data show a significant decrease in any (≥1) asthma ED visits (68.0%) and hospitalizations (84.8%), and any days of limitation of physical activity (42.6%), patient missed school (41.0%), and parent missed work (49.7%) (all P & lt; .0001). Patients with greatest functional impairment from ED visits, limitation of activity, and missed school were more likely to have any nurse home visit and greater number of home visits. There was a significant reduction in hospital costs compared with the comparison community (P & lt; .0001), and a return on investment of 1.46. CONCLUSIONS: The program showed improved health outcomes and cost-effectiveness and generated information to guide advocacy efforts to finance comprehensive asthma care.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2010-3472
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2012
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  • 3
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    Intentions to Use Violence Among Young Adolescents
    American Academy of Pediatrics (AAP) ; 1996
    In:  Pediatrics Vol. 98, No. 6 ( 1996-12-01), p. 1104-1108
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 98, No. 6 ( 1996-12-01), p. 1104-1108
    Abstract: Objective. Frequent violent behavior among adolescents has been found to be associated with previous exposure to violence, personal victimization, depression, hopelessness, and older age. Although young adolescents engage in less severe violent behavior than older adolescents, their perceived normative expectations to use violence to resolve conflicts may already be established by early adolescence. This study examined the influence of exposure to violence, depression, church attendance, multiple drug use, and demographic variables on young adolescents' intentions to use violence to resolve conflict. Methods. Young adolescents (N = 225, males = 49.4%, black = 88.7%, mean age = 12.9 ± 1 years) in two middle schools serving low-income and working-class communities were administered a previously tested anonymous questionnaire. They were also asked how they would resolve conflict in 15 different hypothetical situations. Each situation had 10 possible responses ranging from humor or avoidance to severe violence (eg, use of a gun). The Intentions to Use Violence in Hypothetical Situations Scale had a high internal reliability (α = .88) and was correlated (r = .46) at the expected level for this age group with a standardized use of violence and weapon-carrying scale. Results. The Intentions to Use Violence in Hypothetical Situations Scale was significantly correlated with age (r = .17), school grade (r = .14), lower church attendance (r = -.23), frequency of smoking (r = .24), alcohol use (r = .37), marijuana use (r = .36), crack cocaine use (r = .14), smokeless tobacco use (r = .20), injecting drug use (r = .16), depression (r = .12), and exposure to violence (r = .48). Based on multiple regression analysis, exposure to violence, marijuana use, frequency of church attendance, alcohol use, cocaine use, and tobacco use accounted for 36.6% of the variation in the Intentions to Use Violence in Hypothetical Situations Scale. Conclusion. Although the intention to use violence was associated with previous exposure to violence and current drug use, adolescents who attended religious services more often were less likely to report that they would use violence to resolve interpersonal conflict.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.98.6.1104
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 1996
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  • 4
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    Aggressors or Victims: Gender and Race in Music Video Violence
    American Academy of Pediatrics (AAP) ; 1998
    In:  Pediatrics Vol. 101, No. 4 ( 1998-04-01), p. 669-674
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 101, No. 4 ( 1998-04-01), p. 669-674
    Abstract: Objective. To examine portrayals of violence in popular music videos for patterns of aggression and victimization by gender and race. Design and Setting. Content analysis of 518 music videos broadcast over national music television networks, Black Entertainment Television (BET), Country Music Television (CMT), Music Television (MTV), and Video Hits-1 (VH-1) during a 4-week period at randomly selected times of high adolescent viewership. Main Outcome Measures. Differences in the genders and races portrayed as aggressors and victims in acts of violence. Results. Seventy-six (14.7%) of the analyzed music videos contained portrayals of individuals engaging in overt interpersonal violence, with a mean of 6.1 violent acts per violence-containing video. Among the 462 acts of violence, the music video's main character was clearly the aggressor in 80.1% and the victim in 17.7%. In 391 (84.6%) of the violence portrayals, the gender of the aggressor or victim could be determined. Male gender was significantly associated with aggression; aggressors were 78.1% male, whereas victims were 46.3% female. This relationship was influenced by race. Among whites, 72.0% of the aggressors were male and 78.3% of the victims were female. Although blacks represent 12% of the United States population, they were aggressors in 25.0% and victims in 41.0% of music video violence. Controlling for gender, racial differences were significant among males; 29.0% of aggressors and 75.0% of victims were black. A logistic regression model did not find direct effects for gender and race, but revealed a significant interaction effect, indicating that the differences between blacks and whites were not the same for both genders. Black males were more likely than all others to be portrayed as victims of violence (adjusted odds ratio = 28.16, 95% confidence interval = 8.19, 84.94). Conclusions. Attractive role models were aggressors in more than 80% of music video violence. Males and females were victims with equivalent frequency, but males were more than three times as likely to be aggressors. Compared with United States demographics, blacks were overrepresented as aggressors and victims, whereas whites were underrepresented. White females were most frequently victims. Music videos may be reinforcing false stereotypes of aggressive black males and victimized white females. These observations raise concern for the effect of music videos on adolescents' normative expectations about conflict resolution, race, and male-female relationships.
    Type of Medium: Online Resource
    ISSN: 1098-4275 , 0031-4005
    URL: Article
    DOI: 10.1542/peds.101.4.669
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 1998
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  • 5
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    Early Intervention in Low Birth Weight Premature Infants: Results at 18 Years of Age for the Infant Health and Development Program
    American Academy of Pediatrics (AAP) ; 2006
    In:  Pediatrics Vol. 117, No. 3 ( 2006-03-01), p. 771-780
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 117, No. 3 ( 2006-03-01), p. 771-780
    Abstract: OBJECTIVE. To assess whether improvements in cognitive and behavioral development seen in preschool educational programs persist, we compared those in a multisite randomized trial of such a program over the first 3 years of life (INT) to those with follow-up only (FUO) at 18 months of age. METHODS. This was a prospective follow-up of the Infant Health and Development Program at 8 sites heterogeneous for sociodemographic characteristics. Originally 985 children were randomized to the INT (n = 377) or FUO (n = 608) groups within 2 birth weight strata: heavier low birth weight (HLBW; 2001–2499 g) and lighter low birth weight (LLBW; ≤2000 g). Primary outcome measures were the Peabody Picture Vocabulary Test (PPVT-III), reading and mathematics subscales of the Woodcock-Johnson Tests of Achievement, youth self-report on the Total Behavior Problem Index, and high-risk behaviors on the Youth Risk Behavior Surveillance System (YRBSS). Secondary outcomes included Weschler full-scale IQ, caregiver report on the Total Behavior Problem Index, and caregiver and youth self-reported physical health using the Medical Outcome Study measure. Assessors were masked as to study status. RESULTS. We assessed 636 youths at 18 years (64.6% of the 985, 72% of whom had not died or refused at prior assessments). After adjusting for cohort attrition, differences favoring the INT group were seen on the Woodcock-Johnson Tests of Achievement in math (5.1 points), YRBSS (−0.7 points), and the PPVT-III (3.8 points) in the HLBW youth. In the LLBW youth, the Woodcock-Johnson Tests of Achievement in reading was higher in the FUO than INT group (4.2). CONCLUSIONS. The findings in the HLBW INT group provide support for preschool education to make long-term changes in a diverse group of children who are at developmental risk. The lack of observable benefit in the LLBW group raises questions about the biological and educational factors that foster or inhibit sustained effects of early educational intervention.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2005-1316
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2006
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  • 6
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    Genital Findings in Sexually Abused, Symptomatic and Asymptomatic, Girls
    American Academy of Pediatrics (AAP) ; 1987
    In:  Pediatrics Vol. 79, No. 5 ( 1987-05-01), p. 778-785
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 79, No. 5 ( 1987-05-01), p. 778-785
    Abstract: Although evaluation of the vulva of sexually abused girls using magnification with a colposcope or pediatric otoscope has become increasingly popular, the incidence of various genital findings in sexually abused and asymptomatic children has not been reported. A prospective study was carried out in which 20 genital findings from three groups of girls (mean age 4.8 ± 2.6 years) were analyzed. The three groups were (1) sexually abused girls (n = 119), (2) normal girls with no genital complaints (n = 127), and (3) girls with other genital complaints (n = 59). Group 1 was more likely than group 2 to have scars on the hymen or posterior forchette (9% v 1%, P = .002), increased friability of the posterior forchette (10% v 1%, P = .001), attenuated hymen (18% v 4%, P = .0003), and synechiae from the hymenal ring to the vagina (8% v 0%, P = .0009). Groups 1 and 3 were remarkably similar with the exception of erythema which was more common in group 3 (34% v 68%, P = .0001). Hymenal diameter was slightly greater in group 1 than 2 but not 3. Although genital findings distinguish some sexually abused girls from asymptomatic girls, many findings also occur in girls with other genital complaints, which suggests that many of these girls have also been molested or that vulvar inflammation may lead to some of these findings.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.79.5.778
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 1987
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  • 7
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    A Parenting and Life Skills Intervention for Teen Mothers: A Randomized Controlled Trial
    American Academy of Pediatrics (AAP) ; 2019
    In:  Pediatrics Vol. 143, No. 3 ( 2019-03-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 143, No. 3 ( 2019-03-01)
    Abstract: Teen mothers often present with depression, social complexity, and inadequate parenting skills. Many have rapid repeat pregnancy, which increases risk for poor outcomes. We conducted a randomized controlled trial of a parenting and life skills intervention for teen mothers aimed at impacting parenting and reproductive outcomes. METHODS: Teen mothers were recruited from a teen-tot clinic with integrated medical care and social services. Participants were randomly assigned 1:1 to receive (1) teen-tot services plus 5 interactive parenting and life skills modules adapted from the Nurturing and Ansell-Casey Life Skills curricula, delivered by a nurse and social worker over the infant’s first 15 months or (2) teen-tot services alone. A computerized questionnaire was self-administered at intake, 12, 24, and 36 months. Outcomes included maternal self-esteem, parenting attitudes associated with child maltreatment risk, maternal depression, life skills, and repeat pregnancy over a 36-month follow-up. We used generalized linear mixed modeling and logistic regression to examine intervention effects. RESULTS: Of 152 invited, 140 (92%) participated (intervention = 72; control = 68). At 36 months, maternal self-esteem was higher in the intervention group compared with controls (P = .011), with higher scores on preparedness for mothering role (P = .011), acceptance of infant (P = .008), and expected relationship with infant (P = .029). Repeat pregnancy by 36 months was significantly lower for intervention versus control participants. CONCLUSIONS: A brief parenting and/or life skills intervention paired with medical care for teens and their children has positive effects on maternal self-esteem and repeat pregnancy over 36 months.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2018-2303
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2019
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  • 8
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    Parent Experiences with an Urban Nurse-Supervised Community Health Worker Asthma Home-Visiting Program
    American Academy of Pediatrics (AAP) ; 2019
    In:  Pediatrics Vol. 144, No. 2_MeetingAbstract ( 2019-08-01), p. 146-146
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 144, No. 2_MeetingAbstract ( 2019-08-01), p. 146-146
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.144.2MA2.146
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2019
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  • 9
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    Community Health Workers in Home Visits and Asthma Outcomes
    American Academy of Pediatrics (AAP) ; 2021
    In:  Pediatrics Vol. 147, No. 4 ( 2021-04-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 147, No. 4 ( 2021-04-01)
    Abstract: The Community Asthma Initiative (CAI) was included in the New England Asthma Innovations Collaborative, which received a Centers for Medicare and Medicaid Services (CMS) Innovation grant. Under this grant, CAI transitioned from a mixed community health worker and nurse model to a nurse-supervised community health worker model. CMS limited enrollment to patients with Medicaid and encouraged 3 home visits per family. METHODS: A total of 389 patients enrolled under the CMS grant at Boston Children’s Hospital from 2013 to 2015 (CMS group) were compared with 733 CAI patients with Medicaid enrolled from 2005 to 2012 (comparison group). Changes in 5 asthma-related measures (emergency department visits, hospitalizations, physical activity limitations, missed school days, and parent and/or guardian missed workdays) were compared between baseline and 6 and 12 months postenrollment. Measures were analyzed as dichotomous variables using logistic regression. Numbers of occurrences were analyzed as continuous variables. Changes in quality of life (QoL) among the CMS group were examined through a 13-question survey with activity and emotional health subscales. RESULTS: Although patients in both groups exhibited improvement in all measures, the CMS group had greater odds of decreased hospitalizations (odds ratio 3.13 [95% confidence interval 1.49–6.59]), missed school days (1.91 [1.09–3.36] ), and parent and/or guardian missed workdays (2.72 [1.15–6.41]) compared to the comparison group. Twelve months postenrollment, the CMS group experienced improvement in all QoL questions and subscales (all P values & lt;.01). CONCLUSIONS: The CMS group showed improved outcomes for hospitalizations and missed school and workdays compared to the comparison group. The CMS group also exhibited significant improvement in QoL.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2020-011817
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2021
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  • 10
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    High-Risk Behaviors Among High School Students in Massachusetts Who Use Anabolic Steroids
    American Academy of Pediatrics (AAP) ; 1995
    In:  Pediatrics Vol. 96, No. 2 ( 1995-08-01), p. 268-272
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 96, No. 2 ( 1995-08-01), p. 268-272
    Abstract: Objective. To assess the association between the frequency of anabolic steroid use and the frequency of other health risk and problem behaviors among high school students in Massachusetts. Methods. The 1993 Massachusetts Youth Risk Behavior Survey was conducted on a random sample of 3054 high school students (49% male; mean age, 16 ± 1.2 years). The frequency of lifetime anabolic steroid use was measured on an ordinal scale from 1 to 6, representing "0" to "40 or more times." Other health risk and problem behaviors measured were sexual behaviors, suicidal behaviors, frequency of not wearing a passenger seat belt, riding a motorcycle, not wearing a helmet while riding a motorcycle, driving after drinking alcohol, riding with a driver who had been drinking alcohol, fighting, and carrying a weapon. The associations between the frequency of anabolic steroid use and other high-risk behaviors were determined using the Spearman correlation coefficient for ordinal data and the Kruskall-Wallis analysis of variance for categorical data. Representative indicators of each risk behavior significantly associated with anabolic steroid use were then analyzed using a stepwise multiple-regression analysis. Results. The frequency of anabolic steroid use was associated with all of the other high-risk behaviors analyzed. Using multiple-regression analysis, driving after drinking alcohol accounted for 12.5% of the variance of the model. Carrying a gun, the number of sexual partners within the past 3 months, not using a condom during last intercourse, injury in a physical fight requiring medical attention, history of a sexually transmitted disease, not wearing a helmet on a motorcycle, not wearing a passenger seatbelt, and a suicide attempt requiring medical attention accounted for an additional 9.0% of the variance. The full model accounted for greater than 21% of the variation. Conclusions. The frequency of anabolic steroid use among adolescents is associated with other high-risk behaviors, thus supporting the hypothesis that anabolic steroid use is part of a "risk behavior syndrome" rather than an isolated behavior. This finding emphasizes the need for comprehensive high-risk behavior screening and counseling among teens who use anabolic steroids.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.96.2.268
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 1995
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