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Dissertations / Theses on the topic 'Pediatric and Child Health'

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Published: 11 September 2021
Last updated: 1 February 2022

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1

Susanto, Steffenie. "Pediatric venipuncture| Child Life specialists' perspectives." Thesis, Mills College, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1538411.

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During procedures like venipuncture, Child Life Specialists are able to incorporate non-pharmacological measures when most medical staff focused on pharmacological measures. There is little research about what types of interventions Child Life Specialists believe are effective at minimizing children's pain and increasing coping skills during venipuncture. The purpose of the current study was to examine Child Life Specialists' perspectives on the different techniques available in the hospital setting. An online survey of 75 Certified Child Life Specialists asked about the types of techniques that Child Life Specialists use during venipuncture. Further, questions asked how Child Life Specialists felt about the efficacy of pharmacological and non-pharmacological techniques with a variety of different ages. Results revealed that Child Life Specialists felt that combining two techniques helps to minimize pain during venipuncture for pediatric patients more than the use of a single technique. These results applied to preschoolers, school-aged children and adolescents.

Keywords: child life specialist, venipuncture, pain, distress

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2

Wood, David L. "Comorbidities of Pediatric Epilepsy." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5188.

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3

Tuell, Dawn, Debra Mills, Rebecca Powers, and Karen E. Schetzina. "Evaluation and Utilization of a Pediatric Internet Curriculum." Digital Commons @ East Tennessee State University, 2006. https://dc.etsu.edu/etsu-works/5062.

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Background: In recent years, the Accreditation Council for Graduate Medical Education (ACGME), and the Ambulatory Pediatric Association (APA) have developed detailed resident learning objectives and competencies. Maintaining adequate documentation that residents are fulfilling these objectives and competencies is a challenge. Objectives: To develop and evaluate use of an internet based curriculum, EPIC (East Tennessee Pediatric Internet Curriculum) to facilitate teaching and evaluation of the core competencies. Methods: Goals and content for the site were developed based on literature review and input from a pediatric internet committee. Resident internet-based learning is being evaluated using pre- and post- surveys over a six month period. Results: EPIC is a central location for residents to access information, including announcements, phone lists, and scheduling information. Educational content is organized around the six core competencies for resident education. For example, “Medical Knowledge”consists of a portfolio system developed for the ambulatory clinic. Portfolios include a checklist of pertinent information to be covered during a patient encounter and a related downloadable article to enhance resident knowledge. The section also includes links to other learning resources. An interactive discussion forum exists to facilitate discourse on medical and residency-related topics. Residents also complete online pre- and post- test questions during every clinical rotation and receive instant feedback on their responses. All 11 residents completed the pre-survey. Frequent or very frequent internet use was reported by 54% of residents to answer specific clinical questions and 45% of residents for general medical learning during the work day. Conclusion: Pediatric residents already utilize the internet to access medical information. EPIC accommodates residents’varying schedules and is a useful adjunct to other teaching and evaluation methods.
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Schetzina, Karen E. "Irritability and Intractable Crying." Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etsu-works/5118.

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Now in its Second Edition, this text focuses exclusively on the management of hospitalized pediatric patients from admission to discharge. It is an excellent resource for residency programs, hospitalist fellowships, and continuing education for physicians whose practice includes the management of hospitalized newborns and children. Because pediatric hospital care is provided by a wide variety of healthcare professionals and in many different hospital settings, this text provides a framework for unified management and effective and efficient care. This edition includes new sections on emergency medicine and psychiatric hospitalization and expanded coverage of management of children with complex and chronic conditions.
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5

Wood, David L., Andrew Wilt, and Mary Cataletto. "Pediatric: Specialty Review and Self-Assessment." Digital Commons @ East Tennessee State University, 2015. https://www.amzn.com/B014PWDUK0/.

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StatPearls Publishing Review Series strives to help you learn the pearls in pediatrics. This text contains 1000 multiple-choice questions with explanations that are linked to additional online references.
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6

Wilt, Andrew, and David L. Wood. "Pediatric Hospital Medicine: Specialty Review and Self-Assessment." Digital Commons @ East Tennessee State University, 2016. https://www.amzn.com/B01M6C8MJ9/.

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StatPearls Publishing Review Series strives to help you learn the pearls in pediatric hospital medicine. This text contains 1150 multiple-choice questions with explanations that are linked to additional online references.
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7

Foster, Latrice. "ORAL HEALTH STATUS OF CHILDREN IN THE CHILD HEALTH INVESTMENT PARTNERSHIP (CHIP) PROGRAM." VCU Scholars Compass, 2010. http://scholarscompass.vcu.edu/etd/2144.

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Purpose: The purpose of this study is to describe children’s dental disease status and functional health literacy of families enrolled in the Child Health Investment Partnership program in Roanoke Valley. Methods: This was a prospective cohort study of children (n=166) enrolled in the Child Health Investment Partnership of Roanoke Valley, Virginia (CHIP). The parents of the 166 children completed the Life Skills Progression (LSP) survey at enrollment between September 2004 and September 2008 to assess their functional health literacy levels. Their LSP scores were used to determine their subsequent health care literacy (HCL), personal health literacy (PHL), and dental-child utilization (LSP22) scores. Descriptive statistics were recorded and a paired t-test was used to determine a relationship between the three measures of functional health literacy at baseline and at their most recent literacy assessment. Dental disease status was determined by an epidemiological dental exam and evaluated using d1d2-3f criteria. This was a visual exam that measured the presence of frank (d2-3) and non-cavitated carious lesions (d1), as well as filled teeth. Results: Descriptive analysis of the cohort reveals: 58% of the children enrolled had no carious teeth at the dental screening exam. The average mean of LSP scores for all three scales: HCL, PHL, and LSP22 were significantly different from baseline: p<.0001, p<.0009, and p<.0001, respectively. Conclusion: An improvement of parental functional health literacy has been documented in a low-income pediatric dental population when preventative efforts and education is delivered within the context of a home-visitation health program. The population of high-risk children had low levels of dental disease.
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8

Shah, Phalguni S. "Children's preventive health care center with aspect of play for a child." Virtual Press, 1994. http://liblink.bsu.edu/uhtbin/catkey/897516.

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Children are the most important asset for the society's future. They develop into maturity depending upon how they are moulded by their families, society, and the environment. They are very sensitive and could easily get influenced or affected by the slightest change. Therefore it is important to maintain a normal set-up for them under all of their routine and disturbed mental and physical conditions.Sickness and hospitals are one thing that affect a child's psychology. Children dread to get into the harsh technological environments of today's medical environments. Hospitals are constantly evolving to keep pace with the latest medical technologies. Additions or refurbishments or a totally new set-up usually focuses on the technological requirements rather than the human element of such an undertaking. The Riley Hospital for Children in Indianapolis presents an architectural opportunity to incorporate psychology of the environment into the design and construction of a new outpatient unit. By balancing the technological requirements with the physical and pschological needs of a child patient, one can create a healing environment more conducive to a rapid recovery. This thesis explores one of the possibilities of creating such an environment.
Department of Architecture
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9

Tolliver, Robert Matthew, Deborah Thibeault, Gayatri Bala Jaishankar, Karen E. Schetzina, and Jodi Polaha. "Linking Families to Resources: Assessing Social Determinants of Health in Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5033.

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Background/Rationale: The American Academy of Pediatrics recommends universal surveillance of social determinants of health in primary care. Addressing these determinants is likely crucial to reducing extant health disparities. Such screening in urban pediatric primary care has been shown to increase access to relevant resources for families when combined with provider training in using a community resource binder (Garg et al., 2007). However, resources in more rural areas are often scarce and helping families navigate a complex resource system often requires a more individualized approach. Additionally, in an increasingly screener heavy pediatric environment, social determinant screeners that are comprehensive but brief are needed to reduce the burden on both patients and providers. Methods/Results: A brief TEAM Care social determinants screener protocol was developed to meet the needs of families presenting to ETSU Pediatrics. Our clinic serves primarily low income families, many of which live in ruralareas. During the first eight months of data collection, 2043 TEAM Care screeners were administered at annual well child checks. The prevalence of caregiver endorsed concerns was as follows: financial concerns impacting ability to pay for food, housing, or utilities (7%), transportation problems (4%), caregiver depression (4%), concerns about caregiver drug/alcohol use (2%), domestic violence (1%), and literacy problems (1%). 13.4% of caregivers endorsed at least one concern on the screener. Caregivers who endorsed a concern were provided individualized resources via a warm handoff or phone call by integrated social work interns. Interns were available on an ongoing basis to check in with families, adjust resource recommendations as needed, and coordinate care with the child’s primary care physician. Our poster will report on an anticipated 3000 TEAM Care screeners collected during the first year of administration. Conclusion: Last year at CFHA, we reported the initiation of the TEAM Care Screener, modeled after the WE CARE Screener (Garg et al., 2007) and designed to screen for social determinants of health in pediatric primary care via six items. Previous preliminary reports of this study included data from approximately 1000 screeners. A one year report of the TEAM Care screener will be completed in September 2017, making it ideal timing to present at CFHA in October 2017. We anticipate reporting prevalence data from 3000 screeners and incorporating results from a provider satisfaction survey of the screener process. The TEAM Care screener process was designed to maximize efficiency for families and providers, and the addition of social work interns ensures that families who endorse needs receive individualized help. A future goal is to more systematically follow up with families to determine how many were connected to recommended resources.
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10

Wood, David L. "Child Poverty and Its Impact on Child Health." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5178.

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11

Aujla, Mark Amrinder, and Demetrio Macariola. "Inpatient versus Outpatient Pediatric Antibiograms: An Analysis Looking for Significant Difference." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/asrf/2020/presentations/46.

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Antibiograms are aggregates of susceptibility testing data of pathogens over a period of time. Bacteria are cultured from infected patients. Once identified, a pathogen undergoes testing against common antibiotics, indicating the effectiveness of specific antibiotics to the pathogen identified. This data gives clinicians an understanding of which antibiotics face increasing resistance in their communities. This project involved the development of a pediatric outpatient antibiogram which was compared against a regional inpatient pediatric antibiogram. The goal was to identify a significant difference in susceptibility between inpatient and outpatient pediatric infections. All urine cultures ordered within the ETSU Health pediatrics department over the course of 1 year between September 2018 and September 2019 were examined. There were 251 such cultures, of these 52 were abnormal, and required antibiotic treatment. All abnormal urine cultures were examined for pathogen identity, and susceptibility data. Pathogens were stratified by species and their susceptibility to commonly utilized antibiotics was aggregated and expressed as a percentage. This analysis did not distinguish between intermediate and resistant strains of bacteria, both results were marked resistant. There were 3 patients that presented with repeat cultures. Two of these patients presented with a single species of bacteria on follow-up cultures, and subsequent samples were excluded. One patient presented with two different urine cultures at different points in the year, and both samples were included. When stratified based on species, only E. Coli, with 30 unique samples, presented enough statistical power for analysis. We compared community and hospital pediatric antibiograms and found no statistical difference in susceptibility in E. Coli. However, analysis showed significant difference between both pediatric antibiograms and the inpatient adult antibiogram. We found significant difference in susceptibility between samples for ampicillin 11%, ampicillin-sulbactam 34%, tetracycline 21%, levofloxacin 21%, and Trimethoprim-sulfamethoxazole 12%. The adult antibiogram demonstrated lower susceptibility against all of these antibiotics. Additional research is necessary in this area. Based on this analysis, we cannot recommend pediatric community antibiogram creation. However, the differences observed between adult and pediatric antibiograms indicate a utility for continued stratification of antibiograms by age.
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12

Lynch, Sean E. "Translating cultures of care integrating behavioral health services in pediatric practice /." Diss., Restricted to subscribing institutions, 2009. http://proquest.umi.com/pqdweb?did=2024833501&sid=3&Fmt=2&clientId=1564&RQT=309&VName=PQD.

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13

Torian, Bryce. "The Effects of Discourse on Pediatric Health Outcomes: The Moderating Role of Child Sex." Thesis, Virginia Tech, 2016. http://hdl.handle.net/10919/78143.

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Implicit theories are frameworks that allow an individual to conceptualize the world (Levy, Chiu, & Hong, 2006; Plaks, Levy, & Dweck, 2009). Incremental implicit theories assert humans as dynamic entities, capable of change, whereas entity implicit theories assert that humans are rigid, static, and incapable of change (Dweck, 1999). The present study examined entity and incremental themes in parent child discourse about weight related health decisions. Incremental themes are expected to be related to better pediatric health outcomes (BMI, physical activity, diet, and body image). A moderation model is proposed whereby links between parent child discourse and pediatric health outcomes, specifically body image, will be stronger for boys than girls. Moderation by sex was expected because parents may communicate differently to their children as a function of sex. Cultural ideals have much more stringent evaluations of women than men do and this may be reflected in communications involving parents and children. There were no significant mean-level differences in body image scores and parents' use of entity and incremental themes according to child sex. Additionally, parents use of entity and incremental themes did not predict any of the children's health-related outcomes. These results may indicate that child sex may not be the best predictor of parents' communications concerning children's weight-related decisions.
Master of Science
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14

Smith, Courtney, Karen E. Schetzina, David Wood, and Jodi Polaha Jones. "The Family Check Up in a Pediatric Clinic: An Integrated Care Delivery Model to Improve Child Behaviors in the Home Environment." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/5008.

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15

Leibach, Gillian G. "Urban Stressors and Child Asthma: An Examination of Child and Caregiver Models." VCU Scholars Compass, 2016. http://scholarscompass.vcu.edu/etd/4680.

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The purpose of the present study was to examine how low-income, racial and ethnic minority, urban families experience and manage their child’s asthma. The rationale for this study stems from existing literature on asthma disparities and documented predictors of increased asthma morbidity and mortality. In particular, this study considered how specific types of stress may disproportionately impact low-income, racial and ethnic minority, urban families that have a child with asthma. This study aimed to determine associations between urban stressors (stressful life events, perceived discrimination, subjective socioeconomic status) and child asthma outcomes (emergency department visits, school days missed, asthma control), and considered depressive symptoms and asthma self-efficacy as mediators in these associations. Analyses were conducted in a sample of 97 urban caregivers and their children in Richmond, Virginia. Findings revealed that neighborhood stress was significantly associated with asthma control. Stressful life events were significantly associated with school days missed. Perceived discrimination and subjective SES were not significantly related to any child asthma outcomes. Bootstrapping procedures demonstrated that child depressive symptoms mediated the relation between neighborhood stress and asthma control. Child asthma self-efficacy did not significantly mediate associations between neighborhood stress and any child outcomes. Caregiver depressive symptoms and caregiver asthma self-efficacy did not significantly mediate any associations between caregiver-reported urban stressors and child asthma outcomes. Results from the present study suggest that urban stressors, especially neighborhood stress and stressful life events, are important to consider in the context of child asthma management and subsequent health outcomes. Exposure to urban stressors may further contribute to pediatric asthma disparities because they are disproportionately experienced by low-income, racial and ethnic minority, urban families. Each urban stressor that was related to a child outcome was associated with a particular asthma outcome. Specifically, child-reported neighborhood stress was related to asthma control. Caregiver-reported stressful life events were associated with school days missed. These findings suggest that exposure to specific types of stress may impact asthma management differently. Future research should, therefore, explore the impact and contribution of specific stressors in greater depth. Further, child depressive symptoms significantly mediated the relation between neighborhood stress and asthma control, although caregiver depressive symptoms did not significantly mediate any associations between urban stressors and child asthma outcomes. Additionally, both child and caregiver depressive symptoms were significantly associated with multiple urban stressors and child asthma outcomes. Depressive symptoms may, therefore, be important to target in future research as possible explanatory variables or variables that contribute to stress appraisals and child asthma outcomes.
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Piercey, Lisa M., and Karen E. Schetzina. "Development and Implementation of an Evidence-Based Pediatric Asthma Clinical Pathway." Digital Commons @ East Tennessee State University, 2004. https://dc.etsu.edu/etsu-works/5093.

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17

Dalton, William T., Karen E. Schetzina, Deborah T. Pfortmiller, Deborah L. Slawson, and William S. Frye. "Health Behaviors and Health-Related Quality of Life Among Middle School Children in Southern Appalachia: Data from the Winning with Wellness Project." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/5104.

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Health-related quality of life (HRQoL) is linked to health status in a variety of conditions. Less is known about the relation between quality of life and modifiable health behaviors, especially among medically underserved populations.ObjectiveThe purpose of the current study was to examine HRQoL as it relates to physical activity, sedentary behavior, and eating patterns in youth residing in Southern Appalachia.MethodsThe Pediatric Quality of Life Inventory and questions on physical activity and eating behaviors was completed by 152 sixth grade students in a regional sample of schools participating in the Winning with Wellness child obesity prevention project.ResultsThe current study found higher physical activity levels and lower levels of screen time to be associated with reports of more positive HRQoL.ConclusionsA more comprehensive understanding of factors surrounding health behavior may hold implications for obesity prevention/intervention programs.
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Schetzina, Karen E., William Dalton, Elizabeth Lowe, Nora Azzazy, Katrina VonWerssowetz, Connie Givens, Deborah Pfortmiller, and H. Stern. "A Coordinated School Health Approach to Obesity Prevention Among Appalachian Youth." Digital Commons @ East Tennessee State University, 2009. https://dc.etsu.edu/etsu-works/5102.

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Childhood obesity has been an increasing problem in the United States, especially in rural areas. Effective prevention approaches are needed. This article describes the development, implementation, effectiveness, feasibility, and sustainability of a school-based obesity prevention pilot project, Winning with Wellness. The program was based on the coordinated school health model and included a community-based participatory research approach aimed at promoting healthy eating and physical activity in a rural Appalachian elementary school. Findings from this preliminary project revealed improvements in nutrition offerings and increased physical activity during the school day. In addition, the program was found to be acceptable to teachers, successfully implemented utilizing both existing and newly developed resources, and sustainable as evidenced in continued practice and expansion to other area schools.
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Schetzina, Karen E. "Use of Basal‐Bolus Insulin Therapy at Time of Diagnosis of Type 1 Diabetes Mellitus in Pediatric Patients Provides Improved 1st Year Glycemic Control Compared to Conventional NPH Regimens." Digital Commons @ East Tennessee State University, 2009. https://dc.etsu.edu/etsu-works/5124.

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20

Jaishankar, Gayatri Bala, Jodi Polaha Jones, Deborah Thibeault, Robert Matthew Tolliver, V. Morris, A. Johnson, and Karen E. Schetzina. "A Team Care Screening Tool to Address Social Determinants of Health in a Pediatric Primary Care Clinic." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5034.

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Schetzina, Karen E., William Dalton, Elizabeth F. Lowe, Nora Azzazy, Katrina VonWerssowetz, Connie Givens, and H. P. Stern. "Developing a Coordinated School Health Approach to Child Obesity Prevention in Rural Appalachia: Results of Focus Groups with Teachers, Parents, and Students." Digital Commons @ East Tennessee State University, 2009. https://dc.etsu.edu/etsu-works/5103.

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INTRODUCTION: High prevalence rates of obesity, particularly among those residing in US rural areas, and associated physical and psychosocial health consequences, direct attention to the need for effective prevention programs. The current study describes an initial step in developing a school-based obesity prevention program in rural Appalachia, USA. The program, modeled on the Centers for Disease Control and Prevention Coordinated School Health (CSH) Program, includes a community-based participatory research approach to addressing the health needs specific to this region. METHODS: Focus groups with teachers, parents, and 4th grade students were used to understand perceptions and school policy related to nutrition, physical activity, and the role of the school in obesity prevention. RESULTS: Results revealed that these community stakeholders were concerned about the problem of child obesity and supported the idea of their school doing more to improve the diet and physical activity of its students. Specifically, all groups thought that foods and drinks consumed by students at school should be healthier and that they should have more opportunities for physical activity. However, they cited limitations of the school environment, academic pressures, and lack of parental support as potential barriers to making such changes. Parents were most concerned that their children were not getting enough to eat and they and the teachers were not in favor of BMI screening at the school. Parents were in favor of increasing physical activity during school and thought that parent volunteers should help students select foods in the cafeteria. Students cited examples of how diet and physical activity affect their health and school performance, and thought that they should have more physical education time and recess. CONCLUSIONS: The data collected in the current study contributed to the limited knowledge base regarding rural populations as well as identified strengths and potential barriers to assist with the development of a pilot program based on the CSH model, Winning with Wellness.
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Shellhorn, Wendy Lauran Struchen. "Maternal interaction style, reported experiences of care, and pediatric health care utilization." [Tampa, Fla] : University of South Florida, 2006. http://purl.fcla.edu/usf/dc/et/SFE0001478.

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Shoemaker, Griffin, Gloria Kwak, Gayatri Bala Jaishankar, and Karen E. Schetzina. "Prenatal Drug and Related Exposures in Infant Patients at Northeast Tennessee Pediatric Primary Care Clinic." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/5032.

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Islam, Nadia. "Mechanisms of Motivational Interviewing in a Parent-focused Pediatric Obesity Intervention." VCU Scholars Compass, 2017. http://scholarscompass.vcu.edu/etd/5030.

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Pediatric obesity is a major public health epidemic with serious physical and psychological consequences. Difficulty engaging families in treatment is a significant obstacle in addressing pediatric obesity, especially among underserved populations. Motivational interviewing (MI) is a collaborative, person-centered communication style that has been shown to reduce attrition, increase attendance, and improve patient treatment adherence; however, little is known about the process of MI and how it improves treatment engagement. This study examined clinician and parent language in a pre-treatment MI session that increased initial engagement in a parent- focused pediatric obesity intervention (N= 81). Results showed that increased parent change talk, and preparatory language in particular, was positively related to the likelihood of initial attendance at baseline. Additionally, certain types of MI consistent clinician strategies were positively associated with parent change talk. Complex positive reflections were correlated with preparatory language and overall change talk, suggesting this might be a particularly important MI skill. Findings have implications for better understanding the process of MI and mechanisms through which MI can improve treatment engagement.
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Schetzina, Karen E., William T. Dalton, Deborah Pfortmiller, Hazel Robinson, Elizabeth Lowe, and H. Stern. "The Winning With Wellness Pilot Project: Rural Appalachian Elementary Student Physical Activity and Eating Behaviors and Program Implementation 4 Years Later." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/5106.

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School-based efforts to promote physical activity and healthier eating are a potentially effective approach to decreasing child obesity in rural populations. This article describes follow-up data on student activity and eating behaviors 4 years after implementation of the Winning with Wellness obesity prevention initiative. This project was based on the Centers for Disease Control and Prevention's coordinated school health model and used a community-based participatory research approach to address health behaviors in rural Appalachian elementary students. Results suggest significant increases in daily pedometer steps and healthier food selections by students as well as teacher support for continued health promotion efforts.
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Koo, Sergio Don. "Quality of life in children with chronic allergic respiratory disease a population-based child health survey in Hong Kong /." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B42931538.

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Greasamar, Emily, Taylor Hall, Samantha Pamfill, Tolliver M. PhD Robert, and Deborah DSW LCSW Thibeault. "Systematic Screening to Identify Medication Lockbox Needs in Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/15.

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Introduction: Nearly 60,000 children receive emergency services each year due to accidental medication ingestion. Since families regularly receive verbal anticipatory guidance about locking up medications during pediatric well child visits, primary care clinics are an opportune place to distribute lock boxes to families who need them. ETSU Pediatrics is an interprofessional outpatient clinic that serves a population with many social, medical, and psychological needs. ETSU Pediatrics partnered with a local non-profit organization to provide medication lock boxes free to charge to families who need one. However, it was not known whether more families would endorse a need for a lock box in response to a systematic effort to screen for this need. We hypothesized that more medication lock boxes would be administered if families were given a written screener asking explicitly about their need for a lock box. Method:ETSU Pediatrics added the question “To increase child safety, is your household in need of a lockbox for medications?” to an existing social determinants of health screener that is given annually to each patient during their well child visit. Social work students imbedded in the clinic gave out lock boxes to families who endorsed a need. Frequency counts of the number of medication lock boxes given out were compared 6 months before and after the initiation of the screener. Results: Out of the 2,018 well child visits that occurred in the 6 months after screener initiation, 5.5% (111) of families endorsed a need for a medication lock box. Of those 106 were given a lock box. This was a substantial increase in demand for lock boxes compared to the 6 months prior to screener initiation in which only 16 lock boxes were given out. Conclusions: Systematic screening for medication lock box need resulted in more lock boxes being administered to families over a 6-month period, compared to care as usual. An embedded interprofessional student team helped facilitate this process. These results show promise for other healthcare organizations aimed at reducing accidental medication ingestions in children.
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West, Aimee Michelle. "Child Behavioral Severity and Parents' Perceptions of the Effectiveness and Likelihood of Seeking Behavioral Health Treatment." Kent State University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=kent1366645309.

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Tolliver, Sarah, Sara Reed, Robert Matthew Tolliver, Jodi Polaha Jones, and Karen E. Schetzina. "Assessing For and Treating Postpartum Depression in a Pediatric Primary Care Setting Using a Stepped-Care Model: Is It Feasible?" Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/5073.

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Postpartum Depression (PPD) occurs in 10-20% of new mothers. PPD can lead to serious health risks to both the mother and infant, increase the risk of complications during birth, and cause lasting effects on the development and wellbeing of the child. Many mothers suffering from PPD do not receive treatment due to fear of being stigmatized, lack of education, or not being able to access mental health services. High prevalence of PPD, along with the negative and lasting effects it can cause point to the importance of developing an effective and feasible method of assessing and treating this disorder. A pediatric primary care office may be an opportune setting to screen for PPD since mothers often accompany their children to regularly scheduled well child visits. While some studies have examined PPD screening within the pediatric primary care setting, few have explored the addition of an on-site Behavioral Health Consultant to provide brief interventions for depressed mothers as part of a stepped care model. The primary aim of the current study is assess the feasibility of implementing a stepped care protocol that assesses PPD and provides brief interventions and referrals for depressed mothers within a pediatric primary care clinic. The protocol consists of several phases including: 1) distribution of the Edinburgh Postpartum Depression Screener to every mother arriving for a well child visit during the first six months of their child’s life; 2) appropriate documentation in the clinic’s electronic health record (EHR) of the Edinburgh score and resulting plan of action; 3) a brief same day intervention by the on-site Behavioral Health Consultant and referral to outside provider, if applicable; and 4) phone call follow up with the mother and referred provider, if applicable. Research assistants will monitor the EHR to determine the clinic’s fidelity to the protocol (e.g., if the Edinburgh is being administered properly). Data will also be collected from the EHR to determine if a correlation exists between Edinburgh scores and number of Emergency Room visits made by the child, immunizations administered to the child, and number of well child checks the child attended. Data collected throughout the month of March showing the Edinburgh uptake, consistency with protocol, and any correlation between Edinburgh scores and other variables will be presented.
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Mackinder-Jonas, Mary. "The CHIC Study : Child Health in Coeliac Disease." Thesis, University of Glasgow, 2018. http://theses.gla.ac.uk/8848/.

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Coeliac disease (CD) is an autoimmune condition of the gastrointestinal tract. In untreated patients, an inflammatory response to gluten results in destruction of the gut mucosa resulting in villus atrophy. This often presents with overt clinical symptoms but can also be silent in nature. Continual gluten insult can inevitably lead to a range of complications including nutritional problems from poor growth to deficits in bone mineral density (BMD). The CHIC study aimed to create a comprehensive picture of CD in children, taking into account growth and nutritional status, bone health, micronutrient status and further assessing children with the dual diagnosis of type 1 diabetes mellitus and CD. It is well established that early diagnosis of CD and the prompt initiation of gluten free dietary treatment (GFD) reduces the manifestation of complications. Yet in many previous studies the quality of a GFD and children's compliance to it have not been accounted for. This study assessed nutritional status and body composition in paediatric patients with newly diagnosed CD and found that the presentation of CD has changed, with the majority of patients presenting with normal and even over nutrition. Furthermore, the introduction of GFD with good compliance supports normal growth velocities and enables catch up growth in children presenting with short stature. When considering bone health in paediatric patients with CD the results remain inconclusive. Many previous studies have used the widely available DXA to assess bone mineral content, but in paediatric patients this may not accurately determine bone health. This study used peripheral quantitative computed tomography to distinguish changes in bone mineral density and investigate any alterations in bone microarchitecture. Thus, for the first time in paediatric CD patients identifying disruption to the remodelling mechanisms of trabecular bone, which may be particularly sensitive to resorption and mineral loss in patients with active CD. Furthermore, restoration of BMD was evident with good compliance to dietary treatment. Investigations into micronutrient status revealed that newly diagnosed children are vulnerable to micronutrient deficiency, this is likely due to malabsorption in the gut in patients with active CD. Deficiencies in zinc and magnesium were also identified in children treated with a GFD. This may be due to the inadequate micronutrients intakes with consumption levels of riboflavin, vitamin A, vitamin K, calcium, iron, magnesium and zinc lower than expected in treated CD children.
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Kuo, Alice, David L. Wood, James H. Duffee, and J. M. Pasco. "Poverty and Child Health in the United States." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/5138.

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Almost half of young children in the United States live in poverty or near poverty. The American Academy of Pediatrics is committed to reducing and ultimately eliminating child poverty in the United States. Poverty and related social determinants of health can lead to adverse health outcomes in childhood and across the life course, negatively affecting physical health, socioemotional development, and educational achievement. The American Academy of Pediatrics advocates for programs and policies that have been shown to improve the quality of life and health outcomes for children and families living in poverty. With an awareness and understanding of the effects of poverty on children, pediatricians and other pediatric health practitioners in a family-centered medical home can assess the financial stability of families, link families to resources, and coordinate care with community partners. Further research, advocacy, and continuing education will improve the ability of pediatricians to address the social determinants of health when caring for children who live in poverty. Accompanying this policy statement is a technical report that describes current knowledge on child poverty and the mechanisms by which poverty influences the health and well-being of children.
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32

Ollier, Shannon Laurel. "Effects of Parent-Child Conflict and Involvement on the Health Related Quality of Life of Adolescents with Pediatric Epilepsy." Xavier University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=xavier1500550397856367.

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33

Cligrow, Carrie M. "Pediatric Chronic Illness: How East Indian Children and Their Mothers Negotiate Culture and Hospitalization." Ohio University / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1269884573.

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34

Wood, David L. "New Models of Health and Social Determinants of Health." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5180.

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35

Lilley, Christine Megan. "Psychological predictors of children's pain and parents' medication practices following pediatric day surgery." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/NQ56577.pdf.

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36

Aguilera, Antonio M., David L. Wood, Cortney Keeley, Hector E. James, and Philipp R. Aldana. "Young adults with spina bifida transitioned to a medical home: a survey of medical care in Jacksonville, Florida." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/5134.

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OBJECTIVE The transition of the young adult with spina bifida (YASB) from pediatric to adult health care is considered a priority by organized pediatrics. There is a paucity of transition programs and related studies. Jacksonville Health and Transition Services (JaxHATS) is one such transition program in Jacksonville, Florida. This study’s purpose was to evaluate the health care access, utilization, and quality of life (QOL) of a group of YASBs who have transitioned from pediatric care. METHODS A survey tool addressing access to health care and quality of health and life was developed based on an established survey. Records of the Spinal Defects Clinic held at Wolfson Children’s Hospital and JaxHATS Clinic were reviewed and YASBs (> 18 and < 30 years old) were identified. RESULTS Ten of the 12 invited YASBs in the Jacksonville area completed the surveys. The mean age of respondents was 25.1 years. All reported regular medical home visits, 8 with JaxHATS and 2 with other family care groups. All reported easy access to medical care and routine visits to spina bifida (SB) specialists; none reported difficulty or delays in obtaining health care. Only 2 patients required emergent care in the last year for an SB-related medical problem. Seven respondents reported very good to excellent QOL. Family, lifestyle, and environmental factors were also examined. CONCLUSIONS In this small group of YASBs with a medical home, easy access to care for medical conditions was the norm, with few individuals having recent emergency visits and almost all reporting at least a good overall QOL. Larger studies of YASBs are needed to evaluate the positive effects of medical homes on health and QOL in this population.
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Perazzo, Lauren. "Barriers to Medication Adherence Following Pediatric Renal Transplantation: The Utility of Independent and Interrelated Parent and Child Reports." Xavier University / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=xavier1396372473.

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38

古修齊 and Sergio Don Koo. "Quality of life in children with chronic allergic respiratory disease: a population-based child health survey inHong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B42931538.

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39

Polaha, Jodi, Karen E. Schetzina, Katie Baker, and Diana Morelen. "Adoption and Reach of Behavioral Health Services for Behavior Problems in Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2018. https://doi.org/10.1037/fsh0000380.

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Introduction: The field of implementation science provides the variables adoption and reach, which can be used to evaluate aspects to access, a primary incitement for integrated care. This study compared two integrated models: In Year 1, behavioral health consultants worked collaboratively with pediatricians to provide brief on-the-spot consultations to patients with behavioral concerns, and in Year 2, a structured, evidence-based treatment (EBT), the Family Check-Up, was developed to be delivered in conjunction with the existing collaborative model. Method: A chart review revealed the number of children who (a) attended a 4- to 5-year-old well-visit, (B) were screened, (c) were identified as having behavior problems, (d) were referred, and (e) accessed the services. Outcomes were calculated as percentages of children with behavioral concerns who were referred to (adoption) and received (reach) the services in each year. Results: Key findings were that (a) physician referrals increased when an EBT was added, but (b) patients had better first-session contact with the brief approach than the EBT, which few patients completed. Discussion: Results underscore the utility of measuring adoption and reach as partial indicators of access to services. These are accessible variables, collected in every practice that can be measured routinely in the context of quality improvement and, ideally, reported in studies as a way to disseminate knowledge about how to build behavioral health technology into primary care. Future research should strive for more rigor in measuring adoption and reach, and consider including a number of other implementation outcomes.
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40

Bodhani, Amit Ravindra. "Parenting, Home Environment, and Child Obesity: A Survey of Parents and Children Attending a Pediatric Clinic." Digital Commons @ East Tennessee State University, 2006. https://dc.etsu.edu/etd/2162.

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Data were collected from 60 parents of children 5-11 years of age to describe the parental and family factors and explore the associations of these factors with children's Body Mass Index (BMI) percentiles. Mother's made up 81.7% of the sample. Whites/Caucasians comprised 88.3% of the sample. Males comprised 51.6% of the child participants while females comprised 48.3%. Among the child participants, 38.3% had BMI equal to or greater than the 95th percentile, and 6.7% had BMI 85th to less than 95th percentile. Concerns about child weight (rs = 0.582), pressure to eat (rs = -0.433), and monitoring (rs = 0.348) were found to be significantly associated with children's BMI percentile. There are variations in influence of parenting and home environments on children's eating and physical activity, and in the eating and physical activity habits amongst families. Consideration of parental and family factors is needed in developing child obesity prevention programs.
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41

Fisher, Deborah. "Opioid Withdrawal Signs and Symptoms in the Pediatric Patient during Opioid Tapering." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2719.

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Opioids are used routinely in the pediatric intensive care population for analgesia, sedation, blunting of physiologic responses to stress, and safety. In children, physical dependence may occur in as little as two to three days of continuous opioid therapy. Once the child no longer needs the opioid, the medications are reduced over time. A review of the literature revealed that the majority of the published studies used either a neonatal opioid assessment tool or no assessment tool. A subsequent international survey of pediatric providers found a wide range of opioid tapering practices and sporadic use of opioid withdrawal instruments to guide practice. Since tapering routines vary among practitioners, it is not uncommon to see signs and symptoms of opioid withdrawal. A prospective, descriptive study was conducted to describe the frequency of opioid withdrawal signs and symptoms and to identify factors associated with these opioid withdrawal signs and symptoms. The sample of 25 was drawn from all patients, ages 2 weeks to 21 years admitted to the Children’s Hospital of Richmond Pediatric Intensive Care Unit (PICU) and who have received continuous infusion or scheduled opioids for at least 5 days. Data collected included: opioid withdrawal score (WAT-1), opioid taper rate (total dose of opioid per day in morphine equivalents per kilogram [MEK]), pretaper peak MEK, pretaper cumulative MEK, number of days of opioid exposure prior to taper, and age. Out of 26 enrolled participants, only 9 (45%) had opioid withdrawal on any given day. In addition, there was limited variability in WAT-1 scores. The most common symptoms notes were diarrhea, vomit, sweat, and fever. For optimal opioid withdrawal assessments, clinicians should use a validated instrument such as the WAT-1 to measure for signs and symptoms of opioid withdrawal. Further research is indicated to examine risk factors for opioid withdrawal in children.
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42

Shoemaker, Griffin, Gloria Kwak, Gayatri B. MD Jaishankar, and Karen E. MD MPH Schetzina. "Prenatal Drug and Related Exposures in Infant Patients of a Northeast Tennessee Pediatric Primary Care Clinic." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/18.

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Introduction: The prevalence of opioid abuse has increased throughout Northeast Tennessee. Subsequently, more infants are born drug-exposed or with Neonatal Abstinence Syndrome (NAS). According to the Tennessee Department of Health, hospitalizations for deliveries with maternal substance abuse tripled in Tennessee between 1999 and 2011. During this period, the inpatient hospitalization rate for NAS increased 11-fold. In 2017, there were 163 NAS cases reported in Northeast Tennessee. Depending on intrauterine and environmental exposures, there may be differences in health, growth, behavior, and development in infants. Our goal was to assess and explore those differences to help update education and care recommendations for pediatric primary care clinics. Methods: This cross-sectional study was set in a Northeast Tennessee pediatric clinic. 120 patients seen for a newborn visit between June 30, 2013 and July 1, 2014 were randomly selected. An additional sample of all infants with suspected drug exposure was identified for this period based on diagnosis codes. In total, 99 infants had no drug exposure and 62 were drug-exposed. An 83-item chart abstraction template was developed. Data was analyzed by SPSS. The chi-squared test and Mann-Whitney U test were used, with a critical value of p<0.05 to determine significance. The Bonferroni correction was applied to account for multiple comparisons. The research protocol was reviewed and approved by the Institutional Review Board of East Tennessee State University. Results: Of the 120 charts initially selected, 3.33% of infants were exposed to buprenorphine, 1.67% to methadone, 0.83% to marijuana, 0.83% to cocaine, and 1.67% to tobacco, 8.33% to benzodiazepine, and 1.67% to barbiturates during gestation. In total, 18.33% of infants had any drug exposure, 10.00% to any opiate, and 3.33% had a documented diagnosis of NAS in their chart. Prenatal drug exposure was significantly associated with multiple demographic factors as well as pediatric respiratory, behavioral, gastrointestinal, infectious disease, and cardiac conditions. Conclusions: Prenatal drug exposure was significantly associated with multiple pediatric complications. This illustrates the significance of addressing the increased incidence of prenatal drug exposure in Northeast Tennessee. Future multivariate analyses will attempt to control for potential confounders. This analysis is retrospective and exploratory, and any associations should be confirmed with a prospective study. A weakness of this study includes potential under-diagnosis of drug exposure and NAS due to lack of documentation in the EHR. Additional research will include further comparison of maternal and infant complications in drug-exposed and non-exposed infants. This will allow for a better understanding of the risks associated with maternal drug exposure. Findings from these research projects will be used to inform clinical initiatives for NAS in Northeast Tennessee.
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Smith, S. Courtney, Karen E. Schetzina, Jodi Polaha, Katie Baker, and David L. Wood. "The Family Check-Up in a Pediatric Clinic: An Integrated Care Delivery Model to Improve Behaviors in the Home Environment." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/5114.

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This study examines the feasibility of adapting the Family Check Up (FCU), an evidence-based program to identify and manage behavioral concerns in children ages 4 and 5 years, within a pediatric primary care clinic with an integrated mental health professional. Methods: Caregivers attending their child’s 4 and 5 year-old well child visit were asked to complete a screening tool (Pediatric Symptom Checklist-17; PSC-17) measuring behavioral concerns as part of routine care. Families who screened positively, were referred to the FCU and asked to participate in a study evaluating the intervention. The FCU is a 2-session intervention during which information on home environment and parenting style was collected through tailored questionnaires, videotaped interactions, and a clinical interview. Feasibility was examined using portions of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (REAIM) framework from the Dissemination and Implementation Science field. This study presents preliminary data on the domains of Reach and Adoption over the first 5 months of the FCU. Results: The number of families referred who attended at least one session (Reach) was 77.2%. Current data shows that use of the PSC-17 screening instrument (Adoption) is 91.4% for well child checks and 25% for acute visits. Adoption of those referred to the FCU is 84%, indicating most families screening positively for behavioral concerns were successfully referred to the FCU. Conclusion: Initial results suggest Reach and Adoption rates support the feasibility of adapting a behavioral intervention for delivery in the pediatric clinic. Notably, having an existing integrated care delivery model is a critical piece to this early success. Future directions will continue to explore feasibility of the remaining REAIM domains.
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Wood, David L. "Social Determinants of Health." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5168.

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45

Wood, David L. "Health Care Transition: Bridge or Abyss?" Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5175.

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46

Angelhoff, Charlotte. "What about the parents? : Sleep quality, mood, saliva cortisol response and sense of coherence in parents with a child admitted to pediatric care." Doctoral thesis, Linköpings universitet, Avdelningen för omvårdnad, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-136442.

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Parents experience many stressful situations when their child is ill and needs medical care, irrespective of the child’s age, diagnosis or the severity of the illness. Poor sleep quality and negative mood decrease the parents’ ability to sustain attention and focus, to care for their ill child, and to cope with the challenges they face. The overall aim of this thesis was to evaluate sleep, mood, cortisol response, and sense of coherence (SOC) in parents caring for children in need of medical care, and to identify factors that may influence parents’ sleep. This thesis includes four original studies; two of these are quantitative, prospective, descriptive and comparative studies including parents (n=82) accommodated in six pediatric wards with their ill child, using questionnaires and sleep logs to measure sleep, mood and SOC, and saliva cortisol to measure cortisol response. A follow-up was performed four weeks later at home, after hospital discharge. The other two studies are qualitative, inductive and explorative interview studies, including parents (n=12) staying overnight with their preterm and/or ill infant in three neonatal intensive care units, and parents (n=15) with a child receiving hospital-based home care in two pediatric outpatient clinics. The interviews were analyzed with a phenomenographic method. Being together with one’s family seems beneficial for sleep and may decrease stress. The ability to stay with the child, in the hospital or at home, was highly appreciated by the parents. When caring for a child with illness, parents’ sleep quality was sufficient in the hospital; however, sleep quality improved further (p<0.05) at home after discharge. The parents reported frequent nocturnal awakenings in the hospital caused by the child, medical treatment and hospital staff. Concern and anxiety about the child’s health, and uncertainty about the future were stressors affecting the parents’ sleep and mood negatively. The parents had lower (p=0.01) morning awakening cortisol levels in the pediatric ward compared to at home, and parents accommodated for more than one night had lower (p<0.05) post-awakening cortisol levels compared to parents staying their first night. The findings of this thesis conclude that being together as a family is important for the parents’ sleep. The ability to be accommodated in the hospital and gather the family around the child may have given the parents time for relaxation and recovery, that in turn may lead to a less stressful hospital stay. When it is beneficial for the child, the whole family should be included in the pediatric care. Moreover, pediatric nurses must acknowledge parents’ sleep, in hospital and at home. Medical treatment and care at night should be scheduled and sleep promoted for the parents in order to maintain health and well-being in the family.

The electronic version of the thesis is a corrected version of the printed thesis.

This thesis has also been funded by Barnklinikens 60-årsfond, Filip SchelinsStiftelse, Riksföreningen för barnsjuksköterskor and Synskadades Riksförbund (Lyckopenningen).

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Wood, David L. "Screening Tools in Adolescent Health Care." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5187.

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Learning Objectives: (1) Identify three primary care friendly screening tools useful for identifying behavioral health concerns in adolescents. (2) Describe how a "champion" (quality improvement) team can help facilitate implementation of a screener in a primary care.
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48

Majchrzak, Erin, Lindsey Bull, Debra Mills, Gayatri Bala Jaishankar, and Karen E. Schetzina. "Once Upon a Time: Child Abuse Prevention." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/5068.

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49

Wood, David L., and R. Nathawad. "Health Care Transition." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/5155.

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50

Woo, Teri Moser. "Weight bias in pediatric healthcare providers : an exploratory study using photo elicitation with focus groups /." Connect to full text via ProQuest. Limited to UCD Anschutz Medical Campus, 2008.

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Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2008.
Typescript. Includes bibliographical references (leaves 127-142). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;
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