PubMed Health⌕ Search

Biomedical subjects

Brian D Johnston

Publications and source records attributed to Brian D Johnston.

14 recordsLinked to original sources
PubMed2006

Healthy steps in an integrated delivery system: child and parent outcomes at 30 months.

OBJECTIVE: To test the effects of the Healthy Steps for Young Children program (HS) (which supports parents managing children's developmental and behavioral issues)-with and without a prenatal component-on child health and development, parenting practices, and parental well-being. DESIGN: A concurrent comparison with clinic-level assignment to intervention or usual care status. Nested in the intervention arm, a randomized trial compared HS with and without a prenatal component. SETTING: Five primary care clinics in an integrated delivery system in the Pacific Northwest. PARTICIPANTS: A consecutive sample of 439 pregnant women (80% of eligible) were enrolled. Follow-up data were obtained for 78% when the child was 30 months old. Intervention Families in intervention clinics received HS services, including developmental and behavioral advice and risk factor screening. In addition, those randomized to prenatal services received 3 home visits during pregnancy. MAIN OUTCOME MEASURES: Assessed by telephone interview in the 3 domains of child health and development, parenting practices, and parental well-being. RESULTS: Intervention was associated with positive outcomes in timely well-child care, immunization rates, breastfeeding, television viewing, injury prevention, and discipline strategies. Prenatal initiation of services was associated with larger expressive vocabularies at age 24 months. Mothers who received the intervention reported more depressive symptoms, but there was no increase in the proportion with clinically significant depression. CONCLUSIONS: For members of an integrated delivery system, the HS intervention was associated with positive effects on children's health and parenting practices. There was little evidence of any additional benefit of HS services initiated during the prenatal period.

Accident Prevention↗
PubMed2004

Expanding developmental and behavioral services for newborns in primary care; Effects on parental well-being, practice, and satisfaction.

BACKGROUND: Healthy Steps (HS) was designed to address, prospectively, behavioral and developmental support needs of young families in pediatric clinical care settings. PrePare (PP) initiates these services prenatally, whereas HS begins services in the postnatal period. Both interventions have universal and risk-directed components. Intervention effects in the first 3 months after birth are reported here. METHODS: A quasi-experimental design was used to allocate 439 participants to intervention or usual care conditions. Within the intervention group, enrollees were randomly assigned to receive HS or PP+HS services. Early outcomes were assessed by telephone survey at 1 week and 3 months postpartum. RESULTS: Mothers in either intervention condition were less likely to report depressive symptoms and more likely to describe themselves as pleased in their role as parents. Intervention families were more likely to continue breastfeeding and more likely to read to their 3-month-old. Knowledge of infant development and recognition of appropriate discipline was greater among intervention recipients. Satisfaction with pediatric care was higher among intervention recipients and the rate of health plan disenrollment was 75% lower at 3 months among those enrolled in the prenatal intervention. No other outcome difference emerged between HS and PP+HS enrollees. CONCLUSIONS: Receipt of either intervention was associated with positive effects on health, safety, and developmentally appropriate parenting, as assessed in early infancy. There were positive effects on health plan disenrollment. No additional benefit could be ascribed to prenatal institution of services. A combination of universal and risk-based support for new parents is recommended, rather than the provision of risk-based services alone.

Female↗
PubMed2004

Expanding developmental and behavioral services for newborns in primary care: implications of the findings.

BACKGROUND: In two other papers in this issue, the rationale, development, implementation, experimental design, approach to evaluation, and early results of a program to deliver developmental and behavioral services to all infants in primary care practice were described. Positive effects were seen for parental satisfaction, including decreased disenrollment, provider satisfaction, parenting practices, and health outcomes. METHODS: In the present article, the results are reviewed and implications of our findings for the delivery of care, families, healthcare systems, and further research are discussed. RESULTS: Findings that have broad implications are as follows: (1) developmental and behavioral services can be delivered successfully in practice using dedicated professionals to deliver and integrate services; (2) the "planned care model" was useful in program implementation for making "the right thing to do, the easy thing to do"; (3) the added focus on satisfaction and cost helps to develop the "business case" for broad scale implementation; (4) bonding of parents to organizations has marketing implications; (5) the program provides positive effects for all parents, not just high-risk parents; and (6) several research questions emerge, including persistence of effects on health outcomes, costs, and utilization. CONCLUSIONS: The authors conclude that study results have implications for preventive services, families, child healthcare in office practice, healthcare systems, and healthcare policy. In this ongoing study, examination of intervention effects at 30 months of age shoud be informative. Further research is warranted as it remains to be seen whether or not these interventions can become viable ongoing programs.

Child Development↗
PubMed2004

Expanding developmental and behavioral services for newborns in primary care: program design, delivery, and evaluation framework.

BACKGROUND: Healthy Steps (HS) for Young Children strengthens the healthcare system as a source of developmental and behavioral support for parents. This series of papers presents a study of HS as implemented within a large health maintenance organization that tested the benefit of beginning intervention services during pregnancy with an extension program called "PrePare" (PP). METHODS: The design was a quasi-experimental comparison of intervention families with families receiving usual care. Within the intervention, families were assigned randomly to begin receiving Healthy Steps services prenatally (PP+HS) or shortly after birth (HS). We used a systems model, PRECEDE/PROCEED, for planning, implementation, and process evaluation. Outcomes examined when the infants were aged 3 months included changes in family social support and capacity for parenting, parenting behaviors, and satisfaction and loyalty to the health plan. RESULTS: The sample of 439 families was distributed as follows: usual care (n=136), prenatal initiation of services (PP+HS; n=151), and postnatal Healthy Steps (HS; n=152). Information about program implementation, including provider satisfaction, is provided for the early phases of the study (through age 3 months). The intervention was delivered with fidelity and with minimal disruption to the practice styles of pregnancy providers, most of whom considered the program valuable to their patients. Relative to families in the comparison group, families in the intervention group received more usual care services and more intervention-specific services. CONCLUSIONS: The pregnancy and newborn phases of the intervention were embedded successfully within the existing healthcare delivery system. The program was considered valuable for parents by providers and parents. Participating families received more services and a greater variety of services than families in usual care. Whether these differences result in beneficial outcomes for families or the health plan are topics of the subsequent papers.

Female↗
PubMed2003

Effects and costs of requiring child-restraint systems for young children traveling on commercial airplanes.

CONTEXT: The US Federal Aviation Administration is planning a new regulation requiring children younger than 2 years to ride in approved child-restraint seats on airplanes. OBJECTIVES: To estimate the annual number of child air crash deaths that might be prevented by the proposed regulation, the threshold proportion of families switching from air to car travel above which the risks of the policy would exceed its benefits, and the cost per death prevented. DESIGN: Risk and economic analyses. RESULTS: Child-restraint seat use could prevent about 0.4 child air crash deaths per year in the United States. Increased deaths as a result of car travel could exceed deaths prevented by restraint seat use if the proportion of families switching from air to car travel exceeded about 5% to 10%. The estimate for this proportion varied with assumptions about trip distance, driver characteristics, and the effectiveness of child-restraint seats but is unlikely to exceed 15%. Assuming no increase in car travel, for each dollar increase in the cost of implementing the regulation per round trip per family, the cost per death prevented would increase by about $6.4 million. CONCLUSIONS: Unless space for young children in restraint seats can be provided at low cost to families, with little or no diversion to automobile travel, a policy requiring restraint seat use could cause a net increase in deaths. Even excluding this possibility, the cost of the proposed policy per death prevented is high.

Accident Prevention↗
PubMed2003

Suppression of nitric oxide oxidation to nitrite by curcumin is due to the sequestration of the reaction intermediate nitrogen dioxide, not nitric oxide.

Curcumin, a phytochemical with antioxidant and other cytoprotective properties, has been reported to reduce nitrite formation during nitric oxide (NO) oxidation in solution. This decrease in nitrite production was attributed to the direct sequestration of NO by curcumin. In this report, we confirm that curcumin inhibits nitrite formation from DEA/NO-derived NO in a concentration-dependent manner. However, curcumin over a concentration range of 3-50 microM had no effect on the concentration of free NO (0.5 microM) in solution at 37 degrees C as assessed using an NO electrode. We conclude that the inhibitory effect of curcumin on the oxidation of NO to nitrite is due to its known sequestration of the reaction intermediate nitrogen dioxide (NO(2)). The ability of curcumin to sequester NO(2), but not NO, suggests that curcumin may be useful for separating the actions of NO(2) from those of NO in various biological systems.

Antioxidants↗
PubMed2003

Emergency department analgesia for fracture pain.

STUDY OBJECTIVES: We analyze records of all emergency department (ED) patients with extremity or clavicular fractures to describe analgesic use, compare analgesia between adults and children, and compare analgesia between the subset of these adults and children with documented moderate or severe pain. Among children, we compare treatment between pediatric and nonpediatric facilities. METHODS: Analysis of the ED component of the National Center for Health Statistics National Hospital Ambulatory Medical Care Survey for 1997 through 2000 was conducted. The proportion of patients with closed extremity and clavicular fracture that received any analgesic and narcotic analgesic medications was determined for each age category. Survey-adjusted regression analyses compared pain and narcotic medications by age and ED type (pediatric versus other). Analyses were repeated for the subset of patients with moderate or severe pain severity scores. RESULTS: Of 2,828 patients with isolated closed fractures of the extremities or clavicle, 64% received any analgesic and 42% received a narcotic analgesic. Pain severity scores were recorded for 59% of visits overall, 47% of children younger than 4 years, and 34% of children younger than 1 year. Among patients with documented moderate or severe pain, 73% received an analgesic and 54% received a narcotic analgesic. Compared with adults, a lower proportion of children (< or = 15 years) received either any analgesic or a narcotic analgesic (P <.001). After adjustment for confounders and survey design, the proportion of patients aged 0 to 3, 4 to 8, 9 to 15, 16 to 29, 30 to 69, and 70 years and older who received any analgesic was 54% (95% confidence interval [CI] 41% to 67%), 63% (95% CI 57% to 68%), 60% (95% CI 57% to 64%), 67% (95% CI 62% to 73%), 68% (95% CI 64% to 72%), and 58% (95% CI 52% to 65%), respectively; the proportion who received a narcotic analgesic was 21% (95% CI 11% to 31%), 30% (95% CI 22% to 37%), 27% (95% CI 23% to 32%), 47% (95% CI 40% to 54%), 51% (95% CI 46% to 56%), and 41% (95% CI 35% to 48%), respectively. Compared with children treated in other EDs, children treated in pediatric EDs were about as likely to receive any analgesia (adjusted relative risk [RR] 1.1; 95% CI 0.9 to 1.3) or narcotic analgesia (adjusted RR 0.9; 95% CI 0.6 to 1.2). CONCLUSION: In pediatric and adult patients, pain medications were frequently not part of ED treatment for fractures, even for visits with documented moderate or severe pain. Pain severity scores were often not recorded. Pediatric patients were least likely to receive analgesics, especially narcotics.

Academic Medical Centers↗
PubMed2003

Transient elevation in risk of injury in siblings following injury encounters.

OBJECTIVE: To examine patterns of injury risk within sibling groups to determine whether a clinical encounter for injury care could be used as a marker to identify siblings at high risk for subsequent injury. STUDY DESIGN: Children (n = 16,335; 0-15 years of age) enrolled in a health maintenance organization between 1995 and 1997 contributed 38,215 child-years of data. We tracked medically treated injuries that were diagnosed and classified as unintentional. Incidence rates and hazard ratios were calculated for children whose sibling had been injured in the previous 180 days compared with children without such exposure, adjusted for age, sex, sibling group size, and noninjury health care utilization. RESULTS: The 5,851 children had a total of 8,973 injuries. Injury incidence was 319 per 1,000 child-years among children with recent sibling injury and 235 per 1,000 child-years among children without this exposure (relative risk, 1.44; 95% CI, 1.36-1.53). When minor injuries were excluded, the adjusted relative risk was 1.95 (95% CI, 1.54-2.47). CONCLUSIONS: Injury risk is shared within sibling groups and varies according to recent sibling injury experience. Clinical encounters for injury care might be used to identify sibling groups at increased injury risk.

Adolescent↗
PubMed2002

Behavior change counseling in the emergency department to reduce injury risk: a randomized, controlled trial.

OBJECTIVE: To determine whether a brief session of behavior change counseling (BCC), offered to injured adolescents in the emergency department (ED) as a therapeutic intervention, could be used to change injury-related risk behaviors and the risk of reinjury. STUDY DESIGN: A randomized, controlled trial. PARTICIPANTS: Adolescents between 12 and 20 years old who were undergoing treatment for an injury in the ED and who were cognitively able to participate in the intervention. SETTING: An urban ED at a level 1 pediatric trauma center. INTERVENTION: Study participants completed a baseline risk behavior prevalence assessment. Participants were then randomly assigned to receive BCC or routine ED care. Those in the treatment group underwent a brief session of BCC with a study social worker focused on changing an identified injury-related risk behavior (seatbelt use, bicycle helmet use, driving after drinking, riding with an impaired driver, binge drinking, or carrying a weapon). Participants were recontacted 3 months and 6 months after enrollment to assess the prevalence of positive behavior change and the interim occurrence of medically treated injuries. RESULTS: We enrolled 631 participants (78% of those eligible) and obtained follow-up for 76% at 3 months and 75% at 6 months. The relative risk of a positive behavior change with respect to seatbelt use was 1.34 (95% confidence interval [CI]: 1.00, 1.79) at 3 months, favoring the intervention group. The relative risk for the same outcome was 1.47 (95% CI: 1.09, 1.96) at 6 months. A positive change in bicycle helmet use was 1.81 (95% CI: 1.02, 3.18) times more likely at 3 months and 2.00 (95% CI: 1.00, 4.00) times more likely at 6 months in the intervention group. There was no effect of the intervention on changes in other target behaviors. Over the 6-month follow-up period, the risk of reinjury requiring medical attention did not differ between treatment groups. CONCLUSIONS: Brief BCC can be delivered to adolescents undergoing treatment for injury in the ED and can be used to address injury-related risk behaviors. The intervention was associated with a greater likelihood of positive behavior change in seatbelt and bicycle helmet use. This effect lasted over 6 months of follow-up. BCC was not associated with changes in other risk behaviors and could not be shown to significantly reduce the risk of reinjury.

Accident Prevention↗