Dimitri A. Christakis

Real use or "real cool": adolescents speak out about displayed alcohol references on social networking Websites.

Adolescents frequently display alcohol references on social networking Websites (SNSs). We conducted focus groups to determine adolescents interpretations of these displayed alcohol references. Regardless of whether displayed alcohol references represent actual use, adolescents typically interpret these references as representing actual use and acknowledge their potential influence on peer behavior.

Aminoglycoside-based triple-antibiotic therapy versus monotherapy for children with ruptured appendicitis

OBJECTIVE. We conducted a retrospective cohort study to compare the use of triple therapy versus monotherapy for children and adolescents with perforated appendicitis and to determine whether there has been a transition to monotherapy within the freestanding childrens hospitals that contribute to the Pediatric Health Information System database. METHODS. We used the Pediatric Health Information System database, which includes billing and discharge data for 32 childrens hospitals in the United States, to examine the trend in antibiotic usage and whether the postappendectomy antibiotic regimen was associated with differences in complication-related readmissions, length of stay, or charges in a population of children and adolescents with ruptured appendicitis and discharge dates between March 1, 1999, and September 30, 2004. Pairwise regression analyses were performed to compare the most common monotherapy regimens with the triple therapy. RESULTS. A total of 8545 patients met the inclusion criteria, of whom 58%, over the entire study period, received the aminoglycoside-based triple antibiotic therapy on postoperative day 1. There was, however, a notable transition over this 6-year period, from 69% to 52% of surgeons using aminoglycoside-based combination therapy. There were no significant differences in the odds of readmission at 30 days except for the group receiving ceftriaxone, which was associated with significantly decreased odds. The subgroup receiving piperacillin/tazobactam monotherapy demonstrated significantly decreased length of stay (−0.90 days) and total hospital charges, and the group receiving cefoxitin demonstrated significantly decreased length of stay (−1.89 days), as well as decreased pharmacy and total hospital charges. CONCLUSIONS. Single-agent antibiotic therapy in the treatment of perforated appendicitis is being used with increasing frequency, is at least equal in efficacy to the traditional aminoglycoside-based combination therapy, and may offer improvements in terms of length of stay, pharmacy charges, and hospital charges.

Neonatal Seizures: Treatment and Treatment Variability in 31 United States Pediatric Hospitals

Neonatal seizures are one of the most common neurological disorders in infants. However, the optimal treatment strategy for neonatal seizures remains controversial and there is little data regarding current treatment of neonatal seizures. In this study we describe the current treatment of neonatal seizures and variation in practice among 31 pediatric hospitals in the United States. We retrospectively identified 6099 infants hospitalized in the first month of life in one of 31 pediatric hospitals participating in the Pediatric Health Information System, with a discharge diagnosis of seizure. As expected, most treated infants received phenobarbital. However, there was significant interhospital variability for all treatments studied including any antiepileptic drug treatment, phenytoin treatment, antiepileptic drug treatment through discharge, number of antiepileptic drugs used, and treatment with pyridoxine (P < .001). These findings highlight the need for rigorous controlled outcome studies to determine optimal therapy for neonatal seizures and devise treatment standards.

Validation of parent self reported home safety practices.

Objectives: To evaluate the validity of parents’ self reported home safety practices concerning smoke detectors, bike helmets, car seats, and water heater temperature. Setting: Parents of children 12 years old and under whose child had made at least one visit to a study clinic in the years 2000–2003. Methods: As part of a randomized controlled trial to improve patient provider communication and preventive practices, parents’ responses to telephone interview were compared with observations of safety practices during a home visit. Home visits were completed within nine weeks of the telephone interview. Parents were not told that the visit was part of a validation study and home visit observers were unaware of the interview responses. The authors calculated sensitivities, specificities, positive and negative predictive values, and their corresponding confidence intervals. Results: Sensitivity (0.78 to 0.98) and positive predictive values (0.75 to 1.00) were high for all items. Specificities and negative predictive values were more variable and the highest estimates (specificity 0.95 to 1.00, negative predictive value 0.95 to 0.97) were for car seat types. Conclusions: The results suggest that parent self report practice of certain injury prevention behaviors (owning a car seat, hot water temperatures) is reliable, whereas self reports on other practices (working smoke detectors, properly fitting bike helmets) may be overstated.

Parent Use of Touchscreen Computer Kiosks for Child Health Promotion in Community Settings

OBJECTIVES. The goals were to evaluate the use of touchscreen computer kiosks, containing only child health–promoting information, in urban, low-income, community settings and to characterize the users of these kiosks. METHODS. Three user-driven touchscreen computer kiosks were placed in low-income urban locations in Seattle, Washington, from March 2005 to October 2005. The locations included a public library, a Department of Motor Vehicles office, and a McDonalds restaurant. Users selected age-appropriate modules with prevention information and screening tools. Users entered the age of the child and were presented with age-appropriate modules. On exiting, users were asked to rate their experience and to provide basic demographic data. RESULTS. In total, there were 1846 kiosk sessions. Almost one half occurred at McDonalds. Seventy-eight percent of users identified themselves as first-time users. Users sought information for children of all ages. Sixty-one percent of first-time users explored 1 module. First-time users were most interested in television/media use (16%), smoke exposure (14%), attention-deficit/hyperactivity disorder screening (12%), and asthma assessment (11%). At-risk children were identified in 52% of sessions. Eighty-seven percent of first-time users who completed the asthma assessment had children whose asthma was uncontrolled. Twenty-eight percent of users responded to ≥1 question on the exit survey. Of those, 48% had less than a high school education, and 26% had never used the Internet. Approximately one half found the kiosk easy to use (57%) and the information easy to understand (55%); 66% said there was at least some new information. Fifty-five percent planned to try some of the things they had learned, and 49% intended to talk to their childs doctor about what they had learned. CONCLUSIONS. User-driven computer kiosks were used in community settings to obtain child health information. Users found the kiosks easy to use. Additional study on improving use and understanding the impact is needed.

Infection Control Policies and Hospital-Associated Infections Among Surgical Patients: Variability and Associations in a Multicenter Pediatric Setting

Background. Hospital-associated infections are an important cause of patient morbidity and death. Little is known about the variability of infection rates and infection control practices among pediatric hospitals. Methods. This cross-sectional study was performed with the Pediatric Health Information System database, which includes demographic and diagnostic data for 35 freestanding, noncompeting, childrens hospitals, and with data from a survey of the hospitals, which yielded additional information on infection control policies and practices. Patients undergoing elective surgical procedures were included in this study. Results. Of the 35 eligible hospitals, 31 (89%) chose to participate in the survey component of this study. A total of 48278 patients met the inclusion criteria for the study; 2.3% of these patients had respiratory infections and 0.8% had gastrointestinal infections. The frequency of patients diagnosed with respiratory or gastrointestinal infections varied considerably among the hospitals and ranged from <1% to 6%. Certain infection control processes also varied among the hospitals during the study period. For instance, of the 31 hospitals, 12 monitored hand hygiene, 19 had administrative support of hand hygiene, and 16 had alcohol hand gel present for the entire study period. The presence of alcohol hand gel for the entire study was strongly and independently associated with lower odds of gastrointestinal infections (adjusted odds ratio: 0.64; 95% confidence interval: 0.49-0.85). Conclusions. Hospitals should support the use of alcohol hand gel, with the aim of decreasing hospital-associated infection rates.

Variations between hospitals in antireflux procedures in children.

OBJECTIVEnTo examine the differences and trends in pediatric antireflux procedures (ARPs) across individual pediatric hospitals over time.nnnDESIGNnRetrospective cohort study.nnnSETTINGnAdministrative database containing inpatient records with discharge dates between January 1, 2001, and March 31, 2006.nnnPARTICIPANTSnHospitalized pediatric patients younger than 18 years with primary procedure codes for ARP, appendectomy, pyloromyotomy, and gastrostomy tube placement. The comparisons with admissions for these common procedures were used to identify changes in the incidence of ARP per hospital per year.nnnMAIN OUTCOME MEASURESnThe ratio of ARPs to appendectomies, pyloromyotomies, gastrostomies, and all 3 procedures combined, in each hospital by year.nnnRESULTSnDuring our study period 13 691 ARPs, 41 441 nonincidental appendectomies, 14 895 pyloromyotomies, and 23 527 gastrostomy tube placements were identified. The average number of ARPs per appendectomy, pyloromyotomy, and gastrostomy tube placement declined annually across free-standing pediatric institutions. When these annual changes are examined within each hospital individually, however, it appears that such changes are not occurring equally, in that some hospitals are performing significantly greater and some significantly fewer ARPs relative to these common procedures.nnnCONCLUSIONSnThe number of ARPs being performed in 36 free-standing childrens hospitals is decreasing each year relative to several operations commonly performed at these institutions. Despite this overall annual decrease, there is tremendous variation between individual hospitals in how frequently ARPs are being performed relative to these procedures.

The value of social-cognitive theory to reducing preschool TV viewing: A pilot randomized trial

OBJECTIVEnTo (a) reduce the total amount of television viewing to which preschool children are exposed; and (b) shift the balance of exposure away from commercial television toward educational content.nnnMETHODnRandomized controlled clinical trial. Data collected in 2007; analyzed 2008-2011. Participants were 67 English-speaking families in Seattle with a preschool-aged child exposed to more than 90 min of television viewing on average per day. A case manager for each group used in-person conferences, monthly newsletters, and e-mail contact to motivate behavior change around child television viewing (intervention) or child safety (control).nnnRESULTSnCompared to those in the control group, families randomized to the intervention group experienced a significant reduction by 37 minutes/day in total viewing time (95% CI: 5.6-68.7), including a marginally significant reduction by 29 minutes/day in viewing of commercial content (95% CI: -4.6-63). Compared to those in the control group, those in the intervention group experienced a positive change in outcome expectations. There were no significant changes in self-efficacy or volitional control. An advance in stage-of-change was marginally significant.nnnCONCLUSIONSnTargeting commercial TV viewing may prove a successful behavioral intervention to achieve public health goals in this population.

Perceptions About Computers and the Internet in a Pediatric Clinic Population

BACKGROUNDnA digital divide with respect to computer and Internet access has been noted in numerous studies and reports. Equally important to ownership is comfort with computers and Internet technology, and concerns about privacy of personal data.nnnOBJECTIVEnTo measure how households in a pediatric clinic vary in their attitudes toward computers, concerns about Internet confidentiality, and comfort using the Internet and whether these views are associated with household income or education.nnnDESIGN/METHODSnA phone survey was administered to a population-based sample of parents with children aged 0 to 11 years. All children received medical care from a community-based clinic network serving patients in King County, Wash.nnnRESULTSnEighty-eight percent of respondents used a computer once a week or more, and 83% of respondents reported favorable feelings toward computers. Although 97% of respondents were willing to share personal information over the Internet, many respondents considered data security important. While household income and parental education were associated with comfort and familiarity with computers, the effect is small. Respondents who already owned a computer and had Internet access did not differ in their perceptions according to socioeconomic or educational attainment.nnnCONCLUSIONSnMost families like using computers and feel comfortable using the Internet regardless of socioeconomic status. Fears about the digital divides impact on the attitudes of parents toward computers or their comfort using the Internet should not be seen as a barrier to developing Internet-based health interventions for a pediatric clinic population.

Redefining outcome of first seizures by acute illness.

BACKGROUND: Seizures are common in children, but the causes and recurrence risk for children with a nonfebrile first seizure remain poorly understood. OBJECTIVE: In a prospective longitudinal study of children who presented with a first-time seizure, we investigated the viral etiology of associated infectious illnesses and sought to determine the risk of recurrent seizures stratified by fever and type of illness. PATIENTS AND METHODS: Children (aged 6 months to 6 years) were enrolled at the time of evaluation for their first seizure and followed monthly for up to 5 years. Seizure and illness data were collected through parent interviews and medical-record reviews. Stool, serum, and cerebrospinal fluid collected within 48 hours of the first seizure were evaluated for viral gastrointestinal pathogens. RESULTS: Of the 117 children enrolled, 78 (67%) had febrile seizures, 34 (29%) had nonfebrile-illness seizures, and 5 (4%) had unprovoked seizures. Children with nonfebrile-illness seizures were more likely than those with febrile seizures to have acute gastroenteritis (47% and 28%, respectively; P = .05). No significant differences in seizure recurrence were found between children with or without a fever at first seizure. Children with acute gastroenteritis at first seizure, regardless of fever, had a lower risk of seizure recurrence compared with children with other acute illnesses (hazard ratio: 0.28; 95% confidence interval: 0.09–0.80). CONCLUSIONS: Our results confirm the role of gastrointestinal illness as a distinguishing feature in childhood seizures. Children with this distinct presentation have a low rate of seizure recurrence and few neurologic complications.