Referral and Resource Utilization Among Food Insecure Families Identified in a Pediatric Medical Setting.

Objective: Despite increased routine screening for food insecurity (FI) in pediatric medical settings, the uptake of offered food resources after FI identification is not well understood. We aimed to 1) describe utilization of referral and supplemental resources and 2) identify characteristics associated with utilization.

Methods: We linked hospital screening and Electronic Medical Record data to Hunger Free Colorado (HFC) referral data for patients 0 to 18 years who were screened in the emergency department (ED), inpatient, or outpatient setting from January 2017 to December 2018.

Association of Race/Ethnicity with Surgical Route and Perioperative Outcomes of Hysterectomy for Leiomyomas.

Study Objective: To evaluate the associations among race/ethnicity, route of surgery, and perioperative outcomes for women undergoing hysterectomy for uterine leiomyomas.

Design: Retrospective cohort study.

Setting: Multistate.

Circumferential urethral diverticulum: a surgical conundrum.

Introduction And Hypothesis: Excision of a circumferential diverticulum may be challenging as its extension into the dorsal aspect of the urethra makes access complicated.

Methods: A 69-year-old woman with a history of Stage 3C ovarian cancer on chemotherapy presented with a 3-week history of severe dysuria and suprapubic pain. T2-weighted pelvic magnetic resonance imaging (MRI) showed a circumferential diverticulum extending over the dorsal midurethra without evidence of urethral communication.

Addressing Adolescent Depression in Primary Care: Building Capacity Through Psychologist and Pediatrician Partnership.

Early identification and treatment of depression during adolescence can contribute to healthier outcomes across the lifespan, yet adolescent depression has been underidentified and undertreated. The American Academy of Pediatrics' (AAP) Guidelines for Adolescent Depression in Primary Care (GLAD-PC) were created to enhance the identification and treatment of adolescent depression. Integrated psychologists in a pediatric primary care setting partnered with providers and clinic staff to implement an adolescent depression screening initiative and transform primary care practice around identification and management.

High Body Mass Index in Infancy May Predict Severe Obesity in Early Childhood.

Objective: To characterize growth trajectories of children who develop severe obesity by age 6 years and identify clinical thresholds for detection of high-risk children before the onset of obesity.

Study Design: Two lean (body mass index [BMI] 5th to ≤75th percentile) and 2 severely obese (BMI ≥99th percentile) groups were selected from populations treated at pediatric referral and primary care clinics. A population-based cohort was used to validate the utility of identified risk thresholds.

Estimating the dim light melatonin onset of adolescents within a 6-h sampling window: the impact of sampling rate and threshold method.

Objective/background: Circadian rhythm sleep-wake disorders (CRSWDs) often manifest during the adolescent years. Measurement of circadian phase such as the dim light melatonin onset (DLMO) improves diagnosis and treatment of these disorders, but financial and time costs limit the use of DLMO phase assessments in clinic. The current analysis aims to inform a cost-effective and efficient protocol to measure the DLMO in older adolescents by reducing the number of samples and total sampling duration.

Circadian rhythm phase shifts and endogenous free-running circadian period differ between African-Americans and European-Americans.

Successful adaptation to modern civilization requires the internal circadian clock to make large phase shifts in response to circumstances (e.g., jet travel and shift work) that were not encountered during most of our evolution.

Weight change in pediatric TennCare recipients referred to a commercial weight loss program.

Background: The epidemic of overweight and obesity in the United States is not limited to adults but also affects children and adolescents. Low-income children are disparately affected because they have an elevated risk for developing obesity. Effective interventions are urgently needed to prevent and treat obesity in children.

Febrile seizures and measles-mumps-rubella-varicella (MMRV) vaccine: what do primary care physicians think?

Purpose: Measles-mumps-rubella-varicella (MMRV) vaccine is associated with increased febrile seizure risk compared with measles-mumps-rubella and varicella vaccine given separately (MMR+V) in children 12-15-month old. We assessed knowledge regarding MMRV and febrile seizures, intended practices, and factors influencing the decision to recommend MMRV.

Methods: National survey administered 10/2008-1/2009 of US pediatricians (Peds) and family physicians (FP).

Parental views of school-located delivery of adolescent vaccines.

Purpose: School-located immunization has the potential to increase adolescent vaccination rates. This study assessed parents' attitudes toward administration of adolescent vaccines (tetanus, diphtheria, acellular pertussis [Tdap], meningococcal conjugate [MenACWY], human papillomavirus [HPV], and influenza) at school.

Methods: We conducted a mailed survey of parents of sixth graders from July 2009 to September 2009 in three urban/suburban (Aurora, CO) middle schools assessing barriers and facilitators to school vaccination and willingness to consent for vaccines at school.

Effectiveness and net cost of reminder/recall for adolescent immunizations.

Objective: To assess the effectiveness of reminder/recall (R/R) for immunizing adolescents in private pediatric practices and to describe the associated costs and revenues.

Methods: We conducted a randomized controlled trial in 4 private pediatric practices in metropolitan Denver. In each practice, 400 adolescents aged 11 to 18 years who had not received 1 or more targeted vaccinations (tetanus-diphtheria-acellular pertussis, meningococcal conjugate, or first dose of human papillomavirus vaccine for female patients) were randomly selected and randomized to intervention (2 letters and 2 telephone calls) or control (usual care) groups.

Effectiveness and cost of immunization recall at school-based health centers.

Background And Objective: Effectiveness of recall for immunizations has not been examined in the setting of school-based health centers (SBHCs). We assessed (1) immunization rates achieved with recall among sixth-grade girls (demonstration study); (2) effectiveness of recall among sixth-grade boys (randomized controlled trial [RCT]); and (3) cost of conducting recall in SBHCs.

Methods: During October 2008 through March 2009, in 4 Denver public SBHCs, we conducted (1) a demonstration study among 265 girls needing ≥ 1 recommended adolescent vaccine and (2) an RCT among 264 boys needing vaccines, with half randomized to recall and half receiving usual care.

Pediatricians' attitudes about collaborations with other community vaccinators in the delivery of seasonal influenza vaccine.

Objective: Achieving universal influenza vaccination among children may necessitate collaborative delivery involving both practices and community vaccinators. We assessed among pediatricians nationally their preferences regarding location of influenza vaccination for patient subgroups and their attitudes about collaborative delivery methods.

Methods: The design/setting was a national survey conducted from July 2009 to October 2009.

Adherence to the Advisory Committee on Immunization Practices recommendation to prevent injuries from postvaccination syncope: a national physician survey.

Background: Little is known about physicians' adherence to the 2006 Advisory Committee on Immunization Practices (ACIP) recommendation that providers strongly should consider observing vaccine recipients for 15 minutes to prevent injuries from postvaccination syncope.

Purpose: To assess physicians' knowledge, attitudes, and practices toward observing adolescents for 15 minutes postvaccination.

Methods: A survey was administered during October 2008-January 2009 to 425 pediatricians (Peds) and 424 family medicine physicians (FPs) from a nationally representative network.

Prevalence of parental concerns about childhood vaccines: the experience of primary care physicians.

Background: Little is known about the effects of increased parental vaccine safety concerns on physicians' vaccine communication attitudes and practices.

Purpose: To assess among pediatricians and family medicine (FM) physicians: (1) prevalence of parental requests to deviate from recommended vaccine schedules; (2) responses to such requests; and (3) attitudes about the burden and success of vaccine communications with parents.

Methods: Survey of nationally representative samples of pediatricians and FM physicians (N=696) conducted during February to May 2009 with analysis in 2010.

Late-season influenza vaccination: a national survey of physician practice and barriers.

Background: Although late-season influenza vaccination has been recently promoted, existing data suggest it occurs infrequently.

Purpose: This study aims to describe among primary care physicians: (1) late-season vaccination practices; (2) perceived barriers; and (3) factors associated with late-season influenza vaccination in a year when vaccine supplies are inadequate or delayed.

Methods: A survey administered March 2007-June 2007 to 1268 primary care providers in a national survey network.