Literacy Promotion: An Essential Component of Primary Care Pediatric Practice: Policy Statement.

Reading together often with infants and young children strengthens their relationships with parents/caregivers at a critical time in child development, stimulating brain circuitry and early attachment. A positive parenting practice, shared reading helps build the foundation for healthy social-emotional, cognitive, language, and literacy development, setting the stage for school readiness and providing enduring benefits across the life course. Pediatric physicians and advanced care providers have a unique opportunity to encourage parents/caregivers to establish routines and enjoy conversations around books and stories with their children beginning in infancy. Research has demonstrated that parents read and children learn when pediatricians offer literacy promotion as a practical and evidence-based primary prevention strategy in primary care practice to support early brain and child development. This supports families with a strengths-based approach, shaping a child's life trajectory and helping mitigate stress and adverse experiences. The American Academy of Pediatrics (AAP) recommends that pediatricians encourage shared reading beginning at birth and continuing at least through kindergarten as a strategy for supporting parents/caregivers, enhancing foundational relationships, promoting positive language-rich interactions, and helping families create a nurturing and stimulating home environment. The integration of literacy promotion into pediatric resident education is crucial to achieve that goal and thus is also essential. The AAP supports advocacy toward establishing public and private funding for diverse high-quality, developmentally appropriate children's books in the languages preferred by the family to be provided at pediatric health supervision visits to all children, but especially to children living in underresourced communities. This statement is supported by multiple AAP policies and implementation resources, including the accompanying "Literacy Promotion: An Essential Component of Primary Care Pediatric Practice: Technical Report."

Repeated exposure to physiologically effective doses of contraceptive hormones ethinyl estradiol or levonorgestrel do not alter the reinforcing effects of a brief visual stimulus in ovary-intact rats.

Estradiol and progesterone potentiate and attenuate reward processes, respectively. Despite these well-characterized effects, there is minimal research on the effects of synthetic estrogens (e.g., ethinyl estradiol, or EE) and progestins (e.g., levonorgestrel, or LEVO) contained in clinically-utilized hormonal contraceptives. The present study characterized the separate effects of repeated exposure to EE or LEVO on responding maintained by a reinforcing visual stimulus. Forty ovary-intact female Sprague-Dawley rats received either sesame oil vehicle (n = 16), 0.18 µg/day EE (n = 16), or 0.6 µg/day LEVO (n = 8) subcutaneous injections 30-min before daily one-hour sessions. Rats' responding was maintained by a 30-sec visual stimulus on a Variable Ratio-3 schedule of reinforcement. The day after rats' last session, we determined rats estrous cycle phase via vaginal cytology before sacrifice and subsequently weighing each rat's uterus to further verify the contraceptive hormone manipulation. The visual stimulus functioned as a reinforcer, but neither EE nor LEVO enhanced visual stimulus maintained responding. Estrous cytology was consistent with normal cycling in vehicle rats and halting of normal cycling in EE and LEVO rats. EE increased uterine weights consistent with typical uterotrophic effects observed with estrogens, further confirming the physiological impacts of our EE and LEVO doses. In conclusion, a physiologically effective dose of neither EE nor LEVO did not alter the reinforcing efficacy of a visual stimulus reinforcer. Future research should characterize the effects of hormonal contraceptives on responding maintained by other reinforcer types to determine the generality of the present findings.

The Effect of Exposure to Reach Out and Read on Shared Reading Behaviors.

BACKGROUND: Caregiver-child shared reading improves literacy skills, school readiness, familial relationships, and social-emotional development. This multiyear study seeks to evaluate the effect of exposure to Reach Out and Read (ROR) on caregiver reading frequency and behaviors. METHODS: Caregivers of children 6 months to 5 years in 427 primary care clinics in North and South Carolina were asked to complete the Reach Out and Read Parent Feedback Survey. Caregivers not previously exposed to ROR were categorized as "new," and those who had previously been exposed to ROR as "returning" to compare reading behaviors between groups. RESULTS: From 2014 to 2019, caregivers completed 100,656 surveys. Returning caregivers were more likely to report reading or looking at books every day (adjusted odds ratio [AOR] = 1.27; 95% confidence interval [95% CI], 1.22-1.33). Returning caregivers were more likely to perform behaviors like letting the child turn pages (AOR = 1.71; 95% CI, 1.62-1.79), making up stories about the pictures (AOR = 1.46; 95% CI, 1.39-1.53), asking what is happening in the pictures (AOR = 1.39; 95% CI, 1.32-1.47), helping identify things in the pictures (AOR = 1.57; 95% CI, 1.50-1.65), reading to the child 30 minutes every day (AOR = 1.39; 95% CI, 1.33-1.46), and taking the child to the library (AOR = 1.26; 95% CI, 1.20-1.34). CONCLUSIONS: This study shows a significant association between caregivers' exposure to ROR, high-frequency reading, and positive reading behaviors, and is consistent for all 6 years studied.retain-->.

Restoration of normal blood flow in atherosclerotic arteries promotes plaque stabilization.

Blood flow is a key regulator of atherosclerosis. Disturbed blood flow promotes atherosclerotic plaque development, whereas normal blood flow protects against plaque development. We hypothesized that normal blood flow is also therapeutic, if it were able to be restored within atherosclerotic arteries. Apolipoprotein E-deficient (ApoE-/-) mice were initially instrumented with a blood flow-modifying cuff to induce plaque development and then five weeks later the cuff was removed to allow restoration of normal blood flow. Plaques in decuffed mice exhibited compositional changes that indicated increased stability compared to plaques in mice with the cuff maintained. The therapeutic benefit of decuffing was comparable to atorvastatin and the combination had an additive effect. In addition, decuffing allowed restoration of lumen area, blood velocity, and wall shear stress to near baseline values, indicating restoration of normal blood flow. Our findings demonstrate that the mechanical effects of normal blood flow on atherosclerotic plaques promote stabilization.

Health Care Use Among Latinx Children After 2017 Executive Actions on Immigration.

BACKGROUND: US immigration policy changes may affect health care use among Latinx children. We hypothesized that January 2017 restrictive immigration executive actions would lead to decreased health care use among Latinx children. METHODS: We used controlled interrupted time series to estimate the effect of executive actions on outpatient cancellation or no-show rates from October 2016 to March 2017 ("immigration action period") among Latinx children in 4 health care systems in North Carolina. We included control groups of (1) non-Latinx children and (2) Latinx children from the same period in the previous year ("control period") to account for natural trends such as seasonality. RESULTS: In the immigration action period, 114 627 children contributed 314 092 appointments. In the control period, 107 657 children contributed 295 993 appointments. Relative to the control period, there was an immediate 5.7% (95% confidence interval [CI]: 0.40%-10.9%) decrease in cancellation rates among all Latinx children, but no sustained change in trend of cancellations and no change in no-show rates after executive immigration actions. Among uninsured Latinx children, there was an immediate 12.7% (95% CI: 2.3%-23.1%) decrease in cancellations; however, cancellations then increased by 2.4% (95% CI: 0.89%-3.9%) per week after immigration actions, an absolute increase of 15.5 cancellations per 100 appointments made. CONCLUSIONS: There was a sustained increase in cancellations among uninsured Latinx children after immigration actions, suggesting decreased health care use among uninsured Latinx children. Continued monitoring of effects of immigration policy on child health is needed, along with measures to ensure that all children receive necessary health care.

Randomized controlled trial evaluating a collaborative model of care for transitioning children with medical complexity from hospital to home healthcare: Study protocol.

This article describes the study protocol for an evaluation of an innovative model of care that supports home health nurses (HHN) who serve children with medical complexity (CMC). CMC constitute a small proportion of children, but have very high need for health services, are hospitalized frequently, and account for significant proportion of pediatric healthcare expenditures. High-quality home health nursing services are important for CMC, but models of care of home healthcare, after discharge of CMC from the hospital, have not been tested. Our project aims are to develop, implement, and test a model of care, called ICollab, to improve home healthcare delivery for CMC. The ICollab model consists of collaboration between HHN, primary-care physicians and clinicians of the complex care program of a tertiary-care children's hospital in the care of CMC. In this randomized clinical trial, we will recruit 110 CMC discharged home on home health nursing services. The intervention group (n = 55) will receive the ICollab intervention for 6 months post-discharge from the hospital, in addition to usual care. Children in the control group (n = 55) will receive only usual care. Outcome measures will include healthcare utilization metrics (hospitalization rates, emergency room visit rates, and days to readmission), caregiver burden and caregiver satisfaction with home healthcare, HHN retention, and HHN collaboration with other healthcare providers. We hypothesize that ICollab will reduce healthcare utilization and caregiver burden, and improve caregiver satisfaction with home healthcare, increase HHN retention, and increase HHN collaboration with other healthcare providers. Results of this study have the potential to provide a critically needed evidence-base for interventions to improve the quality of healthcare delivery for CMC. This study is registered on clinicaltrials.gov (NCT03978468) and is ongoing.

Improving Compliance Rates with Health Assessment and Vaccine Documentation to Decrease School Absences: A Community Collaborative.

Students entering North Carolina public schools must have documentation of a health assessment and immunizations by the 30th day of class, or they are excluded from attending school until they submit documentation. A community collaborative was essential in decreasing the number of students excluded from school for noncompliant documentation in the Winston-Salem Forsyth County school district.