bluuebunny/crossref_metadata_2025_split huggingface dataset:
Denial of authorization to pediatric managed‐care patients at an urban emergency department
Authors: Kohlmeier Pamela S , Zautcke John L , Fraker Lesa D , Stevens Jeremy S 
Published: March 2003

ABSTRACTObjective To assess whether some pediatric Health Maintenance Organization (HMO) patients denied authorization for payment of emergency department (ED) services do not meet established nonemergent triage criteria and thus might be at risk for poor outcomes.Design A consecutive case surveillance.Setting and participants A Chicago inner city university‐based ED with a total patient volume of 42 000 patient visits per year, of which 30% are pediatric. Managed care is approximately 20%. Participants who were denied authorization for payment of ED services by their HMO were age 0–16 and subsequently left the ED without treatment.Variables studied Data were collected from the ED nurse's triage notes. Chief complaint, vital signs, and focused examination were used to categorize patients as emergent, urgent, or nonemergent based on previously published pediatric emergency department triage criteria.Results A total of 83 pediatric HMO patients between 0 and 16 years of age were denied authorization for payment of ED services and subsequently left the ED without treatment in the study period. Of these, only eight patients (9.6%) met criteria to be categorized as nonemergent, and 75 (90.4%) met criteria to be categorized as emergent or urgent. Of these 75 patients, 17 (22.7%) had abnormal vital signs as the sole criteria for the emergent/urgent categorization, 16 (21.3%) had chief complaints considered emergent, and 42 (56.0%) had chief complaints considered urgent. One patient was not categorized into either group because he had left the ED before his HMO's authorization decision was rendered.Conclusion The results suggest that many of our pediatric HMO patients denied payment for ED services are being placed at risk for poor outcomes. The results highlight the haphazard nature of telephone authorization by HMOs and question the safety of this triage practice. The patients who are denied authorization for payment of ED services and subsequently leave the ED need to be further studied to determine their ultimate outcomes.
Sexual health services: what do teenagers want?
Authors: Wilson Andrew , Williams Rosemary 
Published: March 2003

ABSTRACTBackground Multi‐agency approaches based on assessment of local need have been recommended to reduce the incidence of teenage pregnancy. This paper explores the views of local teenagers on current and future provision of sexual health services in one part of Leicester, UK.Aim To examine current provision and the views of teenagers on how these could be improved.Method A questionnaire was developed from literature review and focus group interviews. It was administered to 13–16‐year‐olds in two schools, and by post to 16–19‐year‐olds, using the age‐sex registers of five of the seven local practices.Results Of the 399 school attenders aged 13–16 years sampled, 394 (98.7%) completed the questionnaire. The postal questionnaire was sent to 1255 teenagers aged 16–19 years. After removal of wrong addresses, the response rate was 317 of 1213 (26.1%). In total, 711 people completed the questionnaire, of whom 459 (64.6%) were male. General practitioners and pharmacists were the main suppliers of contraception for females and males, respectively, with lack of awareness of the range and location of sexual health services. Major barriers included fears about embarrassment, confidentiality and being examined, especially in general practice.Conclusions Our results suggest that in this locality, the priority should be informing teenagers about existing services, and ensuring confidentiality is both practised and publicised. A leaflet to this effect has been produced and disseminated.Implications for practice Qualitative and quantitative methods are helpful in assessing local need for teenage services and in directing their development.
Not yet ‘Back to Sleep’: sleep position for infants in two inner‐city clinics
Authors: Colson Eve R , Stille Christopher J , Payton Jessica , Bernstein Bruce , Dworkin Paul 
Published: March 2003

ABSTRACTObjective To estimate the occurrence of prone sleep among a group of infants in two inner‐city clinics and examine the factors associated with parents' choice of sleep positionMethods A convenience sample of 80 parents (76 mothers and 4 fathers) was interviewed between June and October 1997, during their healthy, term infant's 2‐week health supervision visit. The interview included questions about sleep position practices, knowledge, and beliefs; knowledge about Sudden Infant Death Syndrome (SIDS); education about SIDS; and socio‐demographic data. All participants received post‐interview SIDS education.Results Thirty‐one percent of parents reported that they placed their infants to sleep in the prone position at least some of the time. Factors associated with prone sleeping included prior child‐rearing experience (P = 0.005) and the opinion of other people that were regarded as important (P = 0.0001). Only 20% of parents usually had their child sleep on its back. The majority worried that the child would vomit and choke while lying on its back. Parents who chose to position their infant to sleep on its back were less likely to describe themselves as Hispanic (P = 0.025) and more likely to remember being told to have the infant sleep on its back by a health care provider (P = 0.001). Just over one‐half of parents recall receiving sleep position instructions from a health care provider. More than 60% of these parents remember being told to place the infant on the side, 24% the back and none prone. Teen parents were more likely to remember being given sleep instructions (P = 0.033). Parents with older children were less likely to remember receiving sleep position instructions (P = 0.001).Conclusions/implications for practice Many parents in our urban practice still put their children to sleep in the prone position at least some of the time. Family and friends, as well as prior child‐rearing experience influence the choice. Parents are more likely to choose the supine position if they are instructed to do so by a health care provider. However, many parents do not recall such instruction being routinely given by their health care provider and have concerns for the safety of supine sleeping. Efforts to promote sleeping on the back should address parental concerns and health care provider practice.
Addressing barriers to change: an RCT of practice‐based education to improve the management of hypertension in the elderly.
Authors: Bhrolchain Cliona Ni 
Published: March 2003

Method A randomised, single‐blind, controlled trial of incorporating an exploration of barriers to changing practice into an educational strategy for GPs was conducted in 18 practices. Both groups of practices received visits during which they received the results of a previous audit on the management of hypertension in the elderly. The nine intervention practices were encouraged to explore barriers that would prevent them from implementing the pertinent research findings, in addition to an exploration of the issues and creation of a practice action plan. Control groups received the education without the element of exploring barriers to change. The outcome measures were changes in response to a questionnaire before and after the educational intervention. Results There were statistically significant differences between the two groups after the educational visit. Those practices who were encouraged to explore barriers to change were more likely to show change in behaviour compared to the control group. All the intervention practices produced an action plan for improving the performance, whereas none of the controls did so. The intervention practices also showed more concordance in management protocols after the intervention. Conclusion Addressing the barriers preventing practitioners from implementing research findings is effective in implementing change.
Environmental illness: educational needs of pediatric care providers
Authors: Woolf Alan , Cimino Sabrina 
Published: March 2003

ABSTRACTBackground Assessing the impact of children's exposures to environmental toxins is an emerging new subspecialty in clinical pediatrics. However, pediatric health professionals in practice may not be familiar with critical information necessary to diagnose and manage environmental toxic exposures in children.Objective The objective of this study was to investigate the perceptions of pediatricians, nurses, and nurse practitioners regarding their own practices and educational needs concerning pediatric environmental exposures.Methods Health professionals attending a general pediatric postgraduate course were administered a 22‐item questionnaire on their practices and educational needs in children's environmental health.Results A total of 93% of participants returned usable questionnaires. Within the previous 6 months, over 90% of pediatricians and nurse practitioners had diagnosed food poisoning; almost 50% had diagnosed lead poisoning; 50% had diagnosed a child's illness as due to exposure to a toxic chemical; and 24% had diagnosed ‘building‐related illness.’ Although 90% of pediatricians and 82% of nurses and nurse practitioners stated that they routinely asked families about parental occupations, only 35% of both groups asked about parental hobbies. Only 58% of the groups asked about smoke detectors in the home, and only 18% of nurses and 9% of pediatricians queried families about their use of radon detectors. Over 70% of all three groups indicated a high interest level in the following postgraduate educational topics: taking in environmental history, breast milk contaminants, food allergies, food contamination, and illness related to tobacco smoke. Topics that did not garner as high an interest level included: childhood lead poisoning, radon poisoning, and building‐related illness.Conclusion Pediatric health professionals commonly diagnose environment‐related illnesses, and they include such topics during well child care. They indicate a variety of educational needs concerning pediatric environmental health issues.Implications for practice Health care professionals are increasingly asked by parents to include environmental toxins among the possible causes of a child's ill health. Our results suggest that clinicians recognize their own need for further training in the principles of pediatric environmental health. Further research is needed in determining which modalities are best suited to achieve such educational objectives.
Normal bowel habit during the first 6 weeks in healthy, term infants
Authors: Griffin Anna , Beattie R Mark 
Published: March 2003

ABSTRACTObjective The bowel habit in the first few weeks is relevant in the assessment of symptoms which are often nonspecific and may or may not be indicative of underlying pathology. There is very little available data. We therefore undertook a study to investigate the normal bowel habit in healthy, term infants.Design, setting and sample Infants were assessed by the health visitor at the initial contact (10–14 days) and at the 6‐week check. Details of feeding method and bowel habit were collected by simple questionnaire.Results A total of 238 infants were recruited after 14 exclusions; 87.3% of babies passed meconium within 24 and 99.2% within 48 hours of birth. The majority of infants at 2 weeks passed at least one stool every day (95.3%). At 6 weeks most babies (87.8%) continued to pass a daily stool, although the range widened, with 98.3% passing a stool within the range three or more per day to once every 3 days.Implications for practice This study suggests in the first 2 weeks of life that most infants have a daily bowel motion. By 6 weeks, although the range has increased, 98.3% will have a bowel motion at least once every 3 days. This means a bowel frequency of less than every 3 days is unusual and requires consideration of underlying pathology.
The Swiss paediatrician and the social problems of families
Authors: Carrel Rebecca , Klingler Jean , Ryffel Meinrad , Vuille Jean‐Claude , Westkæmper Reinhard , Zumstein Matthias 
Published: March 2003

ABSTRACTObjective The objective of this section of the study ‘Schoolchildren in the Pediatric Practice’ was to describe the current experiences of the practising paediatrician in dealing with the social problems of their patients and families.DESIGN For the base study, paediatricians in private practice used a standardized form to register schoolchildren who came to the practice on selected days during the two year‐long research segments. Personal, demographic, social and medical information was recorded. During the semi‐structured interview at the end of the study, each paediatrician contributed highly personal examples, insights, and opinions about the psycho‐social dimension of childcare.SETTING AND SAMPLE Thirty‐four paediatricians practising in the canton of Bern, Switzerland collected a sample of 5971 schoolchildren, aged 6–16 years.Results The paediatricians recorded a definite or suspected case of social problems in the schoolchild's family in 20% of the sample. Quotations from the physicians are used to illustrate what kind of problems they see, how they access information, how willing they are to assist with a problem, and how well formal training prepared them for the task. A total of 83% of the paediatricians denounced the inadequacies of their formal preparation in this area.Implications To better prepare the paediatrician for a job with an increasing psycho‐social dimension, it is recommended to develop a model curriculum in psycho‐social paediatrics, to increase the use of the option for a practicum in a private practice during formal training, to press for coverage by health insurance for a wider scope of activities, and to address the issues implicated in networking with other child‐assistance professionals.
Children and famine: long‐term impact on development
Authors: Galler Janina R , Barrett L Robert 
Published: March 2003

ABSTRACTThe current and long‐term effects of famine and malnutrition on cognitive and behavioral development are reviewed. The brain is vulnerable to the effects of insults during critical periods of brain development from the second trimester of pregnancy until 2 years of age. Malnutrition experienced at these ages will have lifelong consequences that are not reversed by adequate nutrition. Long‐term effects of prenatal, postnatal and childhood malnutrition have been reported even after a long period of recovery from the illness itself. We summarize results of our longitudinal study in Barbados in which we followed individuals, now 28–34 years of age, who experienced moderate to severe malnutrition during their first year of life and a healthy comparison group from the same classrooms. Our studies showed that malnutrition had a negative impact on cognitive and behavioral functioning throughout childhood and adolescence, even after controlling for socioeconomic conditions and other factors in the home environment. The most striking finding in our series of studies was a fourfold increase from 15% to 60% in the frequency of attention deficit disorder following infantile malnutrition. Attention deficits persisted at least through adolescence and was closely associated with poor performance on a national high school examination at 11 years of age. We conclude that, under conditions of famine, it is important to include early and comprehensive interventions to reverse not only medical conditions resulting from malnutrition, but also cognitive and behavioral deficits arising from famine. In the absence of appropriate interventions, compromised behavioral function may continue long beyond the episode, may impact on the quality of life over the long‐term of survivors, and increase costs to society.
Response to the 1999 earthquakes by paediatric training centres in Turkey: a call for action
Authors: Ertem Ilgi Ozturk , Cin Sukru 
Published: March 2003

ABSTRACTOBJECTIVE To assess the response of Turkish paediatric residency training centres to the two earthquakes that hit Turkey in 1999, causing a total of 18 310 deaths and affecting a population of approximately 2 million.METHODS A semi‐structured questionnaire was mailed to the directors of all 26 major paediatric training centres in Turkey. This questionnaire requested information on whether the centres: sent monetary aid, supplies, or paediatricians to the sites; treated child casualties; or developed programmes to enhance health care delivery to children affected by the disaster.RESULTS Of the 21 training centres that responded to the questionnaire, 90% provided monetary aid or supplies, and 73% sent paediatricians to the sites. Although a total of 236 paediatricians from these centres volunteered or were employed at the sites, most were involved in caring for adults as well as children and were unable to provide continuous programmes for children. Paediatric training centres collaborated most frequently with the Ministry of Health and non‐governmental organizations in delivering services but collaboration with UNICEF and the Turkish paediatric associations was rare. More than half of the centres identified a need for training in disaster management and for organizing programmes related to the special needs of children in advance of disasters.CONCLUSIONS Despite the immediate mobilization of paediatric training centres after the earthquakes in Turkey, comprehensive health care services to children did not receive a paediatric input. A collaborative multidisciplinary model led by experienced paediatricians that serves children and their families specifically is needed during and after disasters.
Pediatric issues in complex emergencies
Authors: Burkle Frederick M 
Published: March 2003

ABSTRACTComplex emergencies represent the final pathway of disrupted states leading to conflict and war. Victims of complex emergencies are primarily civilians, with children predominating. The decade of the 1990s has led to the professionalization of relief workers and improved standards of care. Pediatric providers have assumed roles as consultants, advocates and practitioners of care, but future requirements call for increased capacity and capability to meet pediatric demands.
Hyperbaric oxygen for children with cerebral palsy: a randomised multicentre trial.
Authors: Reading Richard 
Published: March 2003

Background The use of hyperbaric oxygen for children with cerebral palsy has spread worldwide, despite little scientific evidence of efficacy. We carried out a randomized trial to assess the efficacy and side‐effects of this form of therapy in children with cerebral palsy.Methods One‐hundred and eleven children with cerebral palsy aged 3–12 years were randomly assigned hyperbaric oxygen (n = 57) or slightly pressurized room air (n = 54). All children received 40 treatments over 2 months. Hyperbaric oxygen treatment was 1 hour in 100% oxygen at 1.75 atmospheres absolute (ATA); children on slightly pressurized air received air at 1.3 ATA (the lowest pressure at which pressure can be felt, thereby ensuring the maintenance of masking). The main outcome measure was gross motor function. Secondary outcomes included performance in activities of daily living, attention, working memory, and speech.Findings For all outcomes, both groups improved over the course of the study, but without any difference between the two treatments. The score on the global gross motor function measure increased by 3.0% in the children on slightly pressurized air and 2.9% in those on hyperbaric oxygen. The mean difference between treatments was –0.40 (95% CI –1.69 to 0.90, p = 0.544). Other changes were seen in speech, attention, memory, and functional skills. Ear problems occurred in 27 children treated by hyperbaric oxygen and in 15 treated with hyperbaric air (p = 0.004).Interpretation In this study, hyperbaric oxygen did not improve the condition of children with cerebral palsy compared with slightly pressurized air. The improvement seen in both groups for all dimensions tested deserves further consideration.
Hyperbaric oxygen is not commonly sought as a complementary treatment for cerebral palsy in the UK, but clearly is in other parts of Europe. If parents do raise this as a possible option then it is very useful to have some scientific information available. This paper confirms what common sense suggests. It is hard to postulate a mechanism whereby hyperbaric oxygen could alter the underlying processes leading to the movement disorder in cerebral palsy. The authors make much of the improvement seen in both treatment and placebo groups but conclude that the active involvement of motivated parents, children and therapists in a trial probably explains this non‐specific but substantial improvement.
Child development services in Medicaid managed care organizations
Authors: Berry Carolyn A , Butler Pamela M , Budetti Peter P 
Published: March 2003

ABSTRACTObjective We explored the current state of developmental screens, child development services, mechanisms to fund screens and services, and incentives for adopting new services within managed care organizations serving Medicaid enrolees.Design National, cross‐sectional mail survey.Sample/setting Survey of 388 Medicaid managed care organizations (MMCO) enrolling children in 1998–99.Results Most of the 155 plans that responded provided an array of developmental screenings and services, funded primarily through internal mechanisms or under Early and Periodic Screening, Diagnostic and Treatment (EPSDT) programs. Plan contacts expressed interest in implementing new services, particularly if additional funding was available. The most important motivators included requiring services in the Medicaid contract, enhanced capitation rates, and demonstration that providing child development services would reduce other utilization costs.Conclusions If state Medicaid agencies want to enhance the child development services available through health plans, they could initiate steps such as requiring child development services in contracts with plans or providers; revising EPSDT language and engaging in more consistent enforcement; and enhancing capitation rates. More research on effectiveness and benefits of specific developmental screens and services is needed.