Karen M. Wilson

Getting the Word Out: Disseminating Scholarly Work in the Technology Age

From the Department of Pediatrics, University of Southern California Keck School of Medicine, Children’s Hospital Los Angeles, Los Angeles, Calif (Dr Trost); Department of Pediatrics, Riley Hospital at IU Health, Indiana School of Medicine, Indianapolis, Ind (Dr Webber); and Department of Pediatrics, Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (Dr Wilson) Conflict of Interest: The authors declare that they have no conflict of interest. Address correspondence to Margaret J. Trost, MD, Department of Pediatrics, University of Southern California Keck School of Medicine, Children’s Hospital Los Angeles, 4650 Sunset Blvd #94, Los Angeles, CA 90027 (e-mail: mtrost@chla.usc.edu).

Impact of Discharge Components on Readmission Rates for Children Hospitalized with Asthma

Objectives To describe hospital‐based asthma‐specific discharge components at childrens hospitals and determine the association of these discharge components with pediatric asthma readmission rates. Study design This is a multicenter retrospective cohort study of pediatric asthma hospitalizations in 2015 at childrens hospitals participating in the Pediatric Health Information System. Children ages 5 to 17 years were included. An electronic survey assessing 13 asthma‐specific discharge components was sent to quality leaders at all 49 hospitals. Correlations of combinations of asthma‐specific discharge components and adjusted readmission rates were calculated. Results The survey response rate was 92% (45 of 49 hospitals). Thirty‐day and 3‐month adjusted readmission rates varied across hospitals, ranging from 1.9% to 3.9% for 30‐day readmissions and 5.7% to 9.1% for 3‐month readmissions. No individual or combination discharge components were associated with lower 30‐day adjusted readmission rates. The only single‐component significantly associated with a lower rate of readmission at 3 months was having comprehensive content of education (P < .029). Increasing intensity of discharge components in bundles was associated with reduced adjusted 3‐month readmission rates, but this did not reach statistical significance. This was seen in a 2‐discharge component bundle including content of education and communication with the primary medical doctor, as well as a 3‐discharge component bundle, which included content of education, medications in‐hand, and home‐based environmental mitigation. Conclusions Childrens hospitals demonstrate a range of asthma‐specific discharge components. Although we found no significant associations for specific hospital‐level discharge components and asthma readmission rates at 30 days, certain combinations of discharge components may support hospitals to reduce healthcare utilization at 3 months.

Adolescent Use of Different E-cigarette Products

Most adolescents use open-system e-cigarettes, especially frequent users. This pattern of use suggests a starter product phenomenon, with a graduation to potentially more dangerous products. BrightcoveDefaultPlayer10.1542/6138648666001PEDS-VA_2018-0260 Video Abstract BACKGROUND: Little is known about the characteristics of electronic cigarettes (e-cigarettes) used by adolescents. Understanding the product landscape of adolescent e-cigarette use may inform counseling and policy strategies. METHODS: Results are from 13 651 adolescents in wave 1 and 12 172 adolescents in wave 2 of the Population Assessment of Tobacco and Health Study, a nationally representative longitudinal study. Past 30-day regular e-cigarettes users were asked about the characteristics of the e-cigarette they used most of the time. RESULTS: In waves 1 and 2, 2.1% and 2.8% of adolescents were regular users in the past 30 days, respectively. These adolescents more often used rechargeable rather than disposable devices (wave 1: 76.0%; wave 2: 82.9%) and refillable rather than nonrefillable devices (wave 1: 66.6%; wave 2: 84.4%) and tended not to use cartridge systems (wave 1: 33.7%; wave 2: 30.5%). Most adolescent past 30-day users (wave 1: 87.5%; wave 2: 89.4%) reported using flavored e-cigarettes. An increased frequency of use was associated with the use of rechargeable (wave 1 adjusted odds ratio [aOR]: 2.7; wave 2 aOR: 2.7) and refillable e-cigarettes (wave 1 aOR: 2.0; wave 2 aOR: 2.7; P < .05). Most users in wave 1 did not continue regular use in wave 2 (70.2%). Among those who continued to use and had reported using closed systems (nonrechargeable and/or nonrefillable) in wave 1, most had progressed to open systems (rechargeable and refillable) in wave 2. CONCLUSIONS: Most adolescents use open-system e-cigarettes, and frequent users are even more likely to use open-system e-cigarettes. The majority of regular users use rechargeable devices that are refillable. A change in product preferences across waves suggests a starter product phenomenon, with a graduation to products that have weaker quality controls and may increase health risks.

Adult Attitudes and Practices Regarding Smoking Restrictions and Child Tobacco Smoke Exposure: 2000 to 2015

By using the Social Climate Survey of Tobacco Control, this study reveals improvements in the protection of children since 2000. BACKGROUND AND OBJECTIVES: Since 2000, tobacco control efforts have greatly increased state and local protections from childhood tobacco smoke exposure. The objective of this study is to examine changes in attitudes and practices regarding smoking bans in multiple public and private settings from 2000 to 2015, as well as to examine the changes in pediatrician and family practitioner screening and counseling for tobacco smoke exposure. METHODS: Cross-sectional data from the annual Social Climate Survey of Tobacco Control were analyzed. RESULTS: The majority of adults, 69.3%, reported household smoking restrictions in 2000, and these restrictions increased to 79.5% through 2015 (P < .05). Car smoking prohibitions increased from 68.3% to 81.8% (P < .05). A growing majority of adults supports smoke-free policies in public settings, and tobacco counseling by child health care providers also increased. However, members of 1 in 5 households still permit smoking inside the home and family vehicle, and half of the US population is not protected by state or local laws prohibiting smoking inside of hospitality venues. CONCLUSIONS: Despite dramatic progress since 2000, these trend data reveal potential areas where child health care clinicians might focus effort at the family and community level to accelerate the protection of children from tobacco smoke exposure.

Evaluating Interventions to Increase Influenza Vaccination Rates among Pediatric Inpatients

Introduction: Hospitalization provides an ideal opportunity for influenza vaccination, and strategies can enhance existing tools within the electronic medical record (EMR). The objectives of the study were to introduce and evaluate the effectiveness of provider and family-directed interventions to increase influenza vaccination ordering among inpatients. Methods: We conducted a quality improvement initiative for children aged older than 6 months on medical inpatient teams at a large pediatric tertiary care hospital from September 2014 to March 2015, comprising 2 intervention groups (provider reminders and family education) and 1 control group for comparison, using EMR prompts alone. The provider reminder interventions comprised weekly e-mails indicating inpatient immunization status; vaccination reports; and visual reminders. The family education group intervention consisted of handouts regarding the benefits and safety of influenza vaccination. We measured vaccine ordering rates for each group among eligible children and overall vaccination rates. Data were analyzed using Statistical Process Control Charts and Chi-square tests. Results: Among 2,552 patients aged older than 6 months hospitalized during the study period, 1,657 were unimmunized. During the intervention period, the provider group ordered 213/409 (52%) influenza vaccines, the family education group ordered 138/460 (30%) and the control group ordered 71/279 (25%) (P < 0.0001). The provider group had higher influenza immunization status than the control group (61% versus 53%; P = 0.0017). Exposure to the intervention did not impact the length of stay/discharge time. Conclusions: Provider reminders including e-mails, visual reminders, and vaccination reports are effective ways of increasing inpatient influenza vaccination rates and are more effective than family education, or EMR prompts alone.

Secondhand smoke exposure and depressive symptoms in children: a longitudinal study

Introduction We investigated whether secondhand smoke (SHS) exposure is associated with depressive symptoms in a population-based sample of children. Methods Never-smoking students from 29 French-language elementary schools in greater Montréal, Canada) were followed from 5th-11th grade (2005-11) in 5 waves: (1 (5th grade), 2 (spring 6th grade), 3 (7th grade), 4 (9th grade) and 5 (11th grade)). Associations between depressive symptoms and SHS exposure at home and in cars were examined in cross-sectional and longitudinal gamma generalized regression models adjusted for sex, maternal education and neighborhood socioeconomic status. Results The sample comprised 1553 baseline never smokers (Mean (SD) age = 10.7 (0.5) years; 44% male; 89% French-speaking). SHS exposure at home and in cars was associated with higher depressive symptom scores in cross-sectional analyses pooled across grades and adjusted for demographics (B (95% CI) = 0.041 (0.017, 0.068) for home exposure; 0.057 (0.030, 0.084) for car exposure). In longitudinal analyses from 5th to 6th grade, B (95% CI), adjusted for demographics and baseline depressive symptoms, was 0.042 (0.003, 0.080) for home exposure and 0.061 (0.019, 0.103) for car exposure. From 6th to 7th grade, B (95% CI) was 0.057 (0.003, 0.110) for home exposure and 0.074 (0.015, 0.133) for car exposure. SHS exposure at any age did not predict depressive symptoms two years later. Conclusions SHS exposure is associated with depressive symptoms in young persons, both concurrently and one year later. This finding adds to the evidence base supporting that children should be protected from SHS exposure.

Assessing pediatric tobacco exposure using parent report: comparison with hair nicotine

IntroductionThe purpose of this study was to examine the relationships between screening questions for secondhand smoke (SHS) exposure and biomarker results using hair nicotine levels. Our ultimate goal was to develop sensitive and valid screening tools in pediatric clinical settings for SHS exposure.MethodsInvestigators developed a core set of questions regarding exposure. Data from two separate ongoing studies of well children and those with bronchopulmonary dysplasia (BPD) were used to assess the concordance between responses and hair nicotine levels. Sensitivity, a positive predictive value, and accuracy were examined.ResultsThere was no single question with similar sensitivity in both populations. The question with the highest positive predictive value (90.8% well-cohort and 84.6% BPD cohort) for both the groups was whether the child had been exposed to in-home smoking in the last 7 days. The question with the highest accuracy for both groups was the number of smokers at home (0 vs ≥ 1), with an accuracy of 72.4% for well children and 79.0% for the BPD cohort.ConclusionsThere was a wide variability in the performance of specific questions. These data demonstrate that a “one-size-fits-all” approach to screening for secondhand tobacco smoke exposure may not be appropriate for all pediatric populations.

Exploring provider and parental perceptions to influenza vaccination in the inpatient setting

Hospitalization provides an ideal opportunity for immunization, but few studies have explored provider and parental attitudes toward pediatric inpatient vaccination against influenza.

Characteristics of Children Hospitalized for Psychogenic Nonepileptic Seizures Due to Conversion Disorder Versus Epilepsy

OBJECTIVES Psychogenic nonepileptic seizures (PNES) are a manifestation of conversion disorder among children but can be difficult to distinguish from epilepsy. We sought to identify characteristics that differentiate children with PNES from those with epilepsy. METHODS We conducted a retrospective cohort study of children admitted with epilepsy or PNES to 45 childrens hospitals from 2004 to 2014. Children with PNES (n = 399) versus those with epilepsy (n = 13 241) were compared on demographic and clinical characteristics, testing, treatment, and health care use. Hierarchical multivariable logistic regression was used to identify characteristics associated with PNES diagnosis. RESULTS Children with PNES were more likely to be female (adjusted odds ratio [aOR] 2.3; 95% confidence interval [CI] 1.8-3.0), older (aOR 3.8; 95% CI 2.7-5.3 for 14-16 years old), African American (aOR 2.0; 95% CI 1.5-2.7), and have diagnosis codes for psychiatric disorders (aOR 7.1; 95% CI 5.6-9.1) and pain (aOR 2.6; 95% CI 1.9-3.4). They were also more likely to be admitted in the fall (aOR 2.0; 95% CI 1.4-2.8) or spring (aOR 1.9; 95% CI 1.4-2.6) versus summer. Total adjusted hospitalization costs were greater for children with epilepsy (

Tobacco-Smoke Incursions and Satisfaction Among Residents With Children in Multiunit Housing, United States, 2013:

4724, 95% CI