bluuebunny/crossref_metadata_2025 huggingface dataset:
Passive Capacity To Perform Juristic Acts As An Element Of Civil Active Capacity Of Minors
Authors: Heints R.M.
Published: December 2021

The article analyzes the definition of civil active capacity of natural persons, reveals the existing approaches in the doctrine to its definition and understanding of passive capacity to perform juristic act as an element of civil active capacity.

The author positively perceives the position of the legislature on the formulation of the concept of civil active capacity through the term «ability», because the process of forming the will of natural persons has a biological nature and, accordingly, the basis for granting of natural persons an active capacity is its natural ability to adequately perceive and evaluate the surrounding reality, own actions, make independent decisions, implement them through own actions and be aware of the responsibility for such actions. Given that the basis of active capacity is the ability to independently perform legally significant lawful acts, the key element of active capacity is passive capacity to perform juristic act.

According to the results of the study, the author proposes to classify all juristic act performing by a minor by the criterion of «coordination of their commission with parents (adopter) or trustees» into three groups: 1) juristic act that can be performing without the consent of parents (adopter) or trustees; 2) juristic act that can be performing with the consent of parents (adopter) or trustees; 3) juristic act that can be performing with the consent of parents (adopter) or trustees and with the permission of the guardianship authority.

The consent of parents (adopter) or trustees to perform a juristic act by a minor should be considered as an additional requirement established by the legislature to the procedure of its performing by a minor and an additional guarantee to protect the interests of a minor who cannot fully assess the need to perform the juristic act and its legal consequences.

According to the current legislation, the consent of the parents (adopter) or trustees to perform a juristic act by a minor may be made orally, for default, or in writing by a notarized form.
Domestic And American Model Of Sanctions For Criminal Violations In The Economic Field: Critical Approach By A Comparativist
Authors: Kamenskyi D.V.
Published: December 2021

The article critically reviews the models of criminal sanctions introduced in Ukraine and the United States for economic criminal offenses. It is emphasized that the meaning of the concept of punishment is inextricably linked to the fundamental category of criminal liability, which means the restrictions provided by criminal law for the exercise of the rights and freedoms of a person for committing a criminal offense.

It has been noted that most American courts do not practice “linear” philosophy in terms of sentencing, but on the contrary, take the whole set of unique facts and circumstances with legal significance into account in each criminal case. It has been established that this approach partially resembles the content of paragraph 3, part 1 of Art. 65 of the Criminal Code of Ukraine: the court imposes punishment, taking into account severity of the crime, identity of the perpetrator as well as mitigating and aggravating circumstances.

It has been also established that in comparison with the American domestic practice of sentencing in general and for economic crimes in particular seems unreasonably humane, such that it is not able to fully implement the purpose of punishment, declared in Art. 50 of the Criminal Code, and therefore, such as objectively unable to restrain the manifestations of illegal behavior in the economic sphere. The large- scale humanization of criminal liability for economic encroachments carried out by the Ukrainian legislator at the end of 2011, combined with the decriminalization of certain acts and the replacement of imprisonment with fines in sanctions of other norms, has intensified such negative trend.

Third, the analysis of the content and application of the federal Penal Code demonstrates not only the advantages of this act of the federal criminal law, but also its individual shortcomings. There is a lot of criticism against this document’s provisions in terms of sentencing for economic crimes. The main reason for criticism is the purely arithmetic relationship between the amount of punishment and the amount of material damage caused by such a crime.

Based on the results of elaboration of the American experience in terms of normative provision and practice of application of punishments for economic crimes, a position has been expressed on the expediency of introducing a model of limited formalization of punishments in Ukraine.
Out of Place, Out of Mind: Min(d)ing Race in Mad Studies Through a Metaphor of Spatiality
Authors: Redikopp Sarah
Published: December 2021

This article examines the racial politics of Mad Studies in Canada through a metaphor of spatiality, underscoring the urgency of an antiracist Mad Studies paradigm. Drawing on critical race scholarship which situates “madness” as reliant on and informed by white supremacist and colonial logics of rationality and reason (Bruce 2017), I foreground claims made by critical race scholars of racialized madness as contingent on and informed by histories of slavery, genocide, and everyday realities of racism and racial violence which an anti-racist Mad Studies project must contend with. By locating the racialization of Mad Studies within a metaphor of spatiality, I heuristically problematize the “space” available for racialized subjects to re/claim madness within contemporary Mad Studies paradigms. I conclude that in failing to rigorously unpack the relations of race which undergird understandings of madness, and to challenge the presence of white supremacy in the Mad Studies discipline, scholars potentially perpetuate a colonial project of “othering” and consequentially maintain the systems of psychiatric violence they seek to undo. Centralizing race in Mad Studies exposes the workings of white supremacy in logics of violence against Mad people more broadly and is thus necessary to an anti-racist and anti- oppressive Mad Studies project.
Removing Ableist Barriers in Nursing Education: Clinical Essential Requirements
Authors: Mack Tracy , Stephens Lindsay , Epstein Iris
Published: December 2021

The current approach to clinical placement training for nurses excludes students with disabilities. The purpose of this article is to introduce a four-step model for nursing programs to identify clinical essential requirements – specific skills and competencies students must gain during placement. Engaging this four-step model will allow educators to identify how essential requirements can be achieved in a variety of ways, and thus can involve accommodations. It will also allow for the identification of which essential requirements cannot be accommodated and must be demonstrated in a prescribed manner due to impacting the nature or integrity of the task. Analyzing clinical essential requirements using this framework will create a consistent and defensible method to determine the flexibility or inflexibility of clinical tasks. The framework provided requires a collaborative process including key experts, nursing students and nurses with disabilities to comprehensively address the challenges clinical environments pose to inclusiveness.
Zum Umgang mit Regressionsanalysen in Kartellschadensersatzfällen
Authors: Inderst Roman , Thomas Stefan
Published: December 2021

In seinem Urteil vom 13. April 2021 (KZR 19/20) hat sich der BGH im Rahmen von Schadensersatzklagen mit dem Instrument der Regressionsanalyse auseinandergesetzt und dabei drei Gütekriterien formuliert: eine hinreichend verlässliche Datengrundlage, die methodische Korrektheit sowie die Signifikanz der Ergebnisse. Wir gehen zunächst auf die allgemeinen Grundsätze dieses Instruments ein, was es sodann erlaubt, die drei Kriterien des BGH zu betrachten. Hierbei soll gezeigt werden, dass die Bewertung einer Regressionsanalyse nicht in einem festen Schema erfolgen kann, was sich auf die konkrete Anwendung der vom BGH formulierten Kriterien in der Tatsacheninstanz auswirkt. Insbesondere darf u. E. das vom BGH aufgestellte Prüfprogramm nicht als eine abschließende „Checkliste“ für die Berücksichtigungsfähigkeit der Aussagen einer Regressionsanalyse verstanden werden. So wäre ein Versuch, sich für eine Schadensschätzung allein auf statistische Gütemaße zu beschränken, einschließlich der Signifikanz der Ergebnisse, nicht sinnvoll. Stattdessen bieten sich gerade der in der Regel vergleichbare Aufbau der Regressionsanalysen der verschiedenen Gutachten in einem Verfahren dazu an, dass das Gericht die Ergebnisse dieser Regressionsanalysen differentialdiagnostisch bewertet, wobei es zwingend auch die Spezifika der Industrie, der vorhandenen Daten sowie des betrachteten Verstoßes im Auge behält. Dies stellt sicher, dass auch wesentliche Informationen, die sich nicht in das Raster einer Regressionsanalyse pressen lassen, im Rahmen einer umfassenden Schadensschätzung nach § 287 ZPO angemessen berücksichtigt werden können. Denn die Durchführung einer Regressionsanalyse ersetzt keine Gesamtbetrachtung aller verfügbaren Evidenz nach dem Maßstab der freien richterlichen Beweiswürdigung.
Concurrent Child Health Status and Maternal Recall of Events in Infancy
Authors: McCormick Marie C. , Brooks-Gunn Jeanne
Published: December 2021

Background.

Obtaining information on children's health and health events is heavily dependent on maternal report. Experience as to what factors influence accuracy of reporting varies, and few studies have examined the influence of current child health status on recall.

Methods.

A prospective cohort study involving 1833 children who were assessed in infancy and at 8 to 10 years of age was conducted to assess maternal reports of birth weight, gestational age, neonatal transport, length of neonatal hospitalization, and rehospitalizations in the first year compared with data collected in infancy overall, and as a function of concurrent child functional health status, socioemotional health, and ratings of child health.

Results.

Maternal recall of neonatal events was accurate but not that of rehospitalizations in the first year. Concurrent child health problems affected accuracy but not sufficiently to make information unusable.

Conclusion.

Maternal recall of neonatal events 8 to 10 years later is accurate; however, the influence of current child health status on recall may be important in research on the cognitive processes underlying health questionnaire responses.
A Systematic Review of Vision Screening Tests for the Detection of Amblyopia
Authors: Kemper Alex R. , Margolis Peter A. , Downs Stephen M. , Bordley W. Clayton
Published: December 2021

Objective.

To review the test characteristics and the quality of evidence regarding available screening tests for the detection of amblyopia in preschool-aged children to help primary care practitioners select a screening strategy.

Design.

Systematic review of published studies.

Data Sources.

The MEDLINE database was searched from 1966 through January 1999 using a broad and inclusive strategy. A total of 9551 citations were identified.

Study Selection.

All studies that compared the results of commercially available screening tests in preschool-aged children to ophthalmologic examination.

Data Extraction.

The setting of the study, the age of the population, the type of screening test, criteria for a positive screen, criteria for the ophthalmologic examination, test characteristics, and measures of reliability were abstracted by 2 reviewers for each selected study.

Data Synthesis.

Four eligible articles were identified that studied the test characteristics of 3 screening tests. None of these studies were performed in a primary care setting. Each study used different criteria for failure of the ophthalmologic examination. None of the studies measured observer or test reliability.

Conclusions.

Few high-quality data exist regarding the performance of preschool vision screening. Important future work should include the development of a consensus gold standard ophthalmologic examination and evaluation of screening tests in the primary care setting.
Defining Asthma in the Preschool-Aged Child
Authors: Strunk Robert C.
Published: December 2021

A physician faces many challenges in making a definitive diagnosis of asthma in young children. Although there are clinical and historical features consistent with asthma, identical features are present in many other diseases. Furthermore, there is no specific test for asthma. Other diseases must always be ruled out before a definitive diagnosis of asthma is made. Determining whether cough or wheeze is the primary symptom is important because asthma is primarily a wheezing disease. Sweat chloride testing, chest radiography, and allergy skin testing should be performed in children with persistent wheezing to rule out other causes and help support a diagnosis of asthma. Allergy skin testing provides particularly useful information for making a diagnosis of asthma in the preschool-aged child. A chart review of patients presenting consecutively to the Division of Allergy and Pulmonary Medicine provides insight and information on an approach to make an asthma diagnosis for this population.
Management of Child and Adolescent Obesity: Attitudes, Barriers, Skills, and Training Needs Among Health Care Professionals
Authors: Story Mary T. , Neumark-Stzainer Dianne R. , Sherwood Nancy E. , Holt Katrina , Sofka Denise , Trowbridge Frederick L. , Barlow Sarah E.
Published: December 2021

Objective. The primary aim of this study was to evaluate among health care professionals their attitudes, perceived barriers, perceived skill level, and training needs in the management of child and adolescent obesity.

Methods. A national needs assessment consisting of a mailed questionnaire was conducted among a random sample of health care professionals. The survey was completed by 202 pediatricians, 293 pediatric nurse practitioners, and 444 registered dietitians.

Results. The majority of all respondents felt that childhood obesity was a condition that needs treatment (75%–93%), and affects chronic disease risk (76%–89%) and future quality of life (83%–93%). The most frequent barriers were lack of parent involvement, lack of patient motivation, and lack of support services. Registered dietitians were less likely to identify barriers to treatment compared with pediatricians or pediatric nurse practitioners. The most common areas of self-perceived low proficiency were in the use of behavioral management strategies, guidance in parenting techniques, and addressing family conflicts. All 3 groups expressed high interest in additional training on obesity management of children and adolescents, especially in the area of behavioral management strategies and parenting techniques. Those practitioners with >10 years of practice reported the greatest interest in training.

Conclusions. Pediatric practitioners view child and adolescent obesity with concern and feel that intervention is important. However, several important barriers interfere with treatment efforts and will need to be addressed. There is also a need for increased training opportunities related to obesity prevention and treatment. The results of this study provide directions and priorities for training, education, and advocacy efforts.
Transition for Youth With Chronic Conditions: Primary Care Physicians’ Approaches
Authors: Scal Peter
Published: December 2021

Since the US Surgeon General’s conference on health care transitions in 1989, transition from pediatric to adult-oriented health care for youth with chronic conditions continues to develop as an important issue among youth, parents, and health professionals. Key professional organizations, public agencies, and disease-specific organizations have promoted research on transition and the development of transition services. Although there is evidence of the advancement of the science and practice of transition in the context of subspecialty medical care, the same may not be true for transition in the context of primary care practice. Little has been written about the role of the primary care provider in facilitating transition, and little is published in the medical literature about how transition occurs in primary care settings.
Binge Drinking in the Preconception Period and the Risk of Unintended Pregnancy: Implications for Women and Their Children
Authors: Naimi Timothy S. , Lipscomb Leslie E. , Brewer Robert D. , Gilbert Brenda Colley
Published: December 2021

Objective. To assess the relationship between unintended pregnancy resulting in a live birth and binge drinking (having 5 or more alcoholic beverages on 1 occasion) in the 3 months before pregnancy (the preconception period) and to characterize women who are of childbearing age and binge drink.

Methods. A case-control study was conducted of women with pregnancies that resulted in a live birth, comparing those with unintended pregnancies with those with intended pregnancies. Data analyzed were from the 15 states that participated in the Pregnancy Risk Assessment Monitoring System from 1996–1999.

Results. Of 72 907 respondents, 45% of pregnancies were unintended. Compared with women with intended pregnancy, women with unintended pregnancy were more likely to be young and black and to report preconception binge drinking (16.3% vs 11.9%; odds ratio [OR]: 1.43; 95% confidence interval [CI]: 1.13–1.54). After adjusting for potential confounders, preconception binge drinking was associated with unintended pregnancy for white women (adjusted OR: 1.63; 95% CI: 1.47–1.80) but not for black women (adjusted OR: 0.96, 95% CI: 0.77–1.20). Overall, 14% of women reported preconception binge drinking. Women who binge drank in the preconception period were more likely to be white and unmarried; to smoke and be exposed to violence in the preconception period; and to consume alcohol, binge drink, and smoke during pregnancy.

Conclusions. Binge drinking in the preconception period was associated with unintended pregnancies resulting in a live birth among white women but not among black women. Preconception binge drinkers were more likely to engage in other risky behaviors, including drinking during pregnancy. Comprehensive interventions to reduce binge drinking may reduce unintended pregnancies, as well as other adverse maternal and pediatric health outcomes.
Do Multivitamin Supplements Attenuate the Risk for Diabetes-Associated Birth Defects?
Authors: Correa Adolfo , Botto Lorenzo , Liu Yecai , Mulinare Joseph , Erickson J. David
Published: December 2021

Objective. To evaluate whether the risk for birth defects associated with maternal diabetes is attenuated by use of multivitamin supplements during the periconceptional period.

Methods. In the population-based Atlanta Birth Defects Case-Control Study, we identified case infants who had nonsyndromic birth defects that were reported to be associated with diabetes (n = 3278) and were born during 1968–1980 to residents of metropolitan Atlanta. Controls were infants without birth defects (n = 3029). Maternal diabetes was defined as reported diabetes with onset before the date of birth of the index infant, and periconceptional use of multivitamins was defined as reported regular use of multivitamin supplements from 3 months before pregnancy through the first 3 months of pregnancy.

Results. Offspring of mothers with diabetes had an increased risk for selected birth defects. However, the increased risk was limited to offspring of mothers who had diabetes and had not taken multivitamins during the periconceptional period (odds ratio: 3.93; 95% confidence interval: 1.79–8.63). Offspring of mothers who had diabetes and had taken multivitamins during the periconceptional period had no increased risk for birth defects (odds ratio: 0.15; 95% confidence interval: 0.00–1.99).

Conclusions. Periconceptional use of multivitamin supplements may reduce the risk for birth defects among offspring of mothers with diabetes.
Trends in Multiple Births Conceived Using Assisted Reproductive Technology, United States, 1997–2000
Authors: Reynolds Meredith A. , Schieve Laura A. , Martin Joyce A. , Jeng Gary , Macaluso Maurizio
Published: December 2021

Objective. To examine trends in multiple births conceived using assisted reproductive technology (ART) in the United States between 1997 and 2000 and to estimate the proportion of all US multiple births attributable to ART use.

Methods. We analyzed population-based data of 109 519 live-born infants who were conceived in the United States using ART and born between 1997 and 2000 and population-based data of 15 856 809 live-born infants who were delivered in the United States between 1997 and 2000. Multiple birth rates (the number of live-born infants delivered in multiple gestation pregnancies per 1000 live births) and the proportion of all US multiple births attributable to ART were evaluated.

Results. The twin rate for ART patients increased between 1997 and 2000, reaching 444.7 per 1000 live births in 2000, whereas the triplet/+ rate declined substantially from 134.3 to 98.7 per 1000 live births from 1997–2000. From 1997–2000, the proportion of multiple births in the United States attributable to ART increased from 11.2% to 13.6%, whereas the proportion attributable to natural conception decreased from 69.9% to 64.5%. In 2000, the proportion of triplet/+ births attributable to ART and to natural conception was 42.5% and 17.7%, respectively. The contribution of ART to multiple births increased substantially with maternal age, from 11.6% for triplet/+ infants born to women aged 20 to 24 to 92.8% for women aged 45 to 49 years.

Conclusions. The contribution of ART to twin birth rates continues to increase, but the contribution of ART to triplet/+ birth rates has declined.
Contribution of Excess Weight Gain During Pregnancy and Macrosomia to the Cesarean Delivery Rate, 1990–2000
Authors: Rhodes Julia C. , Schoendorf Kenneth C. , Parker Jennifer D.
Published: December 2021

Objective. After declining for many years, cesarean delivery rates recently increased. To explore whether this increase is associated with excess weight gain during pregnancy, resulting in macrosomic infants who require cesarean delivery, we examined trends in excess weight gain, macrosomia, and cesarean delivery.

Methods. Analysis of 1990–2000 US Natality Files of birth certificate data were restricted to first birth, singleton infants of 37 to 42 weeks’ gestation to avoid confounding by repeat cesarean delivery, complications of multigestational pregnancy, and preterm and postterm birth. Excess weight gain was defined according to current guidelines (41+ lb) and macrosomia as birth weight >4000 g.

Results. From 1990–2000, excess weight gain rose steadily from 18.6% to 24.2%. There was a 19.3% decline in macrosomic infants among women who gained excess weight compared with an 11.9% decline among women who gained 15–40 lb, although the absolute risk remained substantially greater among women who gained excess weight (eg, 14.2% vs 7.2%, in 2000). From 1990–1997, cesarean delivery declined by 20.2% among women who gained excess weight compared with 15.7% among women who gained 15 to 40 lb. After 1997, cesarean delivery increased in all weight gain categories, and absolute risks in 2000 were 25.8% for women who gained excess weight compared with 21.6% for women who gained 15–40 lb. Overall, women who gained excess weight accounted for 24.1% of cesarean deliveries in 1990 and 28.1% in 2000.

Conclusions. Excess weight gain and macrosomia do not seem to be the primary factors that contribute to the recent increase in cesarean delivery because cesarean delivery rates have increased in all weight gain categories and macrosomia rates have decreased steadily from 1990–2000. Nonetheless, women who gain excess weight account for a growing proportion of cesarean deliveries because their relative numbers have grown.
Maternal Characteristics Associated With Vaccination of Young Children
Authors: Luman Elizabeth T. , McCauley Mary Mason , Shefer Abigail , Chu Susan Y.
Published: December 2021

Objective. Mothers can be instrumental in gaining access to vaccination services for their children. This study examines maternal characteristics associated with vaccination in US preschool children.

Methods. We analyzed data from 21 212 children aged 19 to 35 months in the National Immunization Survey. Bivariate and multivariate analyses were used to identify maternal characteristics associated with completion of all recommended vaccinations in these children.

Results. Factors most strongly associated with undervaccination included having mothers who were black; had less than a high school education; were divorced, separated, or widowed; had multiple children; were eligible for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) but not participating; or had incomes below 50% of the federal poverty level.

Conclusion. Because most mothers play an important role in their children’s vaccination, it is important to address maternal concerns and barriers when developing public health interventions for promoting childhood vaccinations. Encouraging eligible women and their children to participate in the WIC program and providing support and encouragement for immunization to mothers with multiple children may improve early childhood vaccination coverage.
Anaphylaxis and Emergency Treatment
Authors: Sampson Hugh A.
Published: December 2021

Food anaphylaxis is now the leading known cause of anaphylactic reactions treated in emergency departments in the United States. It is estimated that there are 30 000 anaphylactic reactions to foods treated in emergency departments and 150 to 200 deaths each year. Peanuts, tree nuts, fish, and shellfish account for most severe food anaphylactic reactions. Although clearly a form of immunoglobulin E-mediated hypersensitivity, the mechanistic details responsible for symptoms of food-induced anaphylaxis are not completely understood, and in some cases, symptoms are not seen unless the patient exercises within a few hours of the ingestion. At the present time, the mainstays of therapy include educating patients and their caregivers to strictly avoid food allergens, to recognize early symptoms of anaphylaxis, and to self-administer injectable epinephrine. However, clinical trials are now under way for the treatment of patients with peanut anaphylaxis using recombinant humanized anti-immunoglobulin E antibody therapy, and novel immunomodulatory therapies are being tested in animal models of peanut-induced anaphylaxis.
Daily Coping Strategies for Patients and Their Families
Authors: Muñoz-Furlong Anne
Published: December 2021

The diagnosis of food allergy in a child has an impact on every minute of every day for the child and the child’s family. The patient and family must learn how to read labels, adapt recipes, and educate other family members, child care providers, camp counselors, and teachers. They must know how to recognize symptoms of a reaction and what to do during a reaction. Decisions such as which restaurant to go to and where to go on vacation take on new meaning, as family decisions must be centered on avoidance of the child’s food allergen. It is possible to manage food allergies successfully while allowing the child to participate in common childhood activities. Education of the family is key. This discussion provides the pediatrician or primary care physician with practical information for educating patients and their families about managing food allergy.
Future Approaches to Food Allergy
Authors: Nowak-Wegrzyn Anna
Published: December 2021

Food allergy affects ∼2% of the general US population, and its prevalence seems to be increasing. Despite the potential for a fatal outcome, no definitive therapies are available for food allergy. This article reviews novel approaches for the diagnosis and treatment of food allergy. Improved diagnostic methods include more precise in vitro and in vivo tests for immunoglobulin E-mediated food allergies, in vitro assays for predicting development of oral tolerance, and novel noninvasive tests for cell-mediated food allergies such as patch testing, cytokine assays, and detection of eosinophil activation markers. Several promising novel immunomodulatory approaches to food allergy are discussed, including monoclonal anti-immunoglobulin E; probiotics; traditional Chinese medicine; and immunotherapy with modified food proteins, peptides, bacterial adjuvants, and immunostimulatory sequences.
International Environmental Health for the Pediatrician: Case Study of Lead Poisoning
Authors: Falk Henry
Published: December 2021

Childhood lead poisoning is a preventable illness. In the past 3 decades, removal of key lead sources and prevention of exposure in the United States have led to dramatic decreases in population blood lead concentrations and also in instances of severe lead poisoning requiring treatment. From an international perspective, childhood lead poisoning seems to be of greatest concern in developing countries. The phasing out of lead from gasoline is a critical first step in decreasing worldwide blood lead concentrations. However, many focal sources that can cause lead poisoning remain, such as lead from flour mills, lead-glazed ceramics, mining and smelting, and battery repair and recycling. A large and diverse country, such as India, may have many sources of lead. The challenge will be for developing countries to implement effective national and regional efforts to address their specific sources of lead.
Health Policy in Relation to Improving Equity in Child Health
Authors: Gordon David
Published: December 2021

The Issue. A major independent inquiry into inequalities in health—and policies that would reduce them—was published in December 1998.1 It identified >40 recommendations designed to reduce inequalities in health. Lifting children out of poverty is among the most important strategies to improve child health. If we want to change policies on health and poverty, then we have to consider the broad political context within which our health systems work. In the United Kingdom, we have a welfare state that sends checks and cash income to 85% of households every month. Many people pay into the welfare state, many people get money back, and everybody receives services.2 In the United States, the situation is different. There, many people pay into the state, but only the poor and corporations actually receive a check. I leave you to decide who gets the most out of these respective systems. We also have fundamental differences in our health systems. In the United Kingdom, 97% of expenditures on health are made by the state; there is virtually no private spending. In the United States, only 44% of health expenditures are made by the state. The limited amount of private health expenditures in the United Kingdom will be reduced further as the National Health Service provides more dentistry in the future. In terms of the amount of resources, the United States spends 14% of its gross domestic product on health, compared with 6% in the United Kingdom. The United States spent $3700 per person on health care in 1997. In the United Kingdom, we spent less than one third of that.
Children’s Rights and the United Nations Convention on the Rights of the Child
Authors: Goldhagen Jeffrey
Published: December 2021

The Issue. Disparities and inequities characterize the health and social well-being of children in the United States and the United Kingdom. Children’s rights and the United Nations Convention on the Rights of the Child are among the most powerful tools available to respond to and increase the relevance of pediatrics to contemporary disparities and determinants of child health outcomes. The articles of the convention establish the framework for a redefinition of what constitutes child health. The convention establishes a template for child advocacy, a matrix for establishing new approaches to health services, a curriculum for professional education, and a set of challenges for future child health outcomes and health systems research.
Risk Adjustment for Pediatric Quality Indicators
Authors: Kuhlthau Karen , Ferris Timothy G. G. , Iezzoni Lisa I.
Published: December 2021

The movement to measure medical care quality has been accelerating, spurred on by evidence of poor quality of care and trials of interventions to improve care. Appropriate measurement of quality of care is an essential aspect of improving the quality of care, yet some quality measures may be influenced by patients’ attributes unrelated to quality of care. Risk adjustment is the term commonly applied to those methods that account for patient-related attributes, making measurement of health care quality as comparable as possible across providers or organizations seeing different mixes of patients.

The measurement of quality of care for children poses specific challenges. In addition to these measurement challenges, analysts must ensure that quality comparisons among doctors, groups of doctors, hospitals, or health plans are not adversely affected by the likelihood that different types of patients seek care in different places. Although some techniques designed to adjust performance measures for case mix were developed for both adults and children, other systems are specific to childhood circumstances. The theoretical issues involved in risk-adjusting childhood outcomes measures for newborns in the neonatal intensive care unit were reviewed recently. Here, we go beyond the neonatal intensive care unit setting to consider risk adjustment for pediatric quality measures more broadly. In particular, we 1) review the conceptual background for risk-adjusting quality measures, 2) present policy issues related to adjusting pediatric quality measures, and 3) catalog existing risk-adjustment methodologies for pediatric quality measures. We conclude with an overall assessment of the status of risk adjustment for pediatric quality measures and recommendations for additional research and application.
Access to the Medical Home: Results of the National Survey of Children With Special Health Care Needs
Authors: Strickland Bonnie , McPherson Merle , Weissman Gloria , Dyck Peter van , Huang Zhihuan J. , Newacheck Paul
Published: December 2021

Objective. The purpose of this article is to report the findings of the National Survey of Children With Special Health Care Needs regarding parent perceptions of the extent to which children with special health care needs (CSHCN) have access to a medical home.

Methods. Five criteria, selected to reflect the characteristics of a medical home as defined by the American Academy of Pediatrics (AAP) policy statement on the medical home, were analyzed to describe the extent to which CSHCN receive care characteristic of the medical home concept. These criteria included having 1) a usual place for sick/well care, 2) a personal doctor or nurse, 3) no difficulty in obtaining needed referrals, 4) needed care coordination, and 5) family-centered care received. Items from the Survey were selected and clustered to characterize each of the 5 components. Criteria for each item were established with the requirement that the criteria must be met for all items in a component to receive credit for the component.

Results. Results of the survey indicate that 1) approximately half of CSHCN receive care that meets all 5 components established for medical home; 2) most CSHCN have a usual source of care and a personal doctor or nurse, but other components of the medical home, especially elements of care coordination and family-centered care, are lacking; 3) access to a medical home is significantly affected by race/ethnicity, poverty, and the limitations imposed on daily activity by the child’s special health care need; and 4) parents of children who do have a medical home report significantly less delayed or forgone care, significantly fewer unmet health care needs, and significantly fewer unmet needs for family support services. The 5 components described represent major characteristics of the comprehensive care model recommended for all children by the AAP.

Conclusions. The findings suggest that although some components of the medical home concept have been achieved for most CSHCN, the comprehensive care model described by the AAP policy statement on the medical home is not yet in place for a significant number of CSHCN and their families.
The Medical Home, Access to Care, and Insurance: A Review of Evidence
Authors: Starfield Barbara , Shi Leiyu
Published: December 2021

Objective. To review the extent to which the literature supports the position that a medical home is important and to review the extent to which insurance is related to having a medical home.

Methods. A review of literature concerning the benefits of a medical home on effectiveness, costs, and equity (reducing disparities) was conducted.

Results. International and within-nation studies indicate that a relationship with a medical home is associated with better health, on both the individual and population levels, with lower overall costs of care and with reductions in disparities in health between socially disadvantaged subpopulations and more socially advantaged populations. Although important in facilitating use overall, insurance does not guarantee a medical home.

Conclusions. A medical home, with its 4 key features, provides better effectiveness as well as more efficient and more equitable care to individuals and populations. A concerted attempt to provide a means of universal financial access as well as a medical home should be of high priority for the United States.
Care Coordination Services in Pediatric Practices
Authors: Gupta Vidya Bhushan , O’Connor Karen G. , Quezada-Gomez Carlos
Published: December 2021

Objective. To examine the frequency with which pediatricians provide care coordination services to children, particularly those with special health care needs, in their practices and the barriers to providing these services.

Methods. An 8-page questionnaire was mailed to 1632 randomly selected US members of the American Academy of Pediatrics.

Results. The response rate was 56.7%. Most pediatricians (71.2%) reported that they or someone in their practice serves as the primary care coordinator for their children with special needs, but fewer than one fourth (23.3%) always contact the school about the child’s health and educational needs as part of care coordination, only 18.7% always schedule time with the child’s family to discuss the findings of a specialist, and only 23.2% meet with the discharge planning team to facilitate transition from hospital to home. The respondents identified the 2 top barriers that impede this activity: limited time and lack of medical staff in their offices.

Conclusions. Although most pediatricians believe that they are providing care coordination services, when asked about specific care coordination activities, such as contacting the school or scheduling time with the family to discuss the findings of a specialist, many do not provide these services.
Implementing Community-Based Systems of Services for Children and Youths With Special Health Care Needs: How Well Are We Doing?
Authors: McPherson Merle , Weissman Gloria , Strickland Bonnie B. , Dyck Peter C. van , Blumberg Stephen J. , Newacheck Paul W.
Published: December 2021

Objective. To provide a baseline measure of the proportion of US children who meet the Maternal and Child Health Bureau's core outcomes for children with special health care needs (CSHCN). Those core outcomes include the following: 1) families of CSHCN will partner in decision making and will be satisfied with the services that they receive; 2) CSHCN will receive coordinated, ongoing comprehensive care within a medical home; 3) families of CSHCN will have adequate private and/or public insurance to pay for the services that they need; 4) children will be screened early and continuously for special health care needs; 5) community-based service systems will be organized so that families can use them easily; and 6) youths with special health care needs will receive the services necessary to make transitions to adult life, including adult health care, work, and independence.

Methods. A national household survey was conducted using telephone interviews. We analyzed data on 38 866 CSHCN included in the 2001 National Survey of CSHCN and 13 579 children included in the 2001 National Health Interview Survey. We assessed the proportion of US children who met each of the 6 core outcomes for CSHCN using data from 2 surveys.

Results. Success rates ranged from 6% (the core outcome on successful transition to adulthood) to 74% (the core outcome on organization of the service system). For 5 of the 6 core outcomes, success rates exceeded 50%.

Conclusion. Our results indicate that, for the most part, the United States is well positioned to meet the 6 core outcomes. However, much more work lies ahead before success can be claimed. This is especially true for the core outcome on transition to adulthood, for which only 6% of children in the target population are now meeting this goal.
Overview of the Content of Health Supervision for Young Children: Reports From Parents and Pediatricians
Authors: Olson Lynn M. , Inkelas Moira , Halfon Neal , Schuster Mark A. , O’Connor Karen G. , Mistry Ritesh
Published: December 2021

Objective. To describe the content of anticipatory guidance provided to parents of infants and toddlers and to identify primary areas of unmet need as reported by both parents and pediatricians.

Methods. Parent data were obtained from the National Survey of Early Childhood Health, a nationally representative sample of parents of 2068 US children aged 4 to 35 months. Pediatrician data were obtained from the Periodic Survey of Fellows, a national survey of members of the American Academy of Pediatrics.

Results. Parents and pediatricians tend to agree on the relative ranking of which topics are most frequently addressed. Parents and pediatricians both report that the traditional topics of preventive care—immunizations, feeding issues, and sleep patterns—are most frequently discussed, whereas topics that were more recently introduced into pediatric care related to developmental needs and family context are less commonly addressed. Parent-reported discussion of these topics include reading (discussed for 61% of children 19-35 months) and child care (discussed for 26% of children 19-35 months). Parent reports of some unmet need—defined as topics not discussed that the parent believes would have been helpful to them—affect 36% of children aged 4 to 9 months and 56% of children aged 10 to 35 months and are highest for the topics of discipline strategies and toilet training. Other specific areas of unmet need reported by at least 15% of parents are burn prevention, child care, reading, vocabulary development, and social development. Rates of unmet need vary with family characteristics and health system factors, including maternal education, race/ethnicity, and length of well-child visits.

Conclusion. Parents and pediatricians report high rates of discussion on many topics that are critical to healthy development in the first years of life. They also identify areas of need that largely address health supervision on developmental topics. Findings indicate that additional research is needed to understand issues related to specific topic areas as well as the dynamics of personal and system factors that determine what is discussed.
Routine Assessment of Family and Community Health Risks: Parent Views and What They Receive
Authors: Kogan Michael D. , Schuster Mark A. , Yu Stella M. , Park Christina H. , Olson Lynn M. , Inkelas Moira , Bethell Christina , Chung Paul J. , Halfon Neal
Published: December 2021

Objective. To examine the prevalence of parent–provider discussions of family and community health risks during well-child visits and the gaps between which issues are discussed and which issues parents would like to discuss.

Methods. Data came from the National Survey of Early Childhood Health, a nationally representative sample of parents of 2068 children aged 4 to 35 months. The outcome measures were 1) the reported discussions with pediatric clinicians about 7 family and community health risks and 2) whether the parent believes that pediatric clinicians should ask parents about each risk.

Results. Most parents believe that pediatric providers should discuss topics such as smoking in the household, financial difficulties, and emotional support available to the parent. However, with the exception of “household smoking,” fewer than half of parents have been asked about these topics by their child’s clinician. Parents of black and Hispanic children were more likely than parents of white children to be asked about several of these issues, as were parents of the youngest children and those with publicly financed health insurance. The greatest gap between parents’ views and their reports of discussion with the clinician occur for parents of white children and older children. Among parents who hold the view that a topic should be discussed, parents of white and older children are less likely than others to report discussing some or all family and community health risks.

Conclusion. The low frequency of discussions for many topics indicates potential unmet need. More universal surveillance of parents with young children might ensure that needs are not missed, particularly given that strong majorities of parents view family and community topics, with the exception of community violence, as appropriate for discussion in clinic visits.
Satisfaction With Health Care for Young Children
Authors: Halfon Neal , Inkelas Moira , Mistry Ritesh , Olson Lynn M.
Published: December 2021

Objectives. The aims of this study are to 1) assess parent satisfaction with well-child care for their young child and 2) identify how global satisfaction ratings and parent reports on the processes of care vary with child and family characteristics, health care received, and health system factors.

Methods. The National Survey of Early Childhood Health is a telephone survey that used a stratified random-digit-dial sampling design to achieve a nationally representative sample of 2068 children and 4 to 35 months. Parents provided global ratings of satisfaction with their child’s well-child visits (range 0–100) and reported their satisfaction with information provided and the time spent with the provider. A subsample of parents whose child has a particular provider for well-child care (n = 930) also reported their likelihood of recommending their provider.

Results. The mean global satisfaction rating is 86.9 (standard error: 6.1). Approximately 94% of parents of young children reported information satisfaction, 88% reported time satisfaction, and 79% would recommend their child’s provider. Bivariate analysis shows lower satisfaction for uninsured children but few differences associated with insurance type or health care setting. In multivariate analyses including child and family factors and health system factors, Hispanic, Spanish-speaking mothers of young children have lower odds than non-Hispanic white mothers of reporting information (odds ratio [OR]: 0.32; 95% confidence interval [CI]: 0.13–0.79) and time satisfaction (OR: 0.44; 95% CI: 0.21–0.90). Parents of children who experienced missed or delayed care have lower odds of time satisfaction (OR: 0.27; 95% CI: 0.16–0.46) and have lower global satisfaction. Greater length of well-child visits is consistently associated with greater satisfaction on all 4 measures.

Conclusion. Although most parents reported relatively high levels of satisfaction with well-child care, shorter length of well-child visits and experiencing missed or delayed care are the 2 factors consistently associated with lower satisfaction using each of the measures. Efforts to improve satisfaction ratings might focus on improving the delivery of well-child care and ensuring that parents get the time they need.