Mary Ann And J Milburn Smith Child Health Research Program

Chicago, IL, United States

Mary Ann And J Milburn Smith Child Health Research Program

Chicago, IL, United States
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Naureckas S.M.,Erie Family Health Center | Naureckas S.M.,Northwestern University | Zweigoron R.,Childrens Memorial Hospital | Haverkamp K.S.,Erie Family Health Center | And 6 more authors.
Translational Behavioral Medicine | Year: 2011

Overweight and obesity are common challenges facing pediatric clinicians. Electronic health records (EHRs) can impact clinician behavior through the presentation of relevant, patient-specific information during clinical encounters, potentially improving clinician recognition and management of overweight/obesity in children. Little research has been published evaluating the impact of EHR-facilitated decision support on the treatment of obesity in children. The main objectives of our community clinician-led project are: 1) to build customized, evidence-based decision support into an EHR; 2) To evaluate the impact of decision support on the identification and treatment of overweight and obese children; and 3) to improve behavior around screening for obesity-related comorbidities. Through a clinician-led consensus process, we customized end user templates in the commercially-available EHR at an urban community health center with a known high prevalence of childhood overweight and obesity. Evidence based decision support was build into the screens to prompt clinicians to identify and address overweight and obesity, as well as for related comorbidities. Pre/post measures will be used to evaluate the impact of these tactics on clinician behavior. The customized EHR templates took longer than anticipated to develop, but are now being used by pediatric clinicians at the health center. Feedback to date suggests that clinicians find the evidence based decision support useful at the point of care, especially around ordering recommended screening tests. Clinicians must be active participants in the design of decision support in order for it to impact their behavior. Off-the-shelf EHR products do not automatically come with comprehensive functionality to support evidence-based interventions around clinician behavior. Modifications are needed to achieve the full promise of health information technology as it relates to delivering high quality, patient-centered, for underserved populations. © 2011 Society of Behavioral Medicine.

Mason M.,Mary Ann And J Milburn Smith Child Health Research Program
Ethnicity and Disease | Year: 2011

Objective: To describe the challenges, including sociocultural and socioeconomic barriers, faced by an urban immigrant population in the United States affected by thalassemia major. Design: Ethnographic, semi-structured, 1-on-1 interviews using an interview guide developed for this study. Digital recordings were transcribed and data analyzed using constant comparative method. Setting: University-based, Comprehensive Thalassemia Program at Children's Memorial Hospital, Chicago, IL, USA. Participants: Fourteen Southeast Asian and Asian Indian parents of children with transfusion dependent thalassemia. Main Outcome Measure: Qualitative descriptions of parental experiences, frequency of codes applied to interviews and emergent themes. Results: Thalassemia has its greatest impact on the emotional and social well-being of affected children and their parents. Current and future concerns were related to disease-specific complications and challenges with management such as transfusions and chelation therapy. These perceptions were tied to parental hope for a cure, a frequently coded coping mechanism. Despite their availability, few parents relied on support systems beyond immediate family members due to perceived public knowledge gaps about thalassemia. Culturally based past experiences and barriers did not emerge as dominant themes in our analysis. Conclusion: The impact of thalassemia is tremendous for affected children and their parents and is due more to factors that were either disease-specific or common to other chronic disease models rather than those influenced by culture. The unmet needs of these families require additional investigation to facilitate the development of initiatives aimed at improving quality of life and lessening overall impact of thalassemia.

Lavigne J.V.,Ann & Robert H Lurie Childrens Hospital Of Chicago | Lavigne J.V.,Northwestern University | Lavigne J.V.,Mary Ann And J Milburn Smith Child Health Research Program | Lavigne J.V.,Childrens Hospital Of Chicago Research Center | And 2 more authors.
Current Gastroenterology Reports | Year: 2016

Functional abdominal pain (FAP) occurs frequently in pediatric patients. Lacking clear biomarkers, clinicians and researchers must rely on patient reports of pain intensity. Presently, there are challenges affecting our ability to use existing measures of self-reported pediatric pain intensity. This report discusses those challenges, finding that: (a) inter-rater agreement of children’s pain intensity is generally low; (b) typically used approaches to measuring outcomes may yield high levels of unreliable reports of improvement; (c) a distribution-based approach involving the calculation of a reliable change index can produce results that classify individuals as improved reliably, but this approach needs to be combined with another approach that ensures the findings will be clinically meaningful as well; (d) clinical trials for FAP rarely report findings about how many individuals improve in a statistically reliable, clinically meaningful manner; and (e) more information about the test–retest reliability of commonly used measures is needed to accurately gauge treatment-related improvement. © 2016, Springer Science+Business Media New York.

Ariza A.J.,Childrens Memorial Hospital | Ariza A.J.,Mary Ann And J Milburn Smith Child Health Research Program | Ariza A.J.,Northwestern University | Ruch-Ross H.,Mary Ann And J Milburn Smith Child Health Research Program | And 12 more authors.
Journal of Pediatrics | Year: 2012

We evaluated pediatric obesity clinics for internal referrals developed at 5 primary care offices. Clinics developed site-specific strategies: 1 group approach and 4 clinics providing individualized care only. Clinicians reported patient/family motivation as an important referral consideration and compliance as the greatest challenge and perceive clinics to have provided some help. Copyright © 2012 Mosby Inc. All rights reserved.

Greenberg R.S.,Childrens Memorial Hospital | Greenberg R.S.,Northwestern University | Ariza A.J.,Childrens Memorial Hospital | Ariza A.J.,Northwestern University | And 4 more authors.
Clinical Pediatrics | Year: 2010

Objective. To examine associations between activity and dietary habits reported by mothers for themselves and their children aged 2 to 11 years. Design/Methods. Cross-sectional, consecutive samples of parents at 13 primary care practices were surveyed on health behaviors. Survey questions were used to define 5 "healthy" habits: lowfat milk choice; low fast food use; low weekend screen time; low juice/sweet drinks intake; and high-frequency physical activity. Mixed-effects logistic regression models were applied. Results. Responses from a socioeconomically diverse group of 2115 mothers were analyzed. For each healthy behavior self-reported by the mother, the odds of the healthy behavior being reported for the child were significantly higher (range: odds ratio [OR] = 3.2 for high-frequency physical activity to OR = 19.7 for low-fat milk choice). Conclusions. Mothers and children often have similar health habits. The impact of clinician counseling for children may be strengthened by promotion of healthy habits for their mothers. © The Author(s) 2010.

Lavigne J.V.,Northwestern University | Lavigne J.V.,Mary Ann And J Milburn Smith Child Health Research Program | Lavigne J.V.,Childrens Memorial Hospital | Gouze K.R.,Northwestern University | And 5 more authors.
Journal of Abnormal Child Psychology | Year: 2012

Few studies have been designed to assess the pathways by which risk factors are associated with symptoms of psychopathology across multiple domains, including contextual factors, parental depression, parenting, and child characteristics. The present study examines a cross-sectional model of risk factors for symptoms of Oppositional Defiant Disorder (ODD) in a diverse community sample of 796 four-year-old children. In the best-fitting model: (a) SES had indirect effects on contextual factors of stress and conflict, parental depression, and parenting factors including hostility, support, and scaffolding; (b) stress and conflict had both direct effects on ODD symptoms, and indirect effects via parental depression and parenting; (c) parenting had direct effects on ODD symptoms and indirect effects via child effortful control (EC), negative affect (NA) and sensory regulation (SR); (c) NA, EC, and SR had direct effects on symptom frequency, and attachment had indirect effects via EC, and SR. These results highlight the importance of using a multi-domain model to examine risk factors for symptoms of ODD, and also provide information about areas to target in treatment. © Springer Science+Business Media, LLC 2011.

Lavigne J.V.,Childrens Memorial Hospital | Lavigne J.V.,Mary Ann And J Milburn Smith Child Health Research Program | Saps M.,Childrens Memorial Hospital | Bryant F.B.,Loyola University Chicago
Journal of Pediatric Psychology | Year: 2012

Objective Pediatric somatization studies have used the 35-item Child Somatization Inventory (CSI-35) or psychometrically refined 24-item CSI (CSI-24). Exploratory factor analysis of the CSI-24 has identified a single factor that did not show good model fit in confirmatory factor analysis (CFA). Further evaluation of the CSI-24 factor structure is needed. Methods The present study examined alternative factor structures of the CSI-24 in a community sample (N=233, ages 8-15). Results The CFA showed good fit for a single CSI-24 factor, better fit for multiple factor models, and best fit for a single, six-item factor. Construct validity for that factor was found in significant correlations with anxiety, depression, functional disability, and quality of life. Conclusions Results are consistent with a single somatization factor, but research is needed to verify the factor structure in different, race/ethnic/demographic, and clinical groups. © 2011 The Author.

Ibarra M.F.,Childrens Memorial Hospital | Ibarra M.F.,Northwestern University | Klein-Gitelman M.,Childrens Memorial Hospital | Klein-Gitelman M.,Northwestern University | And 11 more authors.
Clinical and Vaccine Immunology | Year: 2011

The objective of this study was to retrospectively evaluate the utility of serum neopterin as a diagnostic marker of hemophagocytic lymphohistiocytosis (HLH). The medical records of patients diagnosed with HLH (familial and secondary) between January 2000 and May 2009 were reviewed retrospectively, and clinical and laboratory information related to HLH criteria, in addition to neopterin levels, was recorded. A group of 50 patients with active juvenile dermatomyositis (JDM) (who routinely have neopterin levels assessed) served as controls for the assessment of the accuracy, sensitivity, and specificity of neopterin as a diagnostic test for HLH. The Pearson correlation was used to measure the association between serum neopterin levels and established HLH-related laboratory data. Serum neopterin levels were measured using a competitive enzyme immunoassay. During the time frame of the study, 3 patients with familial HLH and 18 patients with secondary HLH were identified as having had serum neopterin measured (all HLH patients were grouped together). The mean neopterin levels were 84.9 nmol/liter (standard deviation [SD], 83.4 nmol/liter) for patients with HLH and 21.5 nmol/liter (SD, 10.13 nmol/liter) for patients with JDM. A cutoff value of 38.9 nmol/liter was 70% sensitive and 95% specific for HLH. For HLH patients, neopterin levels correlated significantly with ferritin levels (r = 0.76, P = 0.0007). In comparison to the level in a control group of JDM patients, elevated serum neopterin was a sensitive and specific marker for HLH. Serum neopterin has value as a diagnostic marker of HLH, and prospective studies are under way to further evaluate its role as a marker for early diagnosis and management of patients. Copyright © 2011, American Society for Microbiology. All Rights Reserved.

Zweigoron R.T.,Ann And Robert H Lurie Childrens Hospital Of Chicago | Zweigoron R.T.,Northwestern University | Binns H.J.,Ann And Robert H Lurie Childrens Hospital Of Chicago | Binns H.J.,Northwestern University | And 3 more authors.
Pediatrics | Year: 2012

BACKGROUND AND OBJECTIVES: Filling a prescription is the important first step in medication adherence, but has not been studied in pediatric primary care. The objective of this study was to use claims data to determine the rate of unfilled prescriptions in pediatric primary care and examine factors associated with prescription filling. METHODS: This retrospective observational study of pediatric primary care patients compares prescription data from an electronic medical record with insurance claims data. Illinois Medicaid provided claims data for 4833 patients who received 16 953 prescriptions during visits at 2 primary care sites over 26 months. Prescriptions were compared with claims to determine filling within 1 day and 60 days. Clinical and demographic variables significant in univariate analysis were included in logistic regression models. RESULTS: Patients were 51% male; most (84%) spoke English and were African American (38.7%) or Hispanic (39.1%). Seventy-eight percent of all prescriptions were filled. Among filled prescriptions, 69% were filled within 1 day. African American, Hispanic, and male patients were significantly more likely to have filled prescriptions. Younger age was associated with filling within 1 day but not with filling within 60 days. Prescriptions for antibiotics, from one of the clinic sites, from sick/follow-up visits, and electronic prescriptions were significantly more likely to be filled. CONCLUSIONS: More than 20% of prescriptions in a pediatric primary care setting were never filled. The significant associations with clinical site, visit type, and electronic prescribing suggest system-level factors that affect prescription filling. Development of interventions to increase adherence should account for the factors that affect primary adherence. Copyright © 2012 by the American Academy of Pediatrics.

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