Pediatrics Commons^™

Factors Associated With Urgent Care Reliance And Outpatient Health Care Use Among Children Enrolled In Medicaid., Rebecca R. Burns, Elizabeth R. Alpern, Jonathan Rodean, Therese Canares, Brian R. Lee, Matt Hall, Amanda Montalbano

Manuscripts, Articles, Book Chapters and Other Papers

Importance: Urgent care (UC) centers are a growing option to address children's acute care needs, which may cause unanticipated changes in health care use.

Objectives: To identify factors associated with high UC reliance among children enrolled in Medicaid and examine the association between UC reliance and outpatient health care use.

Design, Setting, and Participants: A retrospective cohort study used deidentified data on 4 133 238 children from the Marketscan Medicaid multistate claims database to calculate UC reliance and outpatient health care use. Children were younger than 19 years, with 11 months or more of continuous Medicaid enrollment and 1 or …

Delivering Trauma And Rehabilitation Interventions To Women And Children In Conflict Settings: A Systematic Review, Reena P. Jain, Sarah Meteke, Michelle F. Gaffey, Mahdis Kamali, Mariella Munyuzangabo, Daina Als, Shailja Shah, Fahad J. Siddiqui, Amruta Radhakrishnan, Anushka Ataullahjan, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: In recent years, more than 120 million people each year have needed urgent humanitarian assistance and protection. Armed conflict has profoundly negative consequences in communities. Destruction of civilian infrastructure impacts access to basic health services and complicates widespread emergency responses. The number of conflicts occurring is increasing, lasting longer and affecting more people today than a decade ago. The number of children living in conflict zones has been steadily increasing since the year 2000, increasing the need for health services and resources. This review systematically synthesised the indexed and grey literature reporting on the delivery of trauma and rehabilitation …

Lifestyle Changes And Glycemic Control In Type 1 Diabetes Mellitus: A Trial Protocol With Factorial Design Approach, Sobia Sawani, Amna Siddiqui, Syed Iqbal Azam, Khadija N Humayun, Asma Ahmed, Aysha Habib, Sabahat Naz, Mayera Tufail, Romaina Iqbal

Community Health Sciences

Background: Type 1 diabetes (T1D) has been increasing globally over the past three decades. Self-monitoring of blood glucose is a challenge in both developed as well as developing countries. Self-management guidelines include maintaining logbooks for blood glucose, physical activity, and dietary intake that affect glycated hemoglobin (HbA1c) and a multitude of life-threatening acute complications. Innovative, cost-effective interventions along with beneficial lifestyle modifications can improve home-based self-monitoring of blood glucose in T1D patients. The overall objective of this study is to evaluate the relationship between maintaining log books for blood glucose levels, reinforcement by e-messages, and/or daily step count and changes …

School-Based Interventions To Promote Personal And Environmental Hygiene Practices Among Children In Pakistan: Protocol For A Mixed Methods Study, Nousheen Pradhan, Waliyah Mughis, Tazeen S. Ali, Maleeha Naseem, Rozina Karmaliani Professor

Community Health Sciences

Background: Poor personal hygiene and inadequate sanitation practices among young children leads to communicable diseases. There remains a gap in the holistic assessment of school children's hygiene literacy, practices and effectiveness of school-based hygiene interventions in Pakistan. Therefore, a school-based intervention protocol has been designed to promote personal and environmental hygiene practices for primary school children. Towards improving children's hygiene behaviors, the study will also focus on enhancing mothers' hygiene knowledge and practices.
Methods: Using quasi-experimental design with mixed methods data collection approaches, this study will be conducted in schools located in an urban squatter settlements in Pakistan. To assess …

Medical Trust In Pediatric Care In The United States, Talia Feldscher

Independent Study Project (ISP) Collection

Trust is a critical aspect of the patient-provider dynamic, but in the U.S., its importance is overlooked in many medical settings, especially among those from low socio-economic groups. As the disparities in American healthcare are being recognized on a larger scale, it is necessary to further uncover why this is the case, and how to begin to remedy this disparity. This study presents an original qualitative data set of perspectives from four current health/mental health practitioners, based on their experiences with their pediatric patients, and how the concept of trust is critical to their service provision. Supported by literature, this …

Delivering Infectious Disease Interventions To Women And Children In Conflict Settings: A Systematic Review, Sarah Meteke, Marianne Stefopulos, Daina Als, Michelle Gaffey, Mahdis Kamali, Fahad J. Siddiqui, Mariella Munyuzangabo, Reena P. Jain, Shailja Shah, Amruta Radhakrishnan, Anushka Ataullahjan, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: Conflict has played a role in the large-scale deterioration of health systems in low-income and middle-income countries (LMICs) and increased risk of infections and outbreaks. This systematic review aimed to synthesise the literature on mechanisms of delivery for a range of infectious disease-related interventions provided to conflict-affected women, children and adolescents.
Methods: We searched Medline, Embase, CINAHL and PsychINFO databases for literature published in English from January 1990 to March 2018. Eligible publications reported on conflict-affected neonates, children, adolescents or women in LMICs who received an infectious disease intervention. We extracted and synthesised information on delivery characteristics, including delivery …

Delivering Non-Communicable Disease Interventions To Women And Children In Conflict Settings: A Systematic Review, Shailja Shah, Mariella Munyuzangabo, Michelle F. Gaffey, Mahdis Kamali, Reena P. Jain, Daina Als, Sarah Meteke, Amruta Radhakrishnan, Fahad J. Siddiqui, Anushka Ataullahjan, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: Non-communicable diseases (NCDs) are the leading cause of death worldwide. In the context of conflict settings, population displacement, disrupted treatment, infrastructure damage and other factors impose serious NCD intervention delivery challenges, but relatively little attention has been paid to addressing these challenges. Here we synthesise the available indexed and grey literature reporting on the delivery of NCD interventions to conflict-affected women and children in low- and middle-income countries (LMICs).
Methods: A systematic search in MEDLINE, Embase, CINAHL and PsycINFO databases for indexed articles published between 1 January 1990 and 31 March 2018 was conducted, and publications reporting on NCD …

Global Burden Of Respiratory Infections Associated With Seasonal Influenza In Children Under 5 Years In 2018: A Systematic Review And Modelling Study, Xin Wang, You Li, Katherine L. O'Brien, Qalab Abbas, Syed Asad Ali, Respiratory Virus Global Epidemiology Network, Mohammad Tahir Yousafzai, Zulfiqar Ahmed Bhutta, Sajid Bashir Soofi, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Background: Seasonal influenza virus is a common cause of acute lower respiratory infection (ALRI) in young children. In 2008, we estimated that 20 million influenza-virus-associated ALRI and 1 million influenza-virus-associated severe ALRI occurred in children under 5 years globally. Despite this substantial burden, only a few low-income and middle-income countries have adopted routine influenza vaccination policies for children and, where present, these have achieved only low or unknown levels of vaccine uptake. Moreover, the influenza burden might have changed due to the emergence and circulation of influenza A/H1N1pdm09. We aimed to incorporate new data to update estimates of the global …

Late Weaning And Maternal Closeness, Associated With Advanced Motor And Visual Maturation, Reinforce Autonomy In Healthy, 2-Year-Old Children, José Villar, Roseline Ochieng, Eleonora Staines-Urias, Michelle Fernandes, Marc Ratcliff, Manorama Purwar, Fernando Barros, Bernardo Horta, Maria Carvalho, Zulfiqar Ahmed Bhutta

Woman and Child Health

We studied neurodevelopmental outcomes and behaviours in healthy 2-year old children (N = 1306) from Brazil, India, Italy, Kenya and the UK participating in the INTERGROWTH-21^st Project. There was a positive independent relationship of duration of exclusive breastfeeding (EBF) and age at weaning with gross motor development, vision and autonomic physical activities, most evident if children were exclusively breastfed for ≥7 months or weaned at ≥7 months. There was no association with cognition, language or behaviour. Children exclusively breastfed from birth to6 months had, in a dose-effect pattern, adjusting for confounding factors, higher scores for "emotional reactivity". The positive …

Assessing Physical Activity In People With Mental Illness: 23-Country Reliability And Validity Of The Simple Physical Activity Questionnaire (Simpaq), S Rosenbaum, R Morell, A Abdel-Baki, M Ahmadpanah, T V. Anilkumar, L Baie, A Bauman, S Bender, Zahra Hoodbhoy, Romaina Iqbal, Ayesha Mian

Department of Paediatrics and Child Health

Background: Physical inactivity is a key contributor to the global burden of disease and disproportionately impacts the wellbeing of people experiencing mental illness. Increases in physical activity are associated with improvements in symptoms of mental illness and reduction in cardiometabolic risk. Reliable and valid clinical tools that assess physical activity would improve evaluation of intervention studies that aim to increase physical activity and reduce sedentary behaviour in people living with mental illness.
Methods: The five-item Simple Physical Activity Questionnaire (SIMPAQ) was developed by a multidisciplinary, international working group as a clinical tool to assess physical activity and sedentary behaviour in …

Mainstreaming Nutrition Services: Stabilization Centers And Outpatient Therapeutic Program Centers, Ashar Muhammad Malik

Community Health Sciences

No abstract provided.

A Descriptive Study Of Double Burden Of Malnutrition In Mothers Of Children With Severe Acute Malnutrition Admitted In Children Hospital And Institute Of Child Health, Multan, Saadia Khan, Umme Ammara, Reema Arshad, Farah Naz, Kamran Ishfaq

Department of Paediatrics and Child Health

Objective: To assess the nutritional status of mothers of severely malnourished children, and to evaluate the factors associated with inadequate caloric intake of children with severe acute malnutrition versus sufficient caloric intake by mothers.
Methods: The cross-sectional descriptive study was conducted from January to June 2016 at Children Hospital and Institute of Child Health, Multan, Pakistan, and comprised mothers of severely malnourished children admitted for treatment. Data was collected using a questionnaire administered through interviews. Elements noted included body mass index, 24-hour recall, dietary restriction during pregnancy, lactation and complimentary feeding patterns of the children. The mothers were also examined …

Using The Medical Expenditure Panel Survey To Explore The Association Between High Healthcare Utilization And Behavioral Health Diagnoses In A Pediatric Population With Chronic Conditions, Marlon D. Satchell, Phd, Mph

Population Health Science Program Doctoral Dissertations

The 2010 Affordable Care Act (ACA) introduced an era of changing healthcare delivery and utilization, which is still evolving and changing to this day. Healthcare providers and healthcare systems need to identify strategies to provide better care to patients, that results in better patient outcomes, in a cost effective way. One strategy to accomplish this goal is to focus on managing the care of the most vulnerable patients, particularly including pediatric patients with one or more chronic conditions. The objective of this study was to assess the extent to which a behavioral health diagnosis in addition to another chronic condition …

Comparison Of The Id Now Influenza A & B 2, Cobas Influenza A/B, And Xpert Xpress Flu Point-Of-Care Nucleic Acid Amplification Tests For Influenza A/B Virus Detection In Children, Neena Kanwar, Jeff Michael, Kathryn Doran, Emily Montgomery, Rangaraj Selvarangan

Manuscripts, Articles, Book Chapters and Other Papers

© 2020 Kanwar et al. Early diagnosis of influenza (Flu) is critical for patient management and infection control. The ID Now influenza A & B 2 (ID Now) assay (Abbott Laboratories), Cobas influenza A/B nucleic acid test (LIAT; Roche Molecular Systems, Inc.), and Xpert Xpress Flu (Xpert; Cepheid) are rapid, point-of-care molecular assays for Flu virus detection. The study aim was to compare the performances of these three commercially available Clinical Laboratory Improvement Amendments (CLIA)-waived Flu virus assays. We prospectively enrolled 201 children platforms, as per the manufacturers' instructions. CDC Flu A/B PCR was used as a reference method to …

A Ten-Year Retrospective Evaluation Of Acute Flaccid Myelitis At 5 Pediatric Centers In The United States, 2005-2014., Margaret M. Cortese, Anita K. Kambhampati, Jennifer E. Schuster, Zaid Alhinai, Gary R. Nelson, Gloria J. Guzman Perez-Carrillo, Arastoo Vossough, Michael A. Smit, Robert C. Mckinstry, Timothy Zinkus, Kevin R. Moore, Jeffrey M. Rogg, Meghan S. Candee, James J. Sejvar, Sarah E. Hopkins

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Acute flaccid myelitis (AFM) is a severe illness similar to paralytic poliomyelitis. It is unclear how frequently AFM occurred in U.S. children after poliovirus elimination. In 2014, an AFM cluster was identified in Colorado, prompting passive US surveillance that yielded 120 AFM cases of unconfirmed etiology. Subsequently, increased reports were received in 2016 and 2018. To help inform investigations on causality of the recent AFM outbreaks, our objective was to determine how frequently AFM had occurred before 2014, and if 2014 cases had different characteristics.

METHODS: We conducted a retrospective study covering 2005-2014 at 5 pediatric centers in 3 …

A Novel Histological Index For Evaluation Of Environmental Enteric Dysfunction Identifies Geographic-Specific Features Of Enteropathy Among Children With Suboptimal Growth, Ta-Chiang Liu, Kelley Vanbuskirk, Syed Asad Ali, M. Paul Kelly, Lori R. Holtz, Omer H. Yilmaz, Kamran Sadiq, Najeeha Talat Iqbal, Beatrice Amadi, Sana Syed

Department of Paediatrics and Child Health

Background: A major limitation to understanding the etiopathogenesis of environmental enteric dysfunction (EED) is the lack of a comprehensive, reproducible histologic framework for characterizing the small bowel lesions. We hypothesized that the development of such a system will identify unique histology features for EED, and that some features might correlate with clinical severity.
Methods: Duodenal endoscopic biopsies from two cohorts where EED is prevalent (Pakistan, Zambia) and North American children with and without gluten sensitive enteropathy (GSE) were processed for routine hematoxylin & eosin (H&E) staining, and scanned to produce whole slide images (WSIs) which we shared among study pathologists …

Sé Un Héroe Tú También, Samantha S. Rohe, Sophie Cemaj

Books: Pediatrics

This children's book explains COVID-19 and how to decrease the incidence of transmissions.

Effect Of Sustained Attention On Early Start Denver Model Outcomes, Katherine Mcleod, Giacomo Vivanti, Phd

Phase 1

Introduction: There is very little research on the use of sustained attention as an outcome predictor for the Early Start Denver Model (ESDM). We hypothesized that a child’s level of sustained attention prior to therapy will correlate with positive ESDM outcomes.

Methods: 10 pre-preschool age children with a diagnosis of autism spectrum disorder received one year of ESDM therapy. A novel coding scheme was developed to evaluate each child’s pre-treatment level of sustained attention. Mullen Scales of Early Learning were evaluated prior to and after one year of ESDM. Pre-treatment levels of sustained attention were compared to pre-and post-treatment Mullen …

Obesity And Cardiovascular Health Differences Between Urban And Suburban Philadelphia High School Athletes, Peri Levey, Kyle Prochno, Prashant Rao, Md, David Shipon, Md, Facc, Facp, Jeremy Close, Md

Phase 1

Introduction: The strongest risk factor for primary hypertension in children is obesity, and concern for pediatric hypertension rises with the rising prevalence of obesity in American children. Specifically, in urban Philadelphia schools from 2009 to 2012, preparticipation physical evaluations (PPEs) demonstrated a positive correlation between blood pressure measurements demonstrating stage 1 or 2 hypertension and elevated body mass index (P < 0.00001).

Objective: The purpose was to identify potential differences in cardiovascular health and prevalence of obesity between adolescents in the urban and suburban Philadelphia areas.

Methods: Data from PPEs administered to urban Philadelphia high school athletes in 2018 by the Athlete …

Quality Improvement Study Of Behavioral Health Resources Access In 19121 And 19132, Courtney Kaye, Rickie Brawer, Mph, Phd, Mches, Jeanne Felter, Phd, Lpc

Phase 1

Introduction: Children who have experienced four or more ACES (adverse childhood events) are shown to have negative mental health outcomes. Adolescents living in the Philadelphia zip codes 19121 and 19132 have higher ACE scores. This makes it necessary for adolescent providers to screen for behavioral health issues in their patients and refer out to appropriate resources.

Objective: The purpose of this quality improvement study is to see what current barriers exist relating to physician referral and access to behavioral health resources for their patients.

Methods: A guide of behavioral health resources available to adolescents in 19121 and 19132 was …

Advocating For Protective Measures Against Childhood Lead-Poisoning In Philadelphia Rental Homes, Claire Miller, Colleen Mccauley

Phase 1

Introduction: Lead exposure has been linked to delays in development and behavioral problems in children. Over 1,500 children are poisoned by lead each year in Philadelphia; the majority (62%) in rental homes.

Objective: The purpose of this project was to understand the impact of lead poisoning on children in Philadelphia, the current policies in place to protect children and the ways in which various stakeholders can advocate for policy changes that will better protect children.

Methods: A mixed-methods approach was utilized including meetings with councilmembers, stakeholder interviews and data analysis, visualization and presentation. This information was used to gain councilmembers’ …

Comorbidities And Treatments In United States Youth With Chronic Musculoskeletal Pain, Matthew T. Taylor, Sabrina Gmuca, Alexis Boneparth, L. Nandini Moorthy, Daniel B. Horton

Phase 1

Introduction: Chronic musculoskeletal (MSK) pain has been associated with chronic illnesses and high rates of pain medication use, often in referral centers, European populations, or studies focused on single drug classes. We aimed to characterize patterns of comorbidities and treatments associated with chronic MSK pain in a nationally-representative sample of US youth.

Methods: We used the National Ambulatory Medical Care Survey (2002-2015) and National Hospital Ambulatory Medical Care Survey (2002-2011), which contain cross-sectional data for US outpatient visits. The study included all visits for youth age 8-24, excluding those with malignancy or sickle cell disease. We compared comorbidities and drugs …

Obesity And Cardiovascular Health Differences Between Urban And Suburban Philadelphia High School Athletes, Kyle W. Prochno, Peri Levey, Prashant Rao, Md, David M. Shipon, Md, Facc, Facp, Jeremy D. Close, Md

Phase 1

Introduction: Limited data exist regarding hypertension and obesity levels of Philadelphia-area high school student-athletes. We aim to assess their prevalence in an urban population, investigate whether they are correlated with demographic factors, and determine whether urban student-athletes differ in these outcomes compared to their suburban/non-urban counterparts.

Methods: Demographic and physical data were extracted from Athlete Health Organization (AHO) 2018 pre-participation physical exams. Adiposity classifications were made from body mass index (BMI) calculations applied to appropriate Centers for Disease Control and Prevention (CDC) growth charts, while systolic/diastolic measurements were used to classify students’ blood pressure according to current American Academy of …

Be A Hero Too, Samantha S. Rohe, Sophie Cemaj

Books: Pediatrics

This children's book explains COVID-19 and how to decrease the incidence of transmissions.

The Impact Of The Fda Warning On Post-Tonsillectomy Opioid Prescribing In Publicly And Privately Insured Children, Dianna J. Soelberg

Theses and Dissertations

Due to reports of significant adverse events, the U.S. FDA placed a Boxed Warning on the opioid codeine in February 2013 – contraindicating its use in pediatric patients undergoing tonsillectomy and/or adenoidectomy. Studies conducted in privately insured children showed a reduction in codeine prescribing and a slight increase in alterative opioid prescribing following the FDA warning, yet the extent to which the FDA warning impacted prescribing in publicly insured children is unknown. Using a quasi-experimental interrupted time series design, this study evaluated codeine and alternative opioid prescribing before and after the FDA warning in both publicly and privately insured children …

Sexting Among Adolescents: Examining The Association Between Sexting And Self-Esteem, Hanaah Fannin

Physician Assistant Studies | Student Capstone Presentations

The primary objective of this study is to provide a systematic review of the published literature, examining the association between sexting and self-esteem in adolescents, and to identify gaps in existing knowledge to provide recommendations for future research.

Postpartum Endometritis And Infection Following Incomplete Or Complete Abortion: Case Definition & Guidelines For Data Collection, Analysis, And Presentation Of Maternal Immunization Safety Data, C E. Rouse, L O. Eckert, F M. Muñoz, J S A. Stringer, S Kochhar, L Bartlett, M Sanicas, D J. Dudley, D M. Harper, Fyezah Jehan

Department of Paediatrics and Child Health

Abstract are not provided by the author/publisher

Deworming Children For Soil-Transmitted Helminths In Low And Middle-Income Countries: Systematic Review And Individual Participant Data Network Meta-Analysis, Vivian Andrea Welch, Alomgir Hossain, Elizabeth Ghogomu, Alison Riddle, Simon Cousens, Michelle Gaffey, Paul Arora, Robert Black, Donald Bundy, Zulfiqar Ahmed Bhutta

Woman and Child Health

Intestinal parasites affect millions of children globally. We aimed to assess effects of deworming children on nutritional and cognitive outcomes across potential effect modifiers using individual participant data (IPD). We searched multiple databases to 27 March 2018, grey literature, and other sources. We included randomised and quasi randomised trials of deworming compared to placebo or other nutritional interventions with data on baseline infection. We used a random-effects network meta-analysis with IPD and assessed overall quality, following a pre-specified protocol. We received IPD from 19 trials of STH deworming. Overall risk of bias was low. There were no statistically significant subgroup …

The Epidemiological Burden Of Obesity In Childhood: A Worldwide Epidemic Requiring Urgent Action, Mariachiara Di Cesare, Maroje Sorić, Pascal Bovet, J Jaime Miranda, Zulfiqar Ahmed Bhutta, Gretchen A. Stevens, Avula Laxmaiah, Andre-Pascal Kengne, James Bentham

Department of Paediatrics and Child Health

Background: In recent decades, the prevalence of obesity in children has increased dramatically. This worldwide epidemic has important consequences, including psychiatric, psychological and psychosocial disorders in childhood and increased risk of developing non-communicable diseases (NCDs) later in life. Treatment of obesity is difficult and children with excess weight are likely to become adults with obesity. These trends have led member states of the World Health Organization (WHO) to endorse a target of no increase in obesity in childhood by 2025.
Main body: Estimates of overweight in children aged under 5 years are available jointly from the United Nations Children's Fund …

Determinants Of Linear Growth Faltering Among Children With Moderate-To-Severe Diarrhea In The Global Enteric Multicenter Study, Rebecca L. Brander, Patricia B. Pavlinac, Judd L. Walson, Grace C. John-Stewart, Marcia R. Weaver, Abu S. G Faruque, Anita K. M. Zaidi, Dipika Sur, Samba O. Sow, M Jahangir Hossain

Department of Paediatrics and Child Health

Background: Moderate-to-severe diarrhea (MSD) in the first 2 years of life can impair linear growth. We sought to determine risk factors for linear growth faltering and to build a clinical prediction tool to identify children most likely to experience growth faltering following an episode of MSD.
Methods: Using data from the Global Enteric Multicenter Study of children 0-23 months old presenting with MSD in Africa and Asia, we performed log-binomial regression to determine clinical and sociodemographic factors associated with severe linear growth faltering (loss of ≥ 0.5 length-for-age z-score [LAZ]). Linear regression was used to estimate associations with ΔLAZ. A …