Arturo Brito

Parental self-efficacy and morbidity in pediatric asthma.

This study investigated the relationship between parental self-efficacy and asthma-related morbidity. Participants included 139 parents of children (ages 5–8) who were diagnosed with asthma and were primarily from lower-income and minority backgrounds. Parents completed a 22-item measure of self-efficacy; factor analysis was conducted on this measure, yielding two factors: learned helplessness and self-efficacy. Correlational analyses indicated that higher scores on the learned helplessness factor were significantly related to increased asthma-related morbidity for the majority of morbidity variables. The self-efficacy factor was significantly related to days of school missed. Regression analyses conducted with the factor scores and the morbidity variables provide further support that the learned helplessness factor accounts for a significant amount of the variance in asthma morbidity for many of the variables studied, while the self-efficacy factor was related to only a few. Although improving health outcomes of children with asthma is a multifaceted process, the results of this study suggest that targeting parental self-efficacy, particularly with parents who are experiencing high levels of perceived learned helplessness, may be a helpful component of an intervention program with this population.

Evidence-based community pediatrics: building a bridge from bedside to neighborhood.

The American Academy of Pediatrics policy statement “The Pediatricians Role in Community Pediatrics” encourages all pediatricians to partner with their communities to create and disseminate innovative programs that improve child health. This article describes 4 pillars of a bridge to evidence-based community pediatrics for pediatricians interested in pursuing effective community action: (1) collaborate with the community to establish a specific, short-term, health-related goal; (2) identify evidence-based best practice(s) for achieving the shared goal; (3) collaborate with the community to adapt this best practice to the communitys unique assets and constraints; and (4) evaluate the project by using appropriate expertise. Practical elements of each pillar are described and illustrated by specific examples from community-based efforts of pediatricians and are accompanied by specific resources to aid pediatricians in their future community health work.

Bridging Mental Health and Medical Care in Underserved Pediatric Populations: Three Integrative Models

In pediatric primary care, the term mental health should be taken to include child and family psychosocial needs across a wide spectrum. Mental illness therefore includes developmental, behavioral, emotional, and cognitive dysfunction. Quantifying the number of children with a mental illness can be challenging. Even within a narrow definition limited to psychiatric disorders, there is wide variation in prevalence estimates because of differing methodologies and criteria used (eg, screening or clinical diagnosis, different screening instruments, who makes the diagnoses and whether diagnoses are ascertained by chart review or parent report, and whether diagnoses reflect current symptoms or a prior lifetime diagnosis). A published review of 52 articles found prevalence estimates ranging from 1% to 51%, with a median of 18% [1]. The most frequently cited prevalence rate for child and adolescent psychiatric disorders is 20%, from the Surgeon General’s mental health report (1999) [2]. This figure, derived from a federal survey that only included children and youths 9 to 17 years of age, indicates that at least 8.4 million children have a diagnosable psychiatric condition, including 4.3 million with a disability (ie, a condition that impairs daily functioning at home, school, and community), of whom an estimated 2 million have severe functional impairments [3]. Although this number of children with psychiatric illness is impressive, it does not include diagnosed preschool-age children or young children who

A Prospective Study of Weight and Metabolic Syndrome in Young Hispanic Children

This study examined weight in young Hispanic children over a 2-year period and investigated the relations among overweight, physical activity (PA), caloric intake, and family history in the development of the metabolic syndrome (MS). Forty-seven children (ages 5–8) from diverse Hispanic backgrounds recruited from elementary schools were evaluated. Laboratory analyses, anthropometric data, and measures of PA and caloric intake were included. The majority of the children were overweight at baseline (66%) and at follow up (72%). Children who were overweight at baseline were more likely to exhibit MS at follow up than were those who were not overweight at baseline. Overweight appears to be an independent predictor of MS among Hispanic children.

Continuing Mobile Care for Katrina's Children

Geographic circumstances: I responded as a volunteer to Hurricane Katrina on the Gulf Coast and subsequently returned frequently to provide on-site clinical services and administrative organizational activities. About the author: I am a community pediatrician and since January 2006 have served as chief medical officer of Childrens Health Fund (CHF), a national not-for-profit organization based in New York that supports a national network of 24 programs that provide comprehensive health care services to medically high-risk children and families. Patients served include the homeless, those who live in rural and urban pockets of the country that lack pediatric providers, and immigrant and postdisaster populations, who face significant barriers to health care. Previously, I served for more than 11 years as medical director of the South Florida Childrens Health Project, a CHF program in Miami-Dade County. My move from south Florida to New York was directly linked to Hurricane Katrina. Before Hurricane Katrina, most of my days were spent on a 38-ft-long mobile clinic providing a medical home to a largely immigrant and low-income population in south Florida. A dedicated team of nurses, mental health providers, and case managers addressed the medical, mental, and social complexities of our patient population. We delivered well-coordinated and integrated health care services between primary and subspecialty providers as well as related community programs, such as food pantries and domestic violence shelters. Medical students and pediatric/family practice residents worked with us, learning the importance of community pediatrics. Then, Hurricane Katrina struck. I quickly volunteered to go to the Gulf Coast to provide care to needy children and families in crisis. In fact, 13 of 17 Childrens Health Fund (CHF) programs at the time sent staff and/or mobile clinics to the region, beginning just days after Katrina made landfall. My experience in southern Mississippi left me with these … Address correspondence to Arturo Brito, MD, MPH, Childrens Health Fund, Executive Office, 215 W 125th St, Suite 301, New York, NY 10027. E-mail: abrito{at}chfund.org