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Objective: To evaluate the usability of touchscreen mediated nutrition and feeding educational modules among low-income Latino immigrant parents.Methods: A cross-sectional study was performed March-August, 2010 in an outpatient pediatric setting among low-income Spanish-speaking parents of children < 3 years. Culturally-targeted educational modules focused on infant/toddler nutrition and feeding were delivered via touchscreen to participants in Spanish using a multimedia format including text, audio and pictures. Viewing of all modules lasted 25 minutes. Demographic and computer use data was collected. The outcomes assessed were perceived ease of use of the touchsreen and usefulness of the educational modules.Results: The majority of the eighty participants reported rarely/never using a computer (64%; n=51) and 46% reported ≤ 8th grade education. 92% of participants found the touchscreen 'easy'/'very easy' to use. Nearly all users found the modules 'useful' (95%) and 'easy' to understand (96%). Higher educated individuals were more likely to find the touchscreen 'very easy' versus 'easy' to use (Odds Ratio=3.67, 95% CI:1.18-11.43) and the modules 'very easy' to understand (OR=3.99, 95% CI:1.37-11.62).Conclusions: Despite low computer experience levels, participants perceived touchscreens and the content presented as highly usable. Ongoing evaluation of providing targeted health education via touchscreens in this population is indicated. [ABSTRACT FROM AUTHOR]

Insect bites and the associated hypersensitivity reactions known as papular urticaria account for a significant number of all referrals from pediatricians and dermatologists to our pediatric dermatology clinic. Unfortunately, children affected by these eruptions are frequently misdiagnosed and often subject to expensive evaluations including invasive and unnecessary procedures. Here we review the course of 4 children with the typical physical findings and natural history of these reactions. On the basis of our clinical findings and experience with this patient population, we propose a set of principles (termed 'SCRATCH') as clinical features to aid clinicians in making an early and accurate clinical diagnosis. We conclude that a more appropriate term for future study and diagnosis of this entity is insect bite-induced hypersensitivity. [ABSTRACT FROM AUTHOR]

Objective: To describe the Coronovirus 19 (COVID-19) pandemic impact among mothers of young children (0-8 years) and assess prepandemic factors associated with greater pandemic impact and psychosocial distress., Methods: Mothers from 3 US birth cohorts (n = 301, mean child age 2.4 years) reported on demographics and psychosocial distress (anxiety, perceived stress, financial stress) before the pandemic (February 2015-February 2020). During the pandemic (July 2020-June 2021), they completed a supplemental survey about the impact of the pandemic on their families (Coronavirus Impact Scale) and psychosocial distress. Multivariable linear and ordinal logistic regression were used to evaluate prepandemic factors associated with pandemic impact overall and by domain., Results: Compared to prepandemic reports, maternal anxiety symptoms increased by 9.4%, perceived stress increased by 13.3%, and financial stress increased by 41.7%, of which all were statistically significant changes. Participants reported the most severe pandemic impact in family routines (72.4%), experiences of stress (40.2%), and social support (38.6%). Mothers with some college or a 4-year degree experienced higher overall pandemic impact compared to mothers with the least and highest education. Prepandemic distress was not associated with pandemic impact; however, midpandemic, all 3 distress measures were significantly positively associated with overall Coronavirus Impact Scale, with the largest effect size noted for perceived stress (B = 1.36, 95% CI: 0.90,1.82)., Conclusions: While, on average, mothers of young children experienced worsening psychosocial stress during the COVID-19 pandemic, prepandemic psychosocial stress alone was not prospectively associated with greater pandemic impact, suggesting that the COVID-19 pandemic may have both elaborated existing systemic social inequalities and created new burdens., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships, which may be considered as potential competing interests: Sara Johnson reports that financial support was provided by the National Institutes of Health. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: Anxiety symptoms increase for some mothers in the perinatal period. Little is known about how increasing anxiety relates to infant feeding beliefs or weight-for-length. We examined relationships between clinically meaningful increases in maternal anxiety symptoms and perceptions of infant feeding behaviors and weight-for-length., Methods: Participants were 237 mothers with singleton pregnancies enrolled from obstetric care between 2015 and 2020 who completed the Infant Feeding Questionnaire (IFQ) at 6 months. Anxiety symptoms were measured during pregnancy (M = 24.6 weeks, SD = 6.3) and 6 weeks postpartum using the PROMIS-6A. Linear regression was used to test associations of prenatal, postpartum, or clinically meaningful increases in anxiety symptoms (ie, 3T-score increase) with two outcomes: IFQ (seven factors) and infant weight-for-length at age 6 months., Results: Prenatal symptoms were unrelated to IFQ factors. Postpartum symptoms predicted IFQ factors related to worry, such as concern for infant undereating/becoming underweight (B = 0.012, P = .02). Increasing symptoms predicted worry-related concerns as well as concern for infant hunger (B = 0.60, P ≤ .01) and greater preference for feeding on a schedule (B = 0.65, P ≤ .01). In a model including both increasing symptoms and postpartum symptoms, increasing anxiety symptoms drove associations with IFQ factors (eg, preference for feeding on a schedule, (B = 0.81, P = .01). Anxiety was unrelated to infant weight-for-length at 6 months., Conclusions: Clinically meaningful increases in anxiety symptoms were associated with feeding beliefs related to worry. Increasing anxiety was a better predictor of feeding beliefs than the presence of pre- or postpartum symptoms alone. Mothers with increasing anxiety may benefit from support establishing health-promoting infant feeding practices., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Food insecurity is a public health concern associated with poor health. Evidence guiding how to best implement screening for food insecurity across a pediatric health care system is lacking. We performed a single-center, multi-department, cross-sectional study of caregivers and health care providers in outpatient and inpatient settings to describe the beliefs, barriers, preferences, and preferred food insecurity screening location. Most providers and caregivers underestimated the pervasiveness of food insecurity while acknowledging the benefit of screening. Caregivers are overall receptive to food insecurity screening and disagree with feelings of discomfort or shame when disclosing food insecurity status. Providers acknowledged perceived caregiver discomfort, lack of community food resources, and lack of a validated screening tool as barriers to screening. Both caregivers and providers identified the primary care setting as the preferred screening setting., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Human immunodeficiency virus (HIV) burden among Florida adolescents and young adults (AYA, aged 13-24 years), particularly in Tampa Bay, is among the highest in the nation. We sought to determine the association between zip code-level test site accessibility and AYA HIV burden, compare this association with adult (aged 25-44 years) HIV burden, and identify local AYA HIV testing deserts. We further aimed to identify the association between test site accessibility and population-level markers of social disadvantage., Methods: We geocoded HIV test sites and determined the percent surface area per zip code within 15-minute walking distance to ≥ 1 test sites (PSA15) in Pinellas and Hillsborough counties. We calculated Pearson's correlation coefficients for the association of PSA15 and HIV burden by age group and, separately, the association of PSA15 and population-level characteristics., Results: Of the 96 zip codes analyzed, 36.5% had a PSA15 for HIV testing of 0%. The association between PSA15 and HIV burden was substantially higher for adults (r = 0.51, p < .001) than for AYA (r = 0.09, p = .38). Overall, we identified four potential AYA testing deserts. We also found that greater PSA15 was correlated with greater %Black/African-American residents (r = 0.32, p = .002), greater %residents living in poverty (r = 0.27, p = .008), and lower child opportunity index scores (r = -0.29, p = .004)., Discussion: Walking-accessible HIV test sites in Tampa Bay were limited and geographically distributed largely based on adult HIV burden, population-level markers of social disadvantage, and among areas with higher percentages of Black/African-American residents. Test site distribution was less correlated with AYA HIV burden, leaving this population vulnerable across multiple testing deserts., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Maternal exposure to childhood adversity is associated with detrimental health outcomes throughout the lifespan and may have implications for offspring. Evidence links maternal adverse childhood experiences (ACEs) to detrimental birth outcomes, yet the impact on the infant's epigenome is unclear. Moreover, maternal sleep habits during pregnancy may influence this association. Here, we explore whether restless sleep during pregnancy moderates the association between exposure to maternal childhood adversity and infant epigenetic age acceleration in 332 mother-infant dyads (56% female; 39% Black; 25% Hispanic). During the 2 nd trimester, mothers self-reported childhood adversity and past-week restless sleep; DNA methylation from umbilical vein endothelial cells was used to estimate five epigenetic clocks. Multivariable linear regression was used to test study hypotheses. Despite no evidence of main effects, there was evidence of an interaction between maternal ACEs and restless sleep in predicting infant epigenetic age acceleration using the EPIC Gestational Age clock. Only infants whose mothers reported exposure to both ACEs and restless sleep demonstrated accelerated epigenetic aging. Results provide preliminary evidence that maternal childhood adversity and sleep may influence the infant epigenome., Competing Interests: Conflict of Interest: The authors declare that they have no competing interests.

Objective: This report is of the construction and initial psychometric properties of the Coronavirus Impact Scale in multiple large and diverse samples of families with children and adolescents. The scale was established to capture the impact of the coronavirus pandemic during its first wave. Differences in impact between samples and internal structure within samples were assessed., Method: A total of 572 caregivers of children and adolescents or expecting mothers in diverse clinical and research settings completed the Coronavirus Impact Scale. Samples differed in regard to developmental stage, background, inpatient/outpatient status, and primary research or clinical setting. Model free methods were used to measure the scale's internal structure and to determine a scoring method. Differences between samples in specific item responses were measured by multivariate ordinal regression., Results: The Coronavirus Impact Scale demonstrated good internal consistency in a variety of clinical and research populations. Across the groups studied, single, immigrant, predominantly Latinx mothers of young children reported the greatest impact of the pandemic, with noteworthy effects on food access and finances reported. Individuals receiving outpatient or inpatient care reported greater impacts on health care access. Elevated scores on the Coronavirus Impact Scale were positively associated with measures of caregiver anxiety and both caregiver- and child-reported stress at a moderate effect size., Conclusion: The Coronavirus Impact Scale is a publicly available scale with adequate psychometric properties for use in measuring the impact of the coronavirus pandemic in diverse populations., (© 2023 The Author(s).)

Background: To examine whether financial stress during pregnancy mediates the association between maternal exposure to adverse childhood experiences (ACEs) and three birth outcomes (i.e., gestational age, birth weight, and admission to the neonatal intensive care unit [NICU])., Methods: Data were obtained from a prospective cohort study of pregnant women and their infants in Florida and North Carolina. Mothers (n = 531; M age at delivery = 29.8 years; 38% Black; 22% Hispanic) self-reported their exposure to childhood adversity and financial stress during pregnancy. Data on infant gestational age at birth, birth weight, and admission to the NICU were obtained from medical records within 7 days of delivery. Mediation analysis was used to test study hypotheses, adjusting for study cohort, maternal race, ethnicity, body mass index, and tobacco use during pregnancy., Results: There was evidence of an indirect association between maternal exposure to childhood adversity and infant gestational age at birth (b = -0.03, 95% CI = -0.06 - -0.01) and infant birth weight (b = -8.85, 95% CI = -18.60 - -1.28) such that higher maternal ACE score was associated with earlier gestational age and lower infant birth weight through increases in financial distress during pregnancy. There was no evidence of an indirect association between maternal exposure to childhood adversity and infant NICU admission (b = 0.01, 95% CI = -0.02-0.08)., Conclusions: Findings demonstrate one pathway linking maternal childhood adversity to a potentially preterm birth or shorter gestational age, in addition to low birth weight at delivery, and present an opportunity for targeted intervention to support expecting mothers who face financial stress., (© 2023. The Author(s).)

Introduction: Recent calls to action have urged graduate medical education leaders to develop health equity-focused curricula (HEFC) to redouble efforts to promote pediatric HE and address racism. Despite this call, examples of HEFC for pediatric residents are lacking. Such curricula could catalyze educational innovations to address training gaps., Objective: To describe the design, content, and delivery of "Leaders in Health Equity (LHE)," an innovative HEFC delivered to categorical pediatric residents using multi-modal, service-free retreats., Methods: This single institution, longitudinal curriculum study occurred between 2014 and 2020 and reports multi-level outcomes including: (1) impact on trainee's health equity related knowledge, skills and satisfaction, (2) residency impact and (3) institutional impact. Educational approaches used related to design, content and delivery are summarized and detailed., Results: Trainees ( n  = 72) demonstrated significant improvements in pre-post knowledge and skills related to HE content. Residents also reported increased desire for advanced HE content over the course of the 6-year study period. Residency impact on operations and resources were sustainable with the opportunity for integration of LHE content in other curricular and training areas noted. Institutional impact included catalyzing organizational HE initiatives and observing an increase in resident-led quality improvement (QI) projects focused on LHE content., Conclusions: On-going adaptation and growth of LHE content to educate increasingly prepared pediatric trainees is a critical next step and a best practice for educators in this evolving field. Developing HEFC within pediatric training programs using a longitudinal, leadership-centered approach may be an effective educational strategy in addressing pediatric health disparities., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Hernandez, Thompson and Cowden.)

Purpose: Subjective social status (SSS), perceived social standing relative to others, has been associated with health status, independent of objective socioeconomic status (SES). Few studies have examined the relationship of prenatal maternal SSS with birth outcomes. We evaluated the association of SSS in pregnancy with low birth weight (LBW) and high birth weight (HBW)., Methods: A total of 378 pregnant women rated their SSS from 1 (low) to 10 (high) compared to others in the United States (SSS-US) and compared to their community (SSS-Comm). Multivariable logistic regression was used to examine the relationship between SSS and odds of LBW or HBW., Results: Higher SSS-US was associated with lower odds of HBW in unadjusted models (OR 0.76, 95% CI 0.60-0.96; p  < 0.05); this relationship persisted after controlling for objective SES, health, and demographic factors (OR 0.73, 95% CI 0.53-0.99; p  < 0.05). Neither SSS measure was associated with LBW., Conclusions: Pregnant women who view themselves as having lower status than others in the US have greater odds of HBW, over and above the influence of factors known to be associated with birth weight. SSS, a brief and non-stigmatizing measure, might help identify women at elevated social risk for adverse birth outcomes.

Training experiences where residents provide Spanish-language concordant care (SLCC) have not been widely described despite their increasing need and prevalence in graduate medical education. In this qualitative study, we enrolled nonnative Spanish-speaking residents (n = 21) within SLCC training clinics from 3 geographically unique programs. Participants completed semistructured interviews focused on their overall SLCC training experience. Major themes identified included (1) high levels of satisfaction in their SLCC experience, (2) concern about ongoing language barriers, (3) demonstration of high levels of cultural humility in caring for patients with limited English proficiency, and (4) identification of several valuable programmatic and clinical resources. Based on these findings, we conclude that SLCC training experiences are of significant value to trainees in becoming pediatricians able to promote health equity. Themes identified could help inform how graduate medical education programs utilize SLCC to grow health-equity based efforts to deliver more effective and compassionate care to our linguistically diverse populations.

Newborn screening using dried plasma spots offers preanalytical advantages over conventional cards for plasma-associated targets of interest. Herein we present dried plasma spot-based methods for measuring metabolites using a 250+ compound liquid chromatography tandem mass spectrometry library. Quality assurance reduced this library to 134, and from these, 30 compounds determined the normal newborn reference ranges., (Copyright © 2021 Elsevier Inc. All rights reserved.)

During the COVID-19 pandemic, antivaccination social media accounts are proliferating online, threatening to further escalate vaccine hesitancy related to the COVID-19 vaccine. This commentary seeks to alert and encourage the health care provider community, including health care professionals and academic organizations, to engage in social media to counter the mounting vaccine-related infodemic . To validate our recommendation for engagement, the authors describe preliminary findings using a mixed methods approach of quantitative Twitter-based ranking algorithms of networks and users with qualitative content analysis of 1 million tweets related to COVID-19 vaccine conversations. Results show highly polarized and active antivaccine conversations that were primarily influenced by political and nonmedical Twitter users. In contrast, less than 10% of the tweets stemmed from the medical community, demonstrating a lack of active health care professional connectivity in addressing COVID-19 misinformation. The authors introduce the concept of Health Care Provider Social Media Hesitancy to refer to the public health threat of health care providers' nonaction in providing pro-vaccine and scientific information about the vaccine on social media. The authors conclude by describing multilevel strategies for encouraging health care providers and the medical community to effectively "Tweet up" to combat the mounting threat of vaccine misinformation and hesitancy.

Objective: To describe prevalence of healthy lifestyle behaviors (HLBs) between two school-age cohorts of racial-ethnically diverse children. Methods: Using two Early Childhood Longitudinal Study cohorts (ECLS-K 1999 and 2010), we compared percentage change in HLBs (sleep, physical activity, screen time, and family meals) by child weight groups and within racial-ethnic groups. Weight groups of interest included healthy weight (HW; BMI 5th-84th percentile), overweight (OW; ≥ 85th-94th), obese (OB; ≥ 95th-99th percentile), and severely obese (SO; ≥ 99th percentile). Results: OW children within the 2010 cohort reported greater percentage change (range: 2.0%-15.1% increase) in HLBs, whereas HW children demonstrated lower percentage change (range: -6.2% to 8.7% increase). OB and SO children showed significant lower percentage change in reducing screen time (range: -11.0% and -12.7%, respectively). HW Latino children demonstrated the least favorable trends with overall declines noted for 4/5 HLBs. Screen time was noted to have the greatest degree of favorable change (2%-14%) across weight groups, whereas adequate sleep duration demonstrated the lowest favorable percentage change (2%-2.8%). Conclusion: Fewer HW and OB children were participating in recommended HLBs compared with OW children in 2010. Recent health campaigns may have helped providers prioritize the identification and counseling of OW children, yet our data suggest that we may be neglecting the role of HLB counseling in OB and HW children. Continued analysis on the social determinants that impact HLBs in school-age and HW/OB minority children should inform how we can best tailor counseling and messages in the coming decades.

High body mass index (BMI) is associated with relapse of certain adult cancers, but limited knowledge exists on its association with pediatric leukemia relapse. We evaluated the association between overweight/obesity (BMI ≥ 85 th percentile) at pediatric leukemia diagnosis and relapse or mortality. A meta-analysis combining our findings with those of previous studies was also performed. The study included 181 pediatric leukemia patients. Sporadic missing data were multiply imputed, and hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated using Cox proportional hazard. Age- and sex-adjusted analysis for patients ≥10 years showed a trend towards increased risk of relapse for overweight/obese patients (HR = 2.89, 95% CI = 0.89-9.36, p =0.08) that was not evident among children<10 years (HR = 0.52, 95% CI = 0.08-3.54, p =0.49). We observed a statistically significant association between mortality and obesity status in unadjusted models (imputed: HR = 2.54, 95% CI = 1.15-5.60, p =0.021; complete set: HR = 2.72, 95% CI = 1.26-5.91, p =0.011) that was not statistically significant in both age- and sex-adjusted and multivariable adjusted analyses. The pooled estimate of our finding and previous studies showed an association between overweight/obese and increased risk of mortality for ALL (HR = 1.39, 95% CI = 1.16-1.46) and AML (HR = 1.64, 95% CI = 1.32-2.04). Although our study did not observe statistically significant associations due to a small sample size, the meta-analyses revealed an increased risk of mortality for overweight/obese patients. The findings of our study suggest an association of obesity status with relapse in children ≥10 years. However, our study was based on a small sample size from a single institution, and this association needs to be investigated in larger, multicenter studies.

Introduction Difficult patient encounters (DPEs) are common and can lead to frustration and dissatisfaction among healthcare providers. Pediatric resident physician experiences with DPEs and curricula for enhancing necessary communication skills have not been well described. Materials and methods We used a cross-sectional survey research design for our needs assessment on resident experiences with DPEs. Thirty-three pediatric residents completed this anonymous survey. The survey assessed residents' experiences with and self-efficacy regarding DPEs. Descriptive statistics were used to analyze the quantitative data. Additionally, two authors independently coded free response data to include in the narrative description of the survey results. Results These survey results include the views of 92% of the residents in the program (33/36). Residents reported a greater frequency of difficult encounters in the inpatient setting than the outpatient setting. The majority of residents rated their communication skills during DPEs as "fair" or "good" (70%, 23/33). Residents tended to have lower confidence when discussing chronic pain, managing parental insistence on a plan, and breaking bad news. They generally reported higher levels of anxiety for scenarios involving angry patients and families, families insisting on a plan, and when breaking bad news. Residents cited many challenges, including working with angry and demanding families. Additionally, residents described difficulty with managing discordant opinions between the family and the healthcare team regarding the care plan. Residents expressed a preference for learning how to manage challenging patient encounters using clinical experiences. Simulation, discussion, and observation of role models also rated highly as educational methods for increasing skills, while most residents rated lectures as the least important means of training skills for these difficult encounters. Discussion We found that pediatric residents experience difficult encounters frequently, especially in the inpatient setting. Individual residents vary in their confidence and anxiety levels with different types of difficult encounters and may benefit from not only general communication skills training, but also from targeted training to equip them for the particular contexts they find most challenging. Residents value interactive structured learning activities, including discussion and simulation. Residents most consistently value the opportunity to lead challenging conversations in the clinical setting, especially when followed by effective debriefing and feedback by trained faculty preceptors. Conclusions Next steps include creating a "Difficult Encounters" communication skills curriculum informed by this needs assessment, which aim to enhance patient care as well as increase resident self-efficacy. In addition to the curriculum development for residents, it may be helpful to initiate faculty development on how to supervise resident-led difficult conversations and provide effective debriefing and feedback to promote resident growth., Competing Interests: The authors have declared that no competing interests exist.

Aim: In 2011, Johns Hopkins Medicine integrated with All Children's Hospital in St. Petersburg Florida to create an academic campus nearly 1000 miles from Baltimore. In 2014, the newly named Johns Hopkins All Children's Hospital established a new pediatric residency program. At that time, the Association for Graduate Medical Education had not accredited a new pediatric program in the USA in over 10 years., Methods: A unique set of circumstances provided an opportunity for program developers to build the residency under newly identified core tenets to create a number of innovative features targeted to address the many calls for change in graduate medical education., Results: This paper focuses on three of those innovations and demonstrates how they address the many challenges introduced by the changing landscape of graduate medical education., Conclusion: Although a full evaluation of our program is only possible after many years, this article presents the core tenets which guided curricular development and discusses our experiences thus far. We provide lessons learned for programs considering similar innovations.

The development of new graduate medical education programmes provides both opportunities and challenges. Efforts to address physician workforce shortages as well as a realisation that curricula need to be updated to adjust to our rapidly changing healthcare environment have resulted in more educators considering the "how to" and "what's new" of programme development. Understanding the Next Accreditation System, an accreditation system introduced by the Accreditation Council of Graduate Medical Education in 2012, is critical to the success of new as well as existing residency and fellowship programmes. Although many educators are aware of the general rational for the Next Accreditation System, an in-depth understanding of the meaning of Next Accreditation System is necessary from an experiential and theoretical perspective to be able to successfully launch new programmes and moves towards accreditation. A new paediatric categorical residency programme and a new paediatric surgical programme were developed at our institution immediately following the implementation of Next Accreditation System. We provide a series of insights and perspectives based on our experience relative to what priorities we saw outlined from both the programmatic and the institutional perspective to have our graduate medical education programmes reviewed for accreditation. During this discussion, the following objectives are outlined: to overview the Next Accreditation System as a framework and priorities, to discuss the opportunities and challenges that may exist in developing new programmes, and to discuss future directions in the evaluation of trainees and assessment of training competency. Although challenges are outlined, we hope to relay the continued excitement and opportunities that exist relative to enhancing training curricula for future graduate medical education programme builders.

The increasing burden of obesity is prevalent in the pediatric populations. Pediatric nurses are spending increasing amounts of time and effort caring for obese patients however no prior studies have explored how nurses perceive obese patients. The purpose of this study is to identify weight bias in pediatric nurses (RNs) and clinical support staff (CSS) working in a pediatric hospital setting. A convenience sample of RNs and CSS from an urban, pediatric hospital were surveyed using the Nurses' Attitudes toward Obesity and Obese Patients Scale (NATOOPS), which consists of 6 patient-care factors with an additional factor added to assess bias towards the patient's caregiver. Mean factor scores ≥50 indicated bias. Data were summarized using descriptive statistics and means were compared using independent t tests. Multivariate logistic regression models were used to determine the association between putative risk factors and weight bias. RNs and CSS (N=308) demonstrated weight bias toward obese patient characteristics (mean=61.9) and perceived controllability of obesity (mean=65.8). CSS felt negatively about their supportive roles in caring for obese patients (mean=52.5). Respondent weight status and professional title resulted in variability of biased attitudes. Race, employment status, number of obese patients cared for daily, and department were predictive of biased attitudes. Weight biased attitudes toward obese pediatric patients and their caregivers were found among RNs and CSS. Future qualitative research will assist in the understanding the factors that cause nurse weight bias., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To report the prevalence of favorable growth patterns, including healthy weight maintenance (HWM) and return to healthy weight (RHW) among US school-age children., Methods: A longitudinal analysis of childhood growth patterns from the Early Childhood Longitudinal Study-Kindergarten Cohort was completed (n = 9416). The primary outcome included describing the prevalence of HWM/RHW patterns using consecutive child growth data from kindergarten to fifth grades. Multivariate logistic regression was used to explore predictors of HWM/RHW. Incidence of RHW is calculated by grade level., Results: Seventy percent (n = 6617) of children enter kindergarten at a healthy weight and approximately 70% maintained a healthy weight through fifth grade. Among overweight/obese kindergartners, only 17.1% outgrew their weight risk (RHW) by fifth grade., Conclusions: Fewer than 1 in 5 at-risk children outgrow their weight risk during school-age yet a majority of healthy weight children can maintain healthy weight during a critical growth period. Future work should explore additional socioecologic factors associated with favorable growth., (© The Author(s) 2015.)

Objective: To assess residents' self-efficacy, satisfaction and frustration in the care of limited English proficient (LEP) families and to identify individual and programmatic factors associated with the above outcomes., Methods: A multisite cross-sectional survey of pediatric residents currently in training and caring for LEP families was conducted. Resident self-efficacy scores in specific skill domains were assessed. Clustered multivariate logistic regression analyses were used to identify individual and programmatic factors associated with increased satisfaction and frustration. Qualitative analyses were also utilized to identify themes related to frustrating aspects of care., Results: A total of 271 of 449 eligible residents representing 7 US pediatric residency programs participated in our study (60% response rate). A majority of residents (51%) rated their self-efficacy in the overall care of LEP families as low. Satisfaction was associated with a high self-efficacy score (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.8-12.6), increasing year in training (OR 3.2, 95% CI 1.01-10.2), frequent non-English language use (OR 3.1, 95% CI 1.1-8.8), and instruction on the use of interpreters (OR 1.9, 95% CI 1.02-3.64). Satisfaction was inversely associated with increased LEP patient volumes (OR 0.40, 95% CI 0.18-0.91). Clinical inefficiency related to interpreter use and distrust of interpreter skills were frequently cited as aspects that contribute to overall frustration., Conclusions: A majority of residents reported lacking self-efficacy in their ability to deliver care to LEP patients, which may influence overall satisfaction with such encounters. Strategies that promote resident self-efficacy and assess non-English language proficiency should be included in future training curricula. Exposing trainees to best practices in interpreter-based encounters may further promote resident satisfaction., (Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate whether educational sessions on interpreter use and experience with interpreters are associated with resident self-efficacy in the use of professional interpreters., Method: In 2010, the authors surveyed residents from seven pediatric residency programs. Their 29-item survey collected data on training and experience with interpreters and self-efficacy in (1) determining when an interpreter is needed and (2) using a professional interpreter. The authors conducted bivariate and multivariate regression analyses., Results: Among the 271 respondents, 82% reported that ≥ 10% of their patients had limited English proficiency (LEP), 53% indicated they had "a lot" of experience with interpreters, and 54% reported never receiving any educational sessions on interpreter use. The majority reported high self-efficacy in knowing when an interpreter is needed (69%) and in using an interpreter (68%). Residents reporting a high experience level with interpreters were more likely to report high self-efficacy in knowing when an interpreter is needed (odds ratio [OR] = 1.85; 95% confidence interval[CI] = 1.03-3.32) and in using an interpreter (OR = 3.97; 95% CI = 1.19-13.31). Formal training on using interpreters was also associated with high self-efficacy in interpreter use(OR = 1.62; 95% CI = 1.22-2.14)., Conclusions: Many residents who care for patients with LEP have never received educational sessions on interpreter use. Such training is associated with high self-efficacy and may enhance patient-provider communication. Incorporating this training into residency programs is necessary to equip providers with skills to communicate with patients and families with LEP.

Objectives: The need for healthcare systems and academic medical centers to be optimally prepared in the event of a disaster is well documented. Events such as Hurricane Katrina demonstrate a major gap in disaster preparedness for at-risk medical institutions. To address this gap, we outline the components of complete self-sufficiency planning in designing and building hospitals that will function at full operational capacity in the event of a disaster. We review the processes used and outcomes achieved in building a new critical access, freestanding children's hospital in Florida., Methods: Given that hurricanes are the most frequently occurring natural disaster in Florida, the executive leadership of our hospital determined that we should be prepared for worst-case scenarios in the design and construction of a new hospital. A comprehensive vulnerability assessment was performed. A building planning process that engaged all of the stakeholders was used during the planning and design phases. Subsequent executive-level review and discussions determined that a disaster would require the services of a fully functional hospital. Lessons learned from our own institution's previous experiences and those of medical centers involved in the Hurricane Katrina disaster were informative and incorporated into an innovative set of hospital design elements used for construction of a new hospital with full operational capacity in a disaster., Results: A freestanding children's hospital was constructed using a new framework for disaster planning and preparedness that we have termed complete self-sufficiency planning., Conclusions: We propose the use of complete self-sufficiency planning as a best practice for disaster preparedness in the design and construction of new hospital facilities.

Objective: To investigate whether educational modules presented on a touchscreen computer increase immediate nutrition and feeding knowledge in low-income, Spanish-speaking Latino immigrant parents., Methods: This was a randomized controlled trial conducted in an urban pediatric clinic with a sample of low-income, Spanish-speaking Latino parents of children <3 years randomly assigned to the intervention (n = 80) and control groups (n = 80). Intervention group members viewed 5 modules on nutrition and feeding presented on an interactive platform using a touchscreen computer. Modules contained text, pictures, and audio. Content was drawn from Bright Futures Guidelines. The primary outcome was a parental total summed knowledge score based on correct responses to 19 questions related to module content. Domain-specific scores were also analyzed., Results: Intervention and control groups did not differ on demographic characteristics. Participants were of varied Latino origins, mean age was 27.5 years, 41% reported a <7th grade education, and 65% reported that they rarely/never use a computer. Compared with the control group, the intervention group had a superior mean total summed knowledge score (72.3% vs 90.8%, P < .001). Mean domain-specific summed knowledge scores were also greater in the intervention arm compared with the control for all 5 domains. These results did not differ on the basis of participant education level. 71% (n = 57) of intervention arm participants planned to change something based on what they learned from the computer program, and 80% reported that they will (n = 49) or may (n = 15) talk to their child's doctor about what they learned in the modules., Conclusions: Results of this pilot study add to the growing literature on the use of this technology for health education in low-income Latino immigrants. Despite low education levels and computer experience, findings suggest that immediate parental knowledge was enhanced supporting the need for a more rigorous evaluation of this technology and its impact on health behaviors., (Copyright © 2012 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objectives: To determine parental rankings of known factors related to early-childhood obesity and compare reports between parents of healthy weight and overweight children., Methods: Parents of 2- to 5-year-old children seeking well-child care ranked card-sort statements including risks, barriers, and motivating factors for achieving a healthy weight child. Frequencies and means of ranked factors are reported and compared., Results: Of the 150 participants, few parents (7.4%) considered low levels of physical activity a top risk factor compared with other known risks. Inability to control the food choices of alternate caregivers was the greatest perceived barrier to achieving a healthy child weight (34%). There were no differences in rankings by child weight groups., Conclusion: Low-income parents of preschoolers are aware of high-risk feeding behaviors, but few recognize the risk of inactivity in their young child. Innovations that promote adequate physical activity and engage influential caregivers during counseling are necessary.

Objective: To compare parental report of child body image with perceived healthy weight body image in preschoolers and describe weight-counseling preferences., Methods: Parents seeking well-child care were interviewed and asked to select images resembling: (a) their own child's current weight, (b) a healthy weight preschooler, and (c) friend and family report of a healthy weight preschooler. Those indicating that their overweight or obese child resembled a healthy weight image were considered to misclassify child weight. Logistic regression was used to identify predictors of misclassification and card-sorting exercises explored weight-counseling preferences., Results: Of the 150 preschoolers in our sample, 32.7% (n = 49) were overweight or obese with misclassification occurring in 71.4% of parents (n = 35). Absence of pediatrician comment on child weight strongly predicted misclassification (odds ratio, 12.3; 95% confidence interval, 1.74-87.2). Pediatricians were highly valued weight advisors., Conclusions: Weight-focused advice from pediatricians matters to parents and may promote parental identification of early childhood weight risks.

The vomeronasal organ (VNO) mediates the induction of behavioral estrus in prairie voles by male chemosignals; however, the importance of this system for the initiation of estrus in meadow voles, a species in which spontaneous estrus has been postulated, is unknown. This experiment was designed to investigate the influence of VNO-mediated chemosensory information on behavioral estrus in meadow voles housed in photoperiods simulating summer (long photoperiods; 14L:10D) and winter (short photoperiods; 10L:14D). The VNO was removed from nulliparous female meadow voles, and the percentage of animals mating after removal and the timing of mating onset were assessed. Removal of the organ did not suppress mating or change the timing of mating onset in females housed in short photoperiods. In animals housed in long photoperiods, in contrast, removal of the organ significantly increased the percentage of females mating and the percentage of females mating rapidly after pairing. The results indicate that chemosensory information mediated via the VNO is not necessary for the induction of behavioral estrus in meadow voles and lends support to the hypothesis that meadow voles have a spontaneous estrus. We postulate that polygynous, solitary meadow voles reproduce more effectively with spontaneous estrus than with the induced estrus described for monogamous, group-living prairie voles.

Two temperature-sensitive mutations, ams-1 and rne-3071, in the ams (altered mRNA stability) gene have been used extensively to investigate the processing and decay of RNA in Escherichia coli. We have sequenced these temperature-sensitive alleles and found that the mutations are separated by only 6 nucleotides and cause conservative amino acid substitutions next to a possible nucleotide-binding site within the N-terminal domain of the Ams protein. Computer analysis revealed that the region altered by the mutations has extensive sequence similarity to a predicted gene product from the mre (murein pathway cluster e) locus of E. coli, which has been implicated previously in determining bacterial cell shape.