Childhood Asthma Control Test and spirometry values in school-age children.

OBJECTIVE: To determine the relationship between child and parent reports of asthma control using the Childhood Asthma Control Test (C-ACT) and spirometry. METHODS: This descriptive study included 648 children ages 5-11 years from a school-based asthma program. Not well-controlled asthma was defined as forced expiratory volume in 1 s (FEV1) and by FEV1/forced vital capacity (FVC) of 80% predicted or lower. Sensitivity and specificity of C-ACT scores for low FEV1 and FEV1/FVC levels were calculated. Logistic regression was used to obtain the area under the receiver operating characteristic curve (AUC) for C-ACT score categories by FEV1 level. RESULTS: Mean child age was 8.2 years, mean C-ACT score was 20.3 (SD = 3.96), mean FEV1 was 94.3% (SD = 17.1), and mean FEV1/FVC was 81.3 (SD = 8.5). Children with an FEV1 of 80% or less had significantly lower C-ACT scores than those with an FEV1 > 80% (p = .023, t = -2.015, df = 167); 95% CI [. -1.79 to -0.018]). The sensitivity and specificity of a C-ACT score of 19 or less for an FEV1 of 80% predicted or lower were 44.9 and 66.4%. With a C-ACT score of 22 or less, sensitivity and specificity for low FEV1 were 67.7 and 30.9%. The AUC for a C-ACT score of 19 or less and FEV1 of 80% or lower was .444 while the AUC was higher at .507 for a CACT score of 22 or less. CONCLUSION: The C-ACT is a useful screen but spirometry should be performed in children with persistent symptoms to assess current asthma control.

Adverse Childhood Experiences as Public Health Threat.

Toxic stress has long-term effects on health and well-being.

Evidence for Revising the Adverse Childhood Experiences Screening Tool: a Scoping Review.

The relationship between adverse childhood experiences (ACEs) and risky behavior, chronic illness, and premature mortality is well documented. Despite this evidence, screening for ACEs in primary care settings remains limited. Objections to widespread screening include concerns that the original ACE screening tool limited childhood adversities to family and household dysfunction. The purpose of this scoping review is to describe current knowledge for expanding ACEs categories and revising the formatting and scoring of the screening tool. With the assistance of a medical librarian, we used a two-step process to conduct a systematic search in three databases (CINAHL, OVID Medline, PsycINFO). Our aim was to focus on articles that expanded ACE categories and/or revised the scoring or formatting of the ACE tool. Eighteen articles (reporting 19 studies) met criteria. A minimum of two authors extracted the relevant characteristics of the studies independently and conferred to reach agreement. The majority of studies broadened ACEs to include community and systemic categories; three studies revised the formatting or scoring of the ACE tool. Exposure to community violence (ECV) was the most frequently added category (15), followed by economic hardship in childhood (EHC) (13); bullying (10); absence/death of parent or significant others (9); and discrimination (7). This evidence supports the expansion of ACE screening tools for assessment of childhood trauma and timely treatment.

Family-Centered Primary Care for Teen Parents and Their Children.

Although the teen birth rate in the United States continues to decline, births remain disproportionately high among disadvantaged teens and teens of color. The vulnerabilities and resilience of teen parents are described from a historical context, with recommendations for advancing primary care of these families. We endorse comprehensive primary care and clinical practices that capitalize on the strengths and resilience of these families while recognizing the social inequities that compromise their health and development. To strengthen the bonds among young mothers, fathers, and children, we recommend family-centered primary care services that are of a youth- and father-friendly, nonstigmatizing, strength-based, and trauma-informed nature.

Effect of a school-based asthma clinic on asthma outcomes.

Background: The St. Louis Children's Hospital Healthy Kids Express Asthma (HKEA) program was developed to improve asthma control in children who attend schools with the highest asthma prevalence in the metropolitan area. The HKEA program differs from other programs because unscheduled visits occur at school without parents present. Objective: To assess the effectiveness of the HKEA program via a retrospective quality assurance study. Methods: A chart review was performed to evaluate the change in health-care utilization, absenteeism, staff and student education, inhaler technique checks, and parent satisfaction surveys before and after participation in the program. The Wilcoxon signed rank test, two-way analysis of variance, and descriptive statistics were used to analyze the data. Results: The HKEA program recruited 1076 participants ages 5-15 years during 3 school years, from 2008 to 2011. The participants showed a reduction in emergency department visits (36.9% to 14.2%) and hospitalizations (7.1% to 5.0%) from the year before beginning the program to the third year of the program. Absenteeism was significantly improved, from 59.1% to 27.1%. Staff and student knowledge of asthma improved significantly after completing asthma education programs. More than 90% of participants completed three technique checks of their inhaler and spacer technique and showed significant improvement in their tech check (an inhaler/aero chamber technique check) scores. Parent satisfaction with the HKEA program was rated excellent or very good by 96.9% of the parents. Conclusion: The HKEA program is a novel school-based asthma clinic that is well accepted by parents, and results in less health-care utilization and school absences as well as improved asthma knowledge in participants and the school staff.

Visually enhanced education and immunization perceptions in low-income parents.

OBJECTIVE: Despite immunizations being an effective health promotion intervention, about 28% of children are not up-to-date on the combined seven-vaccine series by 35 months of age in the United States. Identifying innovative techniques to increase immunization literacy is crucial to the health and well-being of children. DESIGN AND SAMPLE: Based on the theory of multimedia learning, this study examined whether the use of visually enhanced education (VEE) positively impacted parental perception of immunization effectiveness, perceived knowledge of disease, comfort with immunization decision making, and satisfaction with the provider. Forty parents of infants 4-14 days old that could read English. INTERVENTION: Parents completed a questionnaire with 12 items in four categories during the initial visit (4-14 days old) before VEE and at the second visit (17-37 days later) after the second VEE session had been completed. RESULTS: A paired sample t test revealed a significant increase in two of the four categories (i.e., perceived knowledge of the disease [t(37) = 8.73, p = .000] and satisfaction with the provider [t(37) = 2.68, p = .011]. Cohen's effect size value suggested high practical significance in one of the four categories (i.e., perceived knowledge of disease d = 1.31, d = 1.42, d = 1.18, d = 1.05, d = 1.12). Cronbach's alpha for the 12 items was 0.852. CONCLUSIONS: VEE may be an innovative technique for improving parental immunization health literacy and increasing parent-professional communication about immunizations.

An umbrella review of meta-analyses of interventions to improve maternal outcomes for teen mothers.

The purpose of this study was to perform an umbrella review of meta-analyses of intervention studies designed to improve outcomes of pregnant or parenting teenagers. An extensive search retrieved nine reports which provided 21 meta-analyses analyses. Data were extracted by two reviewers. Methodological quality was assessed using the AMSTAR Instrument. Most effect sizes were small but high quality studies showed significant outcomes for reduced low birth weight (RR = 0.60), repeat pregnancies/births (OR = 0.47-0.62), maternal education (OR = 1.21-1.83), and maternal employment (OR = 1.26). Several parenting outcomes (parent-child teaching interaction post-intervention [SMD = -0.91] and at follow-up [SMD = -1.07], and parent-child relationship post-intervention [SMD = -0.71] and at follow-up [SMD = -0.90]) were significant, but sample sizes were very small. Many reports did not include moderator analyses. Behavioral interventions offer limited resources and occur too late to mitigate the educational and social disparities that precede teen pregnancy. Future intervention research and policies that redress the social determinants of early childbearing are recommended.

Asthma control and obesity in urban African American children.

OBJECTIVE: To examine the relationship between body mass index (BMI), gender, age, controller medication use, household smoke exposure, season, and allergic rhinitis status with asthma control in a group of lower income, African American children. We hypothesized that non-obese children would have better asthma control. METHODS: Baseline data from a longitudinal study of children in a school-based asthma program in a Midwest urban area were analyzed. 360 children, ages 4-15 years, who were enrolled in either the 2012-2013 or 2013-2014 program were included. Asthma control was classified using criteria from the 2007 National Asthma Education and Prevention Program. Multiple ordinal regression was performed. RESULTS: The median age was 9 years, 61% had well-controlled asthma, and 29% were obese. The model included all main effects plus two interaction terms and was significant (χ2(7) = 22.17, p =.002). Females who were normal weight (OR, 2.78; 95% CI, 1.38-5.60, p =.004) or overweight (OR, 3.12; 95% CI, 1.26-7.72, p =.014) had better asthma control than obese females. For males, there were no differences by BMI category but males without allergic rhinitis had significantly better asthma control (OR, 2.23; 95% CI, 1.25-3.97, p =.006) than those with allergic rhinitis. CONCLUSIONS: Non-obese girls and non-allergic males had better asthma control. Promotion of healthy activity and nutrition as well as management of allergic rhinitis should be part of the asthma plan in school-based programs in low income urban areas. Innovative approaches to address asthma care in low income populations are essential.

Comparison of Two Postoperative Bowel Regimens in Children With Scoliosis Repair.

BACKGROUND: Orthopaedic procedures place children at risk for postoperative constipation due to combined effects of anesthesia, narcotics, and decreased physical mobility. PURPOSE: This retrospective study analyzed medication use and stool outcomes of 36 children who received polyethylene glycol 3350 (PEG) or mineral oil (MO) after a spinal fusion. METHODS AND RESULTS: A chart review found no statistical differences by group for number of bowel movements (BMs) before discharge (p = .37), time from procedure to BM, use of rescue cathartics (p = .55), or medication refusal (p = .37). In the PEG group, 90% refused the medication one or more times compared with 75% in the MO group. CONCLUSION: Only 17% of patients had a BM before discharge. Findings suggest medication refusal may be related to the method of medication preparation, suggesting the child's choice in bowel regimens may be indicated. A prospective study with a larger, randomized sample size is needed.

Self-Efficacy and Self-Reported Dietary Behaviors in Adolescents at an Urban School With No Competitive Foods.

Over one third of U.S. adolescents are overweight. A descriptive, cross-sectional study examined the relationship between student dietary self-efficacy (SE), sugar-sweetened beverages, and low-nutrient energy-dense food consumption, and exposure to a healthy school food environment without competitive foods. The sample consisted of 292 urban, primarily African American students aged 11 to 16 years. Mantel-Haenszel χ(2) analyses revealed a significant but weak linear trend for girls between number of school meals and SE to drink less soda, χ(2)(1) = 6.882, p = .008, and between semesters attended with SE to eat more fruits and vegetables, χ(2)(1) = 5.908, p = .015. Obese students had significantly higher scores for two SE items than nonobese students, that is, plan better nutrition, χ(2)(1) = 3.998, p = .045, and eat healthy at a fast-food restaurant, χ(2)(1) = 4.078, p = .043. Further study of adolescent SE for healthy eating and school-based, food-focused obesity prevention interventions is needed.

Use of prevention and prevention plus weight management guidelines for youth with developmental disabilities living in group homes.

INTRODUCTION: Prevention and Prevention Plus strategies for weight management were implemented for youth with developmental disabilities living in community group homes at a Midwestern educational/residential center. METHODS: Caregiver staff were provided with weight management education, a communication tool for youth weight indices, weight and physical activity goals, dietary orders, and monthly follow-up communication. This 4-month study examined changes in weight indices, nutrition, physical activity, and staff perceptions of youth status using t tests, χ(2) tests, and Wilcoxon signed-rank tests. RESULTS: A significant decrease in mean body mass index percentile was found (t(39) = 2.93, p < .01, 95% confidence interval 1.29 to 7.04) that was primarily from change in the healthy weight category. More than 80% of the 40 youth achieved their weight goal. A significant improvement in daily fruit consumption ( p = .001) and vegetable consumption ( p < .001) was reported. DISCUSSION: These prevention strategies are useful to promote staff understanding of dietary goals for weight management in youth with developmental disabilities living in group homes and should be incorporated into practice by health care providers. Additional efforts are needed to increase physical activity during the winter months.

Nutritional screening and early intervention in children, adolescents, and young adults with cancer.

Children and adolescents with cancer who receive chemotherapy and/or radiation treatments are at risk for malnutrition due to side effects such as nausea, vomiting, anorexia, and mouth sores. Malnutrition during treatment for childhood cancer increases the risk of infection, decreases tolerance to treatment, and even affects overall survival. A retrospective analysis of 79 children, adolescents, and young adults was conducted to evaluate nutritional screening at baseline and for the first 6 months of treatment. Interventions were also documented. Forty-nine participants had a positive screen for risk of malnutrition. In the patients with a positive screen, 78% had intervention within 24 hours of the identified risk for malnutrition. Thirty-five patients had a nutritional referral, which resulted in a full nutritional assessment and plan. Key independent variables were analyzed to determine if they were associated with an increased risk of malnutrition. In addition, individual risk factors were analyzed to determine their association with malnutrition. Future studies should find whether early intervention is effective in reversing the risk of malnutrition during treatment for childhood cancer.

Promoting physical activity in teen girls: insight from focus groups.

PURPOSE: To describe adolescent girls' views about physical activity and explore strategies that nurses can use to promote physical activity. STUDY DESIGN AND METHODS: A qualitative study using focus groups and interviews with 28 girls (12-18 years of age) recruited from schools and neighborhood health centers in a Midwest metropolitan area. An interview guide with 15 open-ended questions was used, and data were analyzed using content analysis. RESULTS: Most girls preferred the phrase "physical activity" over "exercise." The benefits most frequently mentioned included positive physical attributes, mental health benefits, and staying healthy. Three major themes were identified: autonomy (ask them what they like to do, and then provide choices), fun (being with friends, variation, and enjoyment), and body image (gaining weight, appearance, and self-confidence). CLINICAL IMPLICATIONS: Nursing interventions to promote physical activity and other healthy lifestyle changes that may prevent obesity should include active listening and a focus on the goals of the teen. Nurses need to evaluate their teaching and counseling approach, because the teens emphasized two points: "Don't tell me what to do" and "Don't put me down."

Pediatric nurse practitioner salary and practice: results of a Midwest metropolitan area survey.

The St. Louis Association of Pediatric Nurse Practitioners has conducted a local biennial salary, practice, and benefits survey since the mid 1990s. This cross-sectional, descriptive study investigated demographic characteristics, salary, benefits, and practice patterns of pediatric nurse practitioners (PNPs) in the St. Louis area in fall, 2005. The survey was sent to 199 PNPs who lived within 100 miles of Saint Louis, with a return rate of 60%. The mean salary for full time PNPs engaged in practice was $72,788, which was a 6.3% increase from the 2003 survey results. PNPs with more years of experience received significantly higher salaries than those with less experience; however, there was no difference in salary based on type of practice (primary versus specialty care) or type of practice setting. Increasing numbers of PNPs are reporting their practice focus as specialty care (53%) rather than primary care (47%) in this region, with 70% of full time PNPs indicating specialty care. PNPs with less than 3 years experience were working equally in primary and specialty care. Practice challenges such as reimbursement and prescriptive issues were identified. Only 37% of PNPs indicated that they were credentialed by insurance plans. Nurse practitioners may find a local survey helpful as they negotiate changes in their salaries and benefits. Members of advance practice nursing organizations and educators may find the survey process useful as they observe local practice trends over time. It is essential that nursing education and continuing education conferences address the basic and continuing education needs of PNPs in both primary care and common specialty practices.

The use of complementary and alternative health care practices among children.

INTRODUCTION: The purposes of this descriptive study were to: (a) describe the use of complementary and alternative medicine (CAM) practices for children as reported by their parents, and (b) to develop a CAM screening tool. METHOD: A convenience sample of 191 parents was obtained from 3 primary care settings within a midwestern, metropolitan area. The questionnaire consisted of: (a) seven screening questions, (b) a list of specific CAM therapies used by children and by parents, (c) six open-ended questions about sick child care, and (d) a demographic section. RESULTS: Thirty-three percent of parents reported using CAM for their child within the past year, most commonly citing infant massage, massage therapy, vitamin therapy, and botanical products. Analysis revealed that White parents who used CAM for themselves and had children school-age and older were significantly more likely to provide CAM for their child. Chi-square analyses between the responses to selected screening questions and use of CAM were statistically (P =.001) significant but identified only 24% of the parents who used CAM for their children. DISCUSSION: Pediatric nurses should ask parents and children about CAM use in an open manner that promotes discussion. Further refinement of the screening tool is needed.