bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
REVIEW ARTICLE
Authors: Iversen Torben 
Published: December 2021

This paper gives a survey of the picture of electrolyte disturbance and virilization due to congenital adrenocortical hyperplasia, for which the term "dysadrenocorticism" has been coined.
The series comprises 135 patients, 57 boys and 78 girls.
The incidence of dysadrenocorticism in siblings was 24 per cent. The disorder manifested itself without any relation to birth order.
The clinical manifestations referable to the electrolyte disturbance began during the first week in half the patients and in all of them before the age of 7 weeks. Apathy, hypotonicity and refusal of feedings were commonly described. Vomiting was present in 126 cases (93 per cent) and was described as projectile in 37 of these cases. Diarrhea was observed in 45 cases (33 per cent). Crises with episodes of circulatory collapse were described in 88 cases (65 per cent). Loss of weight during the first few months after birth occurred in at least 109 cases (81 per cent). Dehydration and/or emaciation were observed at the time of admission in 123 cases (91 per cent). Pigmentation of the skin was found in 13 cases (10 per cent).
In male infants the external genitals were usually of normal appearance at birth. In 6 males, however, hypospadias was described. Enlargement of the penis was observed during the first 2 months of life in 7 patients, and in all boys more than 2 years of age. All the female infants except 3 presented pseudohermaphroditism with hypertrophy of the clitoris and common urogenital orifice.
The laboratory investigations showed electrolyte disturbance as in adrenocortical insufficiency. The serum concentration of sodium was below 135 mEq./l. in 34 of 37 cases, and the concentration of potassium above 5.8 mEq./l. in 31 of 36 cases. Hypoglycemia was observed in only 1 of 24 cases. The urinary excretion of 17-ketosteroids in 30 infants ranged from 1.8 to 16 mg. daily. The excretion of 11-oxycorticoids in the urine was normal or increased. Eighty-one of the patients (36 boys and 45 girls) received no specific treatment and all cases terminated fatally. Twenty-one patients died during the first month of life, and 32 within the second month. All non-treated patients except 1 died during the first 13 months of life.
Fifty-four patients (21 boys and 33 girls) were given specific treatment with sodium chloride combined with desoxycorticosterone and/or adrenocortical extract. Several of these patients were also treated with cortisone. Thirty-five patients (14 boys and 21 girls) were alive at the time when the reports were published. Twenty-five patients reported before 1953 were followed up in 1954. At the follow-up examination a total of 19 patients were alive; 5 boys and 5 girls were 5 years of age or older. In 12 patients, of whom 5 were 5 years of age or older, specific treatment of the electrolyte disorder was still required.
The adrenals showed diffuse bilateral hyperplasia in 98 of 100 cases. The total weight of the adrenals ranged from 11 to 34 gm. in 64 patients who died before the age of 12 months. The histologic picture was variable.
Clinical Biochemistry
Authors: BULL HENRY B. 
Published: December 2021

This is the latest edition of a well-known textbook on clinical biochemistry designed essentially for use by advanced medical students and by practicing physicians.
There are 12 chapters beginning with the metabolism of carbohydrates, lipids, proteins and nucleic acids and continuing through the metabolism of iron, sulfur, iodine, etc. There are chapters on electrolytes, water and acid-base balance and on oxygen and carbon dioxide transport. There is a lengthy and impressive section on endocrine function followed by a short summary of the vitamins.
HYPERTONIC DEHYDRATION IN INFANCY
Authors: Weil William B. , Wallace William M. 
Published: December 2021

Dehydration, biochemically characterized by increased concentrations of sodium and chloride in the extracellular fluid, is a frequent result of diarrhea in infants. The genesis of the hypernatremia and hyperchloremia lies in the relatively greater expenditure of water than electrolyte via skin, lungs, stool and urine. The significance of these events in terms of distribution of body water and cation are discussed. The water deficit in these infants is primarily intracellular. Cation deficits are minimal.
The majority of infants with this type of dehydration present certain clinical signs that should serve to make the clinician aware of the abnormality of concentration. These infants show varying degrees of depression of central nervous system varying from lethargy to coma. Convulsions are frequently observed during the course of the disturbance. While dehydration, as measured by water retention during recovery, is invariably present, the traditional signs of water deficit are deceptively absent.
Dilute solutions of electrolyte are indicated in repair. Rapid adjustment, however, of the concentration abnormality appears to accentuate the central nervous system disturbance. Repair is best carried out in a leisurely manner over a 2- to 3-day period.
GASTROENTERITIS IN INFANTS ASSOCIATED WITH SPECIFIC SEROTYPES OF ESCHERICHIA COLI
Authors: Stock Aaron H. , Shuman Mary E. 
Published: December 2021

Except in the face of an epidemic the incidence of isolation of E. coli 0111:B4 and 055:B5 in the Pittsburgh area, as reflected by bacteriologic studies carried out on all patients with gastroenteritis admitted to a children's hospital, was low in a 3-year period. The incidence of salmonella infections was relatively higher. No shigella infections were found.
It may be seen from the tables that in approximately 80 per cent of the patients with diarrheal disease no enteric bacteria known to be pathogenic could be isolated.
GASTROENTERITIS IN INFANTS ASSOCIATED WITH SPECIFIC SEROTYPES OF ESCHERICHIA COLI
Authors: Stock Aaron H. , Shuman Mary E. 
Published: December 2021

The history of outbreaks of infantile gastroenteritis associated with a specific bacteriologic serotype, Escherichia coli 0111:B4, has been presented.
The data presented in this paper add weight to the thesis that E. coli 0111:B4 is a pathogenic agent, especially in newborn infants. The reports of other investigators on other phases has also been corroborated, namely, the high contagiousness of the organism and the preponderance of the specific serotype in the aerobic fecal flora in the initial stages of infection.