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Operationalizing SDoH Into a Broader Screening Context




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Irish commission: Catholic school discriminated against atheist student

CNA Staff, May 4, 2020 / 05:01 pm (CNA).- The Republic of Ireland’s Workplace Relations Commission has decided that an atheist child was discriminated against by his Catholic school when students were rewarded for attending a religious ceremony.

The commission, an independent, quasi-judicial forum, ruled that the Yellow Furze National School in County Meath had discriminated against an atheist student.

Early in the 2019 school year, the students had been promised a homework pass if they took part in the choir during a First Communion ceremony

The boy’s mother complained, but the school defended its policy.

"Any student, regardless of his/her religion in our school who opted not to participate in this extracurricular event was not 'rewarded,'" the school said, according to the Irish Post last year.

The school added that children of any religion were able to participate in the choir, and that the claim of discrimination was thus “wholly unfounded.”

The commission said the school “does not appreciate this action had an adverse effect on students who are not of a Catholic faith,” the Irish Times reported.

His mother said that "on that day my son was the only child in the class who was not participating. He was also the only non-Catholic child in the class." She added that “he came out of school crying.”

“We are atheist and this is not a choice that is open to him,” she said.

The Irish Post reported in 2019 that the boy was one of two pupils in his class of 33 to receive homework instead of attending the choir ceremony.

According to the commission the boy’s parents were “deeply hurt and upset” by the school.

“We felt that the school had disregarded the fact that we have a different set of beliefs,” the mother told RTE News. “We felt that our child had been singled out and punished for not being a Catholic,” and she added that she hoped the ruling would “change things for children here who are not Catholic".

The mother has since enrolled her son in a different school.

The commission ordered the school to pay €5,000 and demanded the school review its policies so it complies with the Equal Status Acts. The school will also have to post a memo of its compliance in a noticeable location within the school.

The mother told RTE News she will return the €5,000 to the school, “because it will be our friends and our neighbours who will be funding it, through school fundraising. We have been vindicated, but we feel that it would be wrong to accept this money.”

Catholic schools in Ireland make up 90% of all primary schools in the country, the Irish Times reported. The ruling is likely to affect how other schools promote and organize religious events.




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Screening Tools for Autism Spectrum Disorder in Primary Care: A Systematic Evidence Review

CONTEXT:

Recommendations conflict regarding universal application of formal screening instruments in primary care (PC) and PC-like settings for autism spectrum disorder (ASD).

OBJECTIVES:

We systematically reviewed evidence for universal screening of children for ASD in PC.

DATA SOURCES:

We searched Medline, PsychInfo, Educational Resources Informational Clearinghouse, and Cumulative Index of Nursing and Allied Health Literature.

STUDY SELECTION:

We included studies in which researchers report psychometric properties of screening tools in unselected populations across PC and PC-like settings.

DATA EXTRACTION:

At least 2 authors reviewed each study, extracted data, checked accuracy, and assigned quality ratings using predefined criteria.

RESULTS:

We found evidence for moderate to high positive predictive values for ASD screening tools to identify children aged 16 to 40 months and 1 study for ≥48 months in PC and PC-like settings. Limited evidence evaluating sensitivity, specificity, and negative predictive value of instruments was available. No studies directly evaluated the impact of screening on treatment or harm.

LIMITATIONS:

Potential limitations include publication bias, selective reporting within studies, and a constrained search.

CONCLUSIONS:

ASD screening tools can be used to accurately identify percentages of unselected populations of young children for ASD in PC and PC-like settings. The scope of challenges associated with establishing direct linkage suggests that clinical and policy groups will likely continue to guide screening practices. ASD is a common neurodevelopmental disorder associated with significant life span costs.1,2 Growing evidence supports functional gains and improved outcomes for young children receiving intensive intervention, so early identification on a population level is a pressing public health challenge.3,4




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Understanding Gaps in Developmental Screening and Referral




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Improving Antibiotic Prescribing for Pediatric Urinary Tract Infections in Outpatient Settings

OBJECTIVES:

To determine if a multicomponent intervention was associated with increased use of first-line antibiotics (cephalexin or sulfamethoxazole and trimethoprim) among children with uncomplicated urinary tract infections (UTIs) in outpatient settings.

METHODS:

The study was conducted at Kaiser Permanente Colorado, a large health care organization with ~127 000 members <18 years of age. After conducting a gap analysis, an intervention was developed to target key drivers of antibiotic prescribing for pediatric UTIs. Intervention activities included development of new local clinical guidelines, a live case-based educational session, pre- and postsession e-mailed knowledge assessments, and a new UTI-specific order set within the electronic health record. Most activities were implemented on April 26, 2017. The study design was an interrupted time series comparing antibiotic prescribing for UTIs before versus after the implementation date. Infants <60 days old and children with complex urologic or neurologic conditions were excluded.

RESULTS:

During January 2014 to September 2018, 2142 incident outpatient UTIs were identified (1636 preintervention and 506 postintervention). Pyelonephritis was diagnosed for 7.6% of cases. Adjusted for clustering of UTIs within clinicians, the proportion of UTIs treated with first-line antibiotics increased from 43.4% preintervention to 62.4% postintervention (P < .0001). The use of cephalexin (first-line, narrow spectrum) increased from 28.9% preintervention to 53.0% postintervention (P < .0001). The use of cefixime (second-line, broad spectrum) decreased from 17.3% preintervention to 2.6% postintervention (P < .0001). Changes in prescribing practices persisted through the end of the study period.

CONCLUSIONS:

A multicomponent intervention with educational and process-improvement elements was associated with a sustained change in antibiotic prescribing for uncomplicated pediatric UTIs.




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Office-Based Screening for Sexually Transmitted Infections in Adolescents

Almost 1 in 4 adolescents have a sexually transmitted infection (STI). These infections are preventable through safe sexual practices and routine screening. Pediatricians are the first line of clinical care for adolescents and are well positioned to offer sexual and reproductive health care counseling and services to their patients; yet, there is a paucity of sexual health screening provided at routine health supervision visits. This article addresses the epidemiology of STIs in adolescents, reviews the evidence of current clinical practice, presents recommended STI screening from government and medical agencies, and offers strategies to address barriers to providing care for adolescents and for sexual health screening in primary care.




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Screening for Problematic Internet Use

Problematic Internet use (PIU) by adolescents is of growing concern among both parents and pediatricians. Early controversies may have contributed to challenges in defining and measuring PIU. A variety of screening tools have evolved, aligned with different constructs of PIU, although a validated screening tool does exist. Current data and American Academy of Pediatrics policy reflect evidence-driven screening for PIU for all youth.




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How to Subscribe to Podcasts on iOS, Mac, and iTunes

Apple's Podcasts app is available on mobile and the desktop, but in macOS Catalina, a new standalone Podcasts app replaces iTunes. Here's how to subscribe, listen, and adjust settings on iOS, iPadOS, iTunes, and Mac.




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Have you ever seen the beautiful Georgian script?

OM EAST responds to the need for Christian books in the Georgian language.




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SPFL league reconstruction plans scrapped - leaving Hearts and Partick Thistle facing relegation

PLANS for league reconstruction have been scrapped after Ladbrokes Premiership clubs indicated there isn't enough support for the proposed changes at this time.




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New Warnings on Screen Time, as Students Nationwide Move to E-Learning

As millions of students nationwide start to settle into virtual learning programs to slow the spread of the coronavirus, a massive new research analysis sounds another note of caution about the effects of exposing significantly more screen time.




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Why Do Schools Hang On to Discriminatory Dress Codes?

School dress codes are clashing with students, parents, and researchers who see the rules and their enforcement as rife with racism and sexism. Some school leaders say the codes are important for safety and teaching kids to comply.




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Disney+ Reaches 28.6 Million Subscribers Since Nov. Launch

Disney's CEO said most of the subscribers to Disney+ came from the US. But going forward, the company expects new subscribers to come from foreign markets as the streaming service expands to more European countries and India this March.




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When Measles Breaks Out, Unvaccinated Kids Send Schools Scrambling

The effects of an ongoing measles outbreak centered in Washington state have spread well beyond the patients who’ve contracted the virus, creating logistical challenges for schools and public health officials.




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Babies as Young as 12 Months Get Nearly an Hour of Screen Time a Day, Study Finds

Babies as young as 12 months are exposed to nearly an hour a day of screen time, despite warnings from pediatricians to avoid digital media exposure for children under a year and a half, according to a new analysis.




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Bring Back Anti-Discrimination Guidance on School Discipline, Commission Urges

But the U.S. Commission on Civil Rights was not unanimous in its support of the findings that students of color were not more likely to commit discipline-worthy offenses.




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The Haunting Reality of Discrimination in School Discipline

Discrimination based on race and disability demands our attention—and action, writes Catherine E. Lhamon, the chair of U.S. Commission on Civil Rights.




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Parental Understanding of Newborn Screening for Cystic Fibrosis After a Negative Sweat-Test

The current standard of care includes informing women about prenatal testing and newborn screening for cystic fibrosis and providing genetic counseling to parents whose child is referred for sweat-testing. Despite counseling, early data identified some persistent confusion about residual risk.

Prenatal discussions about carrier testing and newborn screening for cystic fibrosis are not routine. Parental anxiety about abnormal results from a screen is decreased after speaking to a genetic counselor when scheduling the sweat test. Despite counseling, residual risk continues to be poorly understood. (Read the full article)




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Hearing Screening in a Well-Infant Nursery: Profile of Automated ABR-Fail/OAE-Pass

Combined auditory brainstem response/otoacoustic emission testing is used to screen for auditory neuropathy spectrum disorder (ANSD), which leads to failure to develop normal auditory behavior and oral language. Prevalence estimates have been obtained for infants in NICUs.

ANSD risk in well-infant nurseries has not been examined. This study contributes ANSD prevalence estimates for infants admitted to well-infant nurseries and compares the costs of 2 different 2-technology screening protocols. (Read the full article)




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Chlamydia Screening Among Young Women: Individual- and Provider-Level Differences in Testing

Chlamydia testing among adolescents and young women without symptoms is recommended by the US Preventive Services Task Force, but only approximately one-half of eligible young women presenting for health care are screened appropriately.

Our work indicates that providers screen young women for chlamydia differentially according to patient age, race/ethnicity, insurance status, and sexual health history. Biases in chlamydia screening may contribute to higher reported rates of chlamydia among minority and poor young women. (Read the full article)




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Antihypertensive Prescribing Patterns for Adolescents With Primary Hypertension

Primary hypertension is a growing concern in adolescents due to its association with the obesity epidemic. Recent studies have examined underdetection and underdiagnosis of hypertension in adolescents but medical management of primary hypertension in adolescents is not well-described.

Our study describes patterns of antihypertensive prescribing for adolescents with primary hypertension including the use of monotherapy versus combination therapy by physicians of different specialties and factors associated with receipt of antihypertensive therapy over a multi-year period. (Read the full article)




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Drinking Frequency as a Brief Screen for Adolescent Alcohol Problems

The American Academy of Pediatrics recommends routine alcohol screening for all adolescents. Problem-based substance use screens for adolescents exist, but have limitations. A consumption-based alcohol screen could provide an empirically validated, very brief method to screen youth for alcohol-related problems.

National sample data indicate that frequency of alcohol use has high sensitivity and specificity in identifying youth with alcohol-related problems. A range of age-specific frequency cut scores perform well; specific cut points can be selected based on the screening context. (Read the full article)




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Social-Emotional Screening for Infants and Toddlers in Primary Care

Recommendations in pediatrics call for general developmental screening of young children; however, research suggests social-emotional development, in particular, is important as an initial indicator of general well-being versus risk, and may warrant inclusion in screening protocols.

Via a social-emotional screening program, significant percentages of children can be identified as being at risk for social-emotional problems, and colocation of an early childhood psychologist promotes the ability to effectively address young children’s social-emotional development within their medical home. (Read the full article)




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Citizens' Values Regarding Research With Stored Samples From Newborn Screening in Canada

Newborn screening (NBS) programs may store bloodspot samples and use them for secondary purposes, such as research. Recent public controversies and lawsuits over storage and secondary uses underscore the need to engage the public on these issues.

This public engagement study identifies values underlying citizens’ acceptance of and discomfort with research from NBS samples. Well-designed methods of public education and civic discourse on the risks and benefits of storage and secondary uses of NBS samples are required. (Read the full article)




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Cardiac Screening Prior to Stimulant Treatment of ADHD: A Survey of US-Based Pediatricians

Over the past decade, drug oversight committees and professional organizations have debated the evidence regarding cardiac screening to identify undiagnosed disorders associated with sudden cardiac death in youth with attention-deficit/hyperactivity disorder before beginning treatment with stimulants.

How practicing pediatricians have responded to this controversy is not known. We present results from a national sample of pediatricians regarding current attitudes, barriers, and practices for cardiac screening in youth with attention-deficit/hyperactivity disorder before prescribing stimulants. (Read the full article)




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Public Attitudes Regarding the Use of Residual Newborn Screening Specimens for Research

The retention and use of residual bloodspots is a practice of many state newborn screening programs. This practice has become controversial, and little is known about public attitudes on the retention and research use of newborn residual bloodspots.

This study offers a detailed analysis of public attitudes regarding bloodspot retention and use for biomedical research. The results also offer insights on how education regarding this practice influences support for newborn screening and residual bloodspot use. (Read the full article)




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Comparison of the US and Australian Cystic Fibrosis Registries: The Impact of Newborn Screening

Registries have been established in a number of countries to monitor the health of patients with cystic fibrosis. Few international comparisons have been made between registries. International data registry comparisons may be useful for informing best practice and benchmarking.

Registry comparisons are feasible but are limited by factors such as nonstandardization of data collection. Lung function was lower in Australian children with cystic fibrosis compared with their US counterparts after adjusting for the benefits of diagnosis after newborn screening. (Read the full article)




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A Decision-Tree Approach to Cost Comparison of Newborn Screening Strategies for Cystic Fibrosis

Although it has been shown that cystic fibrosis newborn screening is beneficial, the strategies vary widely, and there has been uncertainty about the costs and consequences of different algorithms and whether screening methods/decisions should be based on assumed cost differences.

This study contributes by offering a comparison of both costs, assessed comprehensively, and the consequences associated with the 2 most popular screening methodologies, immunoreactive trypsinogen/immunoreactive trypsinogen and immunoreactive trypsinogen/DNA, by using a decision-tree framework allowing variation in the model parameters. (Read the full article)




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Effects of Description of Options on Parental Perinatal Decision-Making

Studies have found that the degree of detail with which palliative care is described and the order in which options are presented can affect end-of-life decisions. None of these studies, though, involved decisions regarding very premature infants.

Unlike other end-of-life decisions, those regarding extremely premature infants are influenced neither by the degree of detail nor order of presentation of management options. Deep-seated values embodied in the reasons given for these choices suggest why they are so robust. (Read the full article)




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Automated Primary Care Screening in Pediatric Waiting Rooms

Clinical decision support systems offer a way to help physicians use evidence-based guidelines for screening. Screening patients for common developmental, psychosocial, and behavioral issues informs the clinical decision-making process and may improve patient outcomes.

The Child Health Improvement through Computer Automation system, a clinical decision support system and an electronic medical record, is able to effectively screen patient families in the waiting room by using a tailored questionnaire. The study reveals positive screening rates for identifiable risks in a very large representative urban population by using Child Health Improvement through Computer Automation’s questionnaire. (Read the full article)




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Computer-Facilitated Substance Use Screening and Brief Advice for Teens in Primary Care: An International Trial

Primary care settings provide an important venue for early detection of substance use and intervention, but adolescent screening rates need improvement. Screening and brief interventions appear effective in reducing adult problem drinking but evidence for effectiveness among adolescents is needed.

A computer-facilitated system for screening, feedback, and provider brief advice for primary care can increase adolescent receipt of substance use screening across a variety of practice settings, and shows promise for reducing adolescents’ use of alcohol and cannabis. (Read the full article)




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Trends of Outpatient Prescription Drug Utilization in US Children, 2002-2010

A wide variety of prescription drugs are prescribed to US children. Although one of the steps in assessing the risk/benefit of therapies in the pediatric population is to understand how they are used, pediatric drug utilization is not well characterized.

By using large prescription databases, this study examines the frequency and patterns of national outpatient drug utilization (acute and chronic medications) in US infants, children, and adolescents for 2002 through 2010. (Read the full article)




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The HEADS-ED: A Rapid Mental Health Screening Tool for Pediatric Patients in the Emergency Department

The American Academy of Pediatrics prioritized detection of mental illness in children presenting to emergency departments (ED) by using standardized clinical tools. Only a minority of ED physicians indicate that they use evidence-based screening methods to assess mental health concerns.

This study presents the psychometrics of the HEADS ED (home, education, activities/peers, drugs/alcohol, suicidality, emotions/behavior, discharge resources), a brief, standardized screening tool for pediatric EDs. This tool ensures key information is obtained for decision-making, determining acuity level, and areas of need. (Read the full article)




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Effects of Systematic Screening and Detection of Child Abuse in Emergency Departments

Systematic screening for child abuse of all children presenting at emergency departments might increase the detection rate of child abuse but studies to support this proposal are scarce.

Systematic screening for child abuse in emergency departments is effective in increasing the detection of suspected child abuse. Training emergency department staff and requiring screening legally at emergency departments increase the extent of screening. (Read the full article)




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Hypertension Screening During Ambulatory Pediatric Visits in the United States, 2000-2009

The American Academy of Pediatrics and National Heart, Lung, and Blood Institute recommend routine blood pressure measurement in children. Little is known about the frequency with which blood pressure is currently measured in ambulatory pediatric settings in the United States.

Between 2000 and 2009, providers measured blood pressure during only one-third of ambulatory pediatric visits and two-thirds of pediatric preventive visits. The current rate of screening is especially low for children aged 3 to 7 years. (Read the full article)




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Unfilled Prescriptions in Pediatric Primary Care

Filling a prescription is the first step in medication adherence. Unfilled prescriptions are a documented component of nonadherence in adult and pediatric emergency departments and family practices. No one has reported the proportion of unfilled prescriptions in pediatric primary care.

This study identifies the proportion of unfilled prescriptions in a large sample of primary care pediatric patients. It describes clinical and demographic factors associated with prescription filling and suggests that electronic prescribing may improve adherence. (Read the full article)




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Performance Metrics After Changes in Screening Protocol for Congenital Hypothyroidism

Significant variation in congenital hypothyroidism screening operations/performance has been observed in the United States. The origin of this variation remains unknown, in part because of a lack of evaluation. Accordingly, debates persist about optimal screening operations including laboratory testing methods.

Four distinct screening protocols applied to Michigan resident infants are compared in detecting congenital hypothyroidism overall and specific to cases characterized by high initial thyrotropin concentrations thought to have a more severe form of the disease. (Read the full article)




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Variation in Occult Injury Screening for Children With Suspected Abuse in Selected US Children's Hospitals

Clinical guidelines for the evaluation of suspected physical abuse in young children emphasize performing radiologic imaging to screen for occult fractures. Little is known about the degree of adherence to guidelines for screening for occult fractures among pediatric hospitals.

Adherence to guidelines related to screening for occult fractures in young children diagnosed with physical abuse varies significantly among pediatric hospitals. Use of screening in infants who have injuries associated with a high likelihood of abuse also varies among pediatric hospitals. (Read the full article)




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Comparison of One-Tier and Two-Tier Newborn Screening Metrics for Congenital Adrenal Hyperplasia

The false-positive rate of newborn screening for classic congenital adrenal hyperplasia (CAH) remains high and has not been significantly improved by adjusting 17α-hydroxyprogesterone cutoff values for birth weight and/or gestational age. In response, 4 states have initiated second-tier steroid profile screening.

Under second-tier screening, the false-positive rate remains high, and classic CAH cases missed by screening (false-negatives) occur more frequently than reported. Physicians are cautioned that a negative screen does not necessarily rule out CAH. (Read the full article)




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Office-Based Randomized Controlled Trial to Reduce Screen Time in Preschool Children

Interventions to reduce screen time in preschool-aged children are promising.

A screen time intervention in 3-year-old children implemented in the primary care setting did not reduce screen time or BMI. (Read the full article)




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Informed Choice for Newborn Blood Spot Screening in the United Kingdom: A Survey of Parental Perceptions

Newborn screening is often seen as a fait accompli, even in programs that ostensibly proceed on the basis of informed choice and parental consent.

The study reports details of parental understanding, perceived ability to make an informed choice, and the availability of choice together with variables predictive of parental assessments of having made an informed choice. (Read the full article)




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Age, Academic Performance, and Stimulant Prescribing for ADHD: A Nationwide Cohort Study

The impact of relative age at school entry on academic progress and the risk of being diagnosed with ADHD remains controversial. Stimulants are widely used as a therapeutic option for ADHD in the United States and increasingly in Europe.

Relative age among classmates affects academic performance among boys and girls into puberty, as well as children’s risk of being prescribed stimulants for ADHD. This should be taken into account when evaluating children’s performance and behavior in school to prevent unnecessary stimulant prescribing. (Read the full article)




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Predictors of Persistence After a Positive Depression Screen Among Adolescents

Adolescents have high placebo response rates in depression treatment trials. Screening for depression will likely detect youth with a broad range of symptom severity, including some who would benefit from watchful waiting but might not require active treatment.

The strongest predictors of symptom persistence are depressive symptom severity at presentation and continued symptoms on repeat screening 6 weeks later. These results provide important information for the development of postscreening management protocols in the primary care setting. (Read the full article)




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Effectiveness of Developmental Screening in an Urban Setting

Developmental screening using standardized tools has been endorsed by professional groups to improve rates of identification and referral for young children who have developmental delays. Little is known about the effectiveness of these tools among a high-risk urban population.

Using a randomized design, we found that a program of developmental screening improved the percentage and time to identification of developmental delay, referral, and eligibility for early intervention among a poor, racially diverse urban population of young children. (Read the full article)




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Practical Community Photoscreening in Very Young Children

Amblyopia affects 2% to 4% of the US population and is preventable In January 2011, the US Preventive Services Task Force concluded there is insufficient evidence to support vision screening in children younger than age 3 years.

Results of the Iowa photoscreening program in 210 695 children older than 11 years suggest photoscreening reliably detects amblyogenic risk factors in children 1 to 3 years of age, and we recommend photoscreening children starting at 1 year of age. (Read the full article)




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Neonatal Visual Evoked Potentials in Infants Born to Mothers Prescribed Methadone

Impaired visual development has been reported in infants born to mothers prescribed methadone in pregnancy. Immature visual evoked potentials have been reported in this population, but data were confounded by gestation, growth restriction, and illicit drug use.

Visual evoked potentials are small and immature in infants exposed to methadone and other drugs of misuse in utero. These changes are independently associated with methadone exposure and persist after controlling for gestation, socioeconomic deprivation, alcohol consumption, and cigarette smoking. (Read the full article)




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Racial Differences in Antibiotic Prescribing by Primary Care Pediatricians

Racial disparities in health care have been reported in multiple settings, but not thoroughly examined at the clinician level. The frequent occurrence of respiratory tract infections allows the evaluation of differences in the management of children seen by the same clinician.

Racial differences in the management of common pediatric infections occur among children treated by the same clinician. Given persistent concerns about nonjudicious antibiotic use, examining racial differences may inform our understanding of prescribing practices and identify opportunities for intervention. (Read the full article)




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Characteristics of Screen Media Use Associated With Higher BMI in Young Adolescents

Rates of screen media use have risen in parallel with rates of obesity among young people. Identifying the specific characteristics of media use that are associated with obesity can help elucidate the explanatory processes and inform effective interventions.

This study examines the associations between BMI and characteristics of media use including the type of device, duration of use, and attention to the medium. The more that participants paid primary attention to television, the higher their BMI. (Read the full article)




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Factors Affecting Caregivers' Use of Antibiotics Available Without a Prescription in Peru

Self-medication with antibiotics available without prescription is among the main causes of antibiotic misuse in the developing world and is associated with antibiotic resistance. Inappropriate antibiotic prescription is common in children. Patient expectations seem to influence physicians’ advice.

This study demonstrates that even in places where antibiotics are unregulated, improving physician prescribing habits could reduce irrational use overall and also future caregiver-driven misuse. Physician training in adequate antibiotic prescription could be a cost-effective intervention in these settings. (Read the full article)




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Oxygen Saturation Nomogram in Newborns Screened for Critical Congenital Heart Disease

Universal oxygen saturation screening by pulse oximetry is now recommended for early detection of critical congenital heart disease. The distribution of saturations in asymptomatic newborns in a large population has not been described.

Our study is the largest to date to establish simultaneous pre- and postductal oxygen saturation nomograms in asymptomatic newborns at ~24 hours after birth. The mean postductal saturation is higher than preductal during this time. (Read the full article)