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Gastineau KAB, Bell R, Hanes A, McKay S, Sigel E, Popescu F, Sommer EC, Barkin S. One Step Closer to Safer: Counseling Outcomes from American Academy of Pediatrics Firearm Safe Storage Education Training. J Pediatr 2024; 264:113767. [PMID: 37802387 DOI: 10.1016/j.jpeds.2023.113767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To assess pre and postself-reported counseling outcomes for Safer: Storing Firearms Prevents Harm, an American Academy of Pediatrics universal firearm safe storage counseling training for pediatric clinicians providing health maintenance in outpatient settings. STUDY DESIGN Safer was developed by a national multidisciplinary committee of firearm injury prevention experts with input from firearm-owning families and launched in June 2021. Pediatric clinicians completed baseline and 1-month posttraining surveys after signing up for the Pedialink course from February through June 2022. Primary outcomes included self-reported measures of counseling self-efficacy and frequency. Wilcoxon matched-pairs signed-rank tests compared outcome distributions at baseline and follow-up. Two adjusted, multilevel mixed-effects regression models were conducted. RESULTS Of 230 clinicians who completed baseline surveys, 146 (64%) completed 1-month postsurveys. Regional representation included Southeast = 67 (46%), Northeast = 24 (16%), Midwest = 21 (14%), Pacific = 15 (10%), Southwest = 11 (8%), and Rocky Mountain = 8 (5%). At follow-up, there was significant improvement in both the distribution of self-efficacy (median [first Quartile-third Quartile = 50 [20-70] at baseline and 80 [60-85] at follow-up; P < .001) and self-reported counseling frequency (median [first Quartile-third Quartile] = 10 [0-50] at baseline and 50 [10-80] at follow-up; P < .001). Adjusted regression model results suggested that self-efficacy significantly improved from baseline to follow-up (time coefficient 25.3; 95% CI = [21.0, 29.5]; P < .001) as did counseling frequency (time coefficient 13.6; 95% CI = [9.2, 18.0]; P < .001). CONCLUSIONS Significant improvement in self-reported counseling self-efficacy and frequency was demonstrated 1 month following Safer training.
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Affiliation(s)
- Kelsey A B Gastineau
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, TN.
| | - Rebecca Bell
- Department of Pediatrics, Larner College of Medicine at the University of Vermont and the University of Vermont Children's Hospital, Burlington, VT
| | | | - Sandra McKay
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Eric Sigel
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Filoteia Popescu
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, TN
| | - Evan C Sommer
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, TN
| | - Shari Barkin
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, TN
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Gujral UP, Barkin S, Narayan KMV. Epigenetics of Early-Life Socioeconomic Stressors and the Impact on Childhood Body Mass Index-Potential Mechanism and Biomarker? JAMA Pediatr 2023; 177:1012-1014. [PMID: 37669075 DOI: 10.1001/jamapediatrics.2023.3028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
- Unjali P Gujral
- Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Nutrition and Health Sciences Program, Graduate Division of Biomedical and Biological Sciences, Laney Graduate School, Emory University, Atlanta, Georgia
| | - Shari Barkin
- Children's Hospital of Richmond at the Virginia Commonwealth University, Richmond
| | - K M Venkat Narayan
- Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Nutrition and Health Sciences Program, Graduate Division of Biomedical and Biological Sciences, Laney Graduate School, Emory University, Atlanta, Georgia
- Department of Endocrinology, School of Medicine, Emory University, Atlanta, Georgia
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Roland D, Van Driest SL, Heerman WJ, King KY, Maitre NL, Fritz SA, Barkin S. Navigating success for early stage investigators-practical words of advice. Pediatr Res 2023; 94:1248. [PMID: 32555500 DOI: 10.1038/s41390-020-0949-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Damian Roland
- SAPPHIRE, Health Sciences, University of Leicester, Leicester, UK.
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK.
| | - Sara L Van Driest
- Department of Pediatrics and Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katharine Y King
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Nathalie L Maitre
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Stephanie A Fritz
- Department of Pediatrics, Division of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Shari Barkin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
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Frazier SB, Gay JC, Barkin S, Graham M, Walsh M, Carlson K. Pediatric emergency department to primary care transfer protocol: Transforming access for patients’ needs. Healthcare (Basel) 2022; 10:100643. [DOI: 10.1016/j.hjdsi.2022.100643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/07/2022] [Accepted: 07/14/2022] [Indexed: 11/04/2022] Open
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Sneed NM, Ukwuani S, Sommer E, Samuels L, Truesdale K, Matheson D, Noerper T, Barkin S, Heerman W. Reliability and Validity of Assigning Ultra-Processed Food Categories to 24-Hour Dietary Recall Data Collected Using the Nutrition Data System for Research (NDS-R). Curr Dev Nutr 2022. [PMCID: PMC9194338 DOI: 10.1093/cdn/nzac063.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives Ultra-processed foods (UPFs) are markers of diet quality and high UPF consumption is associated with chronic disease risk. Methods to accurately categorize the degree of food processing are missing from dietary analysis programs. This study evaluated the reliability and validity of assigning the NOVA classification for UPFs to individual foods collected via 24-hour diet recalls. Methods A secondary analysis of 24-hour dietary recalls was conducted from a randomized controlled trial designed to prevent childhood obesity among low-income and minority children. Nutrition Data System for Research (NDS-R) software was used to collect 2 to 3 dietary recalls from caregivers of 610 children 3–5 years old annually over 4 years. Trained and certified coder pairs independently categorized foods into one of four NOVA classifications (minimally processed, processed culinary ingredients, processed, and ultra-processed). The study team adjudicated any coding discrepancies. Inter-rater reliability was assessed by percent concordance between coder pairs and by Cohen's kappa coefficient. Construct validity was evaluated by comparing macronutrient estimates across NOVA classifications. Results In 5,546 valid days of 24-hour diet recalls from 610 children, there were 3,100 unique foods in the dataset, one of which was not possible to categorize. NOVA classifications for the 3,099 remaining foods were unprocessed/minimally processed (18%); processed culinary ingredients (0.4%); processed (15%); and ultra-processed (67%). Coder concordance was 88.3% with a kappa coefficient of 0.75 (P < .0001). Descriptive comparisons of macronutrient content were consistent with expectations. On average, over the 5,546 daily recalls, UPFs made up 62% (SD 19) of the day's calories, but a higher percentage of the day's added sugar (94%; SD 16) and a lower percentage of the day's protein (47%; SD 24). Minimally processed foods made up 30% (SD 17) of the day's calories, but a lower percentage of the day's added sugar (1%; SD 8) and a higher percentage of the day's protein (43%; SD 24). Conclusions This method of applying the NOVA classification to 24-hour dietary recalls using NDS-R software had high inter-rater reliability and good construct validity for identifying individual dietary intake patterns of UPFs. Funding Sources NIH, AHRQ.
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Nguyen C, Barkin S. Where standardized meets personalized when integrating social determinants of health into the electronic health record. Pediatr Res 2022; 91:1645-1646. [PMID: 34429514 DOI: 10.1038/s41390-021-01686-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/19/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Christian Nguyen
- Vanderbilt University Medical Center, Department of General Pediatrics, Nashville, TN, USA.
| | - Shari Barkin
- Vanderbilt University Medical Center, Department of General Pediatrics, Nashville, TN, USA
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Ramaswami SB, Jensen T, Berghaus M, De-Oliveira S, Russ SA, Weiss-Laxer N, Verbiest S, Barkin S. Family Health Development in Life Course Research: A Scoping Review of Family Functioning Measures. Pediatrics 2022; 149:186919. [PMID: 35503321 PMCID: PMC9847419 DOI: 10.1542/peds.2021-053509j] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Our objective is to identify common family functioning measurement tools and assess their compatibility with family-health development and life-course perspectives. METHODS Data sources include PubMed, ERIC, CINAHL, Families and Societies Worldwide, PsychInfo, Web of Science, PsychNet, and Health and Psychosocial Instruments. Title and abstract screening and full-text review of articles were conducted by multiple reviewers based on prespecified inclusion criteria. Data extraction focused on features of identified measurements tools, including: (1) name (2) domains of family functioning measured, (3) established psychometric properties, and (4) original context of psychometric evaluation (eg, details about the study sample). RESULTS Of the 50 measurement tools identified, 94% measured organizational patterns (eg, flexibility, connectedness, or resources), 46% measured belief systems (eg, making meaning of adversity, or positive outlook), and 54% measured communication processes (eg, open emotional sharing, or collaborative problem-solving). CONCLUSIONS Existing measures of family functioning can aid life-course researchers in understanding family processes as contexts for health and well-being. There also remain opportunities to refine or develop measures of family functioning more compatible with a life-course perspective that assess family processes (1) at various life stages; (2) with various backgrounds, identities, structures, and experiences; and (3) embedded in or impacted by various contexts that may facilitate or hinder family functioning.
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Affiliation(s)
- Saswati B. Ramaswami
- Center for Healthier Children, Families, and Communities,Department of Pediatrics, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Todd Jensen
- Jordan Institute for Families, School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Address correspondence to Todd Jensen, PhD, MSW, School of Social Work, University of North Carolina at Chapel Hill; 325 Pittsboro St CB#3550, Chapel Hill, NC 25799. E-mail:
| | - Mary Berghaus
- Center for Healthier Children, Families, and Communities,Department of Pediatrics, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | | | - Shirley A. Russ
- Center for Healthier Children, Families, and Communities,Department of Pediatrics, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Nomi Weiss-Laxer
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, New York
| | - Sarah Verbiest
- Jordan Institute for Families, School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Shari Barkin
- Department of Pediatrics, School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Affiliation(s)
- Shari Barkin
- Department of Pediatrics, Division of General Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah Verbiest
- Jordan Institute for Families and Collaborative for Maternal and Infant Health, University of North Carolina School of Social Work, Chapel Hill, North Carolina
| | - Jerica Berge
- Department of Research, Healthy Eating and Activity Across the Life Course, University of Minnesota, Minneapolis, Minnesota
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Gastineau KA, Williams DJ, Hall M, Goyal MK, Wells J, Freundlich KL, Carroll AR, Browning WL, Doherty K, Fritz CQ, Frost PA, Kreth H, Plancarte C, Barkin S. Pediatric Firearm-Related Hospital Encounters During the SARS-CoV-2 Pandemic. Pediatrics 2021; 148:peds.2021-050223. [PMID: 33980696 PMCID: PMC8670740 DOI: 10.1542/peds.2021-050223] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kelsey A.B. Gastineau
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Derek J. Williams
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | - Monika K. Goyal
- Department of Pediatrics and Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jordee Wells
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Katherine L. Freundlich
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alison R. Carroll
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Whitney L. Browning
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathleen Doherty
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cristin Q. Fritz
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Patricia A. Frost
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Heather Kreth
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carlos Plancarte
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shari Barkin
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
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Hirschfeld S, Goodman E, Barkin S, Faustman E, Halfon N, Riley AW. Health Measurement Model-Bringing a Life Course Perspective to Health Measurement: The PRISM Model. Front Pediatr 2021; 9:605932. [PMID: 34178878 PMCID: PMC8222802 DOI: 10.3389/fped.2021.605932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 04/27/2021] [Indexed: 01/04/2023] Open
Abstract
Health is a multidimensional concept that is challenging to measure, and in the rapidly evolving developmental changes that occur during the first 21 years of human life, requires a dynamic approach to accurately capture the transitions, and overall arc of a complex process of internal and external interactions. We propose an approach that integrates a lifecourse framework with a layered series of assessments, each layer using a many to many mapping, to converge on four fundamental dimensions of health measurement-Potential, Adaptability, Performance, and Experience. The four dimensions can conceptually be mapped onto a plane with each edge of the resulting quadrilateral corresponding to one dimension and each dimensions assessment calibrated against a theoretical ideal. As the plane evolves over time, the sequential measurements will form a volume. We term such a model the Prism Model, and describe conceptually how single domain assessments can be built up to generate the holistic description through the vehicle of a layer of Exemplar Cases. The model is theoretical but future work can use the framework and principles to generate scalable and adaptable applications that can unify and improve the precision of serial measurements that integrate environmental and physiologic influences to improve the science of child health measurement.
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Affiliation(s)
- Steven Hirschfeld
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Elizabeth Goodman
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | - Shari Barkin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Elaine Faustman
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Neal Halfon
- Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA, United States
| | - Anne W. Riley
- Department of Population, Family, and Reproductive Health, Johns Hopkins University, Baltimore, MD, United States
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Davis M, Johnson C, Pettit AR, Barkin S, Hoffman BD, Jager-Hyman S, King CA, Lieberman A, Massey L, Rivara FP, Sigel E, Walton M, Benjamin Wolk C, Beidas RS. Adapting Safety Check as a Universal Suicide Prevention Strategy in Pediatric Primary Care. Acad Pediatr 2021; 21:1161-1170. [PMID: 33901726 PMCID: PMC8429196 DOI: 10.1016/j.acap.2021.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/19/2021] [Accepted: 04/18/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The presence of unlocked firearms in the home is associated with increased risk of suicide and unintentional injury in youth. We adapted an evidence-based program for promoting safe firearm storage, Safety Check, to enhance its acceptability as a universal suicide prevention strategy in pediatric primary care. METHODS We applied ADAPT-ITT, an established adaptation framework, to guide iterative program adaptation with ongoing input from key stakeholders. The present study describes 2 phases of ADAPT-ITT: the Production phase (generating adaptations) and the Topical Experts phase (gathering stakeholder feedback on adaptations). After generating proposed program adaptations based on 3 inputs (stakeholder feedback collected in a prior study, the behavioral science literature, and best practices in pediatric medicine), we elicited feedback from stakeholders with firearm expertise. The adaptations included changes such as clarifying firearm ownership will not be documented in the medical record and offering follow-up reminders. We also crowdsourced feedback from 337 parents to select a new name and program logo. RESULTS Saturation was reached with 9 stakeholders. Feedback confirmed the value of adaptations that: 1) considered context (eg, reason for ownership), 2) promoted parent autonomy in decision-making, and 3) ensured privacy. The most preferred program name was Suicide and Accident prevention through Family Education (SAFE) Firearm. CONCLUSIONS Guided by an established adaptation framework that prioritized multistage stakeholder feedback, adaptations to the original Safety Check were deemed acceptable. We plan to test the SAFE Firearm program as a universal suicide prevention strategy in pediatric primary care via a hybrid effectiveness-implementation trial.
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Affiliation(s)
- Molly Davis
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (M Davis, C Johnson, S Jager-Hyman, A Lieberman, CB Wolk, and RS Beidas), Philadelphia, Pa; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania (M Davis and RS Beidas), Philadelphia, Pa.
| | - Christina Johnson
- Department of Psychiatry, Perelman School of Medicine,
University of Pennsylvania, 3535, Market Street, Philadelphia, PA 19104, USA
| | - Amy R. Pettit
- Independent Consultant, PO Box 15066, Boston, MA 02215,
USA
| | - Shari Barkin
- Department of Pediatrics, Vanderbilt University Medical
Center, 2200 Children’s Way, Nashville, TN 37232, USA
| | - Benjamin D. Hoffman
- Department of Pediatrics, School of Medicine, and
Doernbecher Children’s Hospital, Oregon Health and Science University, 707 SW
Gaines St CDRCP, Portland, OR 97239, USA,Tom Sargent Children’s Safety Center, Doernbecher
Children’s Hospital, Oregon Health and Science University, Portland, OR
97239, USA
| | - Shari Jager-Hyman
- Department of Psychiatry, Perelman School of Medicine,
University of Pennsylvania, 3535, Market Street, Philadelphia, PA 19104, USA
| | - Cheryl A. King
- Department of Psychiatry, Michigan Medicine, University of
Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Adina Lieberman
- Department of Psychiatry, Perelman School of Medicine,
University of Pennsylvania, 3535, Market Street, Philadelphia, PA 19104, USA
| | - Lynn Massey
- Department of Emergency Medicine, Michigan Medicine,
University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Frederick P. Rivara
- Department of Pediatrics, University of Washington, 6200 NE
74th Street, Seattle, WA 98115, USA
| | - Eric Sigel
- Department of Pediatrics, University of Colorado School of
Medicine, 860 N Potomac Circle, Aurora, CO 80011, USA
| | - Maureen Walton
- Department of Psychiatry, Michigan Medicine, University of
Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine,
University of Pennsylvania, 3535, Market Street, Philadelphia, PA 19104, USA,Leonard Davis Institute of Health Economics, University of
Pennsylvania, 3641 Locust Walk #210, Philadelphia, PA 19104, USA
| | - Rinad S. Beidas
- Department of Psychiatry, Perelman School of Medicine,
University of Pennsylvania, 3535, Market Street, Philadelphia, PA 19104, USA,Penn Implementation Science Center at the Leonard Davis
Institute of Health Economics (PISCE@LDI), University of Pennsylvania, 3641 Locust
Walk #210, Philadelphia, PA 19104, USA,Leonard Davis Institute of Health Economics, University of
Pennsylvania, 3641 Locust Walk #210, Philadelphia, PA 19104, USA,Department of Medical Ethics and Health Policy, Perelman
School of Medicine, University of Pennsylvania, 423 Guardian Drive, Blockley Hall,
Philadelphia, PA 19104, USA,Department of Medicine, Perelman School of Medicine,
University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104,
USA,Center for Health Incentives and Behavioral Economics,
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104,
USA
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Hoskins K, Johnson C, Davis M, Pettit AR, Barkin S, Jager-Hyman S, Rivara F, Walton M, Wolk CB, Beidas RS. A mixed methods evaluation of parents' perspectives on the acceptability of the S.A.F.E. Firearm program. J Appl Res Child 2021; 12:2. [PMID: 36883133 PMCID: PMC9987154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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13
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Barkin S. It's Not One Thing, It's All Things. Acad Pediatr 2019; 19:602. [PMID: 31202820 DOI: 10.1016/j.acap.2019.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/08/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Shari Barkin
- Academic General Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn.
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Bejan CA, Angiolillo J, Conway D, Nash R, Shirey-Rice JK, Lipworth L, Cronin RM, Pulley J, Kripalani S, Barkin S, Johnson KB, Denny JC. Mining 100 million notes to find homelessness and adverse childhood experiences: 2 case studies of rare and severe social determinants of health in electronic health records. J Am Med Inform Assoc 2018; 25:61-71. [PMID: 29016793 PMCID: PMC6080810 DOI: 10.1093/jamia/ocx059] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 04/22/2017] [Accepted: 05/10/2017] [Indexed: 01/25/2023] Open
Abstract
Objective Understanding how to identify the social determinants of health from electronic health records (EHRs) could provide important insights to understand health or disease outcomes. We developed a methodology to capture 2 rare and severe social determinants of health, homelessness and adverse childhood experiences (ACEs), from a large EHR repository. Materials and Methods We first constructed lexicons to capture homelessness and ACE phenotypic profiles. We employed word2vec and lexical associations to mine homelessness-related words. Next, using relevance feedback, we refined the 2 profiles with iterative searches over 100 million notes from the Vanderbilt EHR. Seven assessors manually reviewed the top-ranked results of 2544 patient visits relevant for homelessness and 1000 patients relevant for ACE. Results word2vec yielded better performance (area under the precision-recall curve [AUPRC] of 0.94) than lexical associations (AUPRC = 0.83) for extracting homelessness-related words. A comparative study of searches for the 2 phenotypes revealed a higher performance achieved for homelessness (AUPRC = 0.95) than ACE (AUPRC = 0.79). A temporal analysis of the homeless population showed that the majority experienced chronic homelessness. Most ACE patients suffered sexual (70%) and/or physical (50.6%) abuse, with the top-ranked abuser keywords being "father" (21.8%) and "mother" (15.4%). Top prevalent associated conditions for homeless patients were lack of housing (62.8%) and tobacco use disorder (61.5%), while for ACE patients it was mental disorders (36.6%-47.6%). Conclusion We provide an efficient solution for mining homelessness and ACE information from EHRs, which can facilitate large clinical and genetic studies of these social determinants of health.
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Affiliation(s)
| | | | | | | | | | | | - Robert M Cronin
- Department of Biomedical Informatics
- Department of Medicine
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Shari Barkin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kevin B Johnson
- Department of Biomedical Informatics
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joshua C Denny
- Department of Biomedical Informatics
- Department of Medicine
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Schubmehl S, Barkin S, Cort D. C-80Construct Validity of Allen Cognitive Level Screen-5: Role of Executive Function. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Stevens J, Pratt C, Boyington J, Nelson C, Truesdale KP, Ward DS, Lytle L, Sherwood NE, Robinson TN, Moore S, Barkin S, Cheung YK, Murray DM. Multilevel Interventions Targeting Obesity: Research Recommendations for Vulnerable Populations. Am J Prev Med 2017; 52:115-124. [PMID: 28340973 PMCID: PMC5571824 DOI: 10.1016/j.amepre.2016.09.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/18/2016] [Accepted: 09/06/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The origins of obesity are complex and multifaceted. To be successful, an intervention aiming to prevent or treat obesity may need to address multiple layers of biological, social, and environmental influences. METHODS NIH recognizes the importance of identifying effective strategies to combat obesity, particularly in high-risk and disadvantaged populations with heightened susceptibility to obesity and subsequent metabolic sequelae. To move this work forward, the National Heart, Lung, and Blood Institute, in collaboration with the NIH Office of Behavioral and Social Science Research and NIH Office of Disease Prevention convened a working group to inform research on multilevel obesity interventions in vulnerable populations. The working group reviewed relevant aspects of intervention planning, recruitment, retention, implementation, evaluation, and analysis, and then made recommendations. RESULTS Recruitment and retention techniques used in multilevel research must be culturally appropriate and suited to both individuals and organizations. Adequate time and resources for preliminary work are essential. Collaborative projects can benefit from complementary areas of expertise and shared investigations rigorously pretesting specific aspects of approaches. Study designs need to accommodate the social and environmental levels under study, and include appropriate attention given to statistical power. Projects should monitor implementation in the multiple venues and include a priori estimation of the magnitude of change expected within and across levels. CONCLUSIONS The complexity and challenges of delivering interventions at several levels of the social-ecologic model require careful planning and implementation, but hold promise for successful reduction of obesity in vulnerable populations.
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Affiliation(s)
- June Stevens
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Charlotte Pratt
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Josephine Boyington
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Cheryl Nelson
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Kimberly P Truesdale
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Leslie Lytle
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nancy E Sherwood
- HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - Thomas N Robinson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Shirley Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Shari Barkin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ying Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - David M Murray
- Division of Program Coordination, Planning, and Strategic Initiatives, NIH, Bethesda, Maryland
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Hudnut-Beumler J, Po'e E, Barkin S. The Use of Social Media for Health Promotion in Hispanic Populations: A Scoping Systematic Review. JMIR Public Health Surveill 2016; 2:e32. [PMID: 27400979 PMCID: PMC4960404 DOI: 10.2196/publichealth.5579] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/06/2016] [Accepted: 06/10/2016] [Indexed: 12/31/2022] Open
Abstract
Background The Internet is an increasingly popular platform for public health interventions due to its distinct ability to communicate with, engage, and educate communities. Given the widespread use of the Internet, these interventions could be a means of equalizing access to information to address health disparities in minority populations, such as Hispanics. Hispanics are disproportionately affected by poor health outcomes, including obesity, diabetes, and human immunodeficiency virus/acquired immune deficiency syndrome. Although underserved and underrepresented, Hispanics are among the leading users of social media in the United States. Previous reviews have examined the use of social media in public health efforts, but, to our knowledge, none have focused on the Hispanic population. Objective To conduct a scoping systematic review of the published literature to capture the ways social media has been used in health interventions aimed at Hispanic populations and identify gaps in existing knowledge to provide recommendations for future research. Methods We performed a systematic review of the literature related to social media, public health, and Hispanics using the PubMed, PsycINFO, and EMBASE databases to locate peer-reviewed studies published between January 1, 2010, and December 31, 2015. Each article was reviewed for the following inclusion criteria: social media as a main component of study methodology or content; public health topic; majority Hispanic/Latino study population; English or Spanish language; and original research study. Relevant data were extracted from articles meeting inclusion criteria including publication year, location, study design, social media platform, use of social media, target population, and public health topic. Results Of the 267 articles retrieved, a total of 27 unique articles met inclusion criteria. All were published in 2012 or later. The most common study design was a cross-sectional survey, which was featured in 10 of the 27 (37%) articles. All articles used social media for at least one of the following three purposes: recruiting study participants (14 of 27, 52%), promoting health education (12 of 27, 44%), and/or describing social media users (12 of 27, 44%). All but one article used multiple social media platforms, though Facebook was by far the most popular appearing in 24 of the 27 (89%). A diverse array of Hispanic populations was targeted, and health topics featured. Of these, the most highly represented were articles on sexual health directed toward Latino men who have sex with men (12 of 27, 44%). Healthy eating and active living received the second greatest focus (4 of 27, 15%). Conclusions Social media offers a potential accessible venue for health interventions aimed at Hispanics, a group at disproportionate risk for poor health outcomes. To date, most publications are descriptive in nature, with few indicating specific interventions and associated outcomes to improve health.
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Barkin S, Lee C. Can We Change the Way Our Genes Behave and Pave the Way Forward for Childhood Obesity Prevention? NAM Perspect 2016. [DOI: 10.31478/201603b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bialostozky A, McFadden SE, Barkin S. A Novel Approach to Well-Child Visits for Latino Children under Two Years of Age. J Health Care Poor Underserved 2016; 27:1647-1655. [DOI: 10.1353/hpu.2016.0153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Carlson KL, McFadden SE, Barkin S. Improving Documentation Timeliness: A "Brighter Future" for the Electronic Medical Record in Resident Clinics. Acad Med 2015; 90:1641-1645. [PMID: 26107880 DOI: 10.1097/acm.0000000000000792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PROBLEM Electronic medical records have many observed benefits but may cause work disruption, resulting in delayed documentation completion. The purpose of this project was to improve compliance with institutional standards of documentation of well child checks for residents and attendings without increasing stress. APPROACH This project was completed at Children's Hospital Primary Care Clinic at Vanderbilt, which is staffed by 74 residents, supervised by 17 attendings. A longitudinal observational study using convenience sampling for the last full week of each month from October 2010-January 2012 was planned. Baseline documentation completion rates were assessed, then age-specific, structured data-entry forms were introduced beginning in March 2011. Run charts were created for completion data for all clinic visits in the sample. Physician self-report of satisfaction with and stress related to documentation was assessed through pre- and postintervention surveys. OUTCOMES Data were derived for an average of 231 patient visits per month. The median percentage of documentation or attestations completed within the institutional standards increased from 54.7% to 78.9% for residents and from 38.2% to 83.5% for attendings. Physicians reporting high satisfaction with documentation increased from 20.5% to 85.7% (P < .01) for residents and from 11.1% to 76.9% (P < .01) for attendings. Residents reporting high stress with documentation decreased from 59.1% to 28.6% (P < .02). NEXT STEPS Use of age-specific, structured data-entry forms achieved marked improvement in documentation timeliness, but there is still room for improvement. The authors are now teaching computer-based documentation in exam rooms and instituting accountability measures.
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Affiliation(s)
- Kathryn L Carlson
- K.L. Carlson is assistant professor, Department of Pediatrics, Division of General Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee. S.E. McFadden is research assistant, Department of Pediatrics, Division of General Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee. S. Barkin is professor of pediatrics, Department of Pediatrics, Division of General Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
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Wahlqvist ML, Krawetz SA, Rizzo NS, Dominguez-Bello MG, Szymanski LM, Barkin S, Yatkine A, Waterland RA, Mennella JA, Desai M, Ross MG, Krebs NF, Young BE, Wardle J, Wrann CD, Kral JG. Early-life influences on obesity: from preconception to adolescence. Ann N Y Acad Sci 2015; 1347:1-28. [PMID: 26037603 PMCID: PMC4522218 DOI: 10.1111/nyas.12778] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 12/12/2022]
Abstract
The double burden of under- and overnutrition profoundly affects human health globally. According to the World Health Organization, obesity and diabetes rates have almost doubled worldwide since 1980, and, in 2011, more than 40 million children under 5 years of age were overweight. Ecologic factors, parental genetics and fitness, and the intrauterine environment significantly influence the likelihood of offspring developing the dysmetabolic diathesis of obesity. This report examines the effects of these factors, including preconception, intrauterine and postnatal energy balance affecting programming of transgenerational transmission, and development of chronic diseases later in life-in particular, diabesity and its comorbidities.
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Affiliation(s)
| | - Stephen A Krawetz
- C.S. Mott Center for Human Growth and Development and Center for Molecular Medicine and Genetics, Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
| | - Nico S Rizzo
- Center of Community Resilience, School of Public Health, Loma Linda University, Loma Linda, California
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Shari Barkin
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ann Yatkine
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert A Waterland
- Departments of Pediatrics and Molecular and Human Genetics, Baylor College of Medicine and USDA/ARS Children's Nutrition Research Center, Houston, Texas
| | | | - Mina Desai
- University of California Los Angeles Medical Center, Los Angeles, California
| | - Michael G Ross
- University of California Los Angeles Medical Center, Los Angeles, California
| | - Nancy F Krebs
- University of Colorado School of Medicine, Aurora, Colorado
| | | | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Christiane D Wrann
- Dana-Farber Cancer Institute and Department of Cell Biology, Harvard Medical School, Boston, Massachusetts
| | - John G Kral
- SUNY Downstate Medical Center, Brooklyn, New York
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Abstract
BACKGROUND AND OBJECTIVE Many patients with Medicaid do not receive timely, comprehensive well-child care through the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. Missed opportunities for EPSDT well-child check-ups (WCCs) at acute visits contribute to this problem. The authors sought to reduce missed opportunities for WCCs at acute visits for patients overdue for those services. METHODS A quality improvement team developed key drivers and used a people-process-technology framework to devise 3 interventions: (1) an electronic indicator based on novel definitions of EPSDT status (up-to-date, due, overdue, no EPSDT), (2) a standardized scheduling process for acute visits based on EPSDT status, and (3) a dedicated nurse practitioner to provide WCCs at acute visits. Data were collected for 1 year after full implementation. RESULTS At baseline, 10.3 acute visits per month were converted to WCCs. After intervention, 86.7 acute visits per month were converted. Of 13801 acute visits during the project, 31.2% were not up-to-date. Of those overdue for WCCs, 51.4% (n = 552) were converted to a WCC in addition to the acute visit. Including all patients who were not up-to-date, a total of 1047 acute visits (7.6% of all acute visits) were converted to comprehensive WCCs. Deferring needed WCCs at acute visits resulted in few patients who scheduled or completed future WCC visits. CONCLUSIONS Implementation of interventions focused on people-process-technology significantly increased WCCs at acute visits within a feasible and practical model that may be replicated at other academic general pediatrics practices.
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Affiliation(s)
- Barron L. Patterson
- Departments of Pediatrics,,Address correspondence to Barron Lee Patterson, MD, FAAP, Department of Pediatrics, Vanderbilt University School of Medicine, 8236 Doctors’ Office Tower, 2200 Children’s Way, Nashville, TN 37232. E-mail:
| | - William M. Gregg
- Biomedical Informatics, and,Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
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Affiliation(s)
- Shari Barkin
- Diabetes Research and Training Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
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Abstract
The rapidly growing Hispanic American population is experiencing an academic achievement gap that seems to be rooted in disparities in early childhood education and literacy development. Children of non-English-speaking immigrant parents are at greatest risk of poor school performance, but there is potential to capitalize on immigrants’ drive by encouraging them to engage with their children in dialog while reading native-language storybooks. This paper reports on a community-based randomized controlled trial () delivered to mostly Mexican immigrant parents of preschool-age children. Intervention group parents attended three monthly 60-minute sessions based on the Dialogic Reading Model—C.A.R. (Comment and Wait, Ask Questions and Wait, and Respond by Adding More), which teaches parents to have a conversation about pictures in books, with the goal of enhancing verbal exchanges with the child in the parent’s native language. After the 3-month intervention, parents in the bilingual early language development intervention reported placing greater value on children’s active verbal participation in reading compared to control group parents who participated in a healthy lifestyle intervention. These results suggest that Hispanics’ educational outcomes may be improved by educating parents on the value of playful conversations with young children while reading books in one’s native language.
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Affiliation(s)
- Sabina Gesell
- Vanderbilt School of Medicine, 2nd Floor, 2146 Belcourt Avenue, Nashville, TN 37212, USA
| | - Dan Wallace
- Vanderbilt University’s Peabody College, 230 Appleton Place, Nashville, TN 37203, USA
| | - Tommaso Tempesti
- University of Massachusetts Lowell, One University Avenue, Lowell, MA 01854, USA
| | - Vanessa Hux
- Vanderbilt University School of Medicine, 2200 Children’s Way, DOT8246, Nashville, TN 37232, USA
| | - Shari Barkin
- Vanderbilt University School of Medicine, 2200 Children’s Way, DOT8246, Nashville, TN 37232, USA
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Barkin S, Schlundt D. The challenge facing translation of basic science into clinical and community settings to improve health outcomes. Environ Health Perspect 2011; 119:A418-A419. [PMID: 21967758 PMCID: PMC3230459 DOI: 10.1289/ehp.1104467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Ip EH, Wasserman R, Barkin S. Comparison of intraclass correlation coefficient estimates and standard errors between using cross-sectional and repeated measurement data: the Safety Check cluster randomized trial. Contemp Clin Trials 2010; 32:225-32. [PMID: 21070889 DOI: 10.1016/j.cct.2010.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 10/27/2010] [Accepted: 11/04/2010] [Indexed: 10/18/2022]
Abstract
Designing cluster randomized trials in clinical studies often requires accurate estimates of intraclass correlation, which quantifies the strength of correlation between units, such as participants, within a cluster, such as a practice. Published ICC estimates, even when available, often suffer from the problem of wide confidence intervals. Using data from a national, randomized, controlled study concerning violence prevention for children--the Safety Check--we compare the ICC values derived from two approaches only baseline data and using both baseline and follow-up data. Using a variance component decomposition approach, the latter method allows flexibility in handling complex data sets. For example, it allows for shifts in the outcome variable over time and for an unbalanced cluster design. Furthermore, we evaluate the large-sample formula for ICC estimates and standard errors using the bootstrap method. Our findings suggest that ICC estimates range from 0.012 to 0.11 for providers within practice and range from 0.018 to 0.11 for families within provider. The estimates derived from the baseline-only and repeated-measurements approaches agree quite well except in cases in which variation over repeated measurements is large. The reductions in the widths of ICC confidence limits from using repeated measurement over baseline only are, respectively, 62% and 42% at the practice and provider levels. The contribution of this paper therefore includes two elements, which are a methodology for improving the accuracy of ICC, and the reporting of such quantities for pediatric and other researchers who are interested in designing clustered randomized trials similar to the current study.
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Affiliation(s)
- Edward H Ip
- Department of Biostatistical Sciences and Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27012, USA.
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Pemberton VL, McCrindle BW, Barkin S, Daniels SR, Barlow SE, Binns HJ, Cohen MS, Economos C, Faith MS, Gidding SS, Goldberg CS, Kavey RE, Longmuir P, Rocchini AP, Van Horn L, Kaltman JR. Report of the National Heart, Lung, and Blood Institute's Working Group on obesity and other cardiovascular risk factors in congenital heart disease. Circulation 2010; 121:1153-9. [PMID: 20212294 PMCID: PMC2850199 DOI: 10.1161/circulationaha.109.921544] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Victoria L Pemberton
- National Heart, Lung, and Blood Institute, National Institutes of Health, Division of Cardiovascular Sciences, 6701 Rockledge Dr, Room 8102, Bethesda, MD 20892, USA.
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Finch SA, Weiley V, Ip EH, Barkin S. Impact of pediatricians' perceived self-efficacy and confidence on violence prevention counseling: a national study. Matern Child Health J 2007; 12:75-82. [PMID: 17554613 PMCID: PMC5118867 DOI: 10.1007/s10995-007-0223-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 04/25/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To measure impact of pediatricians' perceived self-efficacy and confidence on current practices and attitudes regarding four violence prevention (VP) topics (gun storage, gun removal, limiting exposure to media violence, discipline techniques) during health supervision for children ages 2-11. METHODS Random sample survey of American Academy of Pediatrics Fellows (n = 486; 53% response rate) providing health supervision for children ages 2-11. Participants surveyed about VP issues regarding: (1) current counseling practices for 2-5 and 6-11 year olds; (2) amount of time spent addressing; (3) confidence in addressing; and (4) perceived self-efficacy at changing patients' behaviors. Multivariate analyses explored relationships between pediatricians' perceived self-efficacy and confidence versus VP counseling frequency. RESULTS VP topics were not routinely discussed during health supervision. Most pediatricians (64%) reported spending too little time addressing these topics. Although most pediatricians felt confident discussing and effective at changing behaviors regarding limiting exposure to media violence (89% vs. 50%) and discipline techniques (91% vs. 76%), they were less so for safe gun storage (54% vs. 35%) and gun removal (51% vs. 17%). Perceived self-efficacy was the mediating factor on self-reported VP counseling frequencies for all topics. CONCLUSIONS Pediatricians reported spending insufficient time on VP counseling. Confidence and perceived self-efficacy levels varied by VP topic, but for all topics pediatricians felt more confident discussing than effective at changing behaviors. Since pediatricians' self-efficacy was related to counseling practices, boosting self-efficacy could ultimately improve counseling frequencies. Further research is needed to identify methods to build providers' perceived self-efficacy regarding these VP areas.
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Affiliation(s)
- Stacia A Finch
- Pediatric Research in Office Settings (PROS), Department of Research, American Academy of Pediatrics, 141 Northwest Point Blvd., Elk Grove Village, IL, 60007, USA.
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DuRant RH, Barkin S, Craig JA, Weiley VA, Ip EH, Wasserman RC. Firearm ownership and storage patterns among families with children who receive well-child care in pediatric offices. Pediatrics 2007; 119:e1271-9. [PMID: 17545359 DOI: 10.1542/peds.2006-1485] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE In this study we examined firearm storage patterns and their associations in a diverse sample of families who attended pediatric practices from both rural and nonrural areas across the United States. METHODS Parents who brought their children who were aged 2 to 11 years (N = 3745) to 96 Pediatric Research in Office Settings practices from 45 states, Canada, and Puerto Rico participated in an office-based survey before a well-child examination. The survey measured demographic variables; family history of guns in the home; and firearm types, storage behaviors, and ownership. RESULTS Twenty-three percent of families reported firearm ownership. The majority (60%) of respondents reported making firearm storage decisions. Only one third of firearm owners reported safe firearm storage. Gun type owned was associated with storage habits, with long-gun owners storing their gun in places other than locked cabinets but with ammunition separate from guns and handgun users more likely to store guns loaded and to use gun locks. In a multivariate analysis, not being raised with a firearm was associated with safe storage behaviors. Families who had children aged 2 to 5 years and owned long guns were more likely to store their guns safely than families with older children. CONCLUSIONS Few families reported safe firearm storage. Storage patterns are most influenced by firearm type(s) owned, family socialization with guns, and the age of the child. Primary care providers need to understand better not only whether firearms are in the home but also which types are present and whether parents were raised in homes with guns.
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Affiliation(s)
- Robert H DuRant
- Department of Pediatrics, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA.
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Berman BA, Streja L, Bernaards CA, Eckhardt EA, Kleiger HB, Maucere L, Wong G, Barkin S, Bastani R. Do deaf and hard of hearing youth need antitobacco education? Am Ann Deaf 2007; 152:344-355. [PMID: 18018676 DOI: 10.1353/aad.2007.0024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Little research has focused on tobacco use among deaf and hard of hearing youth. Findings are reported from a first-ever tobacco-related survey, completed by 226 California middle and high school students using either a written questionnaire or the Interactive Video Questionnaire, an interactive multimedia computer video technology. Rates for current smoking (3.1%), ever smoking (45.1%), and multiple types of tobacco use (10.6%) were found to be lower than among high school students generally; mainstreamed students were likelier to have ever tried smoking than their deaf school peers (57.8% vs. 31.8%). No statistically significant associations were found between ever smoking and race/ethnicity, gender, school performance, or prelingual vs. postlingual deafening; a quarter of the sample experienced occasional peer pressure to use tobacco products. Tobacco use covariates, exposure to cigarette marketing and antismoking programming, and tobacco education needs of deaf and hard of hearing youth are discussed.
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Affiliation(s)
- Barbara A Berman
- Division of Cancer Prevention and Control Research, School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles (UCLA), USA
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Abstract
National guidelines urge pediatricians to address discipline as part of anticipatory guidance, yet pediatricians know little about what leads parents to use different discipline approaches. Parents seen in Pediatric Research in Office Settings practices participated in an office-based survey before the well-child visit for children 2 to 11 years old (N = 2134). Parents reported using the following discipline approaches frequently: time-outs (42%), removal of privileges (41%), sent to bedroom (27%), yelling (13%), and spanking (9%). A third of parents believe their discipline approach to be ineffective. This directs the pediatric provider to help families develop effective discipline practices tailored to their context.
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Affiliation(s)
- Shari Barkin
- Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
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Abstract
Creating links to community resources for childhood aggression is one component of office-based violence prevention. Evidence is lacking regarding the effect of training clinicians to make these referrals and families' responses to them. Clinicians who received training (n=47) and parents (1093) were queried on the provision of referrals immediately after the visit. Fewer than half of clinicians (45%) reported making a community referral. A third of providers (37%) noted difficulty in identifying local resources. Training clinicians to utilize community resources for childhood aggression does not often result in creating community links for this purpose.
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Affiliation(s)
- Shari Barkin
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Abstract
BACKGROUND Studies indicate that children use media (television, video, and computer) more than the recommended limit of 2 h/d, but little is known about parents' role in mediating their children's media use. DESIGN Office-based survey. Data were collected on demographics, reported media behaviors, parental awareness about media effects, television in the bedroom, and parental concern. We developed logistic regression models to examine factors associated with the following 3 mediation approaches: restrictive, instructive, and unlimited. SETTING Pediatric Research in Office Settings practices. PARTICIPANTS Parents with children aged 2 to 11 years (n = 1831) presenting for a well-child visit. RESULTS Almost half of parents reported a single mediation approach, including restrictive for 23%, instructive for 11%, and unlimited for 7%, with 59% reporting the use of multiple strategies. Restrictive (odds ratio [OR], 1.16; P<.001) and instructive (OR, 1.06; P = .02) approaches were associated with increased awareness about negative media effects, whereas a decreased awareness existed for those who used an unlimited approach (OR, 0.87; P<.001). A restrictive strategy also occurred with increased parental concern (OR, 1.77; P<.001) and 2 adults in the home (OR, 1.64; P<.01). The only strategy associated with the child's age was instructive mediation, noted more often with younger children (OR, 1.41; P<.001). Allowing unlimited media use occurred when parents permitted a television in the child's bedroom (OR, 2.13; P<.001) and were Latino (OR, 2.03; P<.01) or African American (OR, 2.20; P<.001). Mother as primary decision maker and maternal education were not statistically significant. CONCLUSIONS Pediatric health care providers should identify parental practices and reinforce active media mediation strategies.
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Affiliation(s)
- Shari Barkin
- Department of Pediatrics, Wake Forest University Baptist Medical Center,Wake Forest University, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Berman BA, Bernaards C, Eckhardt EA, Kleiger HB, Maucere L, Streja L, Wong G, Barkin S, Bastani R. Is tobacco use a problem among deaf college students? Am Ann Deaf 2006; 151:441-51. [PMID: 17225639 DOI: 10.1353/aad.2006.0042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
College students' tobacco use poses a significant public health problem. Effective intervention requires understanding of this behavior among race/ethnic, cultural, and linguistic collegiate subgroups, including deaf and hard of hearing collegians. Findings from a first-ever tobacco-related survey among this understudied population are reported. The authors used written questionnaires and the Interactive Video Questionnaire, a multimedia computer technology developed for use with the deaf and hard of hearing, to interview 241 volunteers on seven California college campuses. They found lower self-reported current smoking prevalence (14.5%) relative to collegians in the general population, but considerable ever smoking (65.1%) and multiple types of tobacco use (37.3%). The authors report on factors associated with tobacco use and on students' exposure to cigarette marketing, gaps experienced in receipt of antitobacco messages and services, and students' antitobacco intervention recommendations. Limitations of the research are described, including possible underreporting of participants' tobacco use.
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Affiliation(s)
- Barbara A Berman
- Division of Cancer Prevention and Control Research, School of Public Health and Jonsson Comprehensive Cancer Center, University oF California, Los Angeles (UCLA), USA
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Barkin S, Balkrishnan R, Manuel J, Hall MA. Effect of language immersion on communication with Latino patients. N C Med J 2003; 64:258-62. [PMID: 14983612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND In the US, the fastest growing segment of the general pediatric population is Latino children. Language barriers may impede optimal care for these patients. Programs are needed to enhance communication effectiveness with Latino patients. We examined the effect of language immersion training for pediatric faculty on their communication with Latino patients. METHODS Five general pediatric faculty physicians were sent to Guatemala for a two-week language immersion course and then had monthly one-hour Spanish language meetings for one year. Before and after immersion, six, and twelve months later, their Spanish skills were assessed. Before and after faculty training, Latino parents of pediatric patients were surveyed to assess their trust in and communication with the attending pediatricians. Spanish survey instruments were pilot tested and revised (trust scale alpha = 0.79; communication scale alpha = 0.80). RESULTS Language proficiency increased for all the faculty participants, from a baseline score of 28% to a post-intervention score of 55%, p < 0.001. This increase in proficiency was sustained six and twelve months after the intervention. General linear modeling with repeated measures was used to examine associations between physician, parent, and clinic variables and the doctor-patient communication and patient trust scores. Even though baseline communication and trust scores were high, both improved after the intervention, p < 0.01. CONCLUSION A two-week faculty language-training program can improve physician' language skills, communication, and trust between non-Latino doctor and Latino patient. Other measures of cultural competence should be measured and cost-benefit analyses conducted to assess the impact of immersion versus classroom experience.
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Affiliation(s)
- Shari Barkin
- Department of Pediatrics and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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Sumner D, Barkin S, Hudak C, Rouse A, Langley R. A project to reduce accidental pediatric poisonings in North Carolina. Vet Hum Toxicol 2003; 45:266-9. [PMID: 14513898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
An education program was implemented to increase public awareness of the potential hazards of household chemicals and to reduce the incidence of pediatric poisonings in North Carolina. Data from the Carolinas Poison Center (CPC) were analyzed to determine the success of the program. The ratios of informational calls, exposure calls and total calls were evaluated using log transformations, ANOVA and Duncan's Multiple Range Test. Based upon the statistical analysis, the project successfully increased public awareness of the CPC and thus of potential hazards. It did not significantly reduce the incidence of serious poisonings, but appeared to reduce overall pediatric poisonings in the public who were aware of the CPC.
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Affiliation(s)
- Darrell Sumner
- Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA
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Barkin S. Preventing youth violence: an office-based approach. Pediatr Case Rev 2003; 3:30-9. [PMID: 16222136 DOI: 10.1097/00132584-200301000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Shari Barkin
- Department of Pediatrics and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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Abstract
This study examined young adolescents'intentions to use moralistic violence and their violence exposure, examining male-female differences. Sixth-grade students (n=702) from Georgia middle schools servicing impoverished communities participated. Data were obtained on the students' exposure to violence, family structure and education level, church attendance, gang interest, drug use, and depression status. The dependent variable, intention to use moralistic violence, was measured with an 11-item scale. Linear regression models were run separately for males and females. Males had significantly higher mean intention to use moralistic violence than females (p=0.002). Males reported being exposed to violence more than females, but exposure decreased as attendance to religious services increased. For these 11-12-year-olds, unconventional peer social norms, such as witnessing violence, increased their intention to use violence while involvement in conventional activities, such as church attendance, decreased it. The protective effect was greater for males than females.
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Affiliation(s)
- S Barkin
- Wake Forest University School of Medicine, Department of Pediatrics, Winston-Salem, NC 27157, USA.
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Abstract
PURPOSE To evaluate a Social Cognitive Theory-based violence prevention curriculum among sixth-grade students. METHODS The evaluation was conducted using a quasi-experimental pretest-posttest control group design. Students were pretested 2 weeks before the intervention started and were posttested 2 weeks after it ended. The study was conducted in four middle schools serving children and adolescents living in or around public housing in a southeastern city. The participants included all sixth-grade students who were predominantly African-American (88.7%), 41% lived in public housing, and 80% lived in homes with an employed head of household. The intervention schools had 292 students, and the control schools 412 students. The Peaceful Conflict Resolution and Violence Prevention Curriculum is a 13-module skills-building curriculum based on Social Cognitive Theory. It taught identification of situations that could result in violence; avoidance, confrontation, problem-solving, and communication skills; conflict resolution skills; the conflict cycle; the dynamics of a fight; and how to express anger without fighting. MAIN MEASURES The primary outcome variable was a five-item scale assessing the frequency of fighting and weapon carrying behaviors (alpha =.72) and a scale measuring intentions to use violence in 11 hypothetical situations (alpha = .81). Levels of exposure to violence and victimization (alpha = .82) and depression (alpha = .86) were also assessed. The data were analyzed with general linear modeling with repeated measures. RESULTS At pretest, the intervention and control groups did not differ in gender, age, depression, exposure to violence, or any other demographic variable. A group x time interaction effect (p = .029) was found in the use of violence scale. From pretest to posttest there was a decrease in the use of violence by students in the intervention group and an increase in the use of violence in the control group. Most of the changes were accounted for by changes in the frequencies of carrying concealed guns and fighting resulting in injuries requiring medical treatment. A group x time interaction effect (p = .002) was also found for the intention to use violence scale. Students in the intervention group did not change their mean scores from pretest to posttest, whereas students in the control group increased in their mean intention to use violence scale scores. Neither interaction effect was influenced by gender, exposure to violence, or level of depression. CONCLUSION The Peaceful Conflict Resolution and Violence Prevention curriculum appears to have positive short-term effects on self-reported use of violence and intentions to use violence by these middle-school students.
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Affiliation(s)
- R H Durant
- Department of Pediatrics, Brenner Center for Child and Adolescent Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1801, USA.
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Durant RH, Altman D, Wolfson M, Barkin S, Kreiter S, Krowchuk D. Exposure to violence and victimization, depression, substance use, and the use of violence by young adolescents. J Pediatr 2000; 137:707-13. [PMID: 11060539 DOI: 10.1067/mpd.2000.109146] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the relationships among exposure to violence; tobacco, alcohol, and other substance use; depression; church attendance; and the use of violence among very young adolescents. METHODS An 86-item confidential questionnaire was administered to 722 sixth grade students (mean age = 11.9+/-0.8 years) attending 4 middle schools serving neighborhoods in and around public housing. RESULTS Boys had a higher mean violence scale score than girls (P < or =.0001), and students living in public housing had higher violence scale scores than other students (P< or =.0001). Self-reported use of violence was significantly associated with exposure to violence (r =.45); age (r =.28); frequency of church attendance (r = -.14); depression (r =.28); the probability of being alive at age 25 (r = -.09); the frequency of use of cigarettes (r =.39), alcohol (r =.37), and multiple substances (r =.38); and interest in a gang (r =.37). When all of these variables were analyzed with multiple linear regression, multiple substance use, exposure to violence, interest in a gang, male gender, cigarette smoking, and depression level accounted for 49.7% of the variation in the use of violence scale. CONCLUSION Recent multiple substance use and lifetime exposure to violence and victimization were the strongest correlates with the frequency that these youth reported using violence and carrying weapons.
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Affiliation(s)
- R H Durant
- Department of Pediatrics, The Brenner Center for Child and Adolescent Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA
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Abstract
Formidable barriers hinder use of standard data collection methods among deaf youth. Culturally and linguistically sensitive data collection strategies are needed to identify the unmet health and programming needs of this population. Unfortunately, researchers often fail to describe the issues involved in developing such targeted methods. The authors describe development of a culturally appropriate data collection instrument for a study of tobacco-related knowledge, attitudes, and practices among deaf youth. The instrument uses interactive multimedia technology to administer a questionnaire translated into the primary languages used by the Deaf. The procedures taken to accommodate this technology to these languages and to Deaf culture are described. This process yielded useful insights with respect to data collection not only among the Deaf, but among other frequently overlooked and underserved populations as well.
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Affiliation(s)
- B A Berman
- School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles (UCLA), USA
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Barkin S, Weinberg S. Internal derangements of the temporomandibular joint: the role of arthroscopic surgery and arthrocentesis. J Can Dent Assoc 2000; 66:199-203. [PMID: 10789172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Arthroscopic surgery appears to be a safe, minimally invasive and effective method for treating internal derangements of the temporomandibular joint (TMJ), reducing pain and increasing mandibular range of motion for approximately 80% of patients. Although these results are encouraging, they are largely based on retrospective, uncontrolled and short-term studies. The landmark observation that lysis and lavage in only the upper compartment of the TMJ produce successful clinical results without repositioning the disc has prompted clinicians to question the importance of disc position as a significant factor in the etiology of TMJ pain dysfunction. Although there are prospective, controlled, randomized short-term studies indicating that arthrocentesis and arthroscopic surgery have comparable success rates in the management of acute TMJ closed lock, similar long-term studies are lacking. Until they have been done, the roles of arthroscopic surgery and arthrocentesis in the management of TMJ internal derangements remain unclear.
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Affiliation(s)
- S Barkin
- Department of Oral and Maxillifacial Surgery, Toronto Hospital, ON
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Abstract
BACKGROUND Injury is the primary cause of morbidity and mortality in children and an important topic for counseling. OBJECTIVE To describe and explain clinicians' reported counseling behavior during the well-child examinations for children aged 5 years and younger on the following 4 injury prevention topics: motor vehicle crashes, toxic ingestion, drowning, and firearm injuries. METHODS A random sample of 465 pediatricians, family physicians, and pediatric nurse practitioners in an urban setting received mailed questionnaires; 325 (69.9%) responded. Multivariate logistic regression predicting counseling on each injury prevention topic was performed. RESULTS Most reported discussing motor vehicle occupant protection (66.2%) and toxic ingestion prevention (62.1%) during the well-child examination. Only 31.8% stated they counseled on drowning prevention and 15.7%, on firearm injury prevention. Knowledge of injury mortality and morbidity rates was not associated with counseling. For most topics, female respondents were more likely to counsel than male respondents (motor vehicle crash odds ratio [OR], 2.24 [P = .03]; toxic ingestion OR, 1.82 [P = .05]; drowning OR, 1.97 [P = .04]). Health maintenance organization settings predicted injury prevention counseling for most topics (motor vehicle crash OR, 2.52 [P = .04]; toxic ingestion OR, 2.77 [P = .01]; firearm injury OR, 2.97 [P = .001]). Clinicians placing lower importance on counseling were less likely to counsel on drowning and firearm injury (drowning OR, 0.73 [P = .006]; firearm injury OR, 0.58 [P<.001]). CONCLUSIONS Clinicians' knowledge of local injury epidemiology did not influence their counseling on these topics. Clinicians and their patients might benefit by using programs such as The Injury Prevention Program to help them standardize their approach to injury prevention counseling during the routine well-child examination.
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Affiliation(s)
- S Barkin
- Department of Health Services, University of California-Los Angeles, USA.
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Barkin S, Gelberg L. Sink or swim--clinicians don't often counsel on drowning prevention. Pediatrics 1999; 104:1217-9. [PMID: 10545577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
OBJECTIVE Drowning is one of the leading causes of injury death for young children in the United States. This study examined primary care providers' knowledge of and counseling on drowning prevention. METHODS A random sample of 465 Los Angeles County pediatricians, family physicians, and pediatric nurse practitioners who serve families with young children received mailed questionnaires; 325 (70%) responded. RESULTS About two thirds of clinicians did not know that injury deaths attributable to drowning were more common than those attributable to toxic ingestions and firearm injuries in young children. Only one third of clinicians stated they counseled on drowning prevention. Counseling drowning prevention was positively associated with female gender (odds ratio: 1.97; 95% confidence interval: 1.64, 2.30) and negatively associated with an attitude that drowning prevention counseling was less important than other injury prevention topics (odds ratio:.73; 95% confidence interval:.61,.85). Clinician specialty, age, years out from training, proportion of well-child examinations in a typical week, having children, practice setting, and knowledge of drowning injury deaths were not significant in multivariate analysis. CONCLUSION The belief of clinicians that it is less important to counsel on drowning prevention than other injury prevention topics poses a substantial challenge to their providing such education to families with young children.drowning, counseling, physician's role.
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Affiliation(s)
- S Barkin
- UCLA Department of Health Services, Los Angeles, California, USA.
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Abstract
OBJECTIVE Youth violence is a public health problem world wide. However, the United States has the worst rate of youth violence among industralized countries. This study was conducted to learn what pediatricians, community leaders, and parents think the doctor's role is in youth violence prevention during the well-child examination for children. METHODS Interviews were conducted with pediatricians, community leaders, and parents living or working in Los Angeles, California. RESULTS All three groups interviewed believed that the physician should incorporate violence prevention counseling as part of the well-child examination. The mechanism of action differed for the three groups. Almost half of pediatricians' statements focused on their role as prevention counselor, with respect to such issues as appropriate discipline and gun safety. One third of community leaders' statements, however, related to physician referral to existing community resources. More than half of parents' statements referred to the pediatrician as someone who can directly educate their child about making positive choices. CONCLUSIONS Although pediatricians cannot solve the problem of youth violence alone, findings from this study suggest that they should address this issue with their patients and should work in tandem with existing community resources to further a solution to this growing epidemic.
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Affiliation(s)
- S Barkin
- UCLA School of Public Health, USA.
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Barkin S, Duan N, Fink A, Brook RH, Gelberg L. The smoking gun: do clinicians follow guidelines on firearm safety counseling? Arch Pediatr Adolesc Med 1998; 152:749-56. [PMID: 9701133 DOI: 10.1001/archpedi.152.8.749] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To describe clinicians' behavior regarding firearm safety counseling practices, develop a model to predict current counseling behavior, and identify resources that might positively influence willingness to counsel according to medical guidelines. DESIGN Four hundred sixty-five primary care Los Angeles County, California, pediatricians, family physicians, and pediatric nurse practitioners who serve families with children aged 5 years and younger received mailed questionnaires; 325 (70%) responded. MAIN OUTCOME MEASURE Clinician self-reported behavior. RESULTS Of the respondents, 80% stated that they should counsel on firearm safety; only 38% do so. Of those clinicians who currently counsel, only 20% counsel more than 10% of their patient families. Firearm safety counseling behavior is positively associated with a clinician being 49 years or younger (odds ratio [OR]=2.19, P=.02); a perception that counseling is beneficial (OR=2.62, P=.02); and household handgun ownership (OR=2.47, P=.02). Clinician households that report gun ownership counsel differently than those clinicians who report not possessing a household gun. There are no significant differences in the rates of counseling across specialties and crime area types. Forty-one percent of clinicians report that patient education handouts would increase their likelihood of counseling. CONCLUSIONS In Los Angeles County gaps exist between clinicians' views of the benefits of counseling families with young children regarding firearm safety and their actual behavior. Guidelines and handouts are available from major medical organizations. Research should focus on how to get practitioners to use available materials, enabling them to better adhere to guidelines.
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Affiliation(s)
- S Barkin
- University of California, Los Angeles, USA.
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Moss M, Goodman PL, Heinig M, Barkin S, Ackerson L, Parsons PE. Establishing the relative accuracy of three new definitions of the adult respiratory distress syndrome. Crit Care Med 1995; 23:1629-37. [PMID: 7587227 DOI: 10.1097/00003246-199510000-00006] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Over the last few years, new definitions of the adult respiratory distress syndrome (ARDS) have been introduced that potentially identify patients earlier in their course of acute lung injury. However, these definitions have never been compared with any of the older and potentially stricter definitions of ARDS to determine if similar patients are eventually identified. We compared new definitions of ARDS--as represented by the Lung Injury Score, a modified Lung Injury Score, and the American-European Consensus Conference definition--against a stricter definition of ARDS to determine their accuracy. DESIGN Prospective. SETTING Intensive care unit (ICU) patients in a tertiary, university-affiliated city hospital. PATIENTS ICU patients with clearly defined at-risk diagnoses for ARDS (group 1, n = 111) and general medical ICU patients without clearly defined at-risk diagnoses for ARDS (group 2, n = 125). MEASUREMENTS AND MAIN RESULTS Measurements of hypoxemia, static respiratory system compliance, positive end-expiratory pressure, radiographic changes, and general demographic information were collected. The sensitivity, specificity, positive-predictive value, negative-predictive value, and accuracy of all three new definitions were determined. Accuracy was defined as the true-positive plus the true-negative results divided by the total number of patients. When compared with a stricter definition of ARDS, all three definitions maintained a high degree of accuracy in those patients with a clearly defined at-risk diagnosis (group 1): Lung Injury Score 90.0% (95% confidence interval 84-96); modified Lung Injury Score 97.3% (95% confidence interval 94-100), and the American-European Consensus Conference definition 97.3% (95% confidence interval 94-100). For these at-risk patients, the accuracy of the modified Lung Injury Score and the American-European Consensus Conference definition was significantly better than the Lung Injury Score when compared with the strict definition (p = .027 for both comparisons). Although all three definitions maintained an accuracy of > 90% for general medical ICU patients (group 2), the low frequency of ARDS in these patients (3.4%) produced a low positive-predictive value for all three definitions. CONCLUSIONS We conclude that the Lung Injury Score, the modified Lung Injury Score, and the American-European Consensus Conference definition identify similar patients, provided that these methods are applied to patients with clearly defined at-risk diagnoses for ARDS.
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Affiliation(s)
- M Moss
- Department of Medicine, National Jewish Center for Immunology and Respiratory Medicine, Denver, CO, USA
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Barkin S, Bixon M, Noyes RM, Bar-Eli K. The oxidation of cerous ions by bromate ions comparison of experimental data with computer calculations. INT J CHEM KINET 1977. [DOI: 10.1002/kin.550090514] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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