Benard P Dreyer, M.D.

Early childhood stimulation in the developing and developed world: if not now, when?
Dreyer, Benard P
2011 May;127(5):975-977, Pediatrics
— id: 131963, year: 2011, vol: 127, page: 975, stat: Journal Article,

Response-time variability is related to parent ratings of inattention, hyperactivity, and executive function
Gomez-Guerrero, Lorena; Martin, Cristina Dominguez; Mairena, Maria Angeles; Di Martino, Adriana; Wang, Jing; Mendelsohn, Alan L; Dreyer, Benard P; Isquith, Peter K; Gioia, Gerard; Petkova, Eva; Castellanos, F Xavier
2011 Oct;15(7):572-582, Journal of attention disorders
Objective: Individuals with ADHD are often characterized as inconsistent across many contexts. ADHD is also associated with deficits in executive function. We examined the relationships between response time (RT) variability on five brief computer tasks to parents' ratings of ADHD-related features and executive function in a group of children with a broad range of ADHD symptoms from none to full diagnosis. Methods: We tested 98 children (mean age 9.9 +/- 1.4 years; 66 boys) from community clinics on short tasks of executive control (TEC) and the Eriksen Flanker task, while a parent completed the Conners' Parent Rating Scale and Behavior Rating Inventory of Executive Function. Results: Variability for two of the TEC tasks explained significant proportions of the variance of all five ADHD-related Conners' subscales and several executive function subscales. By contrast, variability on the flanker task or mean RTs for any task were not associated with any rating scale. Conclusion: The significant dimensional relationships observed between variability measures and parent ratings supported the utility of RT variability as an objective measure in ADHD and aspects of executive functioning that is superior to RT means or accuracy measures
— id: 138265, year: 2011, vol: 15, page: 572, stat: Journal Article,

Randomized controlled trial of primary care pediatric parenting programs: effect on reduced media exposure in infants, mediated through enhanced parent-child interaction
Mendelsohn, Alan L; Dreyer, Benard P; Brockmeyer, Carolyn A; Berkule-Silberman, Samantha B; Huberman, Harris S; Tomopoulos, Suzy
2011 Jan;165(1):42-48, Archives of pediatrics & adolescent medicine
OBJECTIVES: To determine whether pediatric primary care-based programs to enhance parenting and early child development reduce media exposure and whether enhanced parenting mediates the effects. DESIGN: Randomized controlled trial. SETTING: Urban public hospital pediatric primary care clinic. PARTICIPANTS: A total of 410 mother-newborn dyads enrolled after childbirth. INTERVENTIONS: Patients were randomly assigned to 1 of 2 interventions, the Video Interaction Project (VIP) and Building Blocks (BB) interventions, or to a control group. The VIP intervention comprised 1-on-1 sessions with a child development specialist who facilitated interactions in play and shared reading through review of videotapes made of the parent and child on primary care visit days; learning materials and parenting pamphlets were also provided. The BB intervention mailed parenting materials, including age-specific newsletters suggesting activities to facilitate interactions, learning materials, and parent-completed developmental questionnaires (Ages and Stages questionnaires). OUTCOME MEASURES: Electronic media exposure in the home using a 24-hour recall diary. RESULTS: The mean (SD) exposure at 6 months was 146.5 (125.0) min/d. Exposure to VIP was associated with reduced total duration of media exposure compared with the BB and control groups (mean [SD] min/d for VIP, 131.6 [118.7]; BB, 151.2 [116.7]; control, 155.4 [138.7]; P = .009). Enhanced parent-child interactions were found to partially mediate relations between VIP and media exposure for families with a ninth grade or higher literacy level (Sobel statistic = 2.49; P = .01). CONCLUSION: Pediatric primary care may represent an important venue for addressing the public health problem of media exposure in young children at a population level. Trial Registration clinicaltrials.gov Identifier: NCT00212576
— id: 117352, year: 2011, vol: 165, page: 42, stat: Journal Article,

Primary care strategies for promoting parent-child interactions and school readiness in at-risk families: the bellevue project for early language, literacy, and education success
Mendelsohn, Alan L; Huberman, Harris S; Berkule, Samantha B; Brockmeyer, Carolyn A; Morrow, Lesley M; Dreyer, Benard P
2011 Jan;165(1):33-41, Archives of pediatrics & adolescent medicine
OBJECTIVE: To determine the effects of pediatric primary care interventions on parent-child interactions in families with low socioeconomic status. DESIGN: In this randomized controlled trial, participants were randomized to 1 of 2 interventions (Video Interaction Project [VIP] or Building Blocks [BB]) or the control group. SETTING: Urban public hospital pediatric primary care clinic. PARTICIPANTS: Mother-newborn dyads enrolled post partum from November 1, 2005, through October 31, 2008. INTERVENTIONS: In the VIP group, mothers and newborns participated in 1-on-1 sessions with a child development specialist who facilitated interactions in play and shared reading by reviewing videos made of the parent and child on primary care visit days; learning materials and parenting pamphlets were also provided. In the BB group, parenting materials, including age-specific newsletters suggesting interactive activities, learning materials, and parent-completed developmental questionnaires, were mailed to the mothers. MAIN OUTCOME MEASURES: Parent-child interactions were assessed at 6 months with the StimQ-Infant and a 24-hour shared reading recall diary. RESULTS: A total of 410 families were assessed. The VIP group had a higher increased StimQ score (mean difference, 3.6 points; 95% confidence interval, 1.5 to 5.6 points; Cohen d, 0.51; 0.22 to 0.81) and more reading activities compared to the control group. The BB group also had an increased overall StimQ score compared with the control group (Cohen d, 0.31; 95% confidence interval, 0.03 to 0.60). The greatest effects for the VIP group were found for mothers with a ninth-grade or higher reading level (Cohen d, 0.68; 95% confidence interval, 0.33 to 1.03). CONCLUSIONS: The VIP and BB groups each led to increased parent-child interactions. Pediatric primary care represents a significant opportunity for enhancing developmental trajectories in at-risk children. Trial Registration clinicaltrials.gov Identifier: NCT00212576
— id: 117351, year: 2011, vol: 165, page: 33, stat: Journal Article,

The APA and the Rise of Pediatric Generalist Network Research
Wasserman R; Serwint JR; Kuppermann N; Srivastava R; Dreyer B
2011 May - June;11(3):195-204, Academic Pediatrics
The Academic Pediatric Association (APA, formerly the Ambulatory Pediatric Association) first encouraged multi-institutional collaborative research among its members over 30 years ago. Individual APA members subsequently went on to figure prominently in establishing formal research networks. These enduring collaborations have been established to conduct investigations in a variety of generalist contexts. At present, 4 generalist networks-Pediatric Research in Office Settings (PROS), the Pediatric Emergency Care Applied Research Network (PECARN), the COntinuity Research NETwork (CORNET), and Pediatric Research in Inpatient Settings (PRIS)-have a track record of extensive achievement in generating new knowledge aimed at improving the health and health care of children. This review details the history, accomplishments, and future directions of these networks and summarizes the common themes, strengths, challenges, and opportunities inherent in pediatric generalist network research
— id: 133427, year: 2011, vol: 11, page: 195, stat: Journal Article,

Use of a pictographic diagram to decrease parent dosing errors with infant acetaminophen: a health literacy perspective
Yin, H Shonna; Mendelsohn, Alan L; Fierman, Arthur; van Schaick, Linda; Bazan, Isabel S; Dreyer, Benard P
2011 Jan-Feb;11(1):50-57, Academic Pediatrics
OBJECTIVE: Medication dosing errors by parents are frequent. We sought to whether a pictographic dosing diagram could improve parent ability to dose infant acetaminophen, and to determine whether pictogram benefit varies by health literacy level. METHODS: We conducted an experimental study of parents presenting with their children to an urban public hospital pediatric clinic. Caregivers were randomized to dose infant acetaminophen with a standard dropper using text-only or text-plus-pictogram instructions (pictographic diagram of dose). The primary outcome variable was dosing accuracy (error defined as >20% deviation above/below dose; large overdosing error defined as >1.5 times recommended dose). Caregiver health literacy was assessed by means of the Newest Vital Sign measure. RESULTS: A total of 299 parents were assessed (144 text-only instructions; 155 text plus pictogram); 77.9% had limited health literacy (Newest Vital Sign score 0-3). Text-plus-pictogram recipients were less likely to make an error compared to text-only recipients (43.9% vs 59.0%, P = .01; absolute risk reduction, 15.2% [95% confidence interval, 3.8-26.0]; number needed to treat, 7 [4-26]). Of text-plus-pictogram recipients, 0.6% made a large overdosing error compared to 5.6% of text-only recipients (absolute risk reduction, 4.9% [0.9-10.0]; number needed to treat, 20 [10-108]). Pictogram benefit varied by health literacy, with a statistically significant difference in dosing error evident in the text-plus-pictogram group compared to the text-only group among parents with low health literacy (50.4% vs 66.4%; P = .02), but not for parents with adequate health literacy (P = .7). CONCLUSIONS: Inclusion of pictographic dosing diagrams as part of written medication instructions for infant acetaminophen may help parents provide doses of medication more accurately, especially those with low health literacy. High error rates, even among parents with adequate health literacy, suggest that additional study of strategies to optimize dosing is needed
— id: 122539, year: 2011, vol: 11, page: 50, stat: Journal Article,

Sources of parenting information in low SES mothers
Berkule-Silberman, Samantha B; Dreyer, Benard P; Huberman, Harris S; Klass, Perri E; Mendelsohn, Alan L
2010 Jun;49(6):560-568, Clinical pediatrics
This study examined 3 questions: (1) What are sources from which low socioeconomic status (SES) mothers of newborns receive parenting information? (2) To what extent are sociodemographic characteristics associated with sources? (3) To what extent are sources associated with intentions regarding activities with infants? In this cross-sectional analysis, mothers were interviewed during the postpartum period about potential sources of information about parenting and asked if and when they planned to initiate shared reading and television exposure during infancy. Maternal high school graduation, US birth, non-Latina ethnicity, language English, higher SES, and firstborn child were each associated with one or more categories representing important sources of parenting information. In adjusted analyses, print, physicians and other health care professionals, and family/friends as important sources of information were each significantly associated with increased frequency of intention to begin shared reading in infancy; television as an important source was associated with intention to begin television in infancy
— id: 109845, year: 2010, vol: 49, page: 560, stat: Journal Article,

Screening for developmental delay in high-risk users of an urban pediatric emergency department
Grossman, Devin S; Mendelsohn, Alan L; Tunik, Michael G; Dreyer, Benard P; Berkule, Samantha B; Foltin, George L
2010 Nov;26(11):793-797, Pediatric emergency care
OBJECTIVE:: To determine whether screening children in an urban pediatric emergency department (PED) would lead to identification of previously undiagnosed developmental delay. METHODS:: This was a cross-sectional study of families presenting to an urban public hospital PED with children 6 to 36 months and no history of developmental delay. Children were screened for possible developmental delay using the Ages and Stages Questionnaire; parents completed an instrument that assesses 5 domains: communication, gross motor, fine motor, problem solving, and personal-social. Sociodemographic data were also obtained. RESULTS:: One hundred thirty-eight children were enrolled, all accompanied by their mothers. Mean age of the children was 18.9 months; 51.5% were female; 56.8% of the mothers were high-school graduates; 59.9% were immigrants; 75.4% were Latino. Twenty-one percent did not have a regular source of primary care; 26.8% (95% confidence interval, 20.1%-34.8%) screened positive in at least 1 domain, with a trend toward the highest percentage of positive screens on the communication domain (z = 1.89, P = 0.059). In a simultaneous multiple logistic regression model including all predictor variables, child age of 12 to 30 months was associated with increased adjusted odds of positive screen (adjusted odds ratio, 8.4; 95% confidence interval, 1.4-48.9). Having a primary caregiver born in the United States was statistically significant for screening positive in at least 1 Ages and Stages Questionnaire domain (P = 0.03). CONCLUSIONS:: Almost 30% of 6- to 36-month-old children presenting to an urban PED without prior developmental concerns screened positive for possible delay, suggesting the utility of performing routine developmental screening in the PED. Pediatric emergency department use alone may be an indication for screening. Further study is needed for feasibility of screening for delay in the PED
— id: 114179, year: 2010, vol: 26, page: 793, stat: Journal Article,

Do Verbal Interactions with Infants During Electronic Media Exposure Mitigate Adverse Impacts on their Language Development as Toddlers?
Mendelsohn AL; Brockmeyer CA; Dreyer BP; Fierman AH; Berkule-Silberman SB; Tomopoulos S
2010 Nov;19(6):577-593, Infant & child development
The goal of this study was to determine whether verbal interactions between mothers and their 6-month-old infants during media exposure ('media verbal interactions') might have direct positive impacts, or mitigate any potential adverse impacts of media exposure, on language development at 14 months. For 253 low-income mother-infant dyads participating in a longitudinal study, media exposure and media verbal interactions were assessed using 24-hour recall diaries. Additionally, general level of cognitive stimulation in the home [StimQ] was assessed at 6 months and language development [Preschool Language Scale-4] was assessed at 14 months. Results suggest that media verbal interactions play a role in the language development of infants from low-income, immigrant families. Evidence showed that media verbal interactions moderated adverse impacts of media exposure found on 14-month language development, with adverse associations found only in the absence the these interactions. Findings also suggest that media verbal interactions may have some direct positive impacts on language development, in that media verbal interactions during the co-viewing of media with educational content (but not other content) were predictive of 14-month language independently of overall level of cognitive stimulation in the home
— id: 145994, year: 2010, vol: 19, page: 577, stat: Journal Article,

Infant media exposure and toddler development
Tomopoulos, Suzy; Dreyer, Benard P; Berkule, Samantha; Fierman, Arthur H; Brockmeyer, Carolyn; Mendelsohn, Alan L
2010 Dec;164(12):1105-1111, Archives of pediatrics & adolescent medicine
OBJECTIVE: To determine whether duration and content of media exposure in 6-month-old infants are associated with development at age 14 months. DESIGN: Longitudinal analysis of 259 mother-infant dyads participating in a long-term study related to early child development, from November 23, 2005, through January 14, 2008. SETTING: An urban public hospital. PARTICIPANTS: Mothers with low socioeconomic status and their infants. Main Exposure Duration and content of media exposure at age 6 months. MAIN OUTCOME MEASURES: Cognitive and language development at age 14 months. RESULTS: Of 259 infants, 249 (96.1%) were exposed to media at age 6 months, with mean (SD) total exposure of 152.7 (124.5) min/d. In unadjusted and adjusted analyses, duration of media exposure at age 6 months was associated with lower cognitive development at age 14 months (unadjusted: r = -0.17, P < .01; adjusted: beta = -0.15, P = .02) and lower language development (r = -0.16, P < .01; beta = -0.16, P < .01). Of 3 types of content assessed, only 1 (older child/adult-oriented) was associated with lower cognitive and language development at age 14 months. No significant associations were seen with exposure to young child-oriented educational or noneducational content. CONCLUSIONS: This study is the first, to our knowledge, to have longitudinally assessed associations between media exposure in infancy and subsequent developmental outcomes in children from families with low socioeconomic status in the United States. Findings provide strong evidence in support of the American Academy of Pediatrics recommendations of no media exposure prior to age 2 years, although further research is needed
— id: 115282, year: 2010, vol: 164, page: 1105, stat: Journal Article,

Parents' medication administration errors: role of dosing instruments and health literacy
Yin, H Shonna; Mendelsohn, Alan L; Wolf, Michael S; Parker, Ruth M; Fierman, Arthur; van Schaick, Linda; Bazan, Isabel S; Kline, Matthew D; Dreyer, Benard P
2010 Feb;164(2):181-186, Archives of pediatrics & adolescent medicine
OBJECTIVES: To assess parents' liquid medication administration errors by dosing instrument type and to examine the degree to which parents' health literacy influences dosing accuracy. DESIGN: Experimental study. SETTING: Interviews conducted in a public hospital pediatric clinic in New York, New York, between October 28, 2008, and December 24, 2008. PARTICIPANTS: Three hundred two parents of children presenting for care were enrolled. MAIN OUTCOME MEASURES: Parents were observed for dosing accuracy (5-mL dose) using a set of standardized instruments (2 dosing cups [one with printed calibration markings, the other with etched markings], dropper, dosing spoon, and 2 oral syringes [one with and the other without a bottle adapter]). RESULTS: The percentages of parents dosing accurately (within 20% of the recommended dose) were 30.5% using the cup with printed markings and 50.2% using the cup with etched markings, while more than 85% dosed accurately with the remaining instruments. Large dosing errors (>40% deviation) were made by 25.8% of parents using the cup with printed markings and 23.3% of parents using the cup with etched markings. In adjusted analyses, cups were associated with increased odds of making a dosing error (>20% deviation) compared with the oral syringe (cup with printed markings: adjusted odds ratio [AOR] = 26.7; 95% confidence interval [CI], 16.8-42.4; cup with etched markings: AOR = 11.0; 95% CI, 7.2-16.8). Compared with the oral syringe, cups were also associated with increased odds of making large dosing errors (cup with printed markings: AOR = 7.3; 95% CI, 4.1-13.2; cup with etched markings: AOR = 6.3; 95% CI, 3.5-11.2). Limited health literacy was associated with making a dosing error (AOR = 1.7; 95% CI, 1.1-2.8). CONCLUSIONS: Dosing errors by parents were highly prevalent with cups compared with droppers, spoons, or syringes. Strategies to reduce errors should address both accurate use of dosing instruments and health literacy
— id: 106513, year: 2010, vol: 164, page: 181, stat: Journal Article,

Evaluation of consistency in dosing directions and measuring devices for pediatric nonprescription liquid medications
Yin, H Shonna; Wolf, Michael S; Dreyer, Benard P; Sanders, Lee M; Parker, Ruth M
2010 Dec 15;304(23):2595-2602, JAMA
CONTEXT: In response to reports of unintentional drug overdoses among children given over-the-counter (OTC) liquid medications, in November 2009 the US Food and Drug Administration (FDA) released new voluntary industry guidelines that recommend greater consistency and clarity in OTC medication dosing directions and their accompanying measuring devices. OBJECTIVE: To determine the prevalence of inconsistent dosing directions and measuring devices among popular pediatric OTC medications at the time the FDA's guidance was released. DESIGN AND SETTING: Descriptive study of 200 top-selling pediatric oral liquid OTC medications during the 52 weeks ending October 30, 2009. Sample represents 99% of the US market of analgesic, cough/cold, allergy, and gastrointestinal OTC oral liquid products with dosing information for children younger than 12 years. MAIN OUTCOME MEASURES: Inclusion of measuring device, within-product inconsistency between dosing directions on the bottle's label and dose markings on enclosed measuring device, across-product use of nonstandard units and abbreviations, and presence of abbreviation definitions. RESULTS: Measuring devices were packaged with 148 of 200 products (74.0%). Within this subset of 148 products, inconsistencies between the medication's dosing directions and markings on the device were found in 146 cases (98.6%). These included missing markings (n = 36, 24.3%) and superfluous markings (n = 120, 81.1%). Across all products, 11 (5.5%) used atypical units of measurement (eg, drams, cc) for doses listed. Milliliter, teaspoon, and tablespoon units were used for doses in 143 (71.5%), 155 (77.5%), and 37 (18.5%) products, respectively. A nonstandard abbreviation for milliliter (not mL) was used by 97 products. Of the products that included an abbreviation, 163 did not define at least 1 abbreviation. CONCLUSION: At the time the FDA released its new guidance, top-selling pediatric OTC liquid medications contained highly variable and inconsistent dosing directions and measuring devices
— id: 115427, year: 2010, vol: 304, page: 2595, stat: Journal Article,

Health literacy and children: introduction
Abrams, Mary Ann; Klass, Perri; Dreyer, Benard P
2009 Nov;124 Suppl 3:S262-S264, Pediatrics
— id: 105411, year: 2009, vol: 124 Suppl 3, page: S262, stat: Journal Article,

Health literacy and children: recommendations for action
Abrams, Mary Ann; Klass, Perri; Dreyer, Benard P
2009 Nov;124 Suppl 3:S327-S331, Pediatrics
— id: 105409, year: 2009, vol: 124 Suppl 3, page: S327, stat: Journal Article,

Introduction: Child health disparities and health literacy
Cheng, Tina L; Dreyer, Benard P; Jenkins, Renee R
2009 Nov;124 Suppl 3:S161-S162, Pediatrics
— id: 133743, year: 2009, vol: 124 Suppl 3, page: S161, stat: Journal Article,

Mental health and child developmental problems: the "not-so-new morbidity"
Dreyer, Benard P
2009 Jul-Aug;9(4):206-208, Academic Pediatrics
— id: 101129, year: 2009, vol: 9, page: 206, stat: Journal Article,

Maternal literacy and associations between education and the cognitive home environment in low-income families
Green, Cori M; Berkule, Samantha B; Dreyer, Benard P; Fierman, Arthur H; Huberman, Harris S; Klass, Perri E; Tomopoulos, Suzy; Yin, Hsiang Shonna; Morrow, Lesley M; Mendelsohn, Alan L
2009 Sep;163(9):832-837, Archives of pediatrics & adolescent medicine
OBJECTIVE: To determine whether maternal literacy level accounts for associations between educational level and the cognitive home environment in low-income families. DESIGN: Analysis of 369 mother-infant dyads participating in a long-term study related to early child development. SETTING: Urban public hospital. PARTICIPANTS: Low-income mothers of 6-month-old infants. MAIN EXPOSURE: Maternal literacy level was assessed using the Woodcock-Johnson III/Bateria III Woodcock-Munoz Tests of Achievement, Letter-Word Identification Test. Maternal educational level was assessed by determining the last grade that had been completed by the mother. MAIN OUTCOME MEASURE: The cognitive home environment (provision of learning materials, verbal responsivity, teaching, and shared reading) was assessed using StimQ, an office-based interview measure. RESULTS: In unadjusted analyses, a maternal literacy level of ninth grade or higher was associated with increases in scores for the overall StimQ and each of 4 subscales, whereas a maternal educational level of ninth grade or higher was associated with increases in scores for the overall StimQ and 3 of 4 subscales. In simultaneous multiple linear regression models including both literacy and educational levels, literacy continued to be associated with scores for the overall StimQ (adjusted mean difference, 3.7; 95% confidence interval, 1.7-5.7) and all subscales except teaching, whereas maternal educational level was no longer significantly associated with scores for the StimQ (1.8; 0.5-4.0) or any of its subscales. CONCLUSIONS: Literacy level may be a more specific indicator of risk than educational level in low-income families. Studies of low-income families should include direct measures of literacy. Pediatricians should develop strategies to identify mothers with low literacy levels and promote parenting behaviors to foster cognitive development in these at-risk families
— id: 102162, year: 2009, vol: 163, page: 832, stat: Journal Article,

Reach out and read: literacy promotion in pediatric primary care
Klass, Perri; Dreyer, Benard P; Mendelsohn, Alan L
2009 ;56(1):11-27, Advances in pediatrics
— id: 105674, year: 2009, vol: 56, page: 11, stat: Journal Article,

Literacy and child health: a systematic review
Sanders, Lee M; Federico, Steven; Klass, Perri; Abrams, Mary Ann; Dreyer, Benard
2009 Feb;163(2):131-140, Archives of pediatrics & adolescent medicine
OBJECTIVES: To assess the prevalence of low health literacy among adolescents, young adults, and child caregivers in the United States, the readability of common child-health information, and the relationship between literacy and child health. DATA SOURCES: MedLine, Educational Resources Information Center, National Library of Medicine, PsychInfo, Harvard Health Literacy Bibliography, and peer-reviewed abstracts from the Pediatric Academic Societies Annual Meetings. STUDY SELECTION: A systematic review using the following key words: health literacy, literacy, reading skill, numeracy, and Wide Range Achievement Test. MAIN OUTCOME MEASURES: Descriptive studies that used at least 1 valid measure of health literacy, studies that assessed the readability of child health information, and observational or experimental studies that included a validated measure of health literacy, literacy, or numeracy skills and an assessment of child health-related outcomes. RESULTS: A total of 1267 articles were reviewed, and 215 met inclusion and exclusion criteria. At least 1 in 3 adolescents and young adults had low health literacy; most child health information was written above the tenth-grade level. Adjusted for socioeconomic status, adults with low literacy are 1.2 to 4 times more likely to exhibit negative health behaviors that affect child health, adolescents with low literacy are at least twice as likely to exhibit aggressive or antisocial behavior, and chronically ill children who have caregivers with low literacy are twice as likely to use more health services. CONCLUSIONS: Low caregiver literacy is common and is associated with poor preventive care behaviors and poor child health outcomes. Future research should aim to ameliorate literacy-associated child health disparities
— id: 93583, year: 2009, vol: 163, page: 131, stat: Journal Article,

Pediatricians and health literacy: descriptive results from a national survey
Turner, Teri; Cull, William L; Bayldon, Barbara; Klass, Perri; Sanders, Lee M; Frintner, Mary Pat; Abrams, Mary Ann; Dreyer, Benard
2009 Nov;124 Suppl 3:S299-S305, Pediatrics
OBJECTIVE: To describe pediatricians' self-reported experiences with health literacy, use of basic and enhanced communication techniques, and perceived barriers to effective communication during office visits. DESIGN/METHODS: A national, random sample of 1605 nonretired, posttraining American Academy of Pediatrics members were surveyed in 2007 about health literacy and patient communication as part of the Periodic Survey of Fellows. The response rate was 56% (N = 900). RESULTS: Eight-one percent of the pediatricians were aware of a situation in the previous 12 months in which a parent had not sufficiently understood health information that had been delivered to him or her. In addition, 44% of all pediatricians were aware of a communication-related error in patient care within the previous 12 months. Using simple language (99%), repeating key information (92%), and presenting only 2 or 3 concepts at a time (76%) were the most commonly used communication strategies. Enhanced communication techniques recommended by health literacy experts such as teach-back and indicating key points on written educational materials were used less often (23% and 28%, respectively). The most common reported barriers to effective communication were limited time to discuss information (73%), volume of information (65%), and complexity of information (64%). The majority of physicians rated themselves highly in their ability to identify caregiver understanding (64%), but only 21% rated themselves as very good or excellent in identifying a parent with a literacy problem. Fifty-seven percent of the respondents were interested in training to improve communication skills, and 58% reported that they would be very likely to use easy-to-read written materials, if available from the American Academy of Pediatrics. CONCLUSIONS: Pediatricians are aware of health literacy-related problems and the need for good communication with families but struggle with time demands to implement these skills. Despite awareness of communication-related errors in patient care, pediatricians report underutilizing enhanced techniques known to improve communication
— id: 105410, year: 2009, vol: 124 Suppl 3, page: S299, stat: Journal Article,

The health literacy of parents in the United States: a nationally representative study
Yin, H Shonna; Johnson, Matthew; Mendelsohn, Alan L; Abrams, Mary Ann; Sanders, Lee M; Dreyer, Benard P
2009 Nov;124 Suppl 3:S289-S298, Pediatrics
OBJECTIVE: To assess the health literacy of US parents and explore the role of health literacy in mediating child health disparities. METHODS: A cross-sectional study was performed for a nationally representative sample of US parents from the 2003 National Assessment of Adult Literacy. Parent performance on 13 child health-related tasks was assessed by simple weighted analyses. Logistic regression analyses were performed to describe factors associated with low parent health literacy and to explore the relationship between health literacy and self-reported child health insurance status, difficulty understanding over-the-counter medication labeling, and use of food labels. RESULTS: More than 6100 parents made up the sample (representing 72600098 US parents); 28.7% of the parents had below-basic/basic health literacy, 68.4% were unable to enter names and birth dates correctly on a health insurance form, 65.9% were unable to calculate the annual cost of a health insurance policy on the basis of family size, and 46.4% were unable to perform at least 1 of 2 medication-related tasks. Parents with below-basic health literacy were more likely to have a child without health insurance in their household (adjusted odds ratio: 2.4 [95% confidence interval: 1.1-4.9]) compared with parents with proficient health literacy. Parents with below-basic health literacy had 3.4 times the odds (95% confidence interval: 1.6-7.4) of reporting difficulty understanding over-the-counter medication labels. Parent health literacy was associated with nutrition label use in unadjusted analyses but did not retain significance in multivariate analyses. Health literacy accounted for some of the effect of education, racial/ethnic, immigrant-status, linguistic, and income-related disparities. CONCLUSIONS: A large proportion of US parents have limited health-literacy skills. Decreasing literacy demands on parents, including simplification of health insurance and other medical forms, as well as medication and food labels, is needed to decrease health care access barriers for children and allow for informed parent decision-making. Addressing low parent health literacy may ameliorate existing child health disparities
— id: 105173, year: 2009, vol: 124 Suppl 3, page: S289, stat: Journal Article,

Mothers' expectations for shared reading after delivery: implications for reading activities at 6 months
Berkule, Samantha B; Dreyer, Benard P; Klass, Perri E; Huberman, Harris S; Yin, Hsiang S; Mendelsohn, Alan L
2008 May-Jun;8(3):169-174, Ambulatory pediatrics
OBJECTIVE: To determine whether mothers with plans related to shared reading and baby books in the home at the time of delivery of their newborns would be more likely to engage in shared reading behaviors at age 6 months. METHODS: This was a cohort study with enrollment after birth and follow-up at 6 months in an urban public hospital. Predictors included mothers' attitudes and resources related to shared reading during the postpartum period. Outcomes included mothers' shared reading activities and resources at 6 months, as assessed by the StimQ-READ measure. RESULTS: A total of 173 mother-infant dyads were assessed. In multiple regression analyses adjusting for sociodemographics and maternal depression and literacy, StimQ-READ score at 6 months was increased in association with all 3 postpartum predictors: plans for reading as a strategy for school success (adjusted mean 1.7-point increase in 6-month score; 95% confidence interval [95% CI], 0.3-3.0), plans to read in infancy (3.1-point increase; 95% CI, 1.6-4.6), and having baby books in the home (2.3-point increase; 95% CI, 0.9-3.6). In multiple logistic regression analysis, mothers with 2 or more attitudes and resources had an adjusted odds ratio of 6.2 (95% CI, 2.0-18.9) for having initiated reading at 6 months. CONCLUSIONS: Maternal attitudes and resources in early infancy related to shared reading are important predictors of reading behaviors by 6 months. Cumulative postnatal attitudes and resources are the strongest predictors of later behaviors. Additional research is needed regarding whether guidance about shared reading in early infancy or pregnancy would enhance programs such as Reach Out and Read
— id: 79413, year: 2008, vol: 8, page: 169, stat: Journal Article,

Overcoming legal obstacles involving the voluntary care of children who are separated from their legal guardians during a disaster
Foltin, George L; Lucky, Christian; Portelli, Ian; Goldfrank, Lewis R; Fertel, Baruch S; Lackey, Benjamin; Marr, Mollie; Dreyer, Benard P
2008 Jun;24(6):392-398, Pediatric emergency care
A large-scale disaster may separate children from their parents or guardians and may strand many children in the care of temporary caregivers, including physicians and nurses. In general, unless a physician or nurse is a member of a public sector emergency response program (a 'VHP'), parental consent is required for the treatment of minors outside of an emergency department unless the minor is suffering from an imminently life-threatening condition. Physicians or nurses who are not VHP's may be held liable (civilly, criminally and administratively) if they provide care without parental consent outside of an emergency room to a child who is not suffering from an imminently life-threatening condition. The existing rules regarding parental consent would, in many cases, limit (or at least discourage) the provision of optimal health care to children in a large-scale disaster by restricting care aimed to alleviate pain, the treatment of chronic conditions as well as the treatment of conditions, or potential conditions, that could worsen or develop in the absence of treatment.Additionally, 'Good Samaritan' laws that generally limit the liability of health care providers who voluntarily provide care in an emergency may not apply when care is provided in a crude or makeshift clinic or when care is not provided at the scene of the emergency. Thus, benevolent physicians and nurses who voluntarily provide care during a large-scale disaster unjustly risk liability. The prospect of such liability may substantially deter the provision of optimal medical care to children in a disaster. This article discusses the shortcomings of current laws and proposes revisions to existing state laws. These revisions would create reasonable and appropriate liability rules for physicians and nurses providing gratuitous care in emergencies and thus would create reasonable incentives for health care providers to deliver such care. ('Gratuitous care' is the legal term for care provided voluntarily and without expectation of payment.)
— id: 81576, year: 2008, vol: 24, page: 392, stat: Journal Article,

Infant television and video exposure associated with limited parent-child verbal interactions in low socioeconomic status households
Mendelsohn, Alan L; Berkule, Samantha B; Tomopoulos, Suzy; Tamis-LeMonda, Catherine S; Huberman, Harris S; Alvir, Jose; Dreyer, Benard P
2008 May;162(5):411-417, Archives of pediatrics & adolescent medicine
OBJECTIVE: To assess verbal interactions related to television and other electronic media exposure among mothers and 6 month-old-infants. DESIGN: Cross-sectional analysis of 154 mother-infant dyads participating in a long-term study related to early child development. SETTING: Urban public hospital. PARTICIPANTS: Low socioeconomic status mothers of 6-month-old infants. Main Exposure Media exposure and content. MAIN OUTCOME MEASURES: Mother-infant verbal interaction associated with media exposure and maternal coviewing. RESULTS: Of 154 low socioeconomic status mothers, 149 (96.8%) reported daily media exposure in their infants, with median exposure of 120 (interquartile range, 60-210) minutes in a 24-hour period. Among 426 program exposures, mother-infant interactions were reported during 101 (23.7%). Interactions were reported most frequently with educational young child-oriented media (42.8% of programs), compared with 21.3% of noneducational young child-oriented programs (adjusted odds ratio, 0.4; 95% confidence interval, 0.1-0.98) and 14.7% of school-age/teenage/adult-oriented programs (adjusted odds ratio, 0.2; 95% confidence interval, 0.1-0.3). Among coviewed programs with educational content, mothers reported interactions during 62.7% of exposures. Coviewing was not reported more frequently for educational young child-oriented programs. CONCLUSIONS: We found limited verbal interactions during television exposure in infancy, with interactions reported for less than one-quarter of exposures. Although interactions were most commonly reported among programs with educational content that had been coviewed, programs with educational content were not more likely to be coviewed than were other programs. Our findings do not support development of infant-directed educational programming in the absence of strategies to increase coviewing and interactions
— id: 78700, year: 2008, vol: 162, page: 411, stat: Journal Article,

Randomized controlled trial of a pictogram-based intervention to reduce liquid medication dosing errors and improve adherence among caregivers of young children
Yin, H Shonna; Dreyer, Benard P; van Schaick, Linda; Foltin, George L; Dinglas, Cheryl; Mendelsohn, Alan L
2008 Sep;162(9):814-822, Archives of pediatrics & adolescent medicine
OBJECTIVE: To evaluate the efficacy of a pictogram-based health literacy intervention to decrease liquid medication administration errors by caregivers of young children. DESIGN: Randomized controlled trial. SETTING: Urban public hospital pediatric emergency department. PARTICIPANTS: Parents and caregivers (N = 245) of children aged 30 days to 8 years who were prescribed liquid medications (daily dose or 'as needed'). INTERVENTION: Medication counseling using plain language, pictogram-based medication instruction sheets. Control subjects received standard medication counseling. OUTCOME MEASURES: Medication knowledge and practice, dosing accuracy, and adherence. RESULTS: Of 245 randomized caregivers, 227 underwent follow-up assessments (intervention group, 113; control group, 114). Of these, 99 were prescribed a daily dose medication, and 158 were prescribed medication taken as needed. Intervention caregivers had fewer errors in observed dosing accuracy (>20% deviation from prescribed dose) compared with caregivers who received routine counseling (daily dose: 5.4% vs 47.8%; absolute risk reduction [ARR], 42.4% [95% confidence interval, 24.0%-57.0%]; number needed to treat [NNT], 2 [2-4]; as needed: 15.6% vs 40.0%; ARR, 24.4% (8.7%-38.8%); NNT, 4 [3-12]). Of intervention caregivers, 9.3% were nonadherent (ie, did not give within 20% of the total prescribed doses) compared with 38.0% of controls (ARR, 28.7% [11.4%-43.7%]; NNT, 3 [2-9]). Improvements were also seen for knowledge of appropriate preparation for both medication types, as well as knowledge of frequency for those prescribed daily dose medications. CONCLUSION: A plain language, pictogram-based intervention used as part of medication counseling resulted in decreased medication dosing errors and improved adherence among multiethnic, low socioeconomic status caregivers whose children were treated at an urban pediatric emergency department. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00537433
— id: 86559, year: 2008, vol: 162, page: 814, stat: Journal Article,

Academic general pediatric fellowships: curriculum design and educational goals and objectives
Baldwin, Constance D; Dreyer, Benard P; Szilagyi, Peter G; Bell, Louis M; Baker, Raymond C; Cheng, Tina L; Coury, Daniel L; DeWitt, Thomas G; Darden, Paul M; Duggan, Anne; Ludwig, Stephen
2007 Sep-Oct;7(5):328-339, Ambulatory pediatrics
Academic generalists are unique and important members of the pediatric landscape.(1) Academic general pediatrics (AGP) is not considered a subspecialty, because it adheres to generalist values and embraces a wide range of clinical activities. Nonetheless, academic generalists engage in important scholarly efforts, contribute extensively to the education of new pediatricians, and must be prepared to survive in academia. Academic general pediatric faculty positions are subject to the same appointment and promotion requirements as those of subspecialist faculty
— id: 95202, year: 2007, vol: 7, page: 328, stat: Journal Article,

Strengthening the academic base of general pediatrics fellowship programs: a national program and curriculum development project
Baldwin, Constance D; Szilagyi, Peter G; Dreyer, Benard P; Bell, Louis M; Baker, Raymond C; Cheng, Tina L; Coury, Daniel L; DeWitt, Thomas G; Darden, Paul M; Duggan, Anne; Ludwig, Stephen
2007 Sep-Oct;7(5):340-347, Ambulatory pediatrics
OBJECTIVE: To improve academic general pediatrics (AGP) fellowship programs by 1) developing curriculum guidelines and program standards and 2) creating a process for program review and consultation that might later be used for accreditation of AGP fellowship programs. METHODS: This project of the Ambulatory Pediatric Association (APA) created 4 documents: AGP fellowship program requirements, core curriculum, educational goals and objectives, and a standardized form to describe required program characteristics. Site visits were conducted at 7 volunteer AGP fellowship programs, selected for diversity of content, structure, and location. Evaluations were conducted using a uniform checklist of requirements that combined numerical ratings with a written evaluation summary. Feedback from programs on the review process enabled refinement of the documents. RESULTS: The site visits revealed great variety in emphasis among the 7 programs. In general, faculty were dedicated and capable, and programs showed considerable educational strengths. Typical problems were lack of integration of the program within departmental structures, overburdened faculty, and uncertain funding. Many programs demonstrated suboptimal curriculum planning and weak evaluation methods. Most program leaders felt that the project materials helped to improve the quality of their programs, and 5 of 7 programs expressed willingness to be involved in formal accreditation review in the future. CONCLUSIONS: AGP fellowship programs that volunteered for piloting of an accreditation process were diverse and vital, with rich educational offerings despite a lack of optimal curriculum structure, minimal evaluation, limited faculty resources, and tenuous funding. An APA accreditation process appears to be feasible and may enhance AGP fellowship programs
— id: 95201, year: 2007, vol: 7, page: 340, stat: Journal Article,

Attitudes about shared reading among at-risk mothers of newborn babies
Berkule, Samantha B; Dreyer, Benard P; Huberman, Harris S; Fierman, Arthur H; Mendelsohn, Alan L
2007 Jan-Feb;7(1):45-50, Ambulatory pediatrics
OBJECTIVE: Attitudes about shared reading among at-risk mothers of newborn babies have not been the focus of previous study. Better understanding of factors associated with these attitudes would facilitate pediatricians' provision of anticipatory guidance. We sought to assess sociodemographic correlates of attitudes regarding and resources available for shared reading among multiethnic, low socioeconomic status (SES) mothers of newborns. METHODS: This was a cross-sectional analysis of consecutive mother-infant dyads enrolled during the postpartum period onto an urban public hospital. Dependent variables were attitudes and resources related to shared reading with infants. Independent variables were family sociodemographics, reading difficulties, and social risks. RESULTS: A total of 211 mother-newborn dyads were assessed; 23.7% reported not planning to look at books together until 12 months or later, 42.2% reported no baby books in the home, and 19.9% reported concerns about shared reading. In multiple logistic regression analyses, independent significant associations with not planning to share books together in infancy were lower maternal education, not speaking English, and firstborn. Independent significant associations of not having baby books were not speaking English, firstborn, and perceived difficulty reading in their native language. CONCLUSIONS: Many at-risk mothers of newborn babies do not report plans to read in infancy and do not have appropriate books in the home. Consideration should be given to universal provision of early anticipatory guidance addressing shared reading, either during the postpartum period or during initial well-child care visits
— id: 71343, year: 2007, vol: 7, page: 45, stat: Journal Article,

Screening for maternal depression in a low education population using a two item questionnaire
Cutler, C B; Legano, L A; Dreyer, B P; Fierman, A H; Berkule, S B; Lusskin, S I; Tomopoulos, S; Roth, M; Mendelsohn, A L
2007 ;10(6):277-283, Archives of women's mental health
OBJECTIVE: To assess a two-question screening tool, the Patient Health Questionnaire-2 (PHQ-2), for identifying depressive symptomatology in economically disadvantaged mothers of children in pediatric settings and to explore risk factors associated with a positive depression screen. METHODS: A convenience sample of mothers was enrolled at an inner city well-child clinic with children age 3 days to 5 years. The PHQ-2 and Edinburgh Postnatal Depression Scale (EPDS) (as reference scale) were completed. RESULTS: Ninety-four mothers participated. Agreement of the PHQ-2 and EPDS was moderate. The sensitivity of the PHQ-2 for identifying a positive screen on the EPDS was 43.5%; the specificity was 97.2%. The sensitivity of the PHQ-2 was higher for mothers with education beyond high school compared to those with less education. Perceived lack of support with child care and having two or more children were associated with a positive screen. The rate of positive screen was similar for mothers with infants and with older children. CONCLUSION: Given the low sensitivity of the PHQ-2 in lower educated mothers, additional research in populations with varying sociodemographic characteristics is indicated. Similar rates of symptoms for mothers within and beyond the postpartum period and mothers previously screened support the need for periodic screening
— id: 78733, year: 2007, vol: 10, page: 277, stat: Journal Article,

Use of videotaped interactions during pediatric well-child care: impact at 33 months on parenting and on child development
Mendelsohn, Alan L; Valdez, Purnima T; Flynn, Virginia; Foley, Gilbert M; Berkule, Samantha B; Tomopoulos, Suzy; Fierman, Arthur H; Tineo, Wendy; Dreyer, Benard P
2007 Jun;28(3):206-212, Journal of developmental & behavioral pediatrics
OBJECTIVE: We performed a randomized, controlled trial to assess the impact of the Video Interaction Project (VIP), a program based in pediatric primary care in which videotaped interactions are used by child development specialists to promote early child development. METHOD: Ninety-nine Latino children (52 VIP, 47 controls) at risk of developmental delay based on poverty and low maternal education were assessed at age 33 months. VIP was associated with improved parenting practices including increased teaching behaviors. RESULTS: VIP was associated with lower levels of parenting stress. VIP children were more likely to have normal cognitive development and less likely to have developmental delays. CONCLUSION: This study provides evidence that a pediatric primary care-based intervention program can have an impact on the developmental trajectories of at-risk young preschool children
— id: 73801, year: 2007, vol: 28, page: 206, stat: Journal Article,

Media content and externalizing behaviors in Latino toddlers
Tomopoulos, Suzy; Dreyer, Benard P; Valdez, Purnima; Flynn, Virginia; Foley, Gilbert; Berkule, Samantha B; Mendelsohn, Alan L
2007 May-Jun;7(3):232-238, Ambulatory pediatrics
OBJECTIVE: There has been limited study of the association between media exposure and behavior in children younger than age 3 years. We sought to study this association in toddlers and determine whether the association varied depending on media content. METHODS: We carried out a secondary analysis of a cohort of Latino mother-infant dyads followed from birth to 33 months. We assessed media exposure at 21 and 33 months with a 24-hour recall diary that included information about the duration and content of each program watched. Behavior was assessed at 33 months by the Child Behavior Checklist. RESULTS: This analysis included 99 dyads. Results from multiple logistic regression analyses indicated associations of child behavior outcomes with 21-month total media exposure and both 21-month and 33-month exposure to noneducational young child media such as cartoons, after adjusting for maternal education, country of origin, and depressive symptoms, participation in a parenting program, and difficult child temperament. Media exposure has most consistent associations with aggressive behavior and externalizing problems. CONCLUSIONS: Media exposure was associated with externalizing behavior in Latino toddlers, with the strongest association for media oriented toward young children but without educational content. This finding has importance for both parents of young children and pediatricians as they provide anticipatory guidance
— id: 73294, year: 2007, vol: 7, page: 232, stat: Journal Article,

Is exposure to media intended for preschool children associated with less parent-child shared reading aloud and teaching activities?
Tomopoulos, Suzy; Valdez, Purnima T; Dreyer, Benard P; Fierman, Arthur H; Berkule, Samantha B; Kuhn, Maggie; Mendelsohn, Alan L
2007 Jan-Feb;7(1):18-24, Ambulatory pediatrics
OBJECTIVE: To determine whether electronic media exposure is associated with decreased parental reading and teaching activities in the homes of preschool children. METHODS: A convenience sample presenting for well-child care to an urban hospital pediatric clinic was enrolled. Inclusion criteria were: child's age 3 to 5 years and not yet in kindergarten. Electronic media exposure (TV, movies/video, computer/video games) was assessed with a 24-hour recall diary and characterized on the basis of industry ratings. Reading aloud and teaching activities were assessed with the StimQ-Preschool READ and PIDA (Parental Involvement in Developmental Advance) subscales, respectively. RESULTS: A total of 77 families were assessed. Children were exposed to a mean (SD) of 200.8 (128.9) minutes per day of media, including 78.2 (63.7) minutes of educational young child-oriented, 62.0 (65.6) minutes of noneducational young child-oriented, 14.8 (41.4) minutes of school age/teen-oriented, and 29.2 (56.6) minutes of adult-oriented media, as well as to 16.6 (47.5) minutes of media of unknown type. A total of 79.2% watched 2 or more hours per day. Noneducational young child-oriented exposure was associated with fewer reading (semipartial correlation coefficient [SR] = -0.24, P = .02) and teaching (SR = -0.27, P = .01) activities; similar relationships were not found for other media categories. Children exposed to 2 or more hours of total electronic media per day had 1.6 (95% confidence interval, 0.4-2.9) fewer days per week of reading than children exposed to less than 2 hours (SR = -0.27, P = .01). CONCLUSIONS: This study found an association between increased exposure to noneducational young child-oriented media and decreased teaching and reading activities in the home. This association represents a mechanism by which media exposure could adversely affect development
— id: 71342, year: 2007, vol: 7, page: 18, stat: Journal Article,

Association of low caregiver health literacy with reported use of nonstandardized dosing instruments and lack of knowledge of weight-based dosing
Yin, H Shonna; Dreyer, Benard P; Foltin, George; van Schaick, Linda; Mendelsohn, Alan L
2007 Jul-Aug;7(4):292-298, Ambulatory pediatrics
OBJECTIVE: Caregivers of young children frequently measure doses of liquid medications incorrectly. Use of nonstandardized dosing instruments and lack of knowledge that dosing is weight-based contribute to dosing errors. We sought to assess whether low caregiver health literacy was associated with these outcomes. METHODS: This was a cross-sectional analysis of caregivers presenting to an urban pediatric emergency room. Dependent variables were caregiver reported use of nonstandardized dosing tools and knowledge of weight-based dosing. The independent variable was caregiver health literacy (Test of Functional Health Literacy in Adults [TOFHLA]). RESULTS: Two hundred ninety-two caregivers were assessed: 23.3% reported use of nonstandardized liquid dosing instruments, and 67.8% were unaware of weight-based dosing. Caregivers who were unaware of weight-based dosing were more likely to use nonstandardized dosing tools (28.3% vs 12.8%; P = .003). In unadjusted analyses, overall health literacy, reading comprehension, and numeracy were all associated with both dependent variables. In analyses adjusting for child age, health care experiences, and caregiver acculturation and education, inadequate/marginal overall health literacy was associated with lack of knowledge of weight-based dosing (adjusted odds ratio [AOR] 2.3; P = .03), whereas lower reading comprehension was associated with both lack of knowledge (AOR 2.0; P = .03) and reported use of nonstandardized instrument (AOR 2.4; P = .007). CONCLUSIONS: Low health literacy, in particular reading comprehension, was associated with reported use of nonstandardized dosing instruments and lack of knowledge regarding weight-based dosing. Both caregiver health literacy and sociodemographic factors should be considered in the design of interventions to prevent medication administration errors
— id: 73796, year: 2007, vol: 7, page: 292, stat: Journal Article,

Health literacy and pediatric health
Yin, H Shonna; Forbis, Shalini G; Dreyer, Benard P
2007 Aug;37(7):258-286, Current problems in pediatric & adolescent health care
— id: 73823, year: 2007, vol: 37, page: 258, stat: Journal Article,

The diagnosis and management of attention-deficit/hyperactivity disorder in preschool children: the state of our knowledge and practice
Dreyer, Benard P
2006 Jan;36(1):6-30, Current problems in pediatric & adolescent health care
— id: 63802, year: 2006, vol: 36, page: 6, stat: Journal Article,

Developmental assessment of Latino Kindergarten children as they transition to English-speaking school settings
Forrest, EK; Dreyer, BP; Valdez, PT; Fleming JW; Luchsinger I; ALmanza L; Mendelsohn AL
2006 OCT ;27(5):449-449, Journal of developmental & behavioral pediatrics
— id: 129585, year: 2006, vol: 27, page: 449, stat: Journal Article,

Books, toys, parent-child interaction, and development in young Latino children
Tomopoulos, Suzy; Dreyer, Benard P; Tamis-LeMonda, Catherine; Flynn, Virginia; Rovira, Irene; Tineo, Wendy; Mendelsohn, Alan L
2006 Mar-Apr;6(2):72-78, Ambulatory pediatrics
OBJECTIVE: To describe the interrelationships between books and toys in the home, parent-child interaction, and child development at 21 months among low-income Latino children. METHODS: Latino mother-infant dyads enrolled in a level 1 nursery and infants were followed to 21 months. The subjects consisted of the control group of a larger intervention study. At 6 and 18 months, the number of books and toys in the home and the frequency of reading aloud were measured by the StimQ. At 21 months, child cognitive and language development and parent-child interaction were assessed by the Bayley Mental Development Index (MDI), the Preschool Language Scale-3 (PLS-3), and the Caregiver-Child Interaction Rating Scale, respectively. Eligibility for early intervention (EI) services was determined on the basis of the MDI and PLS-3. RESULTS: Data were obtained for 46 (63.0%) of 73 at 21 months. In multiple regression analysis, books provided at 18 months predicted both cognition (semipartial correlation [sr] = .49, P= .001) and receptive language (sr = .37, P= .02), whereas toys provided at both 6 and 18 months predicted 21-month receptive language (sr = .40, P= .01; sr = .32, P= .047, respectively). Reading aloud by parents > or =4 days a week was associated with decreased EI eligibility (adjusted odds ratio = 0.16, 95% confidence interval 0.03-0.99). CONCLUSIONS: Reading aloud and provision of toys are associated with better child cognitive and language development as well as with decreased likelihood of EI eligibility
— id: 63745, year: 2006, vol: 6, page: 72, stat: Journal Article,

Use of videotaped interactions during pediatric well-child care to promote child development: a randomized, controlled trial
Mendelsohn, Alan L; Dreyer, Benard P; Flynn, Virginia; Tomopoulos, Suzy; Rovira, Irene; Tineo, Wendy; Pebenito, Charissa; Torres, Carmen; Torres, Heidi; Nixon, Abigail F
2005 Feb;26(1):34-41, Journal of developmental & behavioral pediatrics
ABSTRACT.: The authors performed a randomized, controlled trial to assess the impact of the Video Interaction Project (VIP), a program based in pediatric primary care in which videotaped interactions are used by child development specialists to promote early child development. Ninety-three Latino children (51 VIP, 42 control) at risk of developmental delay on the basis of poverty and low maternal education (none had completed high school) were assessed for cognitive and language development at age 21 months. Results differed depending on the level of maternal education; the VIP was found to have a moderate impact on children whose mothers had between seventh and 11th grade education (approximately 0.75 SD for cognitive development, 0.5 SD for expressive language) but little impact on children whose mothers had sixth grade or lower education
— id: 48224, year: 2005, vol: 26, page: 34, stat: Journal Article,

Effectiveness of a primary care intervention to support reading aloud: a multicenter evaluation
Needlman, Robert; Toker, Karen H; Dreyer, Benard P; Klass, Perri; Mendelsohn, Alan L
2005 Jul-Aug;5(4):209-215, Ambulatory pediatrics
OBJECTIVE: Failure to read at grade level predicts life-long economic and social disability. Early exposure to reading aloud may prevent reading problems. This study seeks to determine whether institution of Reach Out and Read (ROR) programs is associated with increased reading aloud in a national sample. DESIGN: Before-after intervention study: separate convenience samples were studied before and after institution of ROR programs at multiple sites. PARTICIPANTS AND SETTING: A convenience sample of parents of children age 6-72 months seeking routine health care at 19 clinical sites in 10 states. INTERVENTIONS: The ROR model incorporates anticipatory guidance about reading aloud and distribution of free picture books at health supervision visits from 6 months through 5 years as well as reading aloud in the waiting room. MAIN OUTCOME MEASURES: Parents were interviewed about their attitudes and practices related to reading aloud, using questions drawn from validated instruments. RESULTS: The sample included 1647 subjects (730 intervention, 917 comparison). After controlling for multiple potential confounding factors, significant associations were found between exposure to ROR and reading aloud as a favorite parenting activity (Adjusted Odds Ratio [AOR] 1.6, P < .001); reading aloud at bedtime (Adjusted Odds Ratio [AOR*rsqb; 1.5, P < .001); reading aloud 3 or more days per week (AOR 1.8, P < .001); and ownership of > or = 10 picture books (AOR 1.6, P < .001). CONCLUSIONS: In a national sample, implementation of ROR programs was associated with increased parental support for reading aloud. This study provides evidence of the effectiveness of a primary care intervention strategy to promote reading aloud to young children
— id: 67952, year: 2005, vol: 5, page: 209, stat: Journal Article,

Parental perception of child weight status and feeding practices in young children
Corrigan, KP; Messito, M; Fierman, AH; Kendrick, SR; Dreyer, BP; Tomopoulos, S; Yick, CD; Aquino, MR; Thyagarajan, P; Mendelsohn, AL
2004 APR ;55(4):218A-218A, Pediatric research
— id: 46533, year: 2004, vol: 55, page: 218A, stat: Journal Article,

Media violence exposure in Latino toddlers
Tomopoulos, S; Kendrick, SR; Corrigan, KP; Thyagarajan, P; Dreyer, BP; Fierman, AH; Flynn, V; Mendelsohn, AL
2004 APR ;55(4):246A-247A, Pediatric research
— id: 46534, year: 2004, vol: 55, page: 246A, stat: Journal Article,

Media exposure in Latino toddlers and its relationship to behavior
Tomopoulos, S; Thyagarajan, P; Kendrick, S; Corrigan, KP; Flynn, VP; Dreyer, BP; Fierman, AH; Mendelsohn, AL
2004 APR ;55(4):75A-75A, Pediatric research
— id: 46529, year: 2004, vol: 55, page: 75A, stat: Journal Article,

Screening for educational readiness in pediatric primary care
Valdez, P; Dreyer, B; Estrada, P; Ko, S; Sloan-Pena, G; Mendelsohn, A
2004 OCT ;25(5):372-373, Journal of developmental & behavioral pediatrics
— id: 46882, year: 2004, vol: 25, page: 372, stat: Journal Article,

Predictors of obesity in Latino infants
Corrigan, KP; Mendelsohn, AL; Tomopoulos, S; Messito, M; Fierman, AH; Dreyer, BP; PeBenito, C; Brennan, L
2003 APR ;53(4):208A-208A, Pediatric research
— id: 38564, year: 2003, vol: 53, page: 208A, stat: Journal Article,

Medical humanities at New York University School of Medicine: an array of rich programs in diverse settings
Krackov, Sharon K; Levin, Richard I; Catanese, Veronica; Rey, Mariano; Aull, Felice; Blagev, Denitza; Dreyer, Benard; Grieco, Anthony J; Hebert, Cristy; Kalet, Adina; Lipkin, Mack Jr; Lowenstein, Jerome; Ofri, Danielle; Stevens, David
2003 Oct;78(10):977-982, Academic medicine
The New York University School of Medicine has a rich tradition of cultivating programs in medical humanities and professionalism. They are drawn from the departments, centers, students, and faculty in the School of Medicine, have linkages throughout the university, and are interwoven into the fabric and culture of the institution. Some are centrally based in the School of Medicine's deans' office, and others are located in individual departments and receive support from the dean's office. This article describes representative programs for medical students and faculty. Curricular initiatives, the fundamental components of medical students' learning, include a course entitled 'The Physician, Patient, and Society,' a clerkship essay in the Medicine Clerkship, an opportunity for reflection during the medicine clerkship, and a medical humanities elective. In 2002, the Professionalism Initiative was launched to enhance and reflect the values of the medical profession. Its curriculum consists of a series of events that coordinate, particularly, with existing elements of the first-year curriculum (e.g., orientation week, a session during anatomy, a self-assessment workshop, and a peer-assessment workshop). The Master Scholars Program is a group of five, theme-based master societies consisting of faculty and students who share common interests around the society's themes. Programs developed for the societies include colloquia, faculty-led seminars, a mandatory student-mentoring program, and visiting scholars. Finally, the authors describe three high-quality literary publications created at New York University School of Medicine. Each of the initiatives undergoes regular critical examination and reflection that drive future planning
— id: 39038, year: 2003, vol: 78, page: 977, stat: Journal Article,

The impact of parent-child interaction on early child language and cognitive development in Latino families
PeBenito, C; Mendelsohn, AL; Dreyer, BP; Tomopoulos, S; Flynn, V; Corrigan, KP; Tineo, W; Rovira, I; Neves, M; Brennan, L; Fierman, AH
2003 APR ;53(4):73A-74A, Pediatric research
— id: 38562, year: 2003, vol: 53, page: 73A, stat: Journal Article,

An RCT of a clinic-based intervention to promote language development: Effects at 18 months on cognitive home environment and parenting stress
Mendelsohn, AL; Dreyer, BP; Flynn, V; PeBenito, CP; Tomopoulos, S; Rovira, I; Tineo, W; Foley, G; Brennan, LK; Thompson, YT; Fierman, AH; Dickey, E
2002 APR ;51(4):1108-146, Pediatric research
— id: 98257, year: 2002, vol: 51, page: 1108, stat: Journal Article,

Reach out and read multicenter evaluation
Needlman, R; Mendelsohn, A; Toker, KH; Klass, P; Dreyer, B
2002 APR ;51(4):87-146, Pediatric research
— id: 98255, year: 2002, vol: 51, page: 87, stat: Journal Article,

Validity of the caregiver child interaction rating scale, modified for use with low-education Latina mothers
PeBenito, CP; Mendelsohn, AL; Dreyer, BP; Tamis-LeMonda, CS; Tineo, W; Thompson, YT; Tomopoulos, S; Flynn, V; Rovira, I; Neves, M
2002 OCT ;23(5):400-400, Journal of developmental & behavioral pediatrics
— id: 32542, year: 2002, vol: 23, page: 400, stat: Journal Article,

Promoting education, mentorship, and support for pediatric research
Chesney RW; Dungy CI; Gillman MW; Rivara FP; Schonfeld DJ; Takayama JI; Alexander DF; Cairo MS; Dreyer BP; van Dyck P; Ferrieri P; Kohrt AE; McAnarney ER; Margolis LH; Orr DP; Rothstein E; Simpson L; Weitzman M; Schonfeld DJ; Yudkowsky BK
2001 Jun;107(6):1447-1450, Pediatrics
Pediatricians have an important role to play in the advancement of child health research and should be encouraged and supported to pursue research activities. Education and training in child health research should be part of every level of pediatric training. Continuing education and access to research advisors should be available to practitioners and academic faculty. Recommendations to promote additional research education and support at all levels of pediatric training, from premedical to continuing medical education, as well as suggestions for means to increase support and mentorship for research activities, are outlined in this statement
— id: 45000, year: 2001, vol: 107, page: 1447, stat: Journal Article,

The impact of a clinic-based literacy intervention on language development in inner-city preschool children
Mendelsohn AL; Mogilner LN; Dreyer BP; Forman JA; Weinstein SC; Broderick M; Cheng KJ; Magloire T; Moore T; Napier C
2001 Jan;107(1):130-134, Pediatrics
OBJECTIVE: To determine the effect of a clinic-based literacy intervention on the language development of preschool children. METHODS: A convenience sample of families presenting to 2 urban pediatric clinics for well-child care met the following criteria: the family was Latino or black and English- or Spanish-speaking; the child was 2 to 5.9 years old, with no neurodevelopmental disability, at a gestational age of 34 weeks or more, and not attending kindergarten. Participants at the first clinic (intervention group) were exposed to a literacy support program, based on Reach Out and Read (ROR), during the previous 3 years. At the second clinic (comparison group), a similar program started 3 months before the study. Parent-child reading activities were measured using the READ Subscale of the StimQ. Language development was measured using the One-Word Expressive and Receptive Picture Vocabulary Tests, and was performed in the child's primary language. RESULTS: A total of 122 study participants (49 interventions and 73 comparisons) met inclusion criteria and completed all measures. Intervention and comparison families were similar for most sociodemographic variables. Intervention families reported reading together with their children approximately 1 more day per week. Intensity of exposure to ROR (measured by total number of contacts with the program) was associated with increased parent-child reading activities, as measured by the StimQ-Read Subscale (r = 0.20). Intervention children had higher receptive language (mean: 94.5 vs 84.8) and expressive language (mean: 84.3 vs 81.6). After adjusting for potential confounders in a multiple regression analysis, intervention status was associated with an 8.6-point increase (95% confidence interval [CI]: 3.3, 14.0) in receptive language (semipartial correlation [SR]coefficient = 0.27), and a 4.3-point increase (95% CI: 0.04, 8.6) in expressive language (SR = 0.17). In a similar multiple regression, each contact with ROR was associated with an adjusted mean 0.4-point increase (95% CI: 0.1, 0.6) in receptive score, and an adjusted mean 0.21-point increase (95% CI: 0. 02, 0.4) in expressive score. CONCLUSIONS: ROR is an important intervention, promoting parental literacy support and enhancing language development in impoverished preschool children. Integration of literacy promoting interventions such as these into routine pediatric health care for underserved populations can be recommended
— id: 26829, year: 2001, vol: 107, page: 130, stat: Journal Article,

Association of media violence with aggressive and antisocial behavior in young children
Daniel, AM; Mendelsohn, AL; Legano, LA; Vergara, SM; Dreyer, BP; Fierman, AH; Klein, M; Waxman, IM; Welles, RA; Anderson, LT
2000 APR ;47(4):25A-25A, Pediatric research
— id: 54666, year: 2000, vol: 47, page: 25A, stat: Journal Article,

Low-level lead exposure and cognitive development in early childhood
Mendelsohn AL; Dreyer BP; Fierman AH; Rosen CM; Legano LA; Kruger HA; Lim SW; Barasch S; Au L; Courtlandt CD
1999 Dec;20(6):425-431, Journal of developmental & behavioral pediatrics
The authors studied toddlers with low-level lead exposure to determine whether adverse developmental effects were evident. The study sample consisted of a cohort of 68 children aged 12 to 36 months who had blood lead levels lower than 25 microg/dL on a routine screening in a large urban public hospital clinic. Children with blood lead levels between 10 and 24.9 microg/dL had a mean Mental Developmental Index (Bayley Scales of Infant Development, Second Edition) score that was 6.3 points lower than that of children with blood lead levels between 0 and 9.9 microg/dL (95% confidence interval: 0.6, 11.9). After adjusting for confounders, the difference was 6.2 points (95% confidence interval: 1.7, 10.8). Pediatricians and public health entities should continue in their efforts to reduce the lead burden through environmental control and ongoing surveillance
— id: 11895, year: 1999, vol: 20, page: 425, stat: Journal Article,

Shaken baby syndrome--a forensic pediatric response
Chadwick DL; Kirschner RH; Reece RM; Ricci LR; Alexander R; Amaya M; Bays JA; Bechtel K; Beltran-Coker R; Berkowitz CD; Blatt SD; Botash AS; Brown J; Carrasco M; Christian C; Clyne P; Coury DL; Crawford J; Cunningham N; DeBellis MD; Derauf C; de Triquet J; Dreyer BP; Dubowitz H; Zenel JA Jr
1998 Feb;101(2):321-323, Pediatrics
— id: 7528, year: 1998, vol: 101, page: 321, stat: Journal Article,

Pediatric ambulance utilization in a large American city: a systems analysis approach [see comments]
Foltin GL; Pon S; Tunik M; Fierman A; Dreyer B; Cooper A; Welborne C; Treiber M
1998 Aug;14(4):254-258, Pediatric emergency care
BACKGROUND: Research on utilization of ambulances by pediatric patients lacks an objective, reproducible tool for the evaluation of patterns of ambulance use by both the providers and the users of this resource. OBJECTIVES: 1) To develop an objective, diagnosis-based measure of appropriateness of ambulance utilization. 2) To use the measure to evaluate whether Municipal Ambulance Service dispatchers assign ambulances appropriately, and whether parents/caretakers request ambulances appropriately. STUDY DESIGN: 1) Development of the pediatric ambulance need evaluation (PANE) tool: The consensus of an expert panel was used to assign patients arriving by ambulance to three levels of prehospital transport need based upon their ultimate hospital discharge diagnoses, and were as follows: required advanced life support ambulance (ALS); required basic life support ambulance (BLS); required a less acute mode of transport (LAT). 2) Assessment of appropriateness of ambulance assignments by EMS call-receiving operators (CRO) and of ambulance requests by parents/caretakers: Comparison of actual type of ambulance assigned and of need for ambulance, using the PANE tool and hospital admission rates as gold standards. DATA COLLECTION: Level of prehospital transport provided (ALS vs BLS), ultimate ED diagnosis, and ED disposition (admission vs discharge) was collected for each patient from information abstracted from the prehospital and ED records. SETTING: Bellevue Hospital Center and Harlem Hospital Center, two level I trauma centers in New York City, both with Pediatric Emergency Departments staffed 24 hours a day by attending physicians and residents. PATIENT SELECTION: Consecutive sample of 2633 patients, birth to 18 years of age, who arrived to either hospital by ambulance as primary transports from the field over a one-year period. RESULTS: 1) Development of PANE tool: At Bellevue Hospital, 7% of ED visits arrived by ambulance; at Harlem Hospital, 5% arrived by ambulance. Using these ambulance arrivals, 215 diagnoses were identified for inclusion in the PANE tool. An expert panel categorized each diagnosis as requiring ALS, BLS, or LAT, with a high level of interobserver agreement (weighted kappa = 0.793). As a measure of external validity of the PANE, admission rates were highest in the ALS group, next highest in the BLS group, and lowest in the LAT group (chi2 for trend, P < 0.05). 2) Assessment of ambulance assignments and requests: According to the PANE tool, the sensitivity of dispatcher assignment of ALS ambulances was 72 %. Therefore, 28 % of patients who required an ALS ambulance received BLS care. 50% of patients assigned to an ALS ambulance did not require that level of care, and 1/3 of these were categorized by the PANE as not requiring an ambulance at all. CONCLUSIONS: The PANE tool compared favorably to admission rates as a measure of the severity of illness of patients arriving by ambulance. Applying the PANE tool, we conclude that the majority of requests for ambulances are appropriate, and that the majority of the time dispatchers were able to dispatch the appropriate level of care. However, there is room for significant improvement in utilization of ambulances, and tools like the PANE will be useful in achieving this goal
— id: 7565, year: 1998, vol: 14, page: 254, stat: Journal Article,

Low-level lead exposure and behavior in early childhood
Mendelsohn AL; Dreyer BP; Fierman AH; Rosen CM; Legano LA; Kruger HA; Lim SW; Courtlandt CD
1998 Mar;101(3):E10-E10, Pediatrics
OBJECTIVE: To assess whether small elevations in blood lead level were associated with measurable behavioral changes in a group of poor children between 1 and 3 years old. METHODS: The study population consisted of children presenting for routine well-child care to the pediatric clinic at Bellevue Hospital Center, a large urban public hospital. The following inclusion criteria were used for entry into the study: age 12 to 36 months; capillary lead screening result <1.21 micromol/L (25 microg/dL); no known prior history either of blood lead level >1.21 micromol/L (25 microg/dL) or lead exposure requiring chelation therapy; Latino or African-American; English or Spanish spoken in the home; biological mother as primary caretaker; child not presently attending day care; full-term, singleton gestation; birth weight at least 2500 g; no known neurologic or developmental disorder; and no severe chronic disease, including human immunodeficiency virus infection. Study enrollment was simultaneously stratified by capillary lead level and age. All children between 12 and 36 months attending the pediatric clinic during the study period received screening capillary blood measures of lead level following the recommendations of the Centers for Disease Control and Prevention and the American Academy of Pediatrics as part of routine primary care. During periods of enrollment, consecutive lead measurements performed in the pediatric clinic were reviewed by one of the researchers. For those children meeting entry criteria based on lead level and age, further eligibility based on the remainder of the inclusion criteria was determined through parental interview and review of the medical record. Lead exposure was assessed with a single capillary blood specimen, using atomic absorption spectrophotometry. Subjects were considered to be lead-exposed if their lead level was between 0.48 and 1.20 micromol/L (10 and 24.9 microg/dL) and nonexposed if their lead level was between 0 and 0.48 micromol/L (0 and 9.9 microg/dL). Behavior was assessed using the Behavior Rating Scale (BRS) of the Bayley Scales of Infant Development, second edition. The BRS in this age group consists of three components: an Emotional Regulation Factor that measures hyperactive/distractible/easy-frustration behaviors; an Orientation-Engagement Factor that measures fear/withdrawal/disinterest behaviors; and a Motor Quality Factor that assesses the appropriateness of movement and tone. The BRS is scored as a percentile; lower scores reflect more problematic behaviors. Researchers performing the BRS were blinded to capillary lead results. Information was collected concerning factors that might confound the relationship between lead and behavior. Demographic factors were collected, including: child's age, gender, and country of origin; mother's age, marital status, parity, country of origin, and primary language spoken; parental education, and occupation and receipt of public assistance. Socioeconomic status was determined using the Hollingshead Two-Factor Index of Social Position. Maternal verbal IQ was assessed using the Peabody Picture Vocabulary Test-Revised. Maternal depression was assessed using the Center for Epidemiologic Studies-Depression Scale. Cognitive stimulation provided in the home was assessed using a new office-based instrument, the StimQ, which measures the quantity and quality of play materials and parent-toddler activities in the child's home. To assess the child for iron deficiency, we performed a hematocrit and mean corpuscular volume at the time of the capillary lead evaluation. A presumptive diagnosis of iron deficiency was made if the child was either anemic (defined as a hematocrit <32) or had a mean corpuscular volume <72. RESULTS: The study sample consisted of 72 children. Children in the lead-exposed group (n = 41) had a mean BRS behavior score that was 15.8 points lower than that of children in the nonexposed group (n = 31), which was significant by the Stu
— id: 7966, year: 1998, vol: 101, page: E10, stat: Journal Article,

Increased prevalence of abnormal Papanicolaou smears in urban adolescents
Mangan SA; Legano LA; Rosen CM; McHugh MT; Fierman AH; Dreyer BP; Palusci VJ; Winkler B
1997 May;151(5):481-484, Archives of pediatrics & adolescent medicine
OBJECTIVE: To determine the secular trend in the prevalence of cervical dysplasia as evidenced by abnormal Papanicolaou smear results in sexually active adolescents. DESIGN: Descriptive case series. SETTING: Outpatient department of an urban public hospital. PARTICIPANTS: All sexually active adolescents with Papanicolaou smear results recorded during 2 periods: January 1, 1982, through December 31, 1983 (n = 577), and January 1, 1992, through December 31, 1993 (n = 871). MEASUREMENTS: Age, ethnicity, patient care location in which the Papanicolaou smear preparation was performed, and Papanicolaou smear results were obtained for each patient. For patients with more than 1 Papanicolaou smear result during the specified period, only the first result was included in this study. Papanicolaou smear results were classified according to the Bethesda system as within normal limits, benign cellular change, atypical squamous cells of undetermined significance, lowgrade squamous intraepithelial lesion, or high-grade squamous intraepithelial lesion. Any Papanicolaou smear classified as atypical squamous cells of undetermined significance or low- or high-grade squamous intraepithelial lesion was defined as abnormal. RESULTS: The prevalence of abnormal Papanicolaou smear results was 2.8% in 1982 through 1983 vs 11.7% in 1992 through 1993; prevalence odds ratio was 4.7 (95% confidence interval, 2.7-8.3). The higher rate of abnormal Papanicolaou smear results in 1992 through 1993 persisted after controlling for age, patient care location, and ethnicity in a logistic regression model (adjusted prevalence odds ratio, 5.0; 95% confidence interval, 2.8-8.9). The prevalence of benign cellular change was 8.7% in 1982 through 1983 vs 20.1% in 1992 through 1993; prevalence odds ratio was 2.7 (95% confidence interval, 1.9-3.8). CONCLUSIONS: The prevalence of abnormal Papanicolaou smear results has significantly increased in the last decade in sexually active adolescents seen at a city hospital clinic. The results of this study emphasize the importance of routine Papanicolaou smear screening for all sexually active female adolescents
— id: 12319, year: 1997, vol: 151, page: 481, stat: Journal Article,

Assessing the Child's Cognitive Home Environment Through Parental Report; Reliability and Validity
Dreyer BP; Mendelsohn AL; Tamis-LeMonda CS
1996 Dec;5(4):271-287, Early Development & Parenting
In a series of investigations with poor minority families, we examined the reliability and validity of the StimQ, an office-based interview of children's cognitive home environment. Researchers and practitioners alike recognize the importance of assessing meaningful dimensions of children's early experiences, particularly in families where children may be at risk for later cognitive delay. To date, methodological approaches to the study of parenting have most often relied on home visits and/or labour-intensive observations and coding. Our findings suggest that valid and reliable data about the cognitive environments of poor children can be obtained through maternal report, thereby offering applied scientists a useful alternative to assessing children's early experiences
— id: 47703, year: 1996, vol: 5, page: 271, stat: Journal Article,

Immunization status as determined by patients' hand-held cards vs medical records
Fierman AH; Rosen CM; Legano LA; Lim SW; Mendelsohn AL; Dreyer BP
1996 Aug;150(8):863-866, Archives of pediatrics & adolescent medicine
OBJECTIVE: To determine whether patients' hand-held immunization cards provide accurate assessments of immunization status when compared with their corresponding medical records. SETTING: Urban hospital emergency department immunization program. DESIGN: Comparison of 2 criterion standards. PATIENTS: Children aged 4 months to 6 years who presented consecutively with their immunization cards and received routine care in the hospital's pediatric clinic. SELECTION: Of 673 eligible patients seen in the immunization program from November 1992 to October 1993, 140 were randomly selected for comparison of immunization card and medical record immunization dates; in addition, all 123 eligible patients seen between August and October 1994 were selected. Of the total of 263 children, medical records for 257 (98%) were available for review. The dates of diphtheria-tetanus-pertussis, polio, measles-mumps-rubella, and Haemophilus influenzae type b immunization from immunization cards and medical records were recorded, as were patient age, sex, and ethnicity. Immunization card-medical record immunization date pairs were compared. Each immunization card and medical record was categorized as up to date, due for immunization, or delayed 2 months or more for any immunization at the time of the visit. RESULTS: In 218 (85%) of 257 cases, the immunization card and medical record immunization dates were identical (McNemar test, P = .63). The immunization card and medical record agreed that patients were due for immunization in 91 cases and agreed that patients were not due for immunization in 138 cases (kappa = 0.77; 95% confidence interval, 0.70-0.85). The immunization card and medical record agreed that patients were delayed for 1 or more immunizations in 51 cases and agreed that patients were not delayed in 187 cases (kappa = 0.79; 95% confidence interval, 0.71-0.88). CONCLUSION: The hand-held immunization card is a suitable alternative to the medical record when the need for immunization is assessed or when rates of immunization delay in populations are determined
— id: 12577, year: 1996, vol: 150, page: 863, stat: Journal Article,

Status of immunization and iron nutrition in New York City homeless children [see comments]
Fierman AH; Dreyer BP; Acker PJ; Legano L
1993 Mar;32(3):151-155, Clinical pediatrics
A retrospective review of the hospital records of New York City children aged 6 months through 6 years showed that 63 homeless children had a higher rate of immunization delay than an age- and sex-stratified sample of 63 domiciled children living at the same federal poverty level. In a logistic regression model, this difference persisted after controlling for sex, age, ethnicity, presence of chronic illness, and reason for referral. In a 6-month- to 2-year-old subgroup, homeless and domiciled children had equal rates of anemia, but homeless children were more likely to have elevated erythrocyte protoporphyrin (EP) levels consistent with iron deficiency. This difference, too, persisted after controlling for the same confounding factors. Elevated EP levels and immunization delay were likely to coexist in the homeless children. The higher rate of immunization delay is compatible with the occurrence of measles outbreaks in some New York City shelters. The higher rates of iron deficiency may reflect overall poor nutrition. All these findings have significant implications for the design of health-care programs for homeless children
— id: 13227, year: 1993, vol: 32, page: 151, stat: Journal Article,

Growth delay in homeless children
Fierman AH; Dreyer BP; Quinn L; Shulman S; Courtlandt CD; Guzzo R
1991 Nov;88(5):918-925, Pediatrics
This study compared the growth of homeless children with National Center for Health Statistics (NCHS) standards and with growth of age-matched domiciled children of similar income level. Homeless children (n = 167) had lower height percentiles when compared with domiciled children (n = 167; P less than .001) and when compared with NCHS standards (P less than .001). The weight-height percentiles of homeless children did not differ from NCHS standards; however, domiciled children had higher weight-heights when compared with the homeless (P less than .001) and with NCHS standards (P less than .001). After controlling via regression analysis for the effects of potentially confounding factors that affect growth, it was found that homeless children from larger families and with single mothers accounted for the lower height percentiles observed. After controlling for confounding factors, domiciled children still had increased weight-height percentiles when compared with the homeless group. Duration of homelessness was not associated with decreased height or weight-height among homeless children. Homeless children in this study exhibited a pattern of stunting without wasting which is characteristic of poor children experiencing moderate, chronic nutritional stress. They exhibited a greater degree of nutritional stress than domiciled children at a similar income level and than that reported in other groups of poor children in the United States. Preexisting social factors in the families of homeless children were important in explaining the observed growth abnormalities. Further exploration of the associations between social characteristics of homeless children and their families and the growth of these children is warranted
— id: 13843, year: 1991, vol: 88, page: 918, stat: Journal Article,

CAUSES OF DECREASED LINEAR GROWTH AMONG HOMELESS CHILDREN
Courtlandt, CD; Dreyer, BP; Fierman, AH; Berkowitz, W; Hoover, WS; Arbel, M; Taylor, SD
1990 Apr;144(4):425-426, American journal of diseases of children
— id: 32090, year: 1990, vol: 144, page: 425, stat: Journal Article,

Latex agglutination for the rapid diagnosis of streptococcal pharyngitis: use by house staff in a pediatric emergency service
Tunik MG; Fierman AH; Dreyer BP; Krasinski K; Hanna B; Rosenberg C
1990 Jun;6(2):93-95, Pediatric emergency care
A rapid latex agglutination (LA) method was evaluated in 2401 consecutive pediatric patients presenting to an emergency service with suspected group A beta-hemolytic streptococcal pharyngitis. LA tests were performed by the treating physicians, who were not blinded to the clinical condition of the children and who made therapeutic decisions based on the results of the tests. When compared with anaerobic culture, the LA method had a sensitivity of 91%, a specificity of 82%, and a positive predictive value of 43%. There was a marked seasonal variation in the positive predictive value: 62% in winter and 16% in summer. However, even in peak streptococcal pharyngitis season (January to March), basing therapy on a positive LA test leads to the unnecessary treatment of a large number of patients. Therefore, we cannot recommend the routine performance of this test by all practitioners in all clinical settings
— id: 15070, year: 1990, vol: 6, page: 93, stat: Journal Article,