Medicine and Health Sciences Commons^™

Flavored Electronic Cigarette Use And Smoking Among Youth., Hongying Dai, Jianqiang Hao

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND AND OBJECTIVE: Flavored electronic cigarettes (e-cigarettes) are not prohibited in the United States, and e-cigarette flavors proliferate on the market. This study sought to examine flavored e-cigarette use and its association with smoking among youth.

METHODS: Estimates of flavored e-cigarette use from the 2014 National Youth Tobacco Survey were investigated. A logistic regression model was used to assess whether flavored e-cigarette use was associated with (1) intention to initiate cigarette use among never-smoking youth (n = 16 471), (2) intention to quit tobacco use among current-smoking youth (n = 1338), and (3) perception of tobacco's danger among all respondents …

Update From The Advisory Committee On Immunization Practices., Jennifer E. Schuster, Sean O'Leary, David W. Kimberlin

Manuscripts, Articles, Book Chapters and Other Papers

The Advisory Committee on Immunization Practices (ACIP) consists of medical and public health experts who develop recommendations on vaccine use in the United States. The ACIP meets 3 times per year, and members and Centers for Disease Control (CDC) staff present findings and discuss vaccine research, vaccine effectiveness (VE) and safety, clinical trial results, and labeling/package insert information. Outbreaks of vaccine-preventable diseases and vaccine shortages are also discussed. Nonvoting representatives from the American Academy of Pediatrics and the Pediatric Infectious Diseases Society are present. The ACIP met on June 22-23, 2016 to discuss proposed recommendations for influenza vaccination, for human …

Firearm Injury Prevention In Clinical Practice: Staying On Message., M Denise Dowd

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Indoor Tobacco Legislation Is Associated With Fewer Emergency Department Visits For Asthma Exacerbation In Children., Christina E. Ciaccio, Tami Gurley-Calvez, Theresa I. Shireman

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: During the past 3 decades, numerous cities and states have adopted laws that ban smoking in public indoor spaces. The rationale for these policies has been to protect nonsmokers from the adverse health effects of secondhand smoke.

OBJECTIVE: To determine whether the implementation of indoor smoking legislation is associated with a decrease in emergency department visits for asthma in children.

METHODS: This retrospective analysis used a natural experiment to estimate the impact of clean indoor air legislation on the rate of emergency department admissions for asthma exacerbation in children. Data were obtained from the Pediatric Health Information System. A …

Staff Responses When Parents Hit Children In A Hospital Setting., Sarah A. Font, Elizabeth T. Gershoff, Catherine A. Taylor, Amy Terreros, Monica Nielsen-Parker, Lisa Spector, Rebecca H. Foster, Ann Budzak Garza, Denyse Olson-Dorff

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Physical punishment of children is a prevalent practice that is condemned by most medical professionals given its link with increased risk of child physical abuse and other adverse child outcomes. This study examined the prevalence of parent-to-child hitting in medical settings and the intervention behaviors of staff who witness it.

METHOD: Staff at a children's medical center and a general medical center completed a voluntary, anonymous survey. We used descriptive statistics to examine differences in the experiences of physicians, nurses, and other medical staff. We used logistic regression to predict intervention behaviors among staff who witnessed parent-to-child hitting.

RESULTS: …

Progress Toward Eliminating Mother To Child Transmission Of Hiv In Kenya: Review Of Treatment Guideline Uptake And Pediatric Transmission At Four Government Hospitals Between 2010 And 2012., Sarah Finocchario-Kessler, Kristine F. Clark, Samoel Khamadi, Brad J. Gautney, Vincent Okoth, Kathy Goggin, Hitsystem Study Team

Manuscripts, Articles, Book Chapters and Other Papers

We analyzed prevention of mother-to-child transmission (PMTCT) data from a retrospective cohort of n = 1365 HIV+ mothers who enrolled their HIV-exposed infants in early infant diagnosis services in four Kenyan government hospitals from 2010 to 2012. Less than 15 and 20 % of mother-infant pairs were provided with regimens that met WHO Option A and B/B+ guidelines, respectively. Annually, the gestational age at treatment initiation decreased, while uptake of Option B/B+ increased (all p's < 0.001). Pediatric HIV infection was halved (8.6-4.3 %), yet varied significantly by hospital. In multivariable analyses, HIV-exposed infants who received no PMTCT (AOR 4.6 [2.49, 8.62], p < 0.001), mixed foods (AOR 5.0 [2.77, 9.02], p < 0.001), and care at one of the four hospitals (AOR 3.0 [1.51, 5.92], p = 0.002) were more likely to be HIV-infected. While the administration and uptake of WHO PMTCT guidelines is improving, an expanded focus on retention and medication adherence will further reduce pediatric HIV transmission.

A Pressure Ulcer And Fall Rate Quality Composite Index For Acute Care Units: A Measure Development Study., Diane K. Boyle, Ananda Jayawardhana, Mary E. Burman, Nancy E. Dunton, Vincent S. Staggs, Sandra Bergquist-Beringer, Byron J. Gajewski

Manuscripts, Articles, Book Chapters and Other Papers

Background: Composite indices are single measures that combine the strengths of two or more individual measures and provide broader, easy-to-use measures for evaluation of provider performance and comparisons across units and hospitals to support quality improvement.

Objective: The study objective was to develop a unit-level inpatient composite nursing care quality performance index-the Pressure Ulcer and Fall Rate Quality Composite Index.

Design: Two-phase measure development study.

Settings: 5144 patient care units in 857 United States hospitals participating in the National Database of Nursing Quality Indictors® during the year 2013.

Methods: The Pressure Ulcer and Fall Rate Quality Composite Index was developed …

Toxic Environmental Exposures And Kidney Health In Children., Darcy K. Weidemann, Virginia M. Weaver, Jeffrey J. Fadrowski

Manuscripts, Articles, Book Chapters and Other Papers

High-level exposures to a number of agents are known to have direct nephrotoxic effects in children. A growing body of literature supports the hypothesis that chronic, relatively low-level exposure to various nephrotoxicants may also increase the risk for chronic kidney disease (CKD) or accelerate its progression. In this review we highlight several environmental nephrotoxicants and their association with CKD in children and adolescents. We also discuss unique epidemiological challenges in the use of kidney biomarkers in environmental nephrotoxicology.

Risk Factors For Sleep-Related Infant Deaths In In-Home And Out-Of-Home Settings., Hilina Kassa, Rachel Y. Moon, Jeffrey D. Colvin

Manuscripts, Articles, Book Chapters and Other Papers

Background and objective: Multiple environmental risk factors are associated with sleep-related infant deaths. Little is known about differences in risk factors for deaths occurring in-home and out-of-home. We sought to compare risk factors for in-home and out-of-home infant deaths.

Methods: We conducted a cross-sectional analysis of sleep-related infant deaths from 2004 to 2014 in the National Child Fatality Review and Prevention database. The main exposure was setting (in-home versus out-of-home) at time of death. Primary outcomes were known risk factors: sleep position, sleep location (eg, crib), objects in the environment, and bed sharing. Risk factors for in-home versus out-of-home deaths …

School-Located Influenza Vaccinations: A Randomized Trial., Peter G. Szilagyi, Stanley Schaffer, Cynthia M. Rand, Phyllis Vincelli, Ashley Eagan, Nicolas P N Goldstein, A Dirk Hightower, Mary Younge, Aaron Blumkin, Christina S. Albertin, Byung-Kwang Yoo, Sharon Humiston

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Assess impact of offering school-located influenza vaccination (SLIV) clinics using both Web-based and paper consent upon overall influenza vaccination rates among elementary school children.

METHODS: We conducted a cluster-randomized trial (stratified by suburban/urban districts) in upstate New York in 2014-2015. We randomized 44 elementary schools, selected similar pairs of schools within districts, and allocated schools to SLIV versus usual care (control). Parents of children at SLIV schools were sent information and vaccination consent forms via e-mail, backpack fliers, or both (depending on school preferences) regarding school vaccine clinics. Health department nurses conducted vaccine clinics and billed insurers. For all …

Developing Novel Machine Learning Algorithms To Improve Sedentary Assessment For Youth Health Enhancement., Gowtham Kumar Golla, Jordan A. Carlson, Jun Huan, Jacqueline Kerr, Tarrah Mitchell, Kelsey Borner

Manuscripts, Articles, Book Chapters and Other Papers

Sedentary behavior of youth is an important determinant of health. However, better measures are needed to improve understanding of this relationship and the mechanisms at play, as well as to evaluate health promotion interventions. Wearable accelerometers are considered as the standard for assessing physical activity in research, but do not perform well for assessing posture (i.e., sitting vs. standing), a critical component of sedentary behavior. The machine learning algorithms that we propose for assessing sedentary behavior will allow us to re-examine existing accelerometer data to better understand the association between sedentary time and health in various populations. We collected two …

Decreasing Patient Cost And Travel Time Through Pediatric Rheumatology Telemedicine Visits., Elizabeth A. Kessler, Ashley K. Sherman, Mara L. Becker

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: There is a critical shortage of pediatric rheumatologists in the US. Substantial travel to clinics can impose time and monetary burdens on families. The aim of this study was to evaluate the cost of in-person pediatric rheumatology visits for families and determine if telemedicine clinics resulted in time and cost savings. Factors associated with interest in telemedicine were also explored.

METHODS: Surveys were offered to parents and guardians of patients in Pediatric Rheumatology follow-up clinics in Kansas City, Missouri, the primary site of in-person care, and at a telemedicine outreach site 160 miles away, in Joplin, Missouri. Survey questions …

Predictors Of Infant Age At Enrollment In Early Infant Diagnosis Services In Kenya., Kathy Goggin, Catherine Wexler, Niaman Nazir, Vincent S. Staggs, Brad Gautney, Vincent Okoth, Samoel A Khamadi, Andrea Ruff, Michael Sweat, An-Lin Cheng, Sarah Finocchario-Kessler

Manuscripts, Articles, Book Chapters and Other Papers

Despite the importance of early detection to signal lifesaving treatment initiation for HIV+ infants, early infant diagnosis (EID) services have received considerably less attention than other aspects of prevention of mother to child transmission care. This study draws on baseline data from an on-going cluster randomized study of an intervention to improve EID services at six government hospitals across Kenya. Two logistic regressions examined potential predictors of "on time" (infant ≤6 weeks of age) vs. "late" (≥7 weeks) and "on time" versus "very late" (≥12 weeks) EID engagement among 756 mother-infant pairs. A quarter of the infants failed to get …

Reliability Of Pressure Ulcer Rates: How Precisely Can We Differentiate Among Hospital Units, And Does The Standard Signal-Noise Reliability Measure Reflect This Precision?, Vincent S. Staggs, Emily Cramer

Manuscripts, Articles, Book Chapters and Other Papers

Hospital performance reports often include rankings of unit pressure ulcer rates. Differentiating among units on the basis of quality requires reliable measurement. Our objectives were to describe and apply methods for assessing reliability of hospital-acquired pressure ulcer rates and evaluate a standard signal-noise reliability measure as an indicator of precision of differentiation among units. Quarterly pressure ulcer data from 8,199 critical care, step-down, medical, surgical, and medical-surgical nursing units from 1,299 US hospitals were analyzed. Using beta-binomial models, we estimated between-unit variability (signal) and within-unit variability (noise) in annual unit pressure ulcer rates. Signal-noise reliability was computed as the ratio …

Urgent Care And Emergency Department Visits In The Pediatric Medicaid Population., Amanda Montalbano, Jonathan Rodean, Juhi Kangas, Brian R. Lee, Matt Hall

Manuscripts, Articles, Book Chapters and Other Papers

Background: Urgent care (UC) is one of the fastest growing venues of health care delivery. We compared clinical and cost attributes of pediatric UC and emergency department (ED) visits that did not result in admission.

Methods: Our study examined 5 925 568 ED and UC visits of children under 19 years old in the 2010 through 2012 Marketscan Medicaid Multi-State Database. Basic demographics, diagnoses, severity, and payments were compared. Between ED and UC visits, χ(2) tests were used for proportions and Wilcoxon rank-sum tests were used for continuous variables.

Results: The UC and ED had the same most common diagnoses. …

Walking Mediates Associations Between Neighborhood Activity Supportiveness And Bmi In The Women's Health Initiative San Diego Cohort., Jordan A. Carlson, Rosemay A. Remigio-Baker, Cheryl A M Anderson, Marc A. Adams, Gregory J. Norman, Jacqueline Kerr, Michael H. Criqui, Matthew Allison

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: To investigate whether walking mediates neighborhood built environment associations with weight status in middle- and older-aged women.

METHODS: Participants (N=5085; mean age=64 ± 7.7; 75.4% White non-Hispanic) were from the Women's Health Initiative San Diego cohort baseline visits. Body mass index (BMI) and waist circumference were measured objectively. Walking was assessed via survey. The geographic information system (GIS)-based home neighborhood activity supportiveness index included residential density, street connectivity, land use mix, and number of parks.

RESULTS: BMI was 0.22 units higher and the odds ratio for being obese (vs. normal or overweight) was 8% higher for every standard deviation …

Tom Curran, Phd, Frs, Named Executive Director Of Children's Research Institute, Children's Mercy Hospital

Our Story Continues

Tom Curran, PhD, FRS, has been named Chief Scientific Officer and Executive Director of the Children’s Mercy Children’s Research Institute (CRI), effective Feb. 1 [2016]

The Children’s Research Institute at Children’s Mercy Kansas City was established last year to build on the hospital’s century-long history in pediatric research and to focus the hospital’s future research efforts in four key areas:

• Pediatric Genomic Medicine
• Clinical Pharmacology
• Health Services and Outcomes
• Health Care Delivery

The State Of Children's Health: 2016 Community Health Needs Assessment For The Kansas City Region, Margo Quiriconi

Community Benefits

The State of Children’s Health: 2016 Community Health Needs Assessment for the Kansas City Region (2016 CHNA) is the second assessment since the Patient Protection and Affordable Care Act of 2010 (ACA) required hospitals to conduct a triennial community health needs assessments. In addition to fulfilling the ACA requirements and subsequent IRS Section H/Form 990 mandate, the 2016 CHNA process is undertaken:
• to examine the current health status of children and identify unmet health needs in the Children’s Mercy leading service area
• to identify the current health priorities—as well as new and emerging health concerns—among children and families …

Contraceptive Provision To Adolescent Females Prescribed Teratogenic Medications., Stephani L. Stancil, Melissa K. Miller, Holley Briggs, Daryl Lynch, Kathy Goggin, Gregory Kearns

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND AND OBJECTIVES: Rates of adult women receiving contraceptive provision when simultaneously prescribed a known teratogen are alarmingly low. The prevalence of this behavior among pediatric providers and their adolescent patients is unknown. The objective of this study was to describe pediatric provider behaviors for prescribing teratogens concurrently with counseling, referral, and/or prescribing of contraception (collectively called contraceptive provision) in the adolescent population.

METHODS: A retrospective review was conducted examining visits in 2008-2012 by adolescents aged 14 to 25 years in which a known teratogen (US Food and Drug Administration pregnancy risk category D or X) was prescribed. The electronic …

Slug Bug: Quality Improvement With Orchestrated Testing Leads To Nicu Clabsi Reduction., Anthony J. Piazza, Beverly Brozanski, Lloyd Provost, Theresa R. Grover, John Chuo, Joan R. Smith, Teresa Mingrone, Susan Moran, Lorna Morelli, Isabella Zaniletti, Eugenia K. Pallotto

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Reduce central line-associated bloodstream infection (CLABSI) rates 15% over 12 months in children's hospital NICUs. Use orchestrated testing as an approach to identify important CLABSI prevention practices.

METHODS: Literature review, expert opinion, and benchmarking were used to develop clinical practice recommendations for central line care. Four existing CLABSI prevention strategies (tubing change technique, hub care monitoring, central venous catheter access limitation, and central venous catheter removal monitoring) were identified for study. We compared the change in CLABSI rates from baseline throughout the study period in 17 participating centers. Using orchestrated testing, centers were then placed into 1 of 8 …

Comparison Of Affect And Cardiorespiratory Training Responses Between Structured Gym Activities And Traditional Aerobic Exercise In Children., David A. White, S D. Rothenberger, L A. Hunt, F L. Goss

Manuscripts, Articles, Book Chapters and Other Papers

Physical activities (PA) that are pleasurable are likely to be repeated. Structured gym activities (SGA) are defined as dodging, chasing, and fleeing games. Traditional aerobic exercises (TAE) are defined as treadmill, cycle ergometer, and elliptical exercise. The purpose of this investigation was to compare affect and cardiorespiratory training responses between SGA and TAE in children. Thirty-two participants (9.3±0.2) were randomized to either the SGA or TAE group. Exercise training was seven weeks, with two sessions per week, for 35 minutes per session. Affect was measured by the (+5 (pleasurable) to -5 (displeasurable)) feelings scale. Affect was recorded at the mid-point …

Locations Of Physical Activity As Assessed By Gps In Young Adolescents., Jordan A. Carlson, Jasper Schipperijn, Jacqueline Kerr, Brian E. Saelens, Loki Natarajan, Lawrence D. Frank, Karen Glanz, Terry L. Conway, Kelli L. Cain, James F. Sallis, J E. Chapman

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: To compare adolescents' physical activity at home, near home, at school, near school, and at other locations.

METHODS: Adolescents (N = 549) were ages 12 to 16 years (49.9% girls, 31.3% nonwhite or Hispanic) from 447 census block groups in 2 US regions. Accelerometers and Global Positioning System devices assessed minutes of and proportion of time spent in moderate to vigorous physical activity (MVPA) in each of the 5 locations. Mixed-effects regression compared MVPA across locations and demographic factors.

RESULTS: Forty-two percent of adolescents' overall MVPA occurred at school, 18.7% at home, 18.3% in other (nonhome, nonschool) locations, and …

Nurse Staffing And Patient Outcomes: A Longitudinal Study On Trend And Seasonality., Jianghua He, Vincent S. Staggs, Sandra Bergquist-Beringer, Nancy Dunton

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Time trends and seasonal patterns have been observed in nurse staffing and nursing-sensitive patient outcomes in recent years. It is unknown whether these changes were associated.

METHODS: Quarterly unit-level nursing data in 2004-2012 were extracted from the National Database of Nursing Quality Indicators® (NDNQI®). Units were divided into groups based on patterns of missing data. All variables were aggregated across units within these groups and analyses were conducted at the group level. Patient outcomes included rates of inpatient falls and hospital-acquired pressure ulcers. Staffing variables included total nursing hours per patient days (HPPD) and percent of nursing hours provided …

Prevalence Of Nasal Colonization By Methicillin-Resistant Staphylococcus Aureus In Persons Using A Homeless Shelter In Kansas City, Megan Ottomeyer, Charles D. Graham, Avery D. Legg, Elizabeth S. Cooper, Chad D. Law, Mariam Molani, Karine Matevossian, Jerry Marlin, Charlott Williams, Ramon Newman, Jason A. Wasserman, Larry W. Segars, Tracey A H Taylor

Manuscripts, Articles, Book Chapters and Other Papers

Nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA) plays an important role in the epidemiology and pathogenesis of disease. Situations of close-quarter contact in groups are generally regarded as a risk factor for community-acquired MRSA strains due to transmission via fomites and person-to-person contact. With these criteria for risk, homeless individuals using shelter facilities, including showers and toilets, should be considered high risk for colonization and infection. The aim of this study was to determine the prevalence of nasal colonization of MRSA in a homeless population compared to established rates of colonization within the public and a control group of subjects …

Dog Walking Among Adolescents: Correlates And Contribution To Physical Activity., Jessa K. Engelberg, Jordan A. Carlson, Terry L. Conway, Kelli L. Cain, Brian E. Saelens, Karen Glanz, Lawrence D. Frank, James F. Sallis

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: To assess the association of dog walking with adolescents' moderate-to-vigorous physical activity (MVPA) and body mass index (BMI), and identify correlates of dog walking.

METHODS/DESIGN: Participants were 12-17year-olds (n=925) from the Baltimore, MD and Seattle, WA regions. Differences in accelerometer-assessed minutes/day of MVPA and self-reported BMI (percentile) were compared among adolescents (1) without a dog (n=441) and those with a dog who (2) did (≥1days/week, n=300) or (3) did not (n=184) walk it. Correlates of (1) dog walking (any vs. none) among adolescents with dogs (n=484), and (2) days/week of dog walking among dog walkers (n=300) were investigated. Potential …