Prenatal predictors of objectively measured appetite regulation in low-income toddlers and preschool-age children

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152019/1/ijpo12554_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152019/2/ijpo12554.pd

Child cortisol moderates the association between family routines and emotion regulation in lowâ income children

Biological and social influences both shape emotion regulation. In 380 lowâ income children, we tested whether biological stress profile (cortisol) moderated the association among positive and negative home environment factors (routines; chaos) and emotion regulation (negative lability; positive regulation). Children (M ageâ =â 50.6, SDâ =â 6.4 months) provided saliva samples to assess diurnal cortisol parameters across 3 days. Parents reported on home environment and child emotion regulation. Structural equation modeling was used to test whether cortisol parameters moderated associations between home environment and child emotion regulation. Results showed that home chaos was negatively associated with emotion regulation outcomes; cortisol did not moderate the association. Child cortisol level moderated the routinesâ emotion regulation association such that lack of routine was most strongly associated with poor emotion regulation among children with lower cortisol output. Findings suggest that underlying child stress biology may shape response to environmental influences.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135499/1/dev21471_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135499/2/dev21471.pd

A Comprehensive Pediatric Asthma Management Program Reduces Emergency Department Visits and Hospitalizations

We evaluated the impact of a comprehensive pediatric asthma management program (the Children's Asthma Wellness Program, CAWP) on the frequency of emergency department (ED) visits and hospital admissions. The CAWP generally consisted of 4 clinic sessions over a 1-year period, but some patients attended fewer clinic sessions, and some required additional clinic sessions due to incomplete asthma control. Patients were evaluated and treated by pediatric pulmonologists, nurse asthma care coordinator/educator, and social worker. We retrospectively reviewed program results over an 8-year period (2005?2013). We compared ED visits and hospital admissions before and after participation in the CAWP. There were 254 children referred to the CAWP; 172 children were enrolled. Fifty-four children (31%) received >6 sessions due to incomplete asthma control. On average, children requiring additional clinic sessions were older and more likely to be African American, hold Medicaid insurance, and have severe asthma. We obtained a minimum of 1-year preprogram and 1-year postprogram administrative data for 86 children (50%). Using each participating child as his/her own control, we found that taking part in the program decreased the risk of ED visits to 0.26 times the preprogram rate (P?Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140178/1/ped.2015.0561.pd

Family conflict, chaos, and negative life events predict cortisol activity in low‐income children

Childhood poverty is hypothesized to increase risk for mental and physical health problems at least in part through dysregulation of the hypothalamic‐pituitary‐adrenal axis. However, less is known about the specific psychosocial stressors associated with cortisol reactivity and regulation for children living in poverty. The current study investigates negative life events, household chaos, and family conflict in preschool and middle childhood as potential predictors of cortisol regulation in low‐income 7–10 year olds (N = 242; M age = 7.9 years). Participants were assessed in preschool and participated in a follow‐up assessment in middle childhood, during which diurnal free cortisol and free cortisol reactivity to the Trier Social Stress Test for Children (TSST‐C) were assessed. Household chaos during preschool predicted a more blunted diurnal cortisol slope in middle childhood. Greater negative life events during preschool and greater concurrent family conflict were associated with increased free cortisol reactivity in middle childhood.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144279/1/dev21602_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144279/2/dev21602.pd

Extended-Interval Aminoglycoside Use in Cystic Fibrosis Exacerbation in Children and Young Adults

This is a prospective quality improvement project for patients with cystic fibrosis who are 5 years of age and older who were admitted for intravenous antibiotic administration as part of treatment of cystic fibrosis exacerbation. The goal of this project was to compare the pharmacokinetics of once-daily versus thrice-daily aminoglycoside use when treating cystic fibrosis exacerbation in different age groups. Of the total of 119 patient encounters, 82.4% were started on once-daily dosing, and the remainder were started on thrice-daily dosing. Patients with pharmacokinetics allowing the continuation of once-daily dosing differed from patients who required a switch to thrice-daily dosing in terms of baseline forced expiratory volume in 1 second, forced expiratory flow from 25% to 75% of vital capacity, age, and body mass index (BMI) but were similar in BMI percentiles. The once-daily dosing group had higher mean 18-hour level, higher mean half-life, higher mean area under the curve, and lower mean elimination constant. This study showed that aminoglycoside clearance is higher in younger children

Burnout, professional fulfillment, and post‐traumatic stress among pediatric solid organ transplant teams

BackgroundAdverse effects of clinician burnout have been studied across multiple specialties; however, there have been no studies examining rates of burnout among pediatric solid organ transplant teams. This study aimed to measure burnout, work exhaustion, professional fulfillment, and post‐traumatic stress symptoms among clinicians and administrators practicing in this high‐stress field.MethodsThis cross‐sectional study utilized a 50 item web‐based survey that included the Personal Fulfillment Index and the IES‐R. This survey was distributed across four pediatric solid organ transplant centers in North America. Basic demographics, clinician characteristics, and information regarding wellness and self‐care activities were collected. Descriptive and correlational analyses were performed.ResultsOne hundred and thirty five participants completed the survey, 76% were female and 78% were Caucasian. One‐third (34%) of participants endorsed burnout, while 43% reported professional fulfillment. Approximately 15% of respondents endorsed clinically significant levels of post‐traumatic stress symptoms related to patient deaths, with female clinicians more likely to endorse symptoms (p = .01). Nearly 80% of participants reported engaging in self‐care activities outside of work and only 10% of participants reported participation in hospital‐sponsored wellness programs.ConclusionsPediatric solid organ transplant team members exhibited moderate levels of burnout, professional fulfillment, and post‐traumatic stress. Female clinicians were the most likely to experience both work exhaustion and post‐traumatic stress symptoms. Transplant centers are encouraged to consider interventions and programming to improve clinician wellness.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167846/1/petr14020.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167846/2/petr14020_am.pd

Associations between Infant and Parent Characteristics and Measures of Family Well-Being in Neonates with Seizures: A Cohort Study.

OBJECTIVE: To characterize and determine risk factors for key dimensions of well-being at hospital discharge in families of neonates with acute symptomatic seizures. STUDY DESIGN: This prospective, observational cohort study enrolled 144 parent-infant dyads among neonates with acute symptomatic seizures from 9 pediatric hospitals in the Neonatal Seizure Registry. One parent per family completed a discharge survey, which included measures of anxiety and depression, health-related quality of life, and impact on the family. Multivariable regression analyses adjusted for site were constructed to examine parent and infant characteristics associated with well-being. RESULTS: At discharge, 54% of parents reported symptoms of anxiety and 32% reported symptoms of depression. Parents of infants with hypoxic-ischemic encephalopathy reported more depression and worse quality of life than parents of infants with other seizure etiologies. Parental quality of life was also lower with greater infant age at discharge. A higher level of maternal education was associated with greater impact on the family. All these differences were medium to large effect sizes, ranging from 0.52 to 0.78. CONCLUSIONS: Symptoms of anxiety and depression are common in parents of infants with neonatal seizures, and several parent and infant characteristics are associated with poorer parental quality of life and family well-being. These findings are a call to action to improve mental health screening and services for parents of infants with neonatal seizures