The Impact of Physical Disability on Pregnancy and Childbirth.

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The Impact of Physical Disability on Pregnancy and Childbirth. J Womens Health (Larchmt). 2017 Jun 29;: Authors: Long-Bellil L, Mitra M, Iezzoni LI, Smeltzer SC, Smith L Abstract BACKGROUND: Women with physical disabilities increasingly aspire to become pregnant and bear children. Limited information about the potential interaction of their disabling conditions with pregnancy and childbirth exists to guide these women and their clinicians. MATERIALS AND METHODS: The interview guide was created with questions on topics such as pregnancy complications and secondary conditions, the impact of prior surgeries, experiences with pain relief during labor, and the impact on women's independence and participation in life activities. Interviews were conducted by telephone with 25 women with physical disabilities. They were subsequently transcribed verbatim and analyzed by using Atlas TI. RESULTS: Women generally reported a relatively modest impact of disabling conditions on their pregnancies. Most women were satisfied with the mode of delivery, but they experienced challenges during the labor and delivery process. The women found that careful advanced planning was helpful in managing the impact of their disabling conditions. The involvement of clinicians with disability-related expertise was, in some cases, another factor that contributed to a positive outcome. CONCLUSIONS: The importance of advanced planning and the utility of involving clinicians with disability-related expertise suggest that the use of integrated, interdisciplinary team approaches could promote quality care by facilitating improved planning and management. Additional clinical research is needed to provide women and their clinicians with more information on potential complications and options for labor and delivery. PMID: 28661774 [PubMed - as supplied by publisher]

Risk Factors, Protective Factors, and Current Recommendations to Reduce Sudden Infant Death Syndrome: A Review.

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Risk Factors, Protective Factors, and Current Recommendations to Reduce Sudden Infant Death Syndrome: A Review. JAMA Pediatr. 2017 Feb 01;171(2):175-180 Authors: Carlin RF, Moon RY Abstract Importance: Sudden infant death syndrome remains the leading cause of death in infants aged 1 month to 1 year in the United States. Observations: While its exact cause is unknown, sudden infant death syndrome is believed to be multifactorial, ie, occurs in infants with underlying biological vulnerability who experience an exogenous stressor, such as prone/side sleeping or soft bedding, during a critical developmental period. Much genetic and physiologic evidence points to impaired arousal responses to hypercarbia and hypoxia, which ultimately leads to asphyxia. Known risk factors for infants include prone and side sleeping, soft bedding, bed sharing, inappropriate sleep surfaces (including sofas), exposure to tobacco smoke, and prematurity; protective factors include breastfeeding, pacifier use, room sharing, and immunizations. Conclusions and Relevance: Despite our improved understanding of the physiologic mechanisms that cause sudden infant death, the mainstay of risk reduction continues to be a safe sleep environment, as most infants who die suddenly and unexpectedly do so in unsafe sleep environments. PMID: 27918760 [PubMed - indexed for MEDLINE]

Typological Analysis of Victimization Profiles of Young Children.

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Typological Analysis of Victimization Profiles of Young Children. Violence Vict. 2017 Apr 01;32(2):230-250 Authors: Robert-Mazaye C, Clément MÈ, Cyr K, Chamberland C Abstract Although the scope of violence against children has been well documented, the reality of this phenomenon remains to be examined. Using data collected during a populationbased survey on the polyvictimization of children between 2 and 11 years old, this study explores the profiles of 972 children who are victims of many forms of violence (in family, school, and/or community). Cluster analyses identified 4 groups (minimal victimization, generalized victimization, threatening environment, aggressive environment), which differ according to the forms and extent of the violence experienced. The role of age, gender, and adverse life events in forming groups is also examined, as are the links with mental health disorders. Fostering the examination of the phenomenon of violence against children in all its diversity, this taxonomy presents advantages for researchers and professionals, which are discussed. PMID: 28130903 [PubMed - indexed for MEDLINE]

Review of serious events in cases of (suspected) child abuse and/or neglect: A RoSE by any other name?

Review of serious events in cases of (suspected) child abuse and/or neglect: A RoSE by any other name? Child Abuse Negl. 2017 Jun 26;70:283-291 Authors: Raman S, Maiese M, Vasquez V, Gordon P, Jones JM Abstract Child abuse and neglect (CAN) cases presenting to health-services may be complex; when things go seriously wrong such as a child death or near miss, cases are reviewed and health-services and professionals subject to intense scrutiny. While there are a variety of mechanisms to review critical incidents in health-services no formal process for the review of cases where child protection is the primary concern exists in Australia. We aimed to develop a systematic process to review serious events in cases of suspected CAN across two health districts in Sydney, so that shared learnings could fuel system change. Drawing upon mapping, case review, literature findings and using quality improvement methodology, we developed a model named Review of Serious Events (RoSE), in suspected cases of CAN. The RoSE model has the key features of: being child focused; seeking to examine care over a period of time; using child protection staff as lead reviewers; involving health professionals/services in the review who have been involved with the child; and actioning systems change at local levels. The RoSE model was trialled through 2014-2015. Eight cases were reviewed using RoSE; cases were similar to those reviewed prior to having a model. Participant feedback from RoSE group processes was overwhelmingly positive; outputs were transparent and accessible to key stakeholders, there was mixed progress with implementation. The RoSE model is a serious case review process that is strongly child-focused, is both investigative and reflective, led by child protection experts; and can be adapted to other settings and systems. PMID: 28662440 [PubMed - as supplied by publisher]

Preclinical evaluation of drugs to block inflammation-driven preterm birth.

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Preclinical evaluation of drugs to block inflammation-driven preterm birth. Innate Immun. 2017 Jan;23(1):20-33 Authors: Ireland DJ, Nathan EA, Li S, Charles AK, Stinson LF, Kemp MW, Newnham JP, Keelan JA Abstract Intrauterine inflammation, the major cause of early preterm birth, can have microbial and sterile aetiologies. We assessed in a Transwell model the anti-inflammatory efficacies of five drugs on human extraplacental membranes delivered after preterm spontaneous labour (30-34 wk). Drugs [TPCA1 (IKKβ inhibitor), 5 z-7-oxozeaenol (OxZ, TAK1 inhibitor), inhibitor of NF-κB essential modulator binding domain (iNBD), SB239063 (p38 MAPK inhibitor) and N-acetyl cysteine (free radical scavenger free radicals)] were added after 12 h equilibration to the amniotic compartment. Concentrations of IL-6, TNF-α, MCP-1, IL-1β and PGE2 in the media, and IL6, TNFA and PTGS2 mRNA expression levels in membranes, were determined after 12 h. Data were analysed using mixed models analyses. Thirteen of the 28 membranes had histological chorioamnionitis (HCA(+)); five were positive for bacterial culture and six for fetal inflammatory reaction. Baseline PGE2 and cytokine production was similar between HCA(-) and HCA(+) membranes. Anti-inflammatory effects were also similar between HCA(-) and HCA(+) membranes. TPCA1 and OxZ were the most effective drugs; each inhibited amniotic secretion of 4/5 pro-inflammatory mediators and mRNA levels of 2/3, regardless of stimulus. We conclude that treatment with TPCA1 or OxZ, in combination with antibiotics, may minimise the adverse effects of intrauterine inflammation in pregnancy. PMID: 27821647 [PubMed - indexed for MEDLINE]

Trends in the Diagnosis of Vitamin D Deficiency.

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Trends in the Diagnosis of Vitamin D Deficiency. Pediatrics. 2017 Mar;139(3): Authors: Basatemur E, Horsfall L, Marston L, Rait G, Sutcliffe A Abstract BACKGROUND: Vitamin D has attracted considerable interest in recent years, and health care providers have reported large increases in vitamin D test requests. However, rates of diagnosis of vitamin D deficiency in clinical practice have not been investigated. We examined trends in diagnosis of vitamin D deficiency in children in England over time, and by sociodemographic characteristics. METHODS: Cohort study using primary care records of 711 788 children aged 0 to 17 years, from the Health Improvement Network database. Incidence rates for diagnosis of vitamin D deficiency were calculated per year between 2000 and 2014. Rate ratios exploring differences by age, sex, ethnicity, and social deprivation were estimated using multivariable Poisson regression. RESULTS: The crude rate of vitamin D deficiency diagnosis increased from 3.14 per 100 000 person-years in 2000 (95% confidence interval [CI], 1.31-7.54) to 261 per 100 000 person-years in 2014 (95% CI, 241-281). After accounting for changes in demographic characteristics, a 15-fold (95% CI, 10-21) increase in diagnosis was seen between 2008 and 2014. Older age (≥10 years), nonwhite ethnicity, and social deprivation were independently associated with higher rates of diagnosis. In children aged <5 years, diagnosis rates were higher in boys than girls, whereas in children aged ≥10 they were higher in girls. CONCLUSIONS: There has been a marked increase in diagnosis of vitamin D deficiency in children over the past decade. Future research should explore the drivers for this change in diagnostic behavior and the reasons prompting investigation of vitamin D status in clinical practice. PMID: 28159871 [PubMed - indexed for MEDLINE]

Utilization of Mental Health Services After Mild Pediatric Traumatic Brain Injury.

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Utilization of Mental Health Services After Mild Pediatric Traumatic Brain Injury. Pediatrics. 2017 Mar;139(3): Authors: Jimenez N, Quistberg A, Vavilala MS, Jaffe KM, Rivara FP Abstract BACKGROUND: Mild traumatic brain injury injuries (mTBIs), including concussions, represent >2 million US pediatric emergency department visits annually. Post-mTBI mental health symptoms are prominent and often attributed to the mTBI. This study examined whether individuals seeking post-mTBI mental health care had previous mental health diagnoses or a new onset of such disorders, and determined if mental health care utilization differed by race/ethnicity. METHODS: Retrospective cohort study, using the Medicaid Marketscan claims national dataset (2007-2012). Utilization of mental health services 1 year before and 1 year after mTBI was compared between children with and without mental health diagnoses before injury. Primary outcome was receipt of post-mTBI outpatient mental health care. RESULTS: A total of 31 272 children 20 years or younger were included, 8577 (27%) with mental health diagnoses before their mTBI and 22 695 without one. After injury, children without previous mental health disorders increased mental health services utilization; however, most (86%) postinjury mental health care was received by children with previous mental health disorders. Having a mental health diagnosis pre-mTBI was the most important risk factor for receiving post-mTBI mental health care (odds ratio 7.93, 95% confidence interval 7.40-8.50). Hispanic children were less likely to receive post-mTBI mental health care. CONCLUSIONS: mTBI was associated with increased utilization of mental health services but most of these services were received by children with previous mental health disorders. Our documentation of racial/ethnic disparities in mental health care utilization reemphasize the importance of providing individualized, culturally, and linguistically competent care to improve outcomes after mTBI for all children. PMID: 28159872 [PubMed - indexed for MEDLINE]

Perspectives of Low Socioeconomic Status Mothers of Premature Infants.

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Perspectives of Low Socioeconomic Status Mothers of Premature Infants. Pediatrics. 2017 Mar;139(3): Authors: Enlow E, Faherty LJ, Wallace-Keeshen S, Martin AE, Shea JA, Lorch SA Abstract BACKGROUND AND OBJECTIVES: Transitioning premature infants from the NICU to home is a high-risk period with potential for compromised care. Parental stress is high, and families of low socioeconomic status may face additional challenges. Home visiting programs have been used to help this transition, with mixed success. We sought to understand the experiences of at-risk families during this transition to inform interventions. METHODS: Mothers of infants born at <35 weeks' gestation, meeting low socioeconomic status criteria, were interviewed by telephone 30 days after discharge to assess caregiver experiences of discharge and perceptions of home visitors (HVs). We generated salient themes by using grounded theory and the constant comparative method. Interviews were conducted until thematic saturation was achieved. RESULTS: Twenty-seven mothers completed interviews. Eighty-five percent were black, and 81% had Medicaid insurance. Concern about infants' health and fragility was the primary theme identified, with mothers reporting substantial stress going from a highly monitored NICU to an unmonitored home. Issues with trust and informational consistency were mentioned frequently and could threaten mothers' willingness to engage with providers. Strong family networks and determination compensated for limited economic resources, although many felt isolated. Mothers appreciated HVs' ability to address infant health but preferred nurses over lay health workers. CONCLUSIONS: Low-income mothers experience significant anxiety about the transition from the NICU to home. Families value HVs who are trustworthy and have relevant medical knowledge about prematurity. Interventions to improve transition would benefit by incorporating parental input and facilitating trust and consistency in communication. PMID: 28223372 [PubMed - indexed for MEDLINE]

Neonatal Morbidity and 1-Year Survival of Extremely Preterm Infants.

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Neonatal Morbidity and 1-Year Survival of Extremely Preterm Infants. Pediatrics. 2017 Mar;139(3): Authors: Stensvold HJ, Klingenberg C, Stoen R, Moster D, Braekke K, Guthe HJ, Astrup H, Rettedal S, Gronn M, Ronnestad AE, Norwegian Neonatal Network Abstract OBJECTIVE: To determine 1-year survival and major neonatal morbidities (intracranial hemorrhage grade >2, cystic periventricular leukomalacia, retinopathy of prematurity grade >2, necrotizing enterocolitis, severe bronchopulmonary dysplasia) among extremely preterm infants in Norway in 2013-2014, and to compare the results to the first Norwegian Extreme Prematurity Study 1999-2000 and similar contemporary European population-based studies. METHODS: Population-based study of all infants born at 22 through 26 weeks' gestation in Norway in 2013-2014. Prospectively collected data were obtained by linking data in the Norwegian Neonatal Network to the Medical Birth Registry of Norway. RESULTS: Of 420 infants (incidence 3.5 per 1000 births), 145 were stillborn (34.5%), 275 were live-born (82.3% of the 334 fetuses alive at admission for obstetrical care), and 251 (91.3% of live-born infants) were admitted to a neonatal unit. The survival among live-born infants was 18% at 22 weeks, 29% at 23 weeks, 56% at 24 weeks, 84% at 25 weeks and 90% at 26 weeks (for each week increment in gestational age: odds ratio 3.3; 95% confidence interval, 2.4-4.4). Among infants surviving to 1 year of age, major neonatal morbidity was diagnosed in 55%. Decreasing gestational age was moderately associated with rates of major morbidity (odds ratio 1.6; 95% confidence interval, 1.2-2.2). CONCLUSIONS: Compared to the previous 1999-2000 cohort, the rate of stillbirth before admission to an obstetrical unit increased, whereas the survival rate among live born infants was similar in our 2013-2014 cohort. Neonatal morbidity rates remain high among extremely preterm infants. PMID: 28228499 [PubMed - indexed for MEDLINE]

Pediatric Resident Burnout and Attitudes Toward Patients.

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Pediatric Resident Burnout and Attitudes Toward Patients. Pediatrics. 2017 Mar;139(3): Authors: Baer TE, Feraco AM, Tuysuzoglu Sagalowsky S, Williams D, Litman HJ, Vinci RJ Abstract BACKGROUND AND OBJECTIVES: Burnout occurs in up to 75% of resident physicians. Our study objectives were to: (1) determine the prevalence of burnout, and (2) examine the association between burnout and self-reported patient care attitudes and behaviors among pediatric residents. METHODS: A total of 258 residents (53% response rate) from 11 pediatric residency programs completed a cross-sectional Web-based survey. Burnout was measured with 2 items from the Maslach Burnout Inventory. Patient care attitudes and behaviors were measured with 7 questions from a standardized qualitative survey. χ(2) and logistic regression tested the association between burnout and self-reported patient care attitudes and behavior. RESULTS: A total of 39% of respondents (mean age, 29.4 years ± 2.3 SD; 79% female; 83% white; 35% postgraduate year [PGY] -1, 34% PGY-2, and 31% PGY-3), endorsed burnout. Residents with burnout had significantly greater odds (P < .01) of reporting suboptimal patient care attitudes and behaviors, including: discharging patients to make the service more manageable (adjusted odds ratio [aOR] 4.2; 95% confidence interval [CI], 1.6-11.1), not fully discussing treatment options or answering questions (aOR 3.5; 95% CI, 1.7-7.1), making treatment or medication errors (aOR 7.1; 95% CI, 2.0-25.8), ignoring the social or personal impact of an illness (aOR 9.6; 95% CI, 3.2-28.9), and feeling guilty about how a patient was treated (aOR 6.0; 95% CI, 1.6-22.1). CONCLUSIONS: Burnout is highly prevalent among pediatric residents and is associated with self-reported negative patient care attitudes and behaviors. Residency programs should develop interventions addressing burnout and its potential negative impact on patient care. PMID: 28232639 [PubMed - indexed for MEDLINE]

A Multicenter Collaborative to Improve Care of Community Acquired Pneumonia in Hospitalized Children.

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A Multicenter Collaborative to Improve Care of Community Acquired Pneumonia in Hospitalized Children. Pediatrics. 2017 Mar;139(3): Authors: Parikh K, Biondi E, Nazif J, Wasif F, Williams DJ, Nichols E, Ralston S, Value in Inpatient Pediatrics Network Quality Collaborative For Improving Care In Community Acquired Pneumonia Abstract BACKGROUND AND OBJECTIVES: The Value in Inpatient Pediatrics Network sponsored the Improving Care in Community Acquired Pneumonia collaborative with the goal of increasing evidence-based management of children hospitalized with community acquired pneumonia (CAP). Project aims included: increasing use of narrow-spectrum antibiotics, decreasing use of macrolides, and decreasing concurrent treatment of pneumonia and asthma. METHODS: Data were collected through chart review across emergency department (ED), inpatient, and discharge settings. Sites reviewed up to 20 charts in each of 6 3-month cycles. Analysis of means with 3-σ control limits was the primary method of assessment for change. The expert panel developed project measures, goals, and interventions. A change package of evidence-based tools to promote judicious use of antibiotics and raise awareness of asthma and pneumonia codiagnosis was disseminated through webinars. Peer coaching and periodic benchmarking were used to motivate change. RESULTS: Fifty-three hospitals enrolled and 48 (91%) completed the 1-year project (July 2014-June 2015). A total of 3802 charts were reviewed for the project; 1842 during baseline cycles and 1960 during postintervention cycles. The median before and after use of narrow-spectrum antibiotics in the collaborative increased by 67% in the ED, 43% in the inpatient setting, and 25% at discharge. Median before and after use of macrolides decreased by 22% in the ED and 27% in the inpatient setting. A decrease in asthma and CAP codiagnosis was noted, but the change was not sustained. CONCLUSIONS: Low-cost strategies, including collaborative sharing, peer benchmarking, and coaching, increased judicious use of antibiotics in a diverse range of hospitals for pediatric CAP. PMID: 28148730 [PubMed - indexed for MEDLINE]

Neonatal Abstinence Syndrome and High School Performance.

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Neonatal Abstinence Syndrome and High School Performance. Pediatrics. 2017 Feb;139(2): Authors: Oei JL, Melhuish E, Uebel H, Azzam N, Breen C, Burns L, Hilder L, Bajuk B, Abdel-Latif ME, Ward M, Feller JM, Falconer J, Clews S, Eastwood J, Li A, Wright IM Abstract BACKGROUND AND OBJECTIVES: Little is known of the long-term, including school, outcomes of children diagnosed with Neonatal abstinence syndrome (NAS) (International Statistical Classification of Disease and Related Problems [10th Edition], Australian Modification, P96.1). METHODS: Linked analysis of health and curriculum-based test data for all children born in the state of New South Wales (NSW), Australia, between 2000 and 2006. Children with NAS (n = 2234) were compared with a control group matched for gestation, socioeconomic status, and gender (n = 4330, control) and with other NSW children (n = 598 265, population) for results on the National Assessment Program: Literacy and Numeracy, in grades 3, 5, and 7. RESULTS: Mean test scores (range 0-1000) for children with NAS were significantly lower in grade 3 (359 vs control: 410 vs population: 421). The deficit was progressive. By grade 7, children with NAS scored lower than other children in grade 5. The risk of not meeting minimum standards was independently associated with NAS (adjusted odds ratio [aOR], 2.5; 95% confidence interval [CI], 2.2-2.7), indigenous status (aOR, 2.2; 95% CI, 2.2-2.3), male gender (aOR, 1.3; 95% CI, 1.3-1.4), and low parental education (aOR, 1.5; 95% CI, 1.1-1.6), with all Ps < .001. CONCLUSIONS: A neonatal diagnostic code of NAS is strongly associated with poor and deteriorating school performance. Parental education may decrease the risk of failure. Children with NAS and their families must be identified early and provided with support to minimize the consequences of poor educational outcomes. PMID: 28093465 [PubMed - indexed for MEDLINE]

Involvement of Fathers in Pediatric Obesity Treatment and Prevention Trials: A Systematic Review.

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Involvement of Fathers in Pediatric Obesity Treatment and Prevention Trials: A Systematic Review. Pediatrics. 2017 Feb;139(2): Authors: Morgan PJ, Young MD, Lloyd AB, Wang ML, Eather N, Miller A, Murtagh EM, Barnes AT, Pagoto SL Abstract CONTEXT: Despite their important influence on child health, it is assumed that fathers are less likely than mothers to participate in pediatric obesity treatment and prevention research. OBJECTIVE: This review investigated the involvement of fathers in obesity treatment and prevention programs targeting children and adolescents (0-18 years). DATA SOURCES: A systematic review of English, peer-reviewed articles across 7 databases. Retrieved records included at least 1 search term from 2 groups: "participants" (eg, child*, parent*) and "outcomes": (eg, obes*, diet*). STUDY SELECTION: Randomized controlled trials (RCTs) assessing behavioral interventions to prevent or treat obesity in pediatric samples were eligible. Parents must have "actively participated" in the study. DATA EXTRACTION: Two authors independently extracted data using a predefined template. RESULTS: The search retrieved 213 eligible RCTs. Of the RCTs that limited participation to 1 parent only (n = 80), fathers represented only 6% of parents. In RCTs in which participation was open to both parents (n = 133), 92% did not report objective data on father involvement. No study characteristics moderated the level of father involvement, with fathers underrepresented across all study types. Only 4 studies (2%) suggested that a lack of fathers was a possible limitation. Two studies (1%) reported explicit attempts to increase father involvement. LIMITATIONS: The review was limited to RCTs published in English peer-reviewed journals over a 10-year period. CONCLUSIONS: Existing pediatric obesity treatment or prevention programs with parent involvement have not engaged fathers. Innovative strategies are needed to make participation more accessible and engaging for fathers. PMID: 28130430 [PubMed - indexed for MEDLINE]

Designing a sexual health risk assessment for young people.

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Designing a sexual health risk assessment for young people. Nurs Child Young People. 2017 Feb 06;29(1):18 Authors: McGregor F, Cannon E Abstract Sexual health nurses working with teenagers from the black and minority ethnic community reflect on fieldwork undertaken for a Mary Seacole leadership award aimed at reducing inequalities. PMID: 28162075 [PubMed - indexed for MEDLINE]

Midwives’ perceptions and experiences of caring for women who experience perinatal mental health problems: An integrative review.

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Midwives' perceptions and experiences of caring for women who experience perinatal mental health problems: An integrative review. Midwifery. 2017 Feb;45:56-71 Authors: Noonan M, Doody O, Jomeen J, Galvin R Abstract BACKGROUND: perinatal mental health is an important public health issue and consideration must be given to care provision for effective support and care of women in the perinatal period. AIM: to synthesise primary research on midwives' perceived role in Perinatal Mental Health (PMH). DESIGN: integrative review. METHODS: Whittemore and Knafl's (2005) framework was employed. A systematic search of the literature was completed. Studies were included if they met the following criteria: primary qualitative, quantitative and mixed methods research studies published in peer reviewed journals between January 2006 to February 2016, where the population of interest were midwives and the outcomes of interest were their perceived role in the management of women with PMH problems. The methodological quality of studies was assessed using the relevant CASP (Critical Appraisal Skills Programmes, 2014) criteria for quantitative and qualitative research studies. Data extraction, quality assessment and thematic analysis were conducted. FINDINGS: a total of 3323 articles were retrieved and 22 papers were included in the review (15 quantitative, 6 qualitative and one mixed method study). The quality of the studies included was good overall. Two overarching themes emerged relating to personal and professional engagement. Within personal engagement four sub themes are presented: knowledge, skills, decision making and attitude. Within professional engagement four themes are presented: continuous professional development, organisation of care, referral, and support. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the findings indicate midwives require continuous professional development opportunities that address knowledge, attitudes to PMH, communication and assessment skills. However educational and training support in the absence of appropriate referral pathways and support systems will have little benefit. PMID: 28039845 [PubMed - indexed for MEDLINE]

Who Gets Severe Gynecomastia Among HIV-infected Children in the United Kingdom and Ireland?

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Who Gets Severe Gynecomastia Among HIV-infected Children in the United Kingdom and Ireland? Pediatr Infect Dis J. 2017 Mar;36(3):307-310 Authors: Kenny J, Doerholt K, Gibb DM, Judd A, Collaborative HIV Paediatric Study (CHIPS) Steering Committee Abstract There are few data on gynecomastia in HIV-infected children. Within the UK/Ireland's national cohort, 56 of 1873 (3%) HIV-infected children had gynecomastia, of which 10 (0.5%) were severe. All 10 had received antiretroviral therapy for a median of 27.5 (21, 42) months; 4 of 10 had received efavirenz, 7 of 10 and 6 of 10 had received stavudine and/or didanosine respectively. Five were nonreversible, despite changing antiretroviral therapy, and required breast reduction surgery. PMID: 27879556 [PubMed - indexed for MEDLINE]

Atypical monoarthritis presentation in children with oligoarticular juvenile idiopathic arthritis: a case series.

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Atypical monoarthritis presentation in children with oligoarticular juvenile idiopathic arthritis: a case series. Pediatr Rheumatol Online J. 2017 Jan 13;15(1):2 Authors: Lepore N, Cashin M, Bartley D, Ardelean DS Abstract BACKGROUND: Oligoarticular juvenile idiopathic arthritis (oligoJIA), the most common chronic inflammatory arthritis of childhood, usually involves the knees and ankles. Severe oligoJIA monoarthritis presenting in a joint other than knees and ankles, is rare. FINDINGS: We report four children who presented with severe isolated arthritis of the hip, wrist or elbow and were diagnosed with oligoJIA. All four were girls with a median age of 11.5 years. Those with hip arthritis also met the classification criteria for juvenile-onset spondylarthopathy. Median duration of symptoms prior to diagnosis was 9.5 months. Three children had already cartilage loss or erosive disease at diagnosis. CONCLUSIONS: Children diagnosed with oligoJIA that present with monoarthritis of the hip, wrist and elbow can have aggressive disease. Girls with positive HLA-B27 presenting with isolated hip arthritis could meet the classification criteria for both oligoJIA and juvenile-onset SpA. Early referral to specialized care may improve their diagnosis, treatment and outcome. PMID: 28086918 [PubMed - indexed for MEDLINE]

Postpartum Weight Retention and Subsequent Pregnancy Outcomes.

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Postpartum Weight Retention and Subsequent Pregnancy Outcomes. J Perinat Neonatal Nurs. 2016 Oct/Dec;34(4):292-301 Authors: Luke S, Kirby RS, Wright L Abstract The effects of postpartum weight retention on gestational weight gain in successive pregnancies require elucidation. The purpose of the study was (1) to examine the association between postpartum weight retention and subsequent adherence to the Institute of Medicine gestational weight gain guidelines and (2) to determine whether the association varies by body mass index status and affects birth outcomes. Florida vital records for 2005-2010 were analyzed using χ tests and multivariable Poisson regression, adjusted for interpregnancy interval, tobacco use, maternal age, and race/ethnicity. Obese women who gained inadequate weight were more likely to retain weight between pregnancies than obese women who met or exceeded the recommended weight gain. Risks for preterm birth increased among women with inadequate weight and decreased among women with excessive weight gain. Gaining excessive weight was protective for small-for-gestational age infants in all body mass index categories but increased the risks for large-for-gestational age infants. Underweight and normal weight women who gained in excess were 40% more likely to develop hypertension than normal weight women who gained within the recommended amount. Obese women who retain or gain weight postpartum are at increased risk for inadequate weight gain in a successive pregnancy. Achieving Institute of Medicine-recommended gestational weight gain is essential for preventing adverse maternal and infant outcomes. PMID: 26866522 [PubMed - indexed for MEDLINE]

Characteristics of children who do not attend their hospital appointments, and GPs’ response: a mixed methods study in primary and secondary care.

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Characteristics of children who do not attend their hospital appointments, and GPs' response: a mixed methods study in primary and secondary care. Br J Gen Pract. 2017 Jun 19;: Authors: French LR, Turner KM, Morley H, Goldsworthy L, Sharp DJ, Hamilton-Shield J Abstract BACKGROUND: Children who do not attend (DNA) their hospital outpatient appointments are a concern because this potentially compromises the child's health and incurs financial cost. Little is known about children who DNA or the views of GPs to non-attendance. AIM: To describe the characteristics of children who DNA hospital paediatric outpatient appointments, and explore how GPs view and respond to DNAs. DESIGN AND SETTING: A mixed methods study of data from all new referrals to a children's hospital in the South West of England between 1 September and 31 October 2012. METHOD: Data were extracted from patients' hospital and GP records, and Stata was used to analyse the data quantitatively. Analysis focused on describing the characteristics of children who DNA, and the process of care that followed. Practices that had either the highest or lowest number of DNAs were purposefully sampled for GPs who had referred children to secondary care at the study hospital within the previous year. Interviews were held between May 2014 and July 2015, and were analysed thematically. RESULTS: Children who DNA are more likely to be from an area of greater deprivation (adjusted odds ratio [AOR] 1.02, 95% confidence interval [CI] = 1.00 to 1.02, P = 0.04), and with a child protection alert in their hospital notes (AOR 2.72, 95% CI = 1.26 to 5.88, P = 0.01). Non-attendance is communicated poorly to GPs, rarely coded in patients' GP records, and few GP practices have a formal policy regarding paediatric DNAs. CONCLUSION: Non-attendance at hospital outpatient appointments may indicate a child's welfare is at risk. Communication between primary and secondary care needs to be improved, and guidelines developed to encourage GPs to monitor children who DNA. PMID: 28630057 [PubMed - as supplied by publisher]

Different insulin types and regimens for pregnant women with pre-existing diabetes.

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Different insulin types and regimens for pregnant women with pre-existing diabetes. Cochrane Database Syst Rev. 2017 02 03;2:CD011880 Authors: O'Neill SM, Kenny LC, Khashan AS, West HM, Smyth RM, Kearney PM Abstract BACKGROUND: Insulin requirements may change during pregnancy, and the optimal treatment for pre-existing diabetes is unclear. There are several insulin regimens (e.g. via syringe, pen) and types of insulin (e.g. fast-acting insulin, human insulin). OBJECTIVES: To assess the effects of different insulin types and different insulin regimens in pregnant women with pre-existing type 1 or type 2 diabetes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 October 2016), ClinicalTrials.gov (17 October 2016), the WHO International Clinical Trials Registry Platform (ICTRP; 17 October 2016), and the reference lists of retrieved studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared different insulin types and regimens in pregnant women with pre-existing diabetes.We had planned to include cluster-RCTs, but none were identified. We excluded quasi-randomised controlled trials and cross-over trials. We included studies published in abstract form and contacted the authors for further details when applicable. Conference abstracts were superseded by full publications. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion, conducted data extraction, assessed risk of bias, and checked for accuracy. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: The findings in this review were based on very low-quality evidence, from single, small sample sized trial estimates, with wide confidence intervals (CI), some of which crossed the line of no effect; many of the prespecified outcomes were not reported. Therefore, they should be interpreted with caution. We included five trials that included 554 women and babies (four open-label, multi-centre, two-arm trials; one single centre, four-arm RCT). All five trials were at a high or unclear risk of bias due to lack of blinding, unclear methods of randomisation, and selective reporting of outcomes. Pooling of data from the trials was not possible, as each trial looked at a different comparison.1. One trial (N = 33 women) compared Lispro insulin with regular insulin and provided very low-quality evidence for the outcomes. There were seven episodes of pre-eclampsia in the Lispro group and nine in the regular insulin group, with no clear difference between the two groups (risk ratio (RR) 0.68, 95% CI 0.35 to 1.30). There were five caesarean sections in the Lispro group and nine in the regular insulin group, with no clear difference between the two groups (RR 0.59, 95% CI 0.25 to 1.39). There were no cases of fetal anomaly in the Lispro group and one in the regular insulin group, with no clear difference between the groups (RR 0.35, 95% CI 0.02 to 8.08). Macrosomia, perinatal deaths, episodes of birth trauma including shoulder dystocia, nerve palsy, and fracture, and the composite outcome measure of neonatal morbidity were not reported.2. One trial (N = 42 women) compared human insulin to animal insulin, and provided very low-quality evidence for the outcomes. There were no cases of macrosomia in the human insulin group and two in the animal insulin group, with no clear difference between the groups (RR 0.22, 95% CI 0.01 to 4.30). Perinatal death, pre-eclampsia, caesarean section, fetal anomaly, birth trauma including shoulder dystocia, nerve palsy and fracture and the composite outcome measure of neonatal morbidity were not reported.3. One trial (N = 93 women) compared pre-mixed insulin (70 NPH/30 REG) to self-mixed, split-dose insulin and provided very low-quality evidence to support the outcomes. Two cases of macrosomia were reported in the pre-mixed insulin group and four in the self-mixed insulin group, with no clear difference between the two groups (RR 0.49, 95% CI 0.09 to 2.54). There were seven cases of caesarean section (for cephalo-pelvic disproportion) in the pre-mixed insulin group and 12 in the self-mixed insulin group, with no clear difference between groups (RR 0.57, 95% CI 0.25 to 1.32). Perinatal death, pre-eclampsia, fetal anomaly, birth trauma including shoulder dystocia, nerve palsy, or fracture and the composite outcome measure of neonatal morbidity were not reported.4. In the same trial (N = 93 women), insulin injected with a Novolin pen was compared to insulin injected with a conventional needle (syringe), which provided very low-quality evidence to support the outcomes. There was one case of macrosomia in the pen group and five in the needle group, with no clear difference between the different insulin regimens (RR 0.21, 95% CI 0.03 to 1.76). There were five deliveries by caesarean section in the pen group compared with 14 in the needle group; women were less likely to deliver via caesarean section when insulin was injected with a pen compared to a conventional needle (RR 0.38, 95% CI 0.15 to 0.97). Perinatal death, pre-eclampsia, fetal anomaly, birth trauma including shoulder dystocia, nerve palsy, or fracture, and the composite outcome measure of neonatal morbidity were not reported.5. One trial (N = 223 women) comparing insulin Aspart with human insulin reported none of the review's primary outcomes: macrosomia, perinatal death, pre-eclampsia, caesarean section, fetal anomaly, birth trauma including shoulder dystocia. nerve palsy, or fracture, or the composite outcome measure of neonatal morbidity.6. One trial (N = 162 women) compared insulin Detemir with NPH insulin, and supported the outcomes with very low-quality evidence. There were three cases of major fetal anomalies in the insulin Detemir group and one in the NPH insulin group, with no clear difference between the groups (RR 3.15, 95% CI 0.33 to 29.67). Macrosomia, perinatal death, pre-eclampsia, caesarean section, birth trauma including shoulder dystocia, nerve palsy, or fracture and the composite outcome of neonatal morbidity were not reported. AUTHORS' CONCLUSIONS: With limited evidence and no meta-analyses, as each trial looked at a different comparison, no firm conclusions could be made about different insulin types and regimens in pregnant women with pre-existing type 1 or 2 diabetes. Further research is warranted to determine who has an increased risk of adverse pregnancy outcome. This would include larger trials, incorporating adequate randomisation and blinding, and key outcomes that include macrosomia, pregnancy loss, pre-eclampsia, caesarean section, fetal anomalies, and birth trauma. PMID: 28156005 [PubMed - indexed for MEDLINE]

Estimation of the dietary requirement for vitamin D in white children aged 4-8 y: a randomized, controlled, dose-response trial.

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Estimation of the dietary requirement for vitamin D in white children aged 4-8 y: a randomized, controlled, dose-response trial. Am J Clin Nutr. 2016 Nov;104(5):1310-1317 Authors: Mortensen C, Damsgaard CT, Hauger H, Ritz C, Lanham-New SA, Smith TJ, Hennessy Á, Dowling K, Cashman KD, Kiely M, Mølgaard C Abstract BACKGROUND: Children in northern latitudes are at high risk of vitamin D deficiency during winter because of negligible dermal vitamin D3 production. However, to our knowledge, the dietary requirement for maintaining the nutritional adequacy of vitamin D in young children has not been investigated. OBJECTIVE: We aimed to establish the distribution of vitamin D intakes required to maintain winter serum 25-hydroxyvitamin D [25(OH)D] concentrations above the proposed cutoffs (25, 30, 40, and 50 nmol/L) in white Danish children aged 4-8 y living at 55°N. DESIGN: In a double-blind, randomized, controlled trial 119 children (mean age: 6.7 y) were assigned to 0 (placebo), 10, or 20 μg vitamin D3/d supplementation for 20 wk. We measured anthropometry, dietary vitamin D, and serum 25(OH)D with liquid chromatography-tandem mass spectrometry at baseline and endpoint. RESULTS: The mean ± SD baseline serum 25(OH)D was 56.7 ± 12.3 nmol/L (range: 28.7-101.4 nmol/L). Serum 25(OH)D increased by a mean ± SE of 4.9 ± 1.3 and 17.7 ± 1.8 nmol/L in the groups receiving 10 and 20 μg vitamin D3/d, respectively, and decreased by 24.1 ± 1.2 nmol/L in the placebo group (P < 0.001). A nonlinear model of serum 25(OH)D as a function of total vitamin D intake (diet and supplements) was fit to the data. The estimated vitamin D intakes required to maintain winter serum 25(OH)D >30 (avoiding deficiency) and >50 nmol/L (ensuring adequacy) in 97.5% of participants were 8.3 and 19.5 μg/d, respectively, and 4.4 μg/d was required to maintain serum 25(OH)D >40 nmol/L in 50% of participants. CONCLUSIONS: Vitamin D intakes between 8 and 20 μg/d are required by white 4- to 8-y-olds during winter in northern latitudes to maintain serum 25(OH)D >30-50 nmol/L depending on chosen serum 25(OH)D threshold. This trial was registered at clinicaltrials.gov as NCT02145195. PMID: 27733403 [PubMed - indexed for MEDLINE]

Long-Acting Reversible Contraception: An Essential Guide for Pediatric Primary Care Providers.

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Long-Acting Reversible Contraception: An Essential Guide for Pediatric Primary Care Providers. Pediatr Clin North Am. 2017 Apr;64(2):359-369 Authors: Allen S, Barlow E Abstract Long-acting reversible contraception (LARC) methods are 20% more effective than traditional contraceptives and are recommended by the American Academy of Pediatrics and American College of Obstetrics and Gynecology as first-line contraception for adolescent girls. Large studies show that LARC use reduces unintended pregnancies, increases user satisfaction, and prolongs duration of use. This article prepares the primary care provider (PCP) with knowledge on safety, efficacy, eligibility, confidentiality, anticipatory guidance, how to find a LARC provider, and guidance on common side effects so the PCP can confidently counsel adolescent patients on LARC methods. PMID: 28292451 [PubMed - indexed for MEDLINE]

Adolescent trust and primary care: Help-seeking for emotional and psychological difficulties.

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Adolescent trust and primary care: Help-seeking for emotional and psychological difficulties. J Adolesc. 2017 Jan;54:1-8 Authors: Corry DA, Leavey G Abstract Although a quarter of adolescents are likely to experience emotional and psychological difficulties, only a third of them will seek professional help. In this exploratory study we undertook focus groups with 54 adolescents between the ages of 13 and 16 in eight post-primary schools in Northern Ireland. Young people do not trust their GPs, perceiving them as strangers, impersonal and uncaring. The basis of distrust is different among males and females. The findings are discussed in light of adolescents' developmental challenges of identity formation and the consequent demand to be respected and taken seriously by adults. PMID: 27838545 [PubMed - indexed for MEDLINE]

The Individual, Social, and Environmental Correlates of Physical Activity and Screen Time in Irish Children: Growing Up in Ireland Study.

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The Individual, Social, and Environmental Correlates of Physical Activity and Screen Time in Irish Children: Growing Up in Ireland Study. J Phys Act Health. 2016 Dec;13(12):1285-1293 Authors: Garcia JM, Healy S, Rice D Abstract BACKGROUND: The aim of this study was to use a social-ecological approach to examine the influence of individual, social, and environmental factors on moderate-to-vigorous physical activity (MVPA) and screen-time in a sample of 9-year-old children in Ireland. METHODS: The sample was 1509 boys and girls from the Growing Up in Ireland (GUI) national study. MVPA, screen time, and individual, social, and environmental variables were assessed via questionnaires completed by children, their parents, and their teachers. Multiple regression was used to identify factors that correlated with children's MVPA and screen-time levels. RESULTS: For boys, factors such as activity with friends (P < .0001) and popularity (P < .01) were associated with MVPA, while factors such as BMI (P < .01) and MVPA (P < .01) were associated with screen time. Similarly for girls, factors such as activity with friends (P < .0001) and sociability were associated with MVPA, however factors such as BMI (P < .05), and access to play space (P < .05) were more closely associated with screen time. CONCLUSION: Social factors were more closely associated with MVPA, while individual factors were significantly correlated with screen time for both boys and girls. Correlates differed for boys and girls, suggesting that interventions should consider both the target population as well as the activity behavior. PMID: 27633624 [PubMed - indexed for MEDLINE]

Interviewing Adolescents About Sexual Matters.

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Interviewing Adolescents About Sexual Matters. Pediatr Clin North Am. 2017 Apr;64(2):291-304 Authors: Pfeffer B, Ellsworth TR, Gold MA Abstract To optimally address sex and sexuality, normalize gender and sexual diversities, and attend to adolescents' needs, clinicians will best serve their patients and their families by becoming comfortable initiating confidential, developmentally appropriate discussions with all adolescent patients. The goal is to create a safe, affirming, nonjudgmental space wherein adolescents may learn about sexual matters, discuss concerns, ask questions, and find support to assist them to achieve healthy, positive development. This article provides useful, practical suggestions to begin these conversations, offers specific examples and tips to encourage dialogue, and discusses ways to be a resource to adolescent patients. PMID: 28292446 [PubMed - indexed for MEDLINE]

Small Talk: Identifying communication problems in maltreated children.

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Small Talk: Identifying communication problems in maltreated children. Child Abuse Negl. 2017 Jun 17;: Authors: Frederico M, Jackson AL, Black CM, Cox A, Joffe B Abstract Development of speech and language is rapid in early years, yet if developmental problems in speech and language are not addressed they are likely to continue and impact negatively on a child's overall development and their life trajectory. Children who have experienced abuse and or neglect are particularly vulnerable. The aim of this study was to develop a tool to assist in identifying a child's need for assessment by a speech pathologist so that there could be early identification of problems. A culturally sensitive tool was developed to be completed by the child's carer included questions on language, speech and hearing, voice, fluency, understanding sentences, vocabulary and expression. Sixty-five children aged between 4 and 8 years, who had experienced abuse and/or neglect participated in the study. Fourteen percent were Aboriginal. A speech pathologist undertook an assessment for each child and the results were compared with the information on the Small Talk tool. The Tool was found to be high in sensitivity but low in specificity, requiring further refinement. However, it has the potential to assist non speech pathologists to identify a child's need for speech and language assessment with the findings identifying the Tool as promising practice. PMID: 28633958 [PubMed - as supplied by publisher]

Promoting ball skills in preschool-age girls.

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Promoting ball skills in preschool-age girls. J Sci Med Sport. 2017 Jan;20(1):50-54 Authors: Veldman SL, Palmer KK, Okely AD, Robinson LE Abstract OBJECTIVES: Evidence supports that girls are less proficient than boys at performing ball skills. This study examined the immediate and long-term effects of a ball skill intervention on preschool-age girls' ball skill performance. DESIGN: Randomized controlled trial. METHODS: Girls (Mage=47.24±7.38 months) were randomly assigned to a high autonomy, mastery-based 9-week motor skill intervention (the Children's Health Activity Motor Program; CHAMP, 540min; n=38) or a control group (free-play; n=16). Ball skill proficiency was assessed at pretest, posttest, and retention test (after 9 weeks) using the object control subscale of the Test of Gross Motor Development - 2nd Edition. Treatment efficacy was examined using linear mixed models. Two models were fit: one for short-term changes (pretest to posttest) and one for long-term changes (pretest to retention). RESULTS: Linear mixed models revealed a significantly time*treatment interaction for both models. Post hoc analysis confirmed that girls in CHAMP experienced significant gains in ball skills from pretest to posttest (p<.001) and pretest to retention (p<.001). Moreover, girls in CHAMP were no different from the control group at pretest (p>.05) but had significantly higher ball skills scores at both posttest (p<.001) and retention (p<.001). CONCLUSIONS: This study demonstrates the positive effects of a ball skill intervention (i.e., CHAMP) on improving girls' ball skills both short- and long-term. Findings suggest that early childhood interventions that focus on the development of ball skills in young girls might be an avenue to improve girls' ball skill performance. PMID: 27283343 [PubMed - indexed for MEDLINE]

Osteonecrosis in children with acute lymphoblastic leukemia.

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Osteonecrosis in children with acute lymphoblastic leukemia. Haematologica. 2016 Nov;101(11):1295-1305 Authors: Kunstreich M, Kummer S, Laws HJ, Borkhardt A, Kuhlen M Abstract The morbidity and toxicity associated with current intensive treatment protocols for acute lymphoblastic leukemia in childhood become even more important as the vast majority of children can be cured and become long-term survivors. Osteonecrosis is one of the most common therapy-related and debilitating side effects of anti-leukemic treatment and can adversely affect long-term quality of life. Incidence and risk factors vary substantially between study groups and therapeutic regimens. We therefore analyzed 22 clinical trials of childhood acute lymphoblastic leukemia in terms of osteonecrosis incidence and risk factors. Adolescent age is the most significant risk factor, with patients >10 years old at the highest risk. Uncritical modification or even significant reduction of glucocorticoid dosage cannot be recommended at this stage. A novel and innovative approach to reduce osteonecrosis-associated morbidity might be systematic early screening for osteonecrosis by serial magnetic resonance images. However, discriminating patients at risk of functional impairment and debilitating progressive joint disease from asymptomatic patients still remains challenging. PMID: 27742768 [PubMed - indexed for MEDLINE]

Predictors of health-related quality of life in maltreated children and adolescents.

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Predictors of health-related quality of life in maltreated children and adolescents. Qual Life Res. 2017 Jun 15;: Authors: Weber S, Jud A, Landolt MA, Goldbeck L Abstract PURPOSE: Research on the consequences of child maltreatment has primarily focused on behavior and mental health; the children's overall well-being has not received the same attention. A number of studies have investigated health-related quality of life (HRQoL) among victims of child maltreatment, but there is still a lack of knowledge about predictors of HRQoL in maltreated children and adolescents. This study seeks to bridge the gap by drawing data from the German multi-site study Child Abuse and Neglect Case-Management (CANMANAGE). METHODS: Parents or caregivers of 350 children and adolescents completed a proxy version of the Kidscreen-10-Index, a multidimensional instrument measuring child HRQoL. An additional 249 children age 8 years and older completed a self-report version. Multiple regression analyses were performed to identify potential predictors for both self- and proxy-rated HRQoL. RESULTS: Comparisons with the reference group revealed a significantly lower mean proxy-rated HRQoL, the self-rated HRQoL of the study sample was not significantly impaired. Predictors of impaired self-reported HRQoL were older age, self-reported posttraumatic stress symptoms (PTSS), and self-reported emotional and behavioral symptoms. Predictors of impaired proxy-reported HRQoL again were older age, self-reported PTSS, and emotional and behavioral symptoms in the child/adolescent, as reported by the caregiver, as well as low socioeconomic status. Multivariate analysis explained 20% and 38% of the variability in self-reported and proxy-rated HRQoL, respectively. CONCLUSIONS: It is important to treat PTSS and emotional and behavioral symptoms in maltreated children, as these two phenomena are strong cross-sectional predictors of a child's HRQoL. Trauma-focused cognitive behavioral therapies are one possible option to address the needs of such children. PMID: 28620875 [PubMed - as supplied by publisher]

Mental health of adolescents with currently and formerly incarcerated parents.

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Mental health of adolescents with currently and formerly incarcerated parents. J Adolesc. 2017 Jan;54:120-134 Authors: Davis L, Shlafer RJ Abstract Reliable information about children of incarcerated people is difficult to obtain, and major gaps exist in our understanding of their well-being. This study aims to determine whether adolescents with incarcerated parents report higher levels of mental health problems than those without an incarcerated parent, and whether the relationship between parental incarceration and adolescent mental health is moderated by parent-child relationships. Using a statewide survey from one US state, we compared adolescents with a currently incarcerated parent to those with a formerly incarcerated parent and those with no history of parental incarceration on self-reported indicators of mental health, and examined whether strong parent-child relationships were protective against mental health concerns. Results indicate that adolescents with incarcerated parents are at elevated risk for mental health problems, and strong parent-child relationships partially buffer children from risk. Findings underscore the need for more investment in effective early interventions for adolescents in highly adverse contexts. PMID: 28011442 [PubMed - indexed for MEDLINE]

Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety.

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Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety. Obstet Gynecol. 2017 Mar;129(3):422-430 Authors: Kendig S, Keats JP, Hoffman MC, Kay LB, Miller ES, Moore Simas TA, Frieder A, Hackley B, Indman P, Raines C, Semenuk K, Wisner KL, Lemieux LA Abstract Perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age. When left untreated, perinatal mood and anxiety disorders can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide. Perinatal mood and anxiety disorders are associated with increased risks of maternal and infant mortality and morbidity and are recognized as a significant patient safety issue. In 2015, the Council on Patient Safety in Women's Health Care convened an interdisciplinary workgroup to develop an evidence-based patient safety bundle to address maternal mental health. The focus of this bundle is perinatal mood and anxiety disorders. The bundle is modeled after other bundles released by the Council on Patient Safety in Women's Health Care and provides broad direction for incorporating perinatal mood and anxiety disorder screening, intervention, referral, and follow-up into maternity care practice across health care settings. This commentary provides information to assist with bundle implementation. PMID: 28178041 [PubMed - indexed for MEDLINE]

Perceived barriers to leisure-time physical activity during pregnancy: A literature review of quantitative and qualitative evidence.

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Perceived barriers to leisure-time physical activity during pregnancy: A literature review of quantitative and qualitative evidence. J Sci Med Sport. 2017 Jan;20(1):17-25 Authors: Coll CV, Domingues MR, Gonçalves H, Bertoldi AD Abstract OBJECTIVES: Identify perceived barriers to leisure-time physical activity during pregnancy to inform future interventions aimed at improving physical activity levels in pregnancy. DESIGN: PubMed/Medline and Web of Science databases were systematically searched using a reference period between 1986 and January/2016. METHODS: A comprehensive search strategy was developed combining the following keywords: (barriers OR constraints OR perceptions OR attitudes) AND (physical activity OR exercise OR motor activity) AND (pregnancy OR pregnant women OR antenatal OR prenatal). Thematic synthesis was conducted to analyze the data. A socioecological model was used to categorize the reported barriers. RESULTS: Twelve quantitative studies and 14 qualitative studies were included. Barriers belonging to the intrapersonal level of the socioecological model were the most reported in the studies and were categorized in five themes as follows: (1) Pregnancy-related symptoms and limitations; (2) Time constraints; (3) Perceptions of already being active, (4) Lack of motivation and (5) Mother-child safety concerns. At the interpersonal level, barriers were coded into two descriptive themes: (1) Lack of advice and information and (2) Lack of social support. Two other themes were used to summarize Environmental, Organizational and Policy barriers: (1) Adverse weather and (2) Lack of resources. CONCLUSIONS: A range of relevant barriers to leisure-time physical-activity engagement during pregnancy were identified in this literature review. Pregnancy-related symptoms and limitations barriers were the most reported in studies, regardless of study design. Mother-child safety concerns, lack of advice/information and lack of social support were also important emphasized pregnancy-related barriers to be targeted in future interventions. PMID: 27372276 [PubMed - indexed for MEDLINE]

Substantiated childhood maltreatment and young adulthood cannabis use disorders: A pre-birth cohort study.

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Substantiated childhood maltreatment and young adulthood cannabis use disorders: A pre-birth cohort study. Psychiatry Res. 2017 Jun 09;256:21-31 Authors: Abajobir AA, Najman JM, Williams G, Strathearn L, Clavarino A, Kisely S Abstract This study investigates the association between exposure to prospectively-substantiated childhood maltreatment between 0 and 14 years of age and lifetime cannabis use, abuse and dependence reported at 21 years. Data were taken from 2526 (51.6% female) participants in the Mater Hospital-University of Queensland Study of Pregnancy, a pre-birth, prospective, cohort study. Prospectively-substantiated cases of childhood maltreatment, reported to the government child protection agencies between 0 and 14 years of age, were linked to CIDI DSM-IV self-report data from the 21-year follow-up. Exposure to any childhood maltreatment, and childhood neglect in particular, predicted subsequent cannabis abuse with adjusted odds ratios (AORs) of 1.79 and 2.62, respectively. Any childhood maltreatment, physical abuse, emotional abuse and neglect predicted cannabis dependence with AORs of 2.47, 2.81, 2.44 and 2.68, respectively. The associations for an early age of onset of cannabis abuse and dependence were significant and consistent for maltreated children. In addition, frequency of maltreatment substantiations predicted cannabis abuse, dependence and an early age of onset of these disorders. The AORs for cannabis ever use without any DSM-IV cannabis disorder were 1.78 for any maltreatment and 2.15 for emotional abuse. Any childhood maltreatment and neglect predicted lifetime ever cannabis use, as well as cannabis use disorder. There was little evidence for any interaction between gender and different forms of childhood maltreatment and its association with cannabis use disorders. Physical abuse, emotional abuse and neglect, as well as multiple episodes of maltreatment independently predicted cannabis use disorders. PMID: 28622571 [PubMed - as supplied by publisher]

Prioritisation of future research topics in paediatric palliative care in Ireland: a Delphi study.

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Prioritisation of future research topics in paediatric palliative care in Ireland: a Delphi study. Int J Palliat Nurs. 2017 Feb 02;23(2):88-97 Authors: Quinn C, McCarthy S, Devins M, O'Reilly M, Twomey M, Ling J Abstract This paper reports the findings from a Delphi Study undertaken to identify the research priorities in children's palliative care in Ireland. Palliative care for children is a small and highly specialised field of healthcare that focuses on improving the quality of life of children living with, or dying from, a life-limiting condition. Ideally, support for children requiring palliative care begins at the time of diagnosis, which for many children with life-limiting conditions can be from birth. There is a notable overlap between the needs of children requiring palliative care and those with disabilities and other complex care needs, resulting in care being provided by a range of voluntary and statutory agencies. As a new specialty, there is a need to develop an evidence-based approach to providing children's palliative care. In order to do this in a systematic way, identification of the research priorities in children's palliative care within Ireland is required. PMID: 28245162 [PubMed - indexed for MEDLINE]

Screening for potential child maltreatment in parents of a newborn baby: The predictive validity of an Instrument for early identification of Parents At Risk for child Abuse and Neglect (IPARAN).

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Screening for potential child maltreatment in parents of a newborn baby: The predictive validity of an Instrument for early identification of Parents At Risk for child Abuse and Neglect (IPARAN). Child Abuse Negl. 2017 Jun 12;70:160-168 Authors: van der Put CE, Bouwmeester-Landweer MBR, Landsmeer-Beker EA, Wit JM, Dekker FW, Kousemaker NPJ, Baartman HEM Abstract For preventive purposes it is important to be able to identify families with a high risk of child maltreatment at an early stage. Therefore we developed an actuarial instrument for screening families with a newborn baby, the Instrument for identification of Parents At Risk for child Abuse and Neglect (IPARAN). The aim of this study was to assess the predictive validity of the IPARAN and to examine whether combining actuarial and clinical methods leads to an improvement of the predictive validity. We examined the predictive validity by calculating several performance indicators (i.e., sensitivity, specificity and the Area Under the receiver operating characteristic Curve [AUC]) in a sample of 4692 Dutch families with newborns. The outcome measure was a report of child maltreatment at Child Protection Services during a follow-up of 3 years. For 17 children (.4%) a report of maltreatment was registered. The predictive validity of the IPARAN was significantly better than chance (AUC=.700, 95% CI [.567-.832]), in contrast to a low value for clinical judgement of nurses of the Youth Health Care Centers (AUC=.591, 95% CI [.422-.759]). The combination of the IPARAN and clinical judgement resulted in the highest predictive validity (AUC=.720, 95% CI [.593-.847]), however, the difference between the methods did not reach statistical significance. The good predictive validity of the IPARAN in combination with clinical judgment of the nurse enables professionals to assess risks at an early stage and to make referrals to early intervention programs. PMID: 28618320 [PubMed - as supplied by publisher]

Relationship Between Adolescent Report of Patient-Centered Care and of Quality of Primary Care.

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Relationship Between Adolescent Report of Patient-Centered Care and of Quality of Primary Care. Acad Pediatr. 2016 Nov - Dec;16(8):770-776 Authors: Toomey SL, Elliott MN, Schwebel DC, Tortolero SR, Cuccaro PM, Davies SL, Kampalath V, Schuster MA Abstract OBJECTIVE: Few studies have examined adolescent self-report of patient-centered care (PCC). We investigated whether adolescent self-report of PCC varied by patient characteristics and whether receipt of PCC is associated with measures of adolescent primary care quality. METHODS: We analyzed cross-sectional data from Healthy Passages, a population-based survey of 4105 10th graders and their parents. Adolescent report of PCC was derived from 4 items. Adolescent primary care quality was assessed by measuring access to confidential care, screening for important adolescent health topics, unmet need, and overall rating of health care. We conducted weighted bivariate analyses and multivariate logistic regression models of the association of PCC with adolescent characteristics and primary care quality. RESULTS: Forty-seven percent of adolescents reported that they received PCC. Report of receiving PCC was associated with high quality for other measures, such as having a private conversation with a clinician (adjusted odds ratio [aOR] 2.2; 95% confidence interval [CI] [1.9, 2.6]) and having talked about health behaviors (aOR 1.6; 95% CI 1.4, 1.8); it was also associated with lower likelihood for self-reported unmet need for care (aOR 0.8; 95% CI 0.7, 0.9) and having a serious untreated health problem (aOR 0.4; 95% CI 0.3, 0.5). CONCLUSIONS: Many adolescents do not report receiving PCC. Adolescent-reported PCC positively correlates with measures of high-quality adolescent primary care. Our study provides support for using adolescent-report of PCC as a measure of adolescent primary care quality. PMID: 26802684 [PubMed - indexed for MEDLINE]

Paediatric cancer survivors demonstrate a high rate of subclinical renal dysfunction.

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Paediatric cancer survivors demonstrate a high rate of subclinical renal dysfunction. Pediatr Blood Cancer. 2016 Nov;63(11):2026-32 Authors: Mudi A, Levy CS, Geel JA, Poole JE Abstract BACKGROUND: Clinical manifestations of renal dysfunction in childhood cancer survivors include hypertension, proteinuria, tubulopathy (and its biochemical consequences) and renal insufficiency. This study aimed to determine the factors associated with renal dysfunction in paediatric cancer survivors at a single centre in Johannesburg. PROCEDURE: A descriptive cross-sectional study was performed on 130 cancer survivors between 2 and 18 years of age. Physical examination and screening urine dipstick were performed on all patients. Blood results of samples routinely drawn were analysed. RESULTS: After a median follow-up period of 2 years, the various manifestations of renal dysfunction included decreased estimated glomerular filtration rate (eGFR), hypomagnesaemia, hypophosphataemia, proteinuria, haematuria and hypertension. In total, 34 survivors (26.15%) had at least one manifestation of renal dysfunction after completing treatment. The most prevalent manifestation of renal dysfunction was decreased eGFR (17.7%) followed by hypomagnesaemia (6.2%) and hypophosphataemia (4.6%). Patients with pre-existing renal dysfunction were three times more likely to have renal dysfunction post-treatment (P = 0.020). Ifosfamide (P = 0.010) and nephrectomy (P = 0.003) had independent significant impact on reduction in eGFR. High cumulative ifosfamide doses were identified as a possible cause for hypophosphataemia (P = 0.021). CONCLUSION: While not clinically evident in the early follow-up period, the high rate of renal dysfunction is concerning. We suggest that patients with pre-existing renal dysfunction should be assessed by a nephrologist prior to initiation of cancer therapy, and nephro-protective measures should be employed stringently in all children with cancer. Patients with decreased eGFR should be followed up closely in a multidisciplinary late effects clinic. PMID: 27393905 [PubMed - indexed for MEDLINE]

Medication Identification Among Caregivers of Urban Children With Asthma.

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Medication Identification Among Caregivers of Urban Children With Asthma. Acad Pediatr. 2016 Nov - Dec;16(8):799-805 Authors: Frey SM, Fagnano M, Halterman J Abstract OBJECTIVE: To determine caregiver ability to name their child's inhaled asthma medications, and examine whether perceived ease of remembering names is associated with accurate naming and asthma outcomes. METHODS: As part of the School-Based Telemedicine-Enhanced Asthma Management trial in Rochester, New York, we asked caregivers of children with persistent asthma to: 1) name their child's inhaled medications, and 2) indicate agreement with the statement, "it is easy to remember the names of my child's asthma medications." We limited analyses to subjects with 1 inhaled medication. Reported names were compared with canisters available during a home visit; complete matches were considered concordant. We compared ease of remembering names with concordance, asthma symptoms, and adherence using bivariate and multivariate analyses. RESULTS: Overall, 141 caregivers (87%) had children with 1 inhaled medication (62% black race, 68% Medicaid). Most (74%) perceived it easy to remember medication names, yet only 46% reported names concordant with medications at home. Caregivers who did not easily remember medication names were less likely to concordantly name available medications (23% vs 54%; P = .002), and more likely to report that their child experienced >2 symptom days per week (33% vs 16%; P = .03), >2 symptom nights per month (31% vs 12%; P = .02), and missed >1 dose(s) of preventive medication in the previous 2 weeks (52% vs 28%; P = .03). Findings were consistent in multivariate regression analyses. CONCLUSIONS: Caregivers of urban children with persistent asthma who considered medication names difficult to remember were less able to accurately name available medications, and reported worse control and medication adherence. Greater attention to medication identification might improve outcomes in this population. PMID: 27130812 [PubMed - indexed for MEDLINE]

Clinical presentation and risk factors of serious infections in children with Down syndrome treated for acute lymphoblastic leukemia.

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Clinical presentation and risk factors of serious infections in children with Down syndrome treated for acute lymphoblastic leukemia. Pediatr Blood Cancer. 2016 Nov;63(11):1949-53 Authors: Ceppi F, Stephens D, den Hollander BS, Krueger J, Whitlock J, Sung L, Hitzler J Abstract BACKGROUND: Treatment of acute lymphoblastic leukemia (ALL) in children with Down syndrome (DS) is associated with a higher incidence of life-threatening infections compared to the overall pediatric population. The objective of this study was to describe infections and identify risk factors of microbiologically documented infections at a sterile site in children with DS during chemotherapy for ALL. PROCEDURE: We conducted a single-institution retrospective review of infectious episodes encountered by patients with DS during primary treatment for ALL. Correlations between features of clinical presentation and severity of microbiologically proven infections were investigated. RESULTS: Among 237 suspected infectious episodes encountered by 35 patients with DS and ALL (DS-ALL), a total of 40 episodes (16.9%) had the clinical presentation of a severe infection (SI). Seventeen patients had 33 (13.9%) microbiologically proven infections from a sterile site. Fever was not part of the clinical presentation in 27% of microbiologically documented infectious episodes. The odds ratio of a microbiologically proven infection at a sterile site was significantly increased during a 7-day interval after treatment with glucocorticoids (2.18; 95% CI: 1.02-4.66; P = 0.04). Neither administration of anthracyclines in the preceding 14 days nor neutropenia correlated with infections. CONCLUSIONS: Serious infections in DS-ALL may present without typical signs such as fever. The immediate time period following administration of glucocorticoids is particularly associated with the risk of SIs. PMID: 27399585 [PubMed - indexed for MEDLINE]

Universal Cholesterol Screening in Childhood: A Systematic Review.

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Universal Cholesterol Screening in Childhood: A Systematic Review. Acad Pediatr. 2016 Nov - Dec;16(8):716-725 Authors: Smith AJ, Turner EL, Kinra S Abstract BACKGROUND: In 2011, a US expert panel recommended universal cholesterol screening for children ages 9 to 11 years. Controversy exists over this recommendation, especially because the most recent systematic review on universal childhood screening was inconclusive. OBJECTIVES: To conduct an updated systematic review on universal cholesterol screening in childhood and effect on health outcomes, clinical management, screening acceptability, and healthcare costs. DATA SOURCES: We searched MedLine, EMBASE, Psychinfo, and the Cochrane Registry of Controlled Trials from October 2005 to January 2016. We added new studies identified to those from the previous systematic review (1966-September 2005). STUDY ELIGIBILITY, PARTICIPANTS, AND INTERVENTIONS: We included controlled trials, pre-post, cohort, survey, and qualitative studies of universal cholesterol screening in children ages 0 to 18 years. STUDY APPRAISAL AND SYNTHESIS METHODS: Two independent reviewers assessed abstracts and full-text studies, extracted data, and ranked quality. Cost data were inflation-adjusted to 2015 dollars. RESULTS: Nine new studies met inclusion criteria, taking the total number of relevant studies to 21. Screening was associated with no change in cholesterol in 1 of 1 study on health outcomes. A positive screen for dyslipidemia was associated with diet and/or exercise changes in 29% to 92% of families in 4 of 4 studies. Adherence with new guidelines for universal screening was low (16%-18%) in 3 of 3 studies. Costs per case of familial hypercholesterolemia detected were $12,500 to $20,300. LIMITATIONS: Included studies were heterogeneous in outcomes. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Universal cholesterol screening might have small, positive effects on lifestyle change, but the effect on health remains understudied. PMID: 27354197 [PubMed - indexed for MEDLINE]

Relation between milk-fat percentage, vitamin D, and BMI z score in early childhood.

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Relation between milk-fat percentage, vitamin D, and BMI z score in early childhood. Am J Clin Nutr. 2016 Dec;104(6):1657-1664 Authors: Vanderhout SM, Birken CS, Parkin PC, Lebovic G, Chen Y, O'Connor DL, Maguire JL, TARGet Kids! Collaboration Abstract BACKGROUND: Fortified cow milk is a material contributor of vitamin D and dietary fat in children. Recommendations for children >2 y of age advise reduced milk-fat consumption to reduce childhood obesity, yet the relation between lower milk fat, vitamin D stores, and body mass index (BMI) is unclear. OBJECTIVES: The primary objective was to explore the association between milk-fat percentage and both BMI z score (zBMI) and venous 25-hydroxyvitamin D [25(OH)D]; the secondary objective was to assess whether milk volume consumed modified this relation. DESIGN: This was a cross-sectional analysis. Healthy urban children aged 12-72 mo were recruited from 9 primary health care practices within The Applied Research Group for Kids (TARGet Kids!) research group in Toronto, Canada. We used adjusted bivariate linear regression to examine the relation between milk-fat percentage and child 25(OH)D and zBMI concurrently. Effect modification by milk volume consumed on the evaluated relations was explored with the use of an interaction term in the statistical model. RESULTS: Among the 2745 included children there was a positive association between milk-fat percentage and 25(OH)D (P = 0.006) and a negative association between milk-fat percentage and zBMI (P < 0.0001). Participants who drank whole milk had a 5.4-nmol/L (95% CI: 4.32, 6.54) higher median 25(OH)D concentration and a 0.72 lower (95% CI: 0.68, 0.76) zBMI score than children who drank 1% milk. Milk volume consumed modified the effect of milk-fat percentage on 25(OH)D (P = 0.003) but not on zBMI (P = 0.77). CONCLUSIONS: Whole milk consumption among healthy young children was associated with higher vitamin D stores and lower BMI. Longitudinal and interventional studies are needed to confirm these findings. TARGet Kids! was registered at clinicaltrials.gov as NCT01869530. PMID: 27852618 [PubMed - indexed for MEDLINE]

Is accepting circular reasoning in shaken baby studies bad science or misconduct?

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Is accepting circular reasoning in shaken baby studies bad science or misconduct? Acta Paediatr. 2017 Jun 13;: Authors: Lynøe N, Elinder G, Hallberg B, Rosén M, Sundgren P, Eriksson A Abstract Many of the comments on our systematic literature review on shaken baby syndrome (1) have focused on our criticism of how child protection teams' classification of study cases and controls are used as gold standard and the faulty circular reasoning associated with that (2,3). Some commentators have also questioned how reasonable it is to focus on the triad of retinal hemorrhages, This article is protected by copyright. All rights reserved. PMID: 28608979 [PubMed - as supplied by publisher]

Factors that influence evidence-based program sustainment for family support providers in child protection services in disadvantaged communities.

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Factors that influence evidence-based program sustainment for family support providers in child protection services in disadvantaged communities. Child Abuse Negl. 2017 Jun 10;70:134-145 Authors: Hodge LM, Turner KMT, Sanders MR, Forster M Abstract This paper evaluates program, workplace and process factors associated with implementation and sustainment of an evidence-based parenting support program (EBP) in disadvantaged communities. Correlation analyses and binary logistic regressions were used to assess the associations between key implementation support factors and program implementation (at 18 months) and sustainment (at 36 months) post training with (N=35) Australian Aboriginal and Torres Strait Islander family support providers using the Triple P - Positive Parenting Program in Indigenous child protection agencies. This study demonstrated that for implementation at 18 months, there was a trend for implementing providers to report higher levels of partnership support, perceived program benefit, workplace support and workplace cohesion. However, the only significant relationship was with partnership support (r=.31 p<0.05), and regression analysis indicated that none of the variables were significant predictors of program implementation. For sustained implementation at 36 months, no relationship was found between sustainment and program characteristics, workplace characteristics, supervision and peer support or sustainability planning. Supportive coaching was the only significant correlate (r=0.46, p<0.01) and predictor [OR=15.63, 95% CI (1.98-123.68), p=0.009] in the program sustainment model. Overall, these findings suggest the need for further exploration of program and workplace variables and provide evidence to consider incorporating partnership support and supportive coaching in real world implementation models to improve the likelihood of EBP implementation and sustainment in Indigenous communities. PMID: 28609693 [PubMed - as supplied by publisher]

Understanding potential uptake of a proposed mHealth program to support caregiver home management of childhood illness in a resource-poor setting: a qualitative evaluation.

Understanding potential uptake of a proposed mHealth program to support caregiver home management of childhood illness in a resource-poor setting: a qualitative evaluation. Mhealth. 2017;3:19 Authors: Calderón TA, Martin H, Volpicelli K, Frasso R, Díaz Arroyo EC, Gozzer E, Buttenheim AM Abstract BACKGROUND: Extensive uptake of mobile phones offers an unprecedented opportunity to improve global healthcare delivery, especially among underserved populations. Mobile health (mHealth) has been increasingly recognized as a promising approach to addressing challenges in global maternal-child health and may play an important role in accelerating progress towards improved outcomes. However, more evidence guiding development of mHealth interventions is needed. The current study explores factors that may support or hinder adoption and use of a proposed mHealth intervention to improve caregiver home management of common childhood illnesses in order to shape program development. METHODS: Elicitation interviews were conducted with a convenience sample of 25 mothers recruited from a larger cluster-randomized survey sample in the Cono Norte region of Arequipa, Peru. Interview data were analyzed in Spanish to preserve important cultural nuances. RESULTS: Thematic analysis revealed potential facilitators of and barriers to uptake of the proposed mHealth program. Potential facilitators of caregiver participation include opportunity to engage in two-way communication with healthcare providers, development of instrumental and support knowledge to care for sick children, and healthcare challenges faced in a resource-poor community. Potential barriers include preference for in-person healthcare visits, program cost, text messaging abilities, and concern around program legitimacy. CONCLUSIONS: This study underscores the potential for mHealth to improve global healthcare delivery in the area of maternal-child health. It demonstrates that mHealth interventions can meet the needs of vulnerable populations by offering novel approaches to promoting evidence-based care. This in-depth understanding of factors that may influence participation and use of this proposed mHealth program will help shape development of the intervention in this community. PMID: 28607905 [PubMed - in process]

Long-term pediatrician outcomes of a parent led curriculum in developmental disabilities.

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Long-term pediatrician outcomes of a parent led curriculum in developmental disabilities. Res Dev Disabil. 2017 Jan;60:16-23 Authors: Keisling BL, Bishop EA, Kube DA, Roth JM, Palmer FB Abstract Previous research has demonstrated high satisfaction and perceived relevance of Project DOCC (Delivery of Chronic Care), a parent led curriculum in developmental disabilities, across a sample of medical residents. AIMS: The influence of such a training program on the clinical practices and professional activities of these residents once they are established in their careers as physicians, however, has not been studied; this was the aim of the present study. METHODS: An anonymous follow-up survey was designed and disseminated to physicians who participated in Project DOCC during their one-month developmental disabilities rotation as part of their pediatrics or medicine/pediatric residency between 2002 and 2010. Fifty-eight physicians completed the survey. RESULTS: The findings suggest that participation in a parent led curriculum during medical residency had a lasting impact on physicians' relationships with families. Specifically, a majority of the physicians espoused a family-centered approach to care, a sensitivity to the interactional effect that caring for a Child with Special Health Care Needs (CSHCN) has on family members, the need for physicians to have a prominent role in community resource coordination, and the importance of an integrated approach to health care provision. CONCLUSIONS: Use of a parent led curriculum as a means to increase the provision of family-centered care by physicians is supported. PMID: 27875781 [PubMed - indexed for MEDLINE]

Gestational hypertension is associated with increased risk of type 2 diabetes in adult offspring: the Helsinki Birth Cohort Study.

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Gestational hypertension is associated with increased risk of type 2 diabetes in adult offspring: the Helsinki Birth Cohort Study. Am J Obstet Gynecol. 2017 Mar;216(3):281.e1-281.e7 Authors: Kajantie E, Osmond C, Eriksson JG Abstract BACKGROUND: Women with hypertensive disorders in pregnancy are at an increased risk of cardiovascular disease and type 2 diabetes later in life. Offspring born from these hypertensive pregnancies have increased levels of cardiovascular risk factors; whether they are at an increased risk of type 2 diabetes is not known. OBJECTIVE: The objective of the investigation was to study the risk of type 2 diabetes in the adult offspring exposed to maternal preeclampsia or gestational hypertension in utero. STUDY DESIGN: We studied 5335 members of the Helsinki Birth Cohort Study, who were born between 1934 and 1944 and who lived in Finland in 1995 when the National Medication Purchase Register was initiated. We ascertained gestational hypertension and preeclampsia according to modern criteria by using maternal and birth records. We defined type 2 diabetes through purchases of antidiabetic medication recorded in the comprehensive National Medication Purchase Register, excluding the 31 subjects who had purchased only insulin. We used Cox regression to assess hazard ratios for type 2 diabetes. RESULTS: A total of 590 men (21.6%) and 433 women (16.9%) had purchased medication for diabetes. The hazard ratio for type 2 diabetes for offspring exposed to any maternal hypertension in pregnancy was 1.13 (95% confidence interval, 1.00-1.29; n = 1780). For maternal gestational hypertension, it was 1.15 (95% confidence interval, 1.00-1.33; n = 1336) and for preeclampsia 0.98 (95% confidence interval, 0.71-1.34; n = 231). For type 2 diabetes with first medication purchase before 62 years, the corresponding hazard ratios were 1.25 (95% confidence interval, 1.04-1.51); 1.28 (95% confidence interval, 1.05-1.58), and 1.18 (95% confidence interval, 0.75-1.84). The hazard ratios were similar when adjusted for birthweight SD score for gestation, length of gestation, maternal body mass index in late pregnancy, height, age, and parity and for childhood or adult socioeconomic position. An increased risk of type 2 diabetes was also associated with low birthweight SD score, independent of the association with gestational hypertension. CONCLUSION: Offspring exposed to maternal gestational hypertension in utero have an increased risk of type 2 diabetes in late adult life. This finding underlines the role of the whole spectrum of hypertensive disorders of pregnancy as risk factors of offspring disease throughout life. It also reinforces previous suggestions that adult health care providers should incorporate birth histories when evaluating an individual's risk to develop type 2 diabetes. PMID: 27823919 [PubMed - indexed for MEDLINE]

Prescription rates of adrenaline auto-injectors for children in UK general practice: a retrospective cohort study.

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Prescription rates of adrenaline auto-injectors for children in UK general practice: a retrospective cohort study. Br J Gen Pract. 2017 Apr;67(657):e300-e305 Authors: Diwakar L, Cummins C, Ryan R, Marshall T, Roberts T Abstract BACKGROUND: Adrenaline auto-injectors (AAI) should be provided to individuals considered to be at high risk of anaphylaxis. There is some evidence that the rate of AAI prescription is increasing, but the true extent has not been previously quantified. AIM: To estimate the trends in annual GP-issued prescriptions for AAI among UK children between 2000 and 2012. DESIGN AND SETTING: Retrospective cohort study using data from primary care practices that contributed to The Health Improvement Network (THIN) database. METHOD: Children and young people aged between 0-17 years of age with a prescription for AAIs were identified, and annual AAI device prescription rates were estimated using Stata (version 12). RESULTS: A total of 1.06 million UK children were identified, providing 5.1 million person years of follow-up data. Overall, 23 837 children were deemed high risk by their GPs, and were prescribed 98 737 AAI devices. This equates to 4.67 children (95% confidence interval [CI] = 4.66 to 4.69), and 19.4 (95% CI = 19.2 to 19.5) devices per 1000 person years. Between 2000 and 2012, there has been a 355% increase in the number of children prescribed devices, and a 506% increase in the total number of AAI devices prescribed per 1000 person years in the UK. The number of devices issued per high-risk child during this period has also increased by 33%. CONCLUSION: The number of children being prescribed AAI devices and the number of devices being prescribed in UK primary care between 2000 and 2012 has significantly increased. A discussion to promote rational prescribing of AAIs in the NHS is needed. PMID: 28289013 [PubMed - indexed for MEDLINE]

Estimating the number of children in formal alternative care: Challenges and results.

Estimating the number of children in formal alternative care: Challenges and results. Child Abuse Negl. 2017 May 31;: Authors: Petrowski N, Cappa C, Gross P Abstract Given the relatively large body of literature documenting the adverse impacts of institutionalization on children's developmental outcomes and well-being, it is essential that countries work towards reducing the number of children in alternative care (particularly institutional care), and, when possible, reunite children with their families. In order to do so, reliable estimates of the numbers of children living in such settings are essential. However, many countries still lack functional administrative systems for enumerating children living outside of family care. The purpose of this paper is to provide a snapshot of the availability and coverage of data on children living in residential and foster care from some 142 countries covering more than 80 per cent of the world's children. Utilizing these country-level figures, it is estimated that approximately 2.7 million children between the ages of 0 and 17 years could be living in institutional care worldwide. Where possible, the article also presents regional estimates of the number of children living in residential and foster care. This work represents an important step to systematically identify and compile sources of data on children in alternative care and provides updated global and regional estimates on the magnitude of the issue. Its findings contribute to raising awareness of the urgent need to strengthen the capacity of countries to improve national systems for counting, monitoring and reporting on these vulnerable children. PMID: 28578826 [PubMed - as supplied by publisher]

Siblings of children with complex care needs: their perspectives and experiences of participating in everyday life.

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Siblings of children with complex care needs: their perspectives and experiences of participating in everyday life. Child Care Health Dev. 2016 07;42(4):504-12 Authors: Woodgate RL, Edwards M, Ripat JD, Rempel G, Johnson SF Abstract BACKGROUND: Participating in everyday life is essential to the healthy development and emotional well-being of children. However, little is known about siblings of children with complex care needs (CCN), and their perspectives and experiences of participating in everyday life. The aim of this paper is to present research findings that add to our understanding of how siblings of children with CCN view and experience participation in everyday life. METHODS: To arrive at a detailed and accurate understanding of the siblings' perspectives and experiences, we used the qualitative research design of ethnography. Sixteen siblings (seven brothers, nine sisters) of children with CCN were recruited. The siblings ranged in age between 7 and 25 years, with a mean age of 14 years. All siblings took part in opened-ended interviews and completed ecomaps to describe how they participate. Five siblings also took part in the photovoice method. Analysis involved several iterative steps, congruent with ethnography. RESULTS: Four main themes emerged as follows: (1) participation is about being part of a group; (2) it feels good; (3) I love my sibling but…; and (4) promoting participation. Siblings of children with CCN identified challenges to participation and also described ways that they participate that relate to the care of their sibling. CONCLUSIONS: Siblings prioritized the relationship with their sisters and brothers with CCN in their life, and a great deal of their participation was chosen with their sibling in mind. Sibling-to-sibling relationships were distinct and meaningful and, as a result, participation was always done mindfully and with the family needs at the forefront. Nonetheless, clinicians caring for children with CCN must keep in mind the challenges that siblings of children with CCN experience and provide strategies to siblings that will help to promote their participation in everyday life. PMID: 27198644 [PubMed - indexed for MEDLINE]

Need For Improved Skin Cancer Surveillance in Pediatric Cancer Survivors.

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Need For Improved Skin Cancer Surveillance in Pediatric Cancer Survivors. Am J Clin Dermatol. 2017 Apr;18(2):165-168 Authors: Sharma D, Lee T, Friedman AJ, Redbord KP Abstract Survivors of pediatric cancer are at increased risk of developing secondary malignancies, with non-melanoma skin cancer being the most common. These patients are also at increased risk of melanoma. Currently, guidelines provided by the National Cancer Institute and Children's Oncology Group emphasize the importance of annual clinical examination for skin cancer screening; however, the literature reports that less than one-third of survivors of pediatric cancer have ever had a clinical skin exam by a physician. In this article, we review the risk factors for skin cancer in survivors of pediatric cancer as well as the current evidence and recommendations for their care. We suggest that dermatologists collectively establish guidelines for skin cancer surveillance in survivors of pediatric cancer. PMID: 27943084 [PubMed - indexed for MEDLINE]

The effectiveness of therapeutic conversation intervention for caregivers of adolescents with ADHD: a quasi-experimental design.

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The effectiveness of therapeutic conversation intervention for caregivers of adolescents with ADHD: a quasi-experimental design. J Psychiatr Ment Health Nurs. 2017 Feb;24(1):15-27 Authors: Gisladottir M, Svavarsdottir EK Abstract WHAT IS KNOWN ON THE SUBJECT?: Caregivers of adolescents with ADHD experience major difficulties as care providers and are in need of guidance and support. Adolescents with ADHD may develop oppositional and criminal behaviour. More than 50 % have the symptoms in adulthood, and up to one-fourth with severe emotional or antisocial difficulties. There is a lack of evidence of caregivers' supporting intervention although caregiver groups have been found to contribute to better coping, decreased stress and improvements in ADHD symptoms. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Primary caregivers of adolescents with ADHD experienced better quality of life after the Therapeutic Conversation Intervention. The intervention contributed to better social functioning among secondary caregivers. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The content of the Therapeutic Conversation Intervention is significant and highlights the utility of a combination of group and private sessions for caregivers of people with ADHD. The intervention can influence how services for families are organized, such that a Therapeutic Conversation Intervention could be offered on a regular basis. ABSTRACT: Introduction Caregivers of adolescents with Attention Deficit Hyperactivity Disorder are burdened with tasks and many suffer from distress. Adolescents with ADHD may develop antisocial behaviour and caregiver's group can empower caregiver's supporting role. Aim/Question To evaluate the effectiveness of a Therapeutic Conversation Intervention on caregivers of adolescents with ADHD regarding strengthening the supportive role. Method The study utilized a quasi-experimental design. The participants (n = 60) were caregivers of adolescents (13-17 years old) with ADHD. The intervention consisted in-group and parent sessions. The Calgary Family Model and the Family Illness Beliefs Model were used as theoretical frameworks. Results The study revealed significant differences in the improvement of quality of life; regarding primary caregiver (PC) worry, daily activities, family relationships and collaboration post-intervention, as well emotional functioning at both post-intervention and follow-up. Secondary caregiver (SC) social functioning was significantly improved at follow-up. Discussion The intervention proved to be beneficial to the caregivers and is filling a gap in much needed intervention. Implication for practice The results will expand health care professionals' knowledge of how to increase PC quality of life when supporting their adolescent with ADHD. This treatment information should improve service at health care centres/hospitals where adolescents with ADHD receive care. PMID: 27859951 [PubMed - indexed for MEDLINE]

School Nurses’ Role in Helping Children With Attention-Deficit/Hyperactivity Disorders.

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School Nurses' Role in Helping Children With Attention-Deficit/Hyperactivity Disorders. NASN Sch Nurse. 2017 Jan;32(1):36-38 Authors: AlAzzam M, Suliman M, ALBashtawy M Abstract Attention-deficit/hyperactivity disorder (ADHD) is a multifaceted disease characterized by core symptoms of hyperactivity, inattention, and impulsivity, affecting children across every socioeconomic and ethnic group. An estimated 40% to 60% of children with ADHD have comorbidities such as anxiety, depression, and learning disabilities. School nurses must be an integral part of the process of increasing awareness about ADHD through improving the service delivery model for affected children and their families. There is a solid foundation of research on which they can build to improve the benefits through study, workshops, community programs, and national screening programs. PMID: 27194240 [PubMed - indexed for MEDLINE]

Environmental exposure to human carcinogens in teenagers and the association with DNA damage.

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Environmental exposure to human carcinogens in teenagers and the association with DNA damage. Environ Res. 2017 Jan;152:165-174 Authors: Franken C, Koppen G, Lambrechts N, Govarts E, Bruckers L, Den Hond E, Loots I, Nelen V, Sioen I, Nawrot TS, Baeyens W, Van Larebeke N, Boonen F, Ooms D, Wevers M, Jacobs G, Covaci A, Schettgen T, Schoeters G Abstract BACKGROUND: We investigated whether human environmental exposure to chemicals that are labeled as (potential) carcinogens leads to increased (oxidative) damage to DNA in adolescents. MATERIAL AND METHODS: Six hundred 14-15-year-old youngsters were recruited all over Flanders (Belgium) and in two areas with important industrial activities. DNA damage was assessed by alkaline and formamidopyrimidine DNA glycosylase (Fpg) modified comet assays in peripheral blood cells and analysis of urinary 8-hydroxydeoxyguanosine (8-OHdG) levels. Personal exposure to potentially carcinogenic compounds was measured in urine, namely: chromium, cadmium, nickel, 1-hydroxypyrene as a proxy for exposure to other carcinogenic polycyclic aromatic hydrocarbons (PAHs), t,t-muconic acid as a metabolite of benzene, 2,5-dichlorophenol (2,5-DCP), organophosphate pesticide metabolites, and di(2-ethylhexyl) phthalate (DEHP) metabolites. In blood, arsenic, polychlorinated biphenyl (PCB) congeners 118 and 156, hexachlorobenzene (HCB), dichlorodiphenyltrichloroethane (DDT) and perfluorooctanoic acid (PFOA) were analyzed. Levels of methylmercury (MeHg) were measured in hair. Multiple linear regression models were used to establish exposure-response relationships. RESULTS: Biomarkers of exposure to PAHs and urinary chromium were associated with higher levels of both 8-OHdG in urine and DNA damage detected by the alkaline comet assay. Concentrations of 8-OHdG in urine increased in relation with increasing concentrations of urinary t,t-muconic acid, cadmium, nickel, 2,5-DCP, and DEHP metabolites. Increased concentrations of PFOA in blood were associated with higher levels of DNA damage measured by the alkaline comet assay, whereas DDT was associated in the same direction with the Fpg-modified comet assay. Inverse associations were observed between blood arsenic, hair MeHg, PCB 156 and HCB, and urinary 8-OHdG. The latter exposure biomarkers were also associated with higher fish intake. Urinary nickel and t,t-muconic acid were inversely associated with the alkaline comet assay. CONCLUSION: This cross-sectional study found associations between current environmental exposure to (potential) human carcinogens in 14-15-year-old Flemish adolescents and short-term (oxidative) damage to DNA. Prospective follow-up will be required to investigate whether long-term effects may occur due to complex environmental exposures. PMID: 27771571 [PubMed - indexed for MEDLINE]

“Doctor, are you listening?” Communication about children’s mental health and psychosocial concerns.

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"Doctor, are you listening?" Communication about children's mental health and psychosocial concerns. Fam Syst Health. 2017 03;35(1):91-93 Authors: Pidano AE, Padukkavidana MM, Honigfeld L Abstract Effective communication is critical, including in the pediatric primary care setting. Pediatric primary care providers (PPCPs) are in a unique position to address psychosocial and mental health concerns during office visits, and effective communication skills play a crucial role in providing an opportunity for parents and patients to disclose and discuss such concerns. In this article, the authors encourage two relatively simple strategies that have shown potential for enhancing effective communication in pediatric primary care regarding mental health and psychosocial issues: (a) ensure that pediatric residents and practicing providers have access to brief, targeted communications training and (b) strongly promote the use of screening tools both to encourage discussion and to assist in identifying children who may benefit from further assessment and/or treatment. (PsycINFO Database Record PMID: 28333519 [PubMed - indexed for MEDLINE]

Quality of Caregiving in Mothers With Illicit Substance Use: A Systematic Review and Meta-analysis.

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Quality of Caregiving in Mothers With Illicit Substance Use: A Systematic Review and Meta-analysis. Subst Abuse. 2017;11:1178221817694038 Authors: Hatzis D, Dawe S, Harnett P, Barlow J Abstract BACKGROUND: The quality of caregiving in mothers with substance abuse problems appears to be compromised. However, divergent findings, methodological variability, and sample characteristics point to the need for research synthesis. METHODS: A comprehensive systematic search was undertaken. Studies were eligible if they (1) compared substance-misusing mothers with non-substance-misusing mothers, (2) involved children from birth to 3 years, and (3) maternal sensitivity and child responsiveness were measured using observational methodology. RESULTS: A global meta-analysis for maternal sensitivity (n = 24 studies) and child responsiveness (n = 16 studies) on 3433 mother-infant dyads yielded significant population effect sizes and significant heterogeneity. Subgroup analyses found reduced heterogeneity when the meta-analysis was conducted on studies where groups were matched on key demographic characteristics; although the effect size was small, it was still significant for maternal sensitivity but not child responsiveness. CONCLUSIONS: Compromised quality of caregiving is found in high-risk, substance-misusing mothers, emphasising the importance of early intervention that draws from attachment-based interventions. PMID: 28469425 [PubMed - in process]

Students With Asthma and Its Impacts.

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Students With Asthma and Its Impacts. NASN Sch Nurse. 2017 May 01;:1942602X17710499 Authors: Isik E, Isik IS Abstract Asthma is a common chronic disease in children. Uncontrolled asthma is a significant contributor to school absenteeism, emergency room visits, and hospitalization, all of which can lead to low school performance, financial burdens, and emotional problems for children and their parents. Asthma in children restricts the activities of school-aged children, such as participating in before- and after-school activity and extracurricular activities such as sports. Uncontrolled asthma has the potential to impact a student's self-confidence and social interactions. This article reviews the physical, emotional, and social burden of asthma on school-aged children/parents as well as recounting school asthma intervention programs. One of the roles of the school nurse is to be the leader of the intervention programs, manage asthma, and provide education for the students, parents, and school community to promote knowledge about asthma and its management. PMID: 28548873 [PubMed - as supplied by publisher]

Suicide and violent deaths in survivors of cancer in childhood, adolescence and young adulthood-A national cohort study.

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Suicide and violent deaths in survivors of cancer in childhood, adolescence and young adulthood-A national cohort study. Int J Cancer. 2017 Feb 01;140(3):575-580 Authors: Gunnes MW, Lie RT, Bjørge T, Ghaderi S, Syse A, Ruud E, Wesenberg F, Moster D Abstract Suicide risk in adult cancer patients is found to be elevated, but limited information exists regarding risks of suicide and non-suicidal violent deaths when diagnosed with cancer in young age. We investigate suicide and violent deaths in a national cohort including individuals diagnosed with cancer before age 25. Through the linkage of different national registries (Cancer Registry of Norway, Norwegian Causes of Death Registry and the National Registry) a cohort of all live births in Norway during 1965-1985 was defined and followed up through 2008. Individuals diagnosed with cancer before age 25 and the cancer-free references were compared using an extended Cox proportional hazard regression model. The cohort comprised 1,218,013 individuals, including 5,440 diagnosed with cancer before age 25. We identified 24 suicides and 14 non-suicidal violent deaths in the cancer group. The hazard ratio (HR) of suicide in the cancer group was 2.5 (95% confidence interval (CI) 1.7-3.8), and was increased both when diagnosed with cancer in childhood (0-14 years of age); HR = 2.3 (95% CI: 1.2-4.6), and during adolescence/young adulthood (15-24 years); HR = 2.6 (95% CI: 1.5-4.2). Survivors of bone/soft tissue sarcomas, CNS tumors and testicular cancer were at particular risk. The risk of non-suicidal violent death was not increased in the cancer survivors (HR = 1.0; 95% CI: 0.6-1.7). Although based on small numbers and the absolute risk of suicide being low, these are novel findings with important implications for establishing adequate follow-up including suicide prevention strategies for young cancer survivors. PMID: 27750385 [PubMed - indexed for MEDLINE]

Effect of probiotics on digestibility and immunity in infants: A study protocol for a randomized controlled trial.

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Effect of probiotics on digestibility and immunity in infants: A study protocol for a randomized controlled trial. Medicine (Baltimore). 2017 Apr;96(14):e5953 Authors: Xiao L, Ding G, Ding Y, Deng C, Ze X, Chen L, Zhang Y, Song L, Yan H, Liu F, Ben X Abstract The gastrointestinal (GI) tract of a fetus in utero is sterile but it becomes colonized with environmental microorganisms shortly after birth. Since the gut microbiota undergoes substantial changes in early life, healthy gut microflora is essential to an infant's gut health and immune system and probably also has an effect on overall health status in later life. Probiotics, defined as viable microbial preparations that have a beneficial effect on the health of the host, represent a rapidly expanding field. Although randomized controlled trials using probiotics in infants have shown promising results in the prevention and treatment of common diseases such as diarrhea and allergy, little is known about whether probiotics could offer benefits to healthy infants. We have designed a randomized controlled trial to test the hypothesis that an oral preparation of probiotics is superior to placebo in improving digestive and immune function in healthy infants.The trial will be a randomized, double-blind, placebo-controlled, 2-parallel-group study in Shanghai, China. After a 2-week run-in period, 200 exclusively formula-fed healthy infants aged 4 to 6 months will be randomly allocated to receive either a probiotic product containing Bifidobacterium infantis R0033, Bifidobacterium bifidum R0071, and Lactobacillus helveticus R0052 or an identical placebo once daily for 4 weeks and will be followed up for 8 weeks. The duration of the subject's participation will be 14 weeks, with a total of 5 visits: inclusion (Visit 1, Day 1), start of intervention (V2, D15), end of intervention (V3, D44), and follow-up (V4 and V5, D72 and D100). Stool and saliva samples will be collected at the first 3 visits to measure microbial populations and secretory immunoglobulin A (SIgA), respectively. Physical examination will be performed at each visit, and tolerance records will be completed 1 day prior to each visit. The primary endpoints will be the changes in the composition of fecal microbiota, particularly the Bifidobacterium bifidum population. The secondary endpoints will include the change in salivary SIgA level, growth parameters, digestive tolerance, and adverse events.An effective, practical, and acceptable probiotic intervention in manipulating the gut microbiota and boosting the immune system in formula-fed infants would represent a major clinical advance. The administration of probiotic supplementation or follow-on formula to infant may be associated with some clinic benefits. PMID: 28383398 [PubMed - indexed for MEDLINE]

Clinical decision support systems in child and adolescent psychiatry: a systematic review.

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Clinical decision support systems in child and adolescent psychiatry: a systematic review. Eur Child Adolesc Psychiatry. 2017 Apr 28;: Authors: Koposov R, Fossum S, Frodl T, Nytrø Ø, Leventhal B, Sourander A, Quaglini S, Molteni M, de la Iglesia Vayá M, Prokosch HU, Barbarini N, Milham MP, Castellanos FX, Skokauskas N Abstract Psychiatric disorders are amongst the most prevalent and impairing conditions in childhood and adolescence. Unfortunately, it is well known that general practitioners (GPs) and other frontline health providers (i.e., child protection workers, public health nurses, and pediatricians) are not adequately trained to address these ubiquitous problems (Braddick et al. Child and Adolescent mental health in Europe: infrastructures, policy and programmes, European Communities, 2009; Levav et al. Eur Child Adolesc Psychiatry 13:395-401, 2004). Advances in technology may offer a solution to this problem with clinical decision support systems (CDSS) that are designed to help professionals make sound clinical decisions in real time. This paper offers a systematic review of currently available CDSS for child and adolescent mental health disorders prepared according to the PRISMA-Protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols). Applying strict eligibility criteria, the identified studies (n = 5048) were screened. Ten studies, describing eight original clinical decision support systems for child and adolescent psychiatric disorders, fulfilled inclusion criteria. Based on this systematic review, there appears to be a need for a new, readily available CDSS for child neuropsychiatric disorder which promotes evidence-based, best practices, while enabling consideration of national variation in practices by leveraging data-reuse to generate predictions regarding treatment outcome, addressing a broader cluster of clinical disorders, and targeting frontline practice environments. PMID: 28455596 [PubMed - as supplied by publisher]

Understanding the linkages between social safety nets and childhood violence: a review of the evidence from low- and middle-income countries.

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Understanding the linkages between social safety nets and childhood violence: a review of the evidence from low- and middle-income countries. Health Policy Plan. 2017 Apr 22;: Authors: Peterman A, Neijhoft AN, Cook S, Palermo TM Abstract As many as one billion children experience violence every year, and household- and community-level poverty are among the risk factors for child protection violations. Social safety nets (SSNs) are a main policy tool to address poverty and vulnerability, and there is substantial evidence demonstrating positive effects on children's health and human capital. This paper reviews evidence and develops a framework to understand linkages between non-contributory SSNs and the experience of childhood emotional, physical and sexual violence in low- and middle-income countries. We catalogue 14 rigorous impact evaluations, 11 of which are completed, analysing 57 unique impacts on diverse violence indicators. Among these impacts, approximately one in five represent statistically significant protective effects on childhood violence. Promising evidence relates to sexual violence among female adolescents in Africa, while there is less clear evidence of significant impacts in other parts of the developing world, and on young child measures, including violent discipline. Further, few studies are set up to meaningfully unpack mechanisms between SSNs and childhood violence; however, those most commonly hypothesized operate at the household level (through increases in economic security and reductions in poverty-related stress), the interpersonal level (improved parental behaviours, caregiving practices, improved psychosocial well-being) and at the child-level (protective education and decreases in problem or risky behaviours). It is important to emphasize that traditional SSNs are never designed with violence prevention as primary objectives, and thus should not be considered as standalone interventions to reduce risks for childhood violence. However, SSNs, particularly within integrated protection systems, appear to have potential to reduce violence risk. Linkages between SSNs and childhood violence are understudied, and investments should be made to close this evidence gap. PMID: 28444197 [PubMed - as supplied by publisher]

Persistent Pneumonia: Time to Take a Closer Look.

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Persistent Pneumonia: Time to Take a Closer Look. Pediatr Emerg Care. 2017 Jan;33(1):31-33 Authors: Ruttan T, Vezzetti R, Scalo J Abstract Primary pulmonary tumors are rare in pediatrics. When they are encountered, they are usually carcinoid tumors or mucoepidermoid carcinomas. We present a patient who presented to both his primary care physician and the pediatric emergency department with recurrent bouts of wheezing and pneumonia, none of which ever completely resolved despite appropriate treatment. The patient had multiple chest films, which demonstrated the persistence of what appeared to be a right-sided infiltrate/atelectasis. Ultimately, the patient underwent a diagnostic workup that included a computed tomography scan and bronchoscopy. These studies revealed the presence of a bronchial mucoepidermoid carcinoma. The patient was successfully treated with photoablation of the lesion through the involvement of multiple subspecialists, including pediatric pulmonology, pediatric surgery, pediatric otolaryngology, and pediatric oncology. We discuss the incidence and epidemiology of pediatric bronchial tumors in general and mucoepidermoid carcinoma in particular as well as diagnosis, treatment options, and prognosis. Emergency physicians must maintain a high index of suspicion for alternate diagnoses in patients whose disease fails to respond to traditionally accepted therapy. PMID: 26414631 [PubMed - indexed for MEDLINE]

Do Adolescents With Higher Knowledge of HIV Have Lower Sexual Risk Behaviors?

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Do Adolescents With Higher Knowledge of HIV Have Lower Sexual Risk Behaviors? Pediatr Emerg Care. 2016 Dec;32(12):846-850 Authors: Hoehn EF, FitzGerald MR, Bhatt SR, Robinson VM, Lippe JE, Reed JL Abstract OBJECTIVES: Human immunodeficiency virus (HIV) remains a leading cause of morbidity and mortality in the United States, and adolescents account for a disproportionate number of new cases. We aimed to assess knowledge of HIV in relation to sexual risk behaviors among adolescents seeking care in our pediatric emergency department and to assess sources of HIV knowledge among this population. METHODS: Adolescents aged 14 to 21 years who presented to the pediatric emergency department participated in a questionnaire assessing HIV knowledge, sexual risk behaviors, and sources of HIV knowledge. For purposes of statistical analysis, patients were divided into a high-score (greater than or equal to the median score) or low-score (less than the median score) group based on the HIV-Knowledge Questionnaire 18 portion of the survey. RESULTS: A total of 240 adolescents were enrolled. Of those, 112 patients scored higher than or equal to the median HIV-Knowledge Questionnaire 18 score of 11. High-scoring knowledge was independently associated with patients 18 years or older (P = 0.001), any lifetime sexual activity (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.30-3.67; P = 0.003), previous testing for HIV (OR, 2.40; 95% CI, 1.40-4.11; P = 0.002), and an "expert" source (school-based or medical professionals) as their primary source of knowledge (OR, 1.88; 95% CI, 1.05-3.41; P = 0.034). Age of first sexual encounter, number of partners, and condom use were not significantly associated with knowledge score. CONCLUSIONS: Education from "expert" sources is important in providing adolescents with accurate information. However, education alone is unlikely to change sexual practices. A more comprehensive approach to HIV prevention is needed to decrease HIV transmission among this patient population. PMID: 26760829 [PubMed - indexed for MEDLINE]

Context matters! sources of variability in weekend physical activity among families: a repeated measures study.

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Context matters! sources of variability in weekend physical activity among families: a repeated measures study. BMC Public Health. 2017 Apr 18;17(1):330 Authors: Noonan RJ, Fairclough SJ, Knowles ZR, Boddy LM Abstract BACKGROUND: Family involvement is an essential component of effective physical activity (PA) interventions in children. However, little is known about the PA levels and characteristics of PA among families. This study used a repeated measures design and multiple data sources to explore the variability and characteristics of weekend PA among families. METHODS: Families (including a 'target' child aged 9-11 years, their primary caregiver(s) and siblings aged 6-8 years) were recruited through primary schools in Liverpool, UK. Participants completed a paper-based PA diary and wore an ActiGraph GT9X accelerometer on their left wrist for up to 16 weekend days. ActiGraph.csv files were analysed using the R-package GGIR version 1.1-4. Mean minutes of moderate-to-vigorous PA (MVPA) for each weekend of measurement were calculated using linear mixed models, and variance components were estimated for participant (inter-individual), weekend of measurement, and residual error (intra-individual). Intraclass correlation coefficients (ICC) were calculated from the proportion of total variance accounted for by inter-individual sources, and used as a measure of reliability. Diary responses were summed to produce frequency counts. To offer contextual insight into weekend PA among family units, demographic, accelerometer, and diary data were combined to form two case studies representative of low and high active families. RESULTS: Twenty-five participants from 7 families participated, including 7 'target' children (mean age 9.3 ± 1.1 years, 4 boys), 6 siblings (mean age 7.2 ± 0.7 years; 4 boys) and 12 adults (7 mothers and 5 fathers). There was a high degree of variability in target children's (ICC = 0.55), siblings (ICC = 0.38), and mothers' MVPA (ICC = 0.58), but not in fathers' MVPA (ICC = 0.83). Children's weekend PA was mostly unstructured in nature and undertaken with friends, whereas a greater proportion of parents' weekend PA was undertaken alone in structured settings. The family case studies demonstrated that in the selected cases MVPA levels and variability across weekends were contingent on mode of PA participation. CONCLUSIONS: These novel findings enhance understanding of the variability and characteristics of weekend PA among family units. The study demonstrates the utility of PA diaries in conjunction with accelerometers to provide understanding of the mode and contexts of out-of-school and family-based PA. PMID: 28420363 [PubMed - indexed for MEDLINE]

Clinical Status of Adolescents with Perinatal HIV at Transfer to Adult Care in the UK/Ireland.

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Clinical Status of Adolescents with Perinatal HIV at Transfer to Adult Care in the UK/Ireland. Clin Infect Dis. 2017 Apr 15;64(8):1105-1112 Authors: Collins IJ, Foster C, Tostevin A, Tookey P, Riordan A, Dunn D, Gibb DM, Judd A, Collaborative HIV Paediatric Study (CHIPS) Steering Committee Abstract Background.: Increasing numbers of children infected perinatally with human immunodeficiency virus (HIV) are surviving to adolescence and transitioning to adult care, yet there are scarce data on their clinical status at transfer. Methods.: We analyzed prospective cohort data from the UK/Ireland national Collaborative HIV Pediatric Study (CHIPS). Clinical status at last pediatric clinic visit prior to transfer was described. Factors associated with higher CD4 cell count and viral load (VL) suppression<400 c/mL among patients on antiretroviral therapy (ART) at transfer were assessed using linear and logistic regression, respectively. Data were matched with the UK HIV Drug Resistance Database (UKHIVDRB) to assess cumulative resistance profiles at transfer. Results.: Of 1,907 children followed in CHIPS from 1996 to November 2014, 644 (34%) transferred to adult care: 53% were female, 62% born outside the UK/Ireland, 75% black African. At last pediatric follow-up, median age was 17.4 years [interquartile range 16.5,18.1], 27% had previous AIDS diagnosis, CD4 was 444 cells/mm3 [280, 643], 76% were on ART, 13% off-ART, and 11% ART-naive. Among patients on ART, 74% had VL<400 c/mL. In multivariable analysis, higher CD4 at transfer was associated with younger age, higher CD4 at ART initiation and lower VL at transfer (P ≤ .001). Predictors of viral suppression include no AIDS diagnosis and later year of transfer (P ≤ .05). Of 291 patients with resistance data, 82% had resistance to ≥1 drug class, 56% to ≥2 classes and 12% had triple-class resistance. Conclusion.: Three-quarters of adolescents were on stable ART at transfer, of whom 74% were virologically suppressed. The prevalence of triple-class resistance was relatively low at 12%. PMID: 28329212 [PubMed - indexed for MEDLINE]

The Diagnosis of Urinary Tract Infection in Young Children (DUTY) Study Clinical Rule: Economic Evaluation.

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The Diagnosis of Urinary Tract Infection in Young Children (DUTY) Study Clinical Rule: Economic Evaluation. Value Health. 2017 Apr;20(4):556-566 Authors: Hollingworth W, Busby J, Butler CC, O'Brien K, Sterne JA, Hood K, Little P, Lawton M, Birnie K, Thomas-Jones E, Harman K, Hay AD, DUTY Study Team Abstract OBJECTIVE: To estimate the cost-effectiveness of a two-step clinical rule using symptoms, signs and dipstick testing to guide the diagnosis and antibiotic treatment of urinary tract infection (UTI) in acutely unwell young children presenting to primary care. METHODS: Decision analytic model synthesising data from a multicentre, prospective cohort study (DUTY) and the wider literature to estimate the short-term and lifetime costs and healthcare outcomes (symptomatic days, recurrent UTI, quality adjusted life years) of eight diagnostic strategies. We compared GP clinical judgement with three strategies based on a 'coefficient score' combining seven symptoms and signs independently associated with UTI and four strategies based on weighted scores according to the presence/absence of five symptoms and signs. We compared dipstick testing versus laboratory culture in children at intermediate risk of UTI. RESULTS: Sampling, culture and antibiotic costs were lowest in high-specificity DUTY strategies (£1.22 and £1.08) compared to clinical judgement (£1.99). These strategies also approximately halved urine sampling (4.8% versus 9.1% in clinical judgement) without reducing sensitivity (58.2% versus 56.4%). Outcomes were very similar across all diagnostic strategies. High-specificity DUTY strategies were more cost-effective than clinical judgement in the short- (iNMB = £0.78 and £0.84) and long-term (iNMB =£2.31 and £2.50). Dipstick tests had poorer cost-effectiveness than laboratory culture in children at intermediate risk of UTI (iNMB = £-1.41). CONCLUSIONS: Compared to GPs' clinical judgement, high specificity clinical rules from the DUTY study could substantially reduce urine sampling, achieving lower costs and equivalent patient outcomes. Dipstick testing children for UTI is not cost-effective. PMID: 28407997 [PubMed - indexed for MEDLINE]

Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle.

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Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle. Arch Dis Child Fetal Neonatal Ed. 2017 Mar;102(2):F136-F141 Authors: Arya R, Williams G, Kilonback A, Toward M, Griffin M, Blair PS, Fleming P Abstract BACKGROUND AND OBJECTIVE: The American Academy of Pediatrics recommends that preterm infants complete a predischarge 'car seat challenge' observation for cardiorespiratory compromise while in a car seat. This static challenge does not consider the more upright position in a car or the vibration of the seat when the car is moving. This pilot study was designed to assess the cardiorespiratory effects of vibration, mimicking the effect of being in a moving car, on preterm and term infants. METHODS: A simulator was designed to reproduce vertical vibration similar to that in a rear-facing car seat at 30 mph. 19 healthy newborn term and 21 preterm infants, ready for hospital discharge, underwent cardiorespiratory measurements while lying flat in a cot (baseline), static in the seat (30°), simulator (40°) and during motion (vibration 40°). RESULTS: Median test age was 13 days (range 1-65 days) and median weight was 2.5 kg (IQR: 2.1-3.1 kg).Compared with baseline observations, only the total number of desaturations was significantly increased when infants were placed at 30° (p=0.03). At 40°, or with vibration, respiratory and heart rates increased and oxygen saturation decreased significantly. Profound desaturations <85% significantly increased during motion, regardless of gestational age. CONCLUSIONS: This is the first study to assess the effect of motion on infants seated in a car safety seat. Term and preterm infants showed significant signs of potentially adverse cardiorespiratory effects in the upright position at 40°, particularly with simulated motion, not identified in the standard challenge. A larger study is required to investigate the significance of these results. PMID: 27694399 [PubMed - indexed for MEDLINE]

Risk of Pertussis in Relation to Degree of Prematurity in Children Less Than 2 Years of Age.

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Risk of Pertussis in Relation to Degree of Prematurity in Children Less Than 2 Years of Age. Pediatr Infect Dis J. 2017 May;36(5):e151-e156 Authors: Riise ØR, Laake I, Vestrheim D, Flem E, Moster D, Riise Bergsaker MA, Storsæter J Abstract BACKGROUND: A few previous studies reported increased risk of pertussis in children with birth weight less than 2500 g. The risk of pertussis by degree of prematurity has not been determined in a cohort study. The vaccine effectiveness (VE) against reported pertussis in preterm infants is unknown. METHODS: Data were obtained from the Medical Birth Registry of Norway (1998-2010) and linked to other national registries. In total, 713,166 children were included in our study and followed until 2 years of age. Incidence rate ratios (IRRs) and confidence intervals (CIs) were estimated with Poisson regression. RESULTS: We identified 999 reported cases of pertussis. We observed a higher rate of reported pertussis in preterm than in full-term infants, IRR = 1.65 (95% CI: 1.32-2.07). Compared to full-term infants, the risk of reported pertussis in infants born at gestational age (GA) 35-36, 32-34 and 23-27 weeks were higher [IRRs = 1.49 (95% CI: 1.11-2.01), 1.63 (95% CI: 1.06-2.51) and 4.49 (95% CI: 2.33-8.67), respectively]. Moreover, preterm infants had a higher rate of pertussis-related hospitalization than full-term infants [IRR = 1.99 (95% CI: 1.47-2.71)]. The VE against reported pertussis for the third dose was 88.8% (95% CI: 84.3-92.0) in full-term infants and 93.0% (95% CI: 85.8-96.5) in preterm infants. CONCLUSIONS: In this cohort study, preterm infants including those born at GA 35 and 36 weeks had increased risk of reported pertussis. The VE was similar in preterm and full-term infants. PMID: 28403056 [PubMed - indexed for MEDLINE]

Home uterine monitoring for detecting preterm labour.

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Home uterine monitoring for detecting preterm labour. Cochrane Database Syst Rev. 2017 02 15;2:CD006172 Authors: Urquhart C, Currell R, Harlow F, Callow L Abstract BACKGROUND: To reduce the morbidity and mortality associated with preterm birth, home uterine activity monitoring aims for early detection of increased contraction frequency, and early intervention with tocolytic drugs to inhibit labour and prolong pregnancy. However, the effectiveness of such monitoring is disputed. OBJECTIVES: To determine whether home uterine activity monitoring is effective in improving the outcomes for women and their infants considered to be at high risk of preterm birth, when compared with care that does not include home uterine activity monitoring. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2016), CENTRAL (Cochrane Library 2016, Issue 5), MEDLINE (1966 to 28 June 2016), Embase (1974 to 28 June 2016), CINAHL (1982 to 28 June 2016), and scanned reference lists of retrieved studies. SELECTION CRITERIA: Randomised control trials of home uterine activity monitoring, with or without patient education programmes, for women at risk of preterm birth, compared with care that does not include home uterine activity monitoring. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risks of bias, extracted data and checked them for accuracy. We did not attempt to contact authors to resolve queries. We assessed the evidence using the GRADE approach. MAIN RESULTS: There were 15 included studies (6008 enrolled participants); 13 studies contributed data. Women using home uterine monitoring were less likely to experience preterm birth at less than 34 weeks (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.62 to 0.99; three studies, 1596 women; fixed-effect analysis) (GRADE high). This difference was not evident when we carried out a sensitivity analysis, restricting the analysis to studies at low risk of bias based on study quality (RR 0.75, 95% CI 0.57 to 1.00; one study, 1292 women). There was no difference in the rate of perinatal mortality (RR 1.22, 95% CI 0.86 to 1.72; two studies, 2589 babies) (GRADE low).There was no difference in the number of preterm births at less than 37 weeks (average RR 0.85, CI 0.72 to 1.01; eight studies, 4834 women; random-effects, Tau(2) = 0.03, I(2) = 68%) (GRADE very low). Infants born to women using home uterine monitoring were less likely to be admitted to neonatal intensive care unit (average RR 0.77, 95% CI 0.62 to 0.96; five studies, 2367 babies; random-effects, Tau(2) = 0.02, I(2) = 32%) (GRADE moderate). This difference was not maintained when we restricted the analysis to studies at low risk of bias (RR 0.86, 95% CI 0.74 to 1.01; one study, 1292 babies). Women using home uterine monitoring made more unscheduled antenatal visits (mean difference (MD) 0.48, 95% CI 0.31 to 0.64; two studies, 1994 women) (GRADE moderate). Women using home uterine monitoring were also more likely to have prophylactic tocolytic drug therapy (average RR 1.21, 95% CI 1.01 to 1.45; seven studies, 4316 women; random-effects, Tau(2) = 0.03, I(2) = 62%), but this difference was no longer evident when we restricted the analysis to studies at low risk of bias (average RR 1.22, 95% CI 0.90 to 1.65; three studies, 3749 women; random-effects, Tau(2) = 0.05, I(2) = 76%) (GRADE low). The number of antenatal hospital admissions did not differ between home groups (RR 0.91, 95% CI 0.74 to 1.11; three studies, 1494 women (GRADE low)). We found no data on maternal anxiety or acceptability. AUTHORS' CONCLUSIONS: Home uterine monitoring may result in fewer admissions to a neonatal intensive care unit but in more unscheduled antenatal visits and tocolytic treatment; the level of evidence is generally low to moderate. Important group differences were not evident when we undertook sensitivity analysis using only trials at low risk of bias. There is no impact on maternal and perinatal outcomes such as perinatal mortality or incidence of preterm birth. PMID: 28205207 [PubMed - indexed for MEDLINE]

Eliciting Preferences for Information Provision in Newborn Bloodspot Screening Programs.

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Eliciting Preferences for Information Provision in Newborn Bloodspot Screening Programs. Value Health. 2017 Apr;20(4):651-661 Authors: Wright SJ, Ulph F, Dharni N, Payne K Abstract BACKGROUND: The national newborn bloodspot screening programs (NBSPs) are continually expanding to screen for more conditions. OBJECTIVES: To quantify parents' preferences for information and the way in which this is provided in example NBSPs. METHODS: A hybrid choice experiment, combining a conjoint analysis and a discrete choice experiment, was designed. A sample of current and future parents between the ages of 18 and 45 years was identified via an Internet panel. Respondents completed one of two survey versions (9 conditions and 20 conditions) comprising a validated measure of attitudes toward involvement in decision making, 6 CA questions (11 information attributes), 10 DCE questions (4 attributes: 3 process and the ability to make an informed decision), and demographic questions. RESULTS: Of the 702 respondents who completed the survey, 58% were women, 48% were between 25 and 34 years old, and 48% were current parents. All types of information were identified to statistically significantly improve parents' ability to make a decision. Participants preferred taking an "active" role in decision making. Respondents to the 9-condition survey preferred information before 20 weeks (willingness to pay [WTP] £11.88; CI £5.56 to £19.53) and the 20-condition group after 20 weeks (WTP £15.91; CI £10.64 to £21.63). All respondents disliked receiving information 3 days after birth, with the 20-condition group also being averse to receiving it on day 5 (WTP -£11.20; CI -£18.40 to 5.72). Respondents in both groups preferred to receive their information in an individual discussion. CONCLUSIONS: This study suggests that parents' preferences for receiving NBS information differ from how this information is given in current UK practice. PMID: 28408008 [PubMed - indexed for MEDLINE]