Timeliness of Immunizations in CenteringParenting.

OBJECTIVE: To evaluate the timeliness of immunizations of children in CenteringParenting (Centering), a group well-child model, compared to children in individual well-child care. METHODS: We conducted a retrospective cohort study of infants born October 1, 2014 to February 18, 2019 with a 2-month and subsequent well-child visit, both Centering or individual, at an academic pediatric practice in an urban, low-income community. In Centering, same age infants/mothers and a provider meet for 10, 2-hour group visits, and facilitated discussions. Providers are trained in group facilitation and participate in both Centering and individual visits. Primary outcome was timeliness of immunizations at 7, 13, 19, and 25 months. Analyses were by intention to treat. RESULTS: The study population included 1735 children (Centering n = 342, individual n = 1393). By 25 months, 62% of children in Centering were up to date with all recommended immunizations compared to 44.2% of children in individual care, a 17.8% higher rate (P < .001). By 25 months, children in Centering made 3 additional well-child visits (9.2 vs 6.2, P < .001). Mediation analysis showed 82% of the effect on up to date status was due to increased attendance to well-child visits (P < .001); the remaining 18% was due to a Centering effect beyond the visit increase. CONCLUSIONS: Our study showed a strong association of CenteringParenting with timeliness of immunizations and adherence to well-child visits compared to individual visits in a low income community. These findings warrant further exploration of the impact of Centering in reducing health disparities in communities at risk.

Children who engaged in interpersonal problematic sexual behaviors.

BACKGROUND: Over one-third of inappropriate sexual contact experienced by children is initiated by other children. Many studies examined child initiators (CIs) of interpersonal problematic sexual behaviors (IPSBs). This study uniquely links CI information with types of sexual contact as described by children they engaged in IPSBs. OBJECTIVE: Describe CIs' characteristics and types of sexual acts they initiated. PARTICIPANTS/SETTING: Medical charts of CIs and children they engaged in IPSBs. Examinations occurred between 2002 and 2013. METHODS: Retrospective chart review. RESULTS: Most CIs were male (83%) and related to the child they engaged in IPSBs (75%); mean age was 10 years (range 4-17); 58% reported viewing sexually explicit media; 47% experienced sexual abuse. Most CIs (68%) engaged in multiple types of IPSBs. Children who experienced IPSBs initiated by males reported engagement in greater numbers of invasive acts (t(216) = 2.03, p = .043). Older CIs were more likely than younger CIs to report viewing sexually explicit media (χ2(1) = 7.81, p = .007) and those who did were more likely to initiate more invasive acts (t(169) = 2.52, p = .013) compared to CIs who did not. CONCLUSIONS: In this study, most CIs were young and experienced multiple adverse events; the most common types of IPSBs were invasive; and over half the CIs had been exposed to sexually explicit media, which was associated with initiating invasive sexual acts. These findings suggest aiming prevention efforts at young children to help them manage exposure to sexually explicit media and redress victimization experiences.

Qualitative Evaluation of Individual and Group Well-Child Care.

OBJECTIVE: Individual well care (IWC) is the standard delivery model for well-child care in the United States. Alternative models, such as group well care (GWC), may create opportunities to enhance care for babies. The purpose of this study was to evaluate parents' perceptions of social/wellness benefits and system challenges of IWC and GWC. METHODS: Since 2014, we have provided both IWC and GWC at an urban academic practice serving a low-income minority community. We conducted a mixed method study involving surveys and 18 focus groups (11 IWC groups, n = 32 parents; 7 GWC groups, n = 33 parents). Parents completed surveys before convening focus group discussions. Survey results were analyzed using independent t tests; focus groups were digitally recorded, transcribed, and analyzed to identify themes. RESULTS: Both groups had similar demographics: parents were mostly female (91%) and black (>80%); about half had incomes < $20,000. Parents' mean age was 27 years; children's mean age was 11 months. There were no significant differences in overall scores measuring trust in physicians, parent empowerment, or stress. IWC parents' themes highlighted ways to improve care delivery, while GWC parents highlighted both satisfaction with care delivery and social/wellness benefits. GWC parents strongly endorsed this model and reported unique benefits, such as garnering social support and learning from other parents. CONCLUSIONS: Parents receiving both models of care identified ways to improve primary care delivery. Given some of the benefits reported by GWC parents, this model may provide the means to enhance resilience in parents and children in low-income communities.

Change in childhood lead exposure prevalence with new reference level.

In 2012, the Centers for Disease Control and Prevention changed the "actionable" reference blood lead level from 10 µg/dL to 5 µg/dL, representing the highest 2.5 percentile of lead levels nationwide. In a high-risk urban community, the prevalence of children classified as lead exposed increased ninefold, from 1% to 9.1% (p < .0001) with the new reference level. This dramatic increase in the prevalence of children newly classified as lead exposed will require additional health care and public health resources for tracking, surveillance, and home lead abatement.

Urogenital symptoms after sexual abuse vs irritant contact in premenarchal girls.

OBJECTIVES: Sexually abused (SA) girls report urogenital symptoms temporally related to inappropriate genital contact. Since girls also experience symptoms following genital irritant exposure and mostly all girls are exposed to genital irritants, we describe overall symptoms reported by girls that disclosed SA compared to those that did not and we compare how girls describe symptoms following a specific episode of contact SA vs a genital irritant exposure. DESIGN: Cross-sectional study. Parents/girls interviewed; medical records reviewed. PARTICIPANTS: Five to 12-year-old premenarchal girls/parents. SETTING: An urban and a suburban pediatric practice; a regional treatment center for child abuse. OUTCOME MEASURES: Prevalence of histories of urogenital symptoms in SA girls compared to girls attending well-child exams (controls); girls' description of urogenital symptoms following specific episodes of contact SA compared to specific episodes of genital irritant exposure. RESULTS: More parents/girls in SA group reported prior urogenital symptoms. Most SA girls said past symptoms were caused by inappropriate genital touching; most control girls could not identify causes for prior symptoms. Girls' responses following specific irritant exposures: 76% SA vs 24% control girls used negative terms to describe how it felt, 69% SA vs 6% control girls said it bothered her body and her feelings, and 33% SA vs 12% control girls described experiencing dysuria afterwards (all ps < 0.05). CONCLUSIONS: Girls can relate urogenital symptoms to specific genital contacts; more SA girls reported unpleasant symptoms with an emotional component. A skilled medical history can help differentiate these conditions and diagnose sexual abuse with greater certainty.

Urogenital symptoms in premenarchal girls: parents' and girls' perceptions and associations with irritants.

OBJECTIVES: Premenarchal girls commonly seek care for urogenital symptoms, yet little is published about parents' and girls' perceived causes of symptoms or associations with irritant exposures. We sought to describe urogenital symptoms, perceived causes, and associations between symptoms and genital irritant exposures. DESIGN: Descriptive study. Parents/girls interviewed; medical records reviewed. PARTICIPANTS: Five- to 12-year-old well, premenarchal girls and their parents. SETTING: One urban and 1 suburban pediatric practice. OUTCOME MEASURES: Prevalence of histories of urogenital symptoms and perceived causes; association between symptoms and exposure to genital irritants in a well population. RESULTS: Of 191 parent/girl dyads, 33% of parents and 48% of girls reported girls' histories of urogenital symptoms not attributed to urinary tract infections or trauma. Perceived causes: poor hygiene (29% of parents vs 14% of girls); soap products (20% of parents and girls); none identified (24% of parents vs 53% of girls). Analysis of symptoms versus irritant exposures demonstrated these associations: dysuria and genital soreness with poor genital hygiene, tight garments, or exposure to soap products; genital pruritus with poor hygiene (all P < .05). No symptoms were associated with nylon underwear, tights, or bike or horseback riding. Vaginal discharge was not associated with any irritants. CONCLUSION: Almost half the girls had histories of urogenital symptoms. Poor hygiene and soap exposure were perceived causes of most symptoms. When no cause for urogenital symptoms is identified, treatment should be focused on hygiene, soap exposure, and tight-fitting clothes, not on bike or horseback riding or wearing nylon underwear or tights. Vaginal discharge warrants further evaluation.

Psychosocial factors and health perceptions in parents and children who are overweight or obese.

This study examined the relationships among weight status (BMI), health perceptions, and psychosocial characteristics in children, parents, and parent-child dyads. A convenient sample of 114 parent-child dyads participated. All children were overweight or obese. Parents and children completed questionnaires by self-report or interview. Questionnaires included the Parenting Stress Index-Short Form (PSI), the Parents' Stage of Change (SOC) Questionnaire, and the Pediatric Quality of Life Inventory (PedsQL). Child's mean age was 10.34 years (s.d. = 1.87), mean BMI was 28.13 kg/m(2) (s.d. = 5.46), and mean BMI z-score was 2.17 (s.d. = 0.38). Parent mean age was 37.28 years (s.d. = 12.66) and mean BMI was 34.07 kg/m(2) (s.d. = 8.18). Most parents (68.5%) reported that they and their children (70.7%) were African American and many (44.3%) reported that they and their children were Hispanic. Significant correlations included: child health perceptions and child BMI (r = 0.309, P < 0.001) and parent perception of weight and parent BMI (r = 0.691, P < 0.001). For parent-child dyads, one correlation approached significance (child health perceptions and parent stage of change (r = -0.269, P < 0.01). Findings suggest that characteristics of parent-child dyads may be important considerations in the management of childhood obesity.

Girls who disclose sexual abuse: urogenital symptoms and signs after genital contact.

BACKGROUND: Little information is available about idiosyncratic historical details provided by sexually abused girls, yet this information can help medical professionals diagnose sexual abuse. OBJECTIVES: Our goals were to describe types and frequencies of urogenital symptoms/signs reported by girls who disclosed direct genital contact and to explore factors associated with this reporting. METHODS: We reviewed 161 medical charts of 3- to 18-year-old girls who disclosed sexual abuse by direct genital contact for urogenital symptoms/signs, type of genital contact (oral, object, digital, or genital), time interval between last perpetrator contact and physical examination, age and sexual maturity at the time of last perpetrator contact, genital findings, and other medical diagnoses. Regression analyses were performed to determine factors that were most predictive of symptom/sign reporting. RESULTS: Many of the girls reported multiple types of genital contact; 33% reported oral/object-genital contact, 72% reported digital-genital contact, and 55% reported genital-genital contact. Sixty percent of the girls reported experiencing >or=1 symptom/sign; 53% of the total sample had genital pain, 37% had dysuria, and 11% had genital bleeding. Symptoms/signs were highly associated with genital-genital contact: 48% of the girls reporting genital-genital contact had dysuria compared with 25% of girls not reporting genital-genital contact, 72% had genital pain/soreness compared with 32% not reporting genital-genital contact, and 16% had bleeding compared with 4% of those not reporting genital-genital contact. Using regression analysis, the strongest factor predictive of symptom reporting by the girls was genital-genital contact. CONCLUSIONS: Sexually abused girls who experienced direct genital contact frequently reported symptoms related to the abusive episode. These symptoms were reported most frequently with genital-to-genital contact. This information sheds some light on the mechanism of injury leading to symptom reporting and can be used to further study symptoms/signs reported by sexually abused girls compared with the general population.

Evaluation and comparison of a 1-month versus a 2-week community pediatrics and advocacy rotation for pediatric residents.

This prospective study was conducted to assess the effects of a 4-week community pediatrics and advocacy rotation with a unique project (Curriculum A), a 2-week community pediatrics rotation with advocacy training and unique project throughout residency (Curriculum B), or no curriculum exposure on residents' attitudes, perceived competence, knowledge, and behaviors. A 27-item questionnaire was used to assess attitudes, competence, and knowledge. Examination of residents' patients' use of Early Intervention services during the 5-year period after curricula introduction assessed behaviors. Seventy percent of questionnaires distributed over several years were completed by 105 of 111 eligible residents. Residents exposed to Curriculum A or B demonstrated improved competence and knowledge but no significant increase in positive attitudes toward community pediatrics and advocacy. Residents' patients' use of Early Intervention services increased 65% during the 5-year period after curriculum introduction. No significant differences in outcome measures were observed between Curriculum A and Curriculum B.

A videotape to improve parental knowledge of lead poisoning.

BACKGROUND: Disadvantaged children are at high risk for lead poisoning. Their parents often have poor knowledge of lead poisoning and do not know how to prevent lead poisoning in their child. OBJECTIVE: To assess an educational videotape's impact on parental knowledge and behavior about lead poisoning. DESIGN: Prospective study by self-administered parental survey immediately before (pretest) and after (posttest 1) well visits and mailed 2-4 weeks later (posttest 2). The intervention group watched the videotape immediately after the pretest. SETTING: Pediatric clinic in tertiary care hospital. PARTICIPANTS: Consecutive sample of parents of 6-month-old to 6-year-old children (n = 146). MAIN OUTCOME MEASURES: Survey included demographic questions, the shortened Chicago Lead Knowledge Test (sCLKT), and questions about parental behaviors. RESULTS: Mean pretest scores were 5.8 (SD, 2.8) and 5.3 (SD, 2.2), posttest 1 scores were 6.0 (SD, 2.6) and 10.6 (SD, 2.1), and posttest 2 scores were 6.1 (SD, 2.8) and 9.5 (SD, 2.8) of 14 in the control and intervention groups, respectively. Control and intervention group posttest 1 and posttest 2 score differences were statistically significant (P <.05). Intervention group parents reported more frequent washing of their child's hands (P <.05) and windows, walls, or floors at study completion (P <.05). CONCLUSIONS: The videotape significantly increased sCLKT scores and behaviors that may decrease children's risk of developing lead poisoning. Improvement persisted throughout the study period.