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Biomedical subjects

Michael Silverstein

Publications and source records attributed to Michael Silverstein.

11 recordsLinked to original sources
PubMed2006

Maternal depression and violence exposure: double jeopardy for child school functioning.

OBJECTIVE: The goal was to determine how violence exposure affects the relationship between maternal depression, cognitive ability, and child behavior. METHODS: A multivariate regression analysis of data for a nationally representative sample of kindergarten students was performed. Maternal depression and violence exposure were measured with standardized parent interviews. Standardized T scores were derived from direct testing of children in reading, mathematics, and general knowledge; child behavior was reported by teachers. RESULTS: A total of 9360 children had neither maternal depression nor violence exposure, 779 violence only, 1564 depression only, and 380 both. Maternal depression alone was associated with poorer mean T scores for reading, mathematics, and general knowledge. However, this effect was attenuated by nearly 25% for reading and general knowledge with adjustment for violence. Children with concurrent exposure to depression and violence had lower mean T scores for reading, mathematics, and general knowledge, as well as more-concerning behaviors, than did those exposed to either factor alone. Across all outcome measures, boys seemed more affected than girls. CONCLUSIONS: Violence compounds the effect of maternal depression on school functioning and behavior. Research and intervention planning for children affected by maternal depression should consider violence exposure.

Adult↗
PubMed2005

Pediatricians' reported practices regarding developmental screening: do guidelines work? Do they help?

BACKGROUND: In 2001, the American Academy of Pediatrics (AAP) adopted a policy that all infants and young children should be screened for developmental delays at regular intervals. The policy statement promoted the use of valid reliable instruments. It is unknown, however, what proportion of pediatricians follow this recommendation and whether such a practice is associated with improved identification of children with developmental difficulties. OBJECTIVES: To describe the use of developmental screening tests among board-certified pediatricians practicing general pediatrics and to determine the association between standardized screening and the self-reported identification of children with developmental difficulties. METHODS: We mailed a survey to a random sample of AAP members. We used multivariate logistic/linearregression analyses to determine the association between standardized screening and the self-reported identification of children with developmental disabilities. RESULTS: Of the 1617 surveys mailed, 894 were returned, for a response rate of 55%. Of the respondents, 646 practiced general pediatrics and were included in the analysis. Seventy-one percent of those pediatricians indicated that they almost always used clinical assessment without an accompanying screening instrument to identify children with developmental delays. Only 23% indicated that they used a standardized screening instrument. The most commonly used instrument was the Denver II. Logistic regression modeling demonstrated odds ratios between 1.71 and 1.90 for a >10% rate of identification of developmental problems among patients of pediatricians reporting standardized screening. Each adjusted odds ratio bordered on statistical significance. Linear-regression models estimating the difference in mean proportions of children identified with developmental problems across screening groups failed to show a statistically or clinically significant difference in physician-reported identification rates. CONCLUSIONS: Our findings indicate that, despite the AAP policy and national efforts to improve developmental screening in the primary care setting, few pediatricians use effective means to screen their patients for developmental problems. It is uncertain whether standardized screening, as it is practiced currently, is associated with an increase in the self-reported identification of children with developmental disabilities.

Child, Preschool↗
PubMed2004

Effect of a clinic-based referral system to head start: a randomized controlled trial.

CONTEXT: Early childhood development programs such as Head Start have proven benefits for impoverished children. However, few physicians assist families with enrollment. OBJECTIVE: To test if a primary care-based intervention is efficacious in increasing Head Start attendance. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial of 246 Head Start-eligible children aged 0 through 4 years recruited in spring 2003 from 4 health clinics in Seattle, Wash. INTERVENTIONS: List of Head Start telephone contacts provided to families of all children and, for those in the intervention group, a computer-generated packet containing a physician referral letter (and a physical examination form and immunization record, if available) mailed directly to Head Start by study personnel. MAIN OUTCOME MEASURE: Head Start attendance by January 2004. RESULTS: The 123 children analyzed in each study group were similar at baseline. Overall, 72 children (29%) were successfully connected with Head Start (ie, actively attending or on a waiting list) by January 2004. Among the intervention group, 50 children (41%) were successfully connected with Head Start, contrasted with 22 (18%) in the control group (adjusted difference, 17%; 95% confidence interval [CI], 8%-27%). Among the intervention group, 31 children (25%) were actively attending Head Start, contrasted with 14 (11%) in the control group (adjusted difference, 12%; 95% CI, 3%-21%). Only 2 clinics contributed children to Head Start waiting lists. Among children from these clinics, 19 of 87 (22%) in the intervention group got onto a Head Start waiting list, vs 8 of 94 (9%) in the control group (adjusted difference, 13%; 95% CI, 5%-21%). To get 1 child either into Head Start or onto a waiting list, we needed to refer 4 children. CONCLUSION: Facilitating an initial connection to Head Start on families' behalf substantially increased Head Start attendance.

Child, Preschool↗
PubMed2004

Pediatric interventions to support reading aloud: how good is the evidence?

Pediatricians and family practitioners increasingly provide free picture books and anticipatory guidance about reading aloud as part of routine health supervision for infants and young children, and arrange for volunteers to read aloud to children in the waiting rooms. These interventions comprise the Reach Out and Read (ROR) model, which has been adopted by more than 2000 clinical sites nationally. To date, 12 published studies have evaluated ROR and its variations, including three prospective, controlled trials. All but one have shown associations between ROR and increased reading aloud; additionally, four studies have linked program exposure to clinically meaningful increases in child language. Nonetheless, conclusive evidence of efficacy is lacking. This article provides a systematic, critical review of the literature, focusing on theoretical assumptions, issues of study design and measurement, and directions for future research.

Child, Preschool↗
PubMed2003

Health care utilization and expenditures associated with child care attendance: a nationally representative sample.

OBJECTIVE: Participation in center-based child care among preschool-aged children is associated with an increased incidence of communicable illness. Although estimates of health care utilization and costs associated with child care attendance exist in other countries with different health care systems, nationally representative data for the United States are lacking. The objective of this study was to determine the patterns of health care utilization and costs associated with attendance at different types of child care, among a nationally representative sample of preschool-aged children. METHODS: A nationally representative sample of children aged 0 to 5 years enrolled in the Medical Expenditure Panel Survey, 1997 Cohort were studied. Data were analyzed by cross-sectional analysis within a single calendar year. The Rand Health Insurance experiment 2-part multivariate regression model was used to accommodate skewed expenditure data. RESULTS: A total of 871 children were included in the study. A total of 484 (56%) attended no child care provided by anyone other than their primary caregiver; 134 (15%) attended center-based child care; 76 (9%) attended friend or neighbor care; and 170 (20%) attended in-home or relative care. In a weighted multivariate model, children in center-based child care were more likely than those not in child care to have attended at least 1 office-based visit (adjusted odds ratio [aOR]: 2.8; 95% confidence interval [CI]: 1.0-7.9) and emergency department visit (aOR: 2.0; 95% CI: 1.1-3.6) and to have received a medication prescription (aOR: 2.8; 95% CI: 1.2-6.1). The adjusted 2-part model predicted total health care expenditures for those not attending child care to be 642 dollars (95% CI: 508-813), versus 985 dollars (95% CI: 714-1336) for a similar population in center-based child care. Expenditure data for office-based visits and medication prescriptions mirrored these trends. CONCLUSION: In the immediate term, children in center-based child care tend to use more health care services. This increased utilization translates into modest per-child differences in health care expenditures. We hypothesize that this pattern of utilization and expenditure is attributable primarily to a higher incidence of minor, self-limited, communicable illness among children in center-based child care.

Child Care↗
PubMed2003

Pediatricians' reported practices regarding early education and Head Start referral.

BACKGROUND: Early learning programs have proven benefits for impoverished children; Head Start is the most widespread of such programs. The current involvement of pediatricians in the Head Start enrollment process is unknown. OBJECTIVES: 1) To assess the knowledge, attitudes, and reported practices of pediatricians on referring families to Head Start; 2) to assess pediatricians' receptivity to a potential practice-based intervention to enhance their ability to make Head Start referrals. METHODS: Mail survey to stratified random sample of pediatricians practicing in poor and non-poor US zip codes. Prevalence estimates and logistic regression models were estimated using weighted data. RESULTS: Of 1000 surveys distributed, 472 of 772 presumed-eligible subjects completed surveys for a response rate of 61%. Respondents and nonrespondents were similar with regard to age, gender, years in practice, and urban/rural practice setting. Eighty percent of pediatricians reported discussing child care arrangements with a majority of their preschool-aged patients' families, while only 14% reported actually assisting these families in applying to Head Start. Lack of time (77% of pediatricians) and nonphysician office staff (71%) were listed as the most significant barriers to helping families apply to Head Start. Unfamiliarity with early childhood education (10%) was generally not seen as a barrier to this practice. Head Start knowledge (adjusted odds ratio [aOR]: 1.43; 95% confidence interval [CI]: 1.01, 2.02), self-efficacy in advising families how to access local Head Start programs (aOR: 3.49; 95% CI: 1.46, 8.38), and the belief that it is the pediatrician's responsibility to do so (aOR: 9.98; 95% CI: 3.91, 25.48) were significantly associated with assisting families with Head Start enrollment. The majority of respondents (77%) reported a willingness to participate in a proposed computer-based intervention to aid eligible families in applying to Head Start. Having access to a social worker (aOR: 2.48; 95% CI: 1.17, 5.21) and respondent age (aOR: 0.96 for each year; 95% CI: 0.93, 0.99) were significantly associated with likely participation in the intervention. CONCLUSIONS: Although pediatricians report commonly discussing child care issues, few actively assist patients in the application process for Head Start. An intervention to facilitate Head Start referral from the physician's office must address time and staff limitations; education of pediatricians is a secondary need.

Child, Preschool↗
PubMed2002

An English-language clinic-based literacy program is effective for a multilingual population.

OBJECTIVE: To assess the effectiveness of a clinic-based pediatric literacy intervention on a multilingual population. BACKGROUND: Clinic-based literacy interventions are effective among English- and Spanish-speaking children. No data exist for multilingual populations. SETTING: Pediatric clinic in an urban county hospital. Design/Methods. Reading practices of 2 cross-sectional groups were assessed by standardized interview before and after the intervention. The intervention consisted of waiting-room volunteers reading to children, literacy counseling, and gift of a children's book at each well-child visit from 6 months to 5 years. Outcomes were assessed separately for primary English-speaking and primary non-English-speaking families. RESULTS: The baseline (N=85) and postintervention (N=95) groups were similar with respect to child age and sex, parental education, and length of time in the United States. Fourteen languages were represented in total, the most common being English (41%), Somali (28%), Spanish (9%), Vietnamese (7%), Oromo (3%), and Tigrinyan (3%). Compared with baseline, postintervention respondents were more likely to report reading as a favorite activity for the child (10% vs 25%) and parent (18% vs 40%), to read to their child before bed at least weekly (45% vs 71%), and to possess over 10 children's books at home (49% vs 63%). Among English-speaking families (N=30 baseline, N=40 postintervention), weekly bedtime reading increased (63% to 93%), reading as child's favorite activity increased (7% vs 30%), and reading as the parent's favorite activity to do with child increased (33% vs 58%). The proportion of English-speaking families possessing over 10 books at home and those reading with their children at least weekly showed no difference between the baseline and postintervention groups. Among non-English-speaking families (N=55 baseline, N=55 postintervention), weekly bedtime reading increased (36% vs 56%), reading as the parent's favorite activity increased (11% vs 27%), and the number of families to possess >10 children's books in the home increased (31% vs 49%). Reading as child's favorite activity (13% vs 24%) and weekly book sharing (60% vs 76%) showed nonsignificant trends between the non-English-speaking baseline and postintervention groups. CONCLUSIONS: This clinic-based literacy intervention influences home literacy behavior in this multiethnic setting, in both English-speaking and non-English-speaking families. Although efforts should be made to make such programs more appropriate for linguistic minorities, non-English-speaking families do stand to benefit from English-language-oriented programs. literacy, Reach Out and Read, pediatrics, reading, child development.

Child, Preschool↗
PubMedDate not supplied

Pediatrician practices regarding referral to early intervention services: is an established diagnosis important?

OBJECTIVE: Early intervention (EI) programs provide services to children with developmental conditions, regardless of whether such children have an underlying medical diagnosis. We aim to (1) Determine the proportion of general pediatricians who believe an established diagnosis is important when considering EI referral; and (2) Determine whether this perception is associated with lower reported likelihood of referral. METHODS: Mailed survey to random sample of pediatricians. We used multivariable logistic regression to study the association between the perception that a medical diagnosis is important when referring to EI, and the reported likelihood of EI referral for children with common developmental conditions. RESULTS: Response rate was 55% (894 of 1617). A total of 64% of respondents considered an established diagnosis important for EI referral. Likelihood of referral for delayed speech was lower among those who considered a diagnosis important than among those who did not (77% vs 87%; P = .02). Similar patterns held for global delay (91% vs 97%; P = .02), loss of developmental milestones (80% vs 88%; P = .03), and parental concern for inappropriate development (45% vs 60%; P = .002). In multivariable models, perception of the importance of an established diagnosis was associated with lower likelihood of referral for children with delayed speech (adjusted odds ratio [aOR] 0.48; 95% confidence interval [CI] 0.26-0.87) and for parental concern for inappropriate development (aOR 0.46; 95% CI 0.30-0.72). CONCLUSIONS: A majority of general pediatricians believe that an established diagnosis is important when considering EI referral. This perception is associated with decreased reported referral for children with speech delay and those whose parents express concern for inappropriate development.

Attitude of Health Personnel↗