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Background Health care systems increasingly rely on patients’ data entry efforts to organize and assist in care delivery through health information exchange. Objectives We sought to determine (1) the variation in burden imposed on parents by data entry efforts across paper-based and computer-based environments, and (2) the impact, if any, of parents’ health literacy on the task burden. Methods We completed a randomized controlled trial of parent-completed data entry tasks. Parents of children with attention deficit hyperactivity disorder (ADHD) were randomized based on the Test of Functional Health Literacy in Adults (TOFHLA) to either a paper-based or computer-based environment for entry of health information on their children. The primary outcome was the National Aeronautics and Space Administration Task Load Index (TLX) total weighted score. Results We screened 271 parents: 194 (71.6%) were eligible, and 180 of these (92.8%) constituted the study cohort. We analyzed 90 participants from each arm. Parents who completed information tasks on paper reported a higher task burden than those who worked in the computer environment: mean (SD) TLX scores were 22.8 (20.6) for paper and 16.3 (16.1) for computer. Assignment to the paper environment conferred a significant risk of higher task burden (F1,178 = 4.05, P = .046). Adequate literacy was associated with lower task burden (decrease in burden score of 1.15 SD, P = .003). After adjusting for relevant child and parent factors, parents’ TOFHLA score (beta = -.02, P = .02) and task environment (beta = .31, P = .03) remained significantly associated with task burden. Conclusions A tailored computer-based environment provided an improved task experience for data entry compared to the same tasks completed on paper. Health literacy was inversely related to task burden. Trial registration Clinicaltrials.gov NCT00543257; http://www.clinicaltrials.gov/ct2/show/NCT00543257 (Archived by WebCite at http://www.webcitation.org/5vUVH2DYR)

Currently, both the DSM-IV-TR and ICD-10 preclude the diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) in cases that present with an Autism Spectrum Disorder (ASD). This criterion will be removed in the upcoming DSM-V, but the relationship between ASD and ADHD, and in particular the prevalence of ADHD among the ASD population, remains controversial. Previous studies have reported clinically significant ADHD symptoms in one-third to three-quarters of ASD-affected individuals (probands). In our sample of 1,838 simplex children and adolescents with ASD, we found that less than 16 % met clinically significant levels of ADHD symptoms, per parent report. When both parent and teacher reports were considered, the comorbidity rate was even lower, at 2 %. Keywords Autism spectrum disorder * Attention deficit hyperactivity disorder * Comorbidity * DSM-V, Introduction It is only in the last decade that a systematic investigation of the relationship between Autism Spectrum Disorders (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD) has emerged (Gargaro et al. [...]

Abstract Background Early life lead exposure might be a risk factor for neurocognitive impairment in adulthood. Objectives We sought to assess the relationship between early life environmental lead exposure and intellectual function in adulthood. We also attempted to identify which time period blood-lead concentrations are most predictive of adult outcome. Methods We recruited adults in the Boston area who had participated as newborns and young children in a prospective cohort study that examined the relationship between lead exposure and childhood intellectual function. IQ was measured using the Wechsler Abbreviated Scale of Intelligence (WASI). The association between lead concentrations and IQ scores was examined using linear regression. Results Forty-three adults participated in neuropsychological testing. Childhood blood-lead concentration (mean of the blood-lead concentrations at ages 4 and 10 years) had the strongest relationship with Full-Scale IQ (β = -1.89 ± 0.70, p = 0.01). Full-scale IQ was also significantly related to blood-lead concentration at age 6 months (β = -1.66 ± 0.75, p = 0.03), 4 years (β = -0.90 ± 0.41, p = 0.03) and 10 years (β = -1.95 ± 0.80, p = 0.02). Adjusting for maternal IQ altered the significance of the regression coefficient. Conclusions Our study suggests that lead exposure in childhood predicts intellectual functioning in young adulthood. Our results also suggest that school-age lead exposure may represent a period of increased susceptibility. Given the small sample size, however, the potentially confounding effects of maternal IQ cannot be excluded and should be evaluated in a larger study.

Purpose: The purpose of this investigation was to establish a normal range of maximal incisal opening (MIO) in children, and the correlation between MIO with age, height, weight, gender, race, and molar relationship. Methods: Calibrated examiners used the TheroBite Range of Motion (ROM) scale to obtain two MIO readings from 500 enrolled subjects, accounting for overbite or open bite. The subject's height, weight, molar relationship, age, gender, and race were recorded. Subjects were stratified according to age, and mean MIO ± standard deviation for each age group mas determined. Results: Mean MIO was positively correlated with age (P<.001), height (P<.001), weight (P<.001), and race (P<.001). However, height became insignificant in the multivariable regression model. On average, MIO of African-Americans was 3.66 mm larger than Whites (P<.001), and MIO of Hispanics/Latinos was 2.52mm greater than Whites (P<.001). There was no statistically significant association with left or right molar relationships (P=.O7, P=.26 respectively) or gender (P=.58). Conclusions: TheraBite ROM scale is a practical tool to clinically measure MIO. MIO mimics somatic growth, peaking at age 12-13 years for females and 14-15 years for males. African-Americans and Hispanics/Latinos have a greater mean MIO than Whites. The established norms will be useful in diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background: Early life lead exposure might be a risk factor for neurocognitive impairment in adulthood.Objectives: We sought to assess the relationship between early life environmental lead exposure and intellectual function in adulthood. We also attempted to identify which time period blood-lead concentrations are most predictive of adult outcome.Methods: We recruited adults in the Boston area who had participated as newborns and young children in a prospective cohort study that examined the relationship between lead exposure and childhood intellectual function. IQ was measured using the Wechsler Abbreviated Scale of Intelligence (WASI). The association between lead concentrations and IQ scores was examined using linear regression.Results: Forty-three adults participated in neuropsychological testing. Childhood blood-lead concentration (mean of the blood-lead concentrations at ages 4 and 10 years) had the strongest relationship with Full-Scale IQ (β = -1.89 ± 0.70, p = 0.01). Full-scale IQ was also significantly related to blood-lead concentration at age 6 months (β = -1.66 ± 0.75, p = 0.03), 4 years (β = -0.90 ± 0.41, p = 0.03) and 10 years (β = -1.95 ± 0.80, p = 0.02). Adjusting for maternal IQ altered the significance of the regression coefficient.Conclusions: Our study suggests that lead exposure in childhood predicts intellectual functioning in young adulthood. Our results also suggest that school-age lead exposure may represent a period of increased susceptibility. Given the small sample size, however, the potentially confounding effects of maternal IQ cannot be excluded and should be evaluated in a larger study. [ABSTRACT FROM AUTHOR]

Background and Objectives: Interactive voice response systems integrated with electronic health records have the potential to improve primary care by engaging parents outside clinical settings via spoken language. The objective of this study was to determine whether use of an interactive voice response system, the Personal Health Partner (PHP), before routine health care maintenance visits could improve the quality of primary care visits and be well accepted by parents and clinicians., Methods: English-speaking parents of children aged 4 months to 11 years called PHP before routine visits and were randomly assigned to groups by the system at the time of the call. Parents' spoken responses were used to provide tailored counseling and support goal setting for the upcoming visit. Data were transferred to the electronic health records for review during visits. The study occurred in an urban hospital-based pediatric primary care center. Participants were called after the visit to assess (1) comprehensiveness of screening and counseling, (2) assessment of medications and their management, and (3) parent and clinician satisfaction., Results: PHP was able to identify and counsel in multiple areas. A total of 9.7% of parents responded to the mailed invitation. Intervention parents were more likely to report discussing important issues such as depression (42.6% vs 25.4%; P < .01) and prescription medication use (85.7% vs 72.6%; P = .04) and to report being better prepared for visits. One hundred percent of clinicians reported that PHP improved the quality of their care., Conclusions: Systems like PHP have the potential to improve clinical screening, counseling, and medication management., (Copyright © 2014 by the American Academy of Pediatrics.)

Purpose: The purpose of this investigation was to establish a normal range of maximal incisal opening (MIO) in children, and the correlation between MIO with age, height, weight, gender, race, and molar relationship., Methods: Calibrated examiners used the TheraBite Range of Motion (ROM) scale to obtain two MIO readings from 500 enrolled subjects, accounting for overbite or open bite. The subject's height, weight, molar relationship, age, gender, and race were recorded. Subjects were stratified according to age, and mean MIO ± standard deviation for each age group was determined., Results: Mean MIO was positively correlated with age (P<.001), height (P<.001), weight (P<.001), and race (P<.001). However, height became insignificant in the multivariable regression model. On average, MIO of African-Americans was 3.66 mm larger than Whites (P<.001), and MIO of Hispanics/Latinos was 2.52mm greater than Whites (P<.001). There was no statistically significant association with left or right molar relationships (P=.07, P=.26 respectively) or gender (P=.58)., Conclusions: TheraBite ROM scale is a practical tool to clinically measure MIO. MIO mimics somatic growth, peaking at age 12-13 years for females and 14-15 years for males. African-Americans and Hispanics/Latinos have a greater mean MIO than Whites. The established norms will be useful in diagnosis and treatment.

Objective: The objective of our study was to determine the rate of pulmonary embolism (PE) on pulmonary CT angiography (CTA) in children and adolescents visiting adult-centered community hospitals. We also investigated alternative diagnoses that may account for presenting symptoms., Materials and Methods: We identified consecutive children and adolescents (age ≤ 19 years) who underwent pulmonary CTA during a 12- and 24-month period, respectively, at two community hospitals. Staff radiologists' clinical interpretations of pulmonary CTA studies were compared with interpretations performed by a blinded, subspecialty-trained thoracic radiologist, with a third tie-breaking interpretation performed in cases of discrepancy. A systematic review of pulmonary CTA studies for possible alternative diagnoses was completed. Diagnostic rates of PE on pulmonary CTA studies in adults at these hospitals were also reviewed for comparison., Results: The study population consisted of 130 individuals (32 boys and 98 girls; median age, 18 years; age range, 11-19 years) who underwent 137 examinations, 11 as inpatients and 126 as outpatients. CTA studies were positive for PE in six patients (4.6%). CTA showed an important alternative diagnosis, such as pulmonary consolidation, in 27 patients (21%). By comparison, pulmonary CTA studies in adults at these two hospitals yielded a 16% positive rate for PE., Conclusion: The prevalence of PE in young ambulatory patients with clinically suspected PE at adult-centered community hospitals is substantially lower than in adults. Alternative diagnoses, such as pulmonary consolidation and pneumothorax, are discovered more frequently than PE on pulmonary CTA studies. Pulmonary CTA should be used with discretion in adolescents, especially when radiography may provide the necessary diagnosis.

Background: Early life lead exposure might be a risk factor for neurocognitive impairment in adulthood., Objectives: We sought to assess the relationship between early life environmental lead exposure and intellectual function in adulthood. We also attempted to identify which time period blood-lead concentrations are most predictive of adult outcome., Methods: We recruited adults in the Boston area who had participated as newborns and young children in a prospective cohort study that examined the relationship between lead exposure and childhood intellectual function. IQ was measured using the Wechsler Abbreviated Scale of Intelligence (WASI). The association between lead concentrations and IQ scores was examined using linear regression., Results: Forty-three adults participated in neuropsychological testing. Childhood blood-lead concentration (mean of the blood-lead concentrations at ages 4 and 10 years) had the strongest relationship with Full-Scale IQ (β = -1.89 ± 0.70, p = 0.01). Full-scale IQ was also significantly related to blood-lead concentration at age 6 months (β = -1.66 ± 0.75, p = 0.03), 4 years (β = -0.90 ± 0.41, p = 0.03) and 10 years (β = -1.95 ± 0.80, p = 0.02). Adjusting for maternal IQ altered the significance of the regression coefficient., Conclusions: Our study suggests that lead exposure in childhood predicts intellectual functioning in young adulthood. Our results also suggest that school-age lead exposure may represent a period of increased susceptibility. Given the small sample size, however, the potentially confounding effects of maternal IQ cannot be excluded and should be evaluated in a larger study.