Pediatric Screening Research Articles

Identification of targetable molecular alterations in the NCI-COG Pediatric MATCH trial.

10011 Background: The screening protocol for the NCI-Children’s Oncology Group (COG) Pediatric Molecular Analysis for Therapy Choice (MATCH) trial detects tumor alterations that are used to assign patients with treatment-refractory or recurrent cancers to phase 2 treatment arms of molecularly-targeted therapies. Methods: Patients age 1 to 21 years old with treatment-refractory or recurrent solid tumors, non-Hodgkin lymphomas, or histiocytic disorders treated at U.S. based COG sites are eligible. DNA and RNA extracted from FFPE tumor samples are sequenced using an Oncomine cancer gene panel for detection of mutations, amplifications, and fusions. Loss of SMARCB1, SMARCA4, and PTEN expression is detected by immunohistochemistry. Lists of actionable mutations (aMOIs) based upon available clinical and pre-clinical data are used a priori to determine eligibility for treatment arms. Results: Between 7/24/17 and 12/31/18, 422 patients with a median age of 13 years (range 1-21) were enrolled from 93 COG sites. Solid tumors comprised 71% (n = 300) of diagnoses, CNS tumors 24% (n = 101) and lymphomas/histiocytoses 5% (n = 21). A tumor sample was submitted for 390 patients, sequencing was attempted for 370 (95%), and results were confirmed for 357 (92%). Median turn-around time was 15 days. An aMOI for at least one of the 10 current treatment arms was identified in 112 patients (29%, 95% CI 24%-33%); 95 patients (24%, 95% CI 20%-29%) were assigned to a treatment arm with 39 patients (10%, 95% CI 7%-13%) enrolled to date. The aMOI rate was similar in patients less than 12 years of age (35%) compared to patients 12 years and older (25%). Actionable MAPK pathway alterations were found in 11% of patients (n = 41), most often HRAS/ KRAS/ NRAS mutations (n = 16), BRAF mutations or fusions (n = 14), or NF1 mutations (n = 11). Other genes with recurrent aMOIs included SMARCB1 (n = 14), ALK (n = 8), CDK4 (n = 8), PIK3CA (n = 7), PTEN (n = 7), FGFR1 (n = 5), and BRCA1/BRCA2 (n = 5). Conclusions: Approximately one-quarter of patients with tumor submitted for Pediatric MATCH screening have been assigned to an investigational therapy, facilitating the evaluation of molecularly-targeted agents in biomarker-positive pediatric cohorts through a collaborative nationwide study. Clinical trial information: NCT03155620.

Glottal function index questionnaire for screening of pediatric dysphonia

Objectiveto assess the diagnostic value of Lithuanian version of Glottal Function Index (GFI-LT) questionnaire in pediatric dysphonia screening. MethodsThe GFI-LT was completed by 82 children (7–16 years old): 41 patients with voice disorders (patients group) and 41 healthy subjects (control group). Auditory-perceptual evaluation of voice was performed using the Grade Roughness Breathiness (GRB) protocol. Acoustic voice analysis was accomplished for F0, SDF0, jitter, shimmer and NNE using Dr. Speech, Tiger Elemetrics software. To evaluate the diagnostic accuracy differentiating normal and dysphonic voice, the receiver operating characteristic statistics were used. ResultsPerceptually dysphonia was revealed in all children of the patients group. Grade I (65.9%) was the most prevalent (p > 0.05). No dysphonia was detected in the control group. Acoustic voice analysis revealed statistically significantly (p < 0.001) deteriorated all acoustic voice parameters in patients' group comparing to control group. Statistically significant (p < 0.05) strong or moderate correlations were found between the GFI-LT, auditory-perceptual rating and all acoustic voice parameters of the patients group. The strongest correlations were observed between GFI-LT and G (r = 0.70), R (r = 0.69), jitter (r = 0.56) and SDF0 (r = 0.56). No statistically significant correlations between GFI-LT and children’ age or gender were found (p > 0.05). The GFI-LT cut-off score of ≥3.0 was associated with excellent test accuracy (AUC = 0.961) distinguishing children with voice disorders from healthy controls, resulting in a balance between sensitivity and specificity (95.1% vs 85.4%). ConclusionGFI-LT is considered to be a valid and reliable tool for self-assessment and screening of voice disorders in children.

003–Initial Psychometric Evaluation of a Pediatric Diabetic Peripheral Neuropathy Screening Tool

003–Initial Psychometric Evaluation of a Pediatric Diabetic Peripheral Neuropathy Screening Tool

Random tree algorithm-based pediatric pneumonia screening using heart rate, respiration rate and temperature

Random tree algorithm-based pediatric pneumonia screening using heart rate, respiration rate and temperature

Determining Interrater Reliability of the Cornell Assessment of Pediatric Delirium Screening Tool Among PICU Nurses.

To determine the interrater reliability of the Cornell Assessment of Pediatric Delirium Screening Tool amount PICU nurses. The design was setup as a cross-sectional study and conducted over the course of a year. This study setting was a PICU and a pediatric cardiac ICU at Seattle Children's Hospital, a tertiary freestanding university-affiliated hospital in Seattle, Washington. A total sample of 108 patients were included in this study. Patients were selected using a convenience sample. Inclusion in this study involved all patients eligible for a Cornell Assessment of Pediatric Delirium assessment, reflecting practice standards. Exclusion criteria included patients who had a Richmond Agitation and Sedation Score of (-4) or (-5), based on the Cornell Assessment of Pediatric Delirium procedure. There were 113 patients screened, but five were excluded from the final sample size due to missing information. The research nurse would screen the patient using the Cornell Assessment of Pediatric Delirium during the 12:00 noon hour, which coincided with the clinical nurse Cornell Assessment of Pediatric Delirium assessment. The clinical and research nurse were kept blind to each other's assessment. Scores were then analyzed to determine the kappa coefficient. The kappa coefficient between nurses was found to be 0.60 (95% CI, 0.44-0.76), indicating moderate agreement. Age was found to have a higher association with agreement. In children 2 years old or greater, the kappa coefficient was 0.85 (95% CI, 0.68-1.00). Children whose raters did not agree on scoring were more likely to be younger than those who had raters that agreed (p < 0.01). Evaluating the interrater reliability of clinical tool, such as the Cornell Assessment of Pediatric Delirium, may be important to more accurately identify patients at high risk of delirium in a PICU or pediatric cardiac ICU. The evaluation of the tool's performance in practice may also be helpful to ensure ongoing consistency among the clinical nurses that complete these assessments on a daily basis.

Validation of the Traumatic Events Screening Inventory for ACEs.

Our purpose in this study was to adapt and validate the Traumatic Events Screening Inventory (TESI) as a primary-care childhood adversity screening tool for children living in vulnerable neighborhoods using a community-partnered approach. In this cross-sectional, descriptive study, we used a sample of 261 children (3-16 years old) who were seeking services at a Federally Qualified Health Center with colocated behavioral health services in Chicago and had a positive Pediatric Symptom Checklist screen result or received a referral for behavioral health evaluation. The TESI was adapted as a screening tool to be sensitive to adverse childhood experiences (ACEs) unique to the clinic communities. ACEs were mapped by zip code with objective neighborhood crime data, and latent class analysis was performed to identify ACE subgroups. The mapping validation suggested face validity for geographic overlap between participant ACEs and objective violent-crime occurrence. With latent class analysis, we identified 3 ACE subgroups: (1) high ACE (18.0% of the sample; polyvictimization and/or maltreatment), (2) moderate ACE (52.1%; violent environments), and (3) low ACE (29.9%; few adverse experiences). Membership in the high-ACE subgroup was associated with higher odds of a clinically significant Pediatric Symptom Checklist score (odds ratio = 3.83) and clinical-level attention problems (odds ratio = 3.58) even after accounting for child resilience and parent depression. ACEs play a significant role in predicting a need for behavioral health services among children seeking primary-care services. The community-adapted TESI is a valid ACE screening tool.

Isolating Brain Regions Implicated in the Affective Components of Neuropathic Pain

ABSTRACTIntroduction/Aim: The psychosocial factors implicated in neuropathic pain are profound. Pain symptoms can lead to prolonged manifestations of affective and other psychological disorders (e.g., negative mood; avoidance behaviors). In this investigation, we sought to (1) evaluate the extent to which psychological factors are elevated in an acute neuropathic pain cohort, and (2) evaluate brain changes implicated in the affective components of acute neuropathic pain.Methods: Participants included ankle sprain patients with acute neuropathic pain (n = 24, Age = 16.1 years, SD = 4.1), and age- and gender-matched healthy controls (n = 12, Age = 16.1, SD = 2.95). Participants were evaluated using self-report questionnaires of psychological and pain-related symptoms: Multidimensional Anxiety Scale for Children-MASC; Children’s Depression Inventory-CDI; Fear of Pain Questionnaire-FOPQ, Functional Disability Inventory-FDI, Pediatric Pain Screening Tool-PPST, and Pain Catastrophizing Scale-PCS. Cortical thickness and sub-cortical volumes were extracted from Freesurfer.Results: The neuropathic pain cohort exhibited elevated scores on the CDI, FOPQ, FDI, PPST, and PCS relative to controls (p < 0.05). K-means clustering was used to create groups within the patient cohort with lower vs. higher psychological questionnaire scores. In patients with elevated questionnaires scores, greater cortical thickness was found in regions implicated in pain processing, including the orbitofrontal gyrus and caudal anterior cingulate cortex compared to patients with lower scores (p < 0.01).Discussion/Conclusions: Neuropathic pain implicates many brain regions. Here, we demonstrated that persons with acute injury-induced neuropathic pain and greater levels of psychological manifestations display increased cortical thickness in regions involved in processing pain and its psychological components. Findings inform the diversity of changes observed in neuropathic pain patients.

Screening for Access to Firearms by Pediatric Trainees in High-Risk Patients

ObjectiveAccess to firearms is an independent risk factor for completed suicide and homicide, and the American Academy of Pediatrics recommends that pediatricians screen and counsel about firearm access and safe storage. This study investigates how often pediatric residents screen for access to firearms or counsel about risk-reduction in patients with suicidal or homicidal ideation. MethodsRetrospective chart review of visits by patients younger than the age of 19 years presenting to the pediatric emergency department (ED) of a tertiary academic medical center from January to December 2016. Visits were eligible if there was an ultimate ED discharge diagnosis of “suicidal ideation,” “suicide attempt,” or “homicidal ideation” as identified by International Statistical Classification of Diseases and Related Health Problems, 10th revision codes and the patient was seen by a pediatric resident before evaluation by psychiatry. Descriptive statistics were used to analyze results. ResultsNinety-eight patients were evaluated by a pediatric resident for medical assessment before evaluation by a psychiatry team during the study period and were therefore eligible for inclusion. Screening for firearm access was documented by a pediatric resident in 5 of 98 (5.1%) patient encounters. Twenty-five patients (25.5%) had no documented screening for firearm access by any provider during the ED visit, including in 5 cases when patients were discharged home. ConclusionsPediatric residents rarely document screening for firearm access in patients with known suicidal or homicidal ideation who present to the ED. Additional understanding of the barriers to screening and potential strategies for improving screening and counseling are critical to providing appropriate care for high-risk pediatric patients.

Validation of the Brazilian version of the Pediatric Obstructive Sleep Apnea Screening Tool questionnaire

ObjectiveTo validate the Pediatric Obstructive Sleep Apnea Screening tool for use in Brazil. Materials and methodsThe Brazilian version of this questionnaire, originally validated and tested in the United States, was developed as follows: (a) translation; (b) back‐translation; (c) completion of the final version; (d) pre‐testing. The questionnaire was applied prior to polysomnography to children aged 3–9 years from October 2015 to October 2016, and its psychometric properties (i.e., validity and reliability) were evaluated. The accuracy was assessed from comparisons between polysomnographic results and corresponding questionnaire scores. ResultsSixty patients were enrolled, and based on polysomnographic findings, 48% patients had normal apnea‐hypopnea index, while the remaining 52% met the criteria for obstructive sleep apnea. Minimum O2 saturation level was obstructive sleep apnea children (p=0.021). Satisfactory concordance was found between individual apnea-hypopnea index and questionnaire scores. Bland–Altman plot‐derived bias was 0.1 for the difference between measures, with 5.34 (95% CI: 4.14–6.55) and −5.19 (95%CI: −6.39 to −3.98) for the upper and lower agreement range. Internal consistency derived from Cronbach's alpha was 0.84 (95%CI: 0.78–0.90). ConclusionThe questionnaire was translated to and validated into Brazilian‐Portuguese version, and showed good reliability and concordance with apnea‐hypopnea index. This questionnaire offers a reliable screening option for sleep‐disordered breathing in children.

PERIPARTUM DISCOVERED CONGENITAL COMPLETE HEART BLOCK IN HONDURAS

Congenital Complete Atrioventricular Block (CHB) is often diagnosed during childhood. However, in developing countries where pediatric screenings are limited, congenital arrhythmias should be included in a differential for new arrhythmia because they often go undiagnosed into adulthood. A 20 year

Simplification of the severity hierarchy score for pediatric sleep apnea screening

Pediatric Obstructive Sleep Apnea is a common condition. However, it remains under diagnosed exposing to associated morbidities. Polysomnography is the standard diagnostic test, but its availability is sometimes limited, especially in poor countries.The questionnaire proposed by Spruyt and Gazal has been validated as a screening tool by many studies. A score above 2.75 have an 82% sensitivity, a 81% specificity and a negative predictive value of 92% for detecting moderate OSA. However, the way of calculating the score seems to us rather complicated and may limit its use in daily practice.Therefore, we propose, for calculating the score, a table that may be printed in sheets of paper. We propose a simple modification that could, in our opinion; greatly facilitate the use of this screening tool by reducing the use of calculators and the risks of errors. In this way, we hope to make its use much easier in everyday practice

Paediatric vision screening by non-healthcare volunteers: evidence based practices

BackgroundThe purpose of this study was to test the sensitivity and specificity of eight undergraduate volunteer examiners conducting vision screening tests in a community setting, in order to determine if non-eye care professionals were able to be trained to an appropriate level of skill.MethodsEight undergraduate volunteer examiners were trained to conduct vision screening tests to address a gap in pediatric community eye care. Phase I of the study was implemented in the pediatric ophthalmology clinic, and phase II was conducted in nine local schools. Phase I consisted of 40 h of training for each volunteer regarding specific vision tests. Phase II consisted of screening children at nine local schools.ResultsA total of 690 children from nine local schools were screened by both the volunteer examiners and the optometrist during the course of this study. Volunteer examiners had a screening sensitivity of 0.80 (95%CI 0.66–0.90) and screening specificity of 0.75 (95%CI 0.71–0.78) when compared to the study optometrist. The overall accuracy of volunteer examiners was 75%. The resulting positive likelihood ratio was 3.24 (95%CI 2.6–3.9), indicating that a child with vision impairment was 3.2 times more likely to fail the vision test performed by the volunteer examiners compared to a child with no vision impairment.ConclusionsNon-healthcare professionals can be trained to an acceptable degree of accuracy to perform vision screening tests on children, which may assist in mitigating existing gaps in paediatric eye care.

Factors Affecting Pediatric Dyslipidemia Screening and Treatment.

Identification and management of dyslipidemia in childhood can reduce future cardiovascular risk. We performed a retrospective cohort study of children ages 2 to 18 years during 2009 to 2013 to evaluate factors that affect screening and treatment of pediatric dyslipidemia related to 2011 National Heart, Lung, and Blood Institute (NHLBI) guidelines. Logistic regression analysis determined the impact of NHLBI-identified factors on odds of being screened, elevated low-density lipoprotein cholesterol (LDL-C), and receiving pharmacotherapy. A total of 1 736 032 children were included; 113 780 (6.6%) were screened for dyslipidemia. Screening in 9 to 11 year olds increased from 2009 to 2012. Of children screened, 18 801 (16.5%) had elevated LDL-C; 425 (2.3%) were treated pharmacologically. Parental dyslipidemia, diabetes mellitus, chronic kidney disease, Kawasaki disease, human immunodeficiency virus infection, nephrotic syndrome, liver, thyroid, and other endocrine disorders increased odds of screening. Older age, nephrotic syndrome, chronic kidney disease, diabetes mellitus, and hypertension increased odds of having elevated LDL-C and receiving treatment. Pediatric dyslipidemia screening rates remain low.

A multimethod screening approach for pediatric depression onset: An incremental validity study.

Screening protocols that rely on a single informant are inadequate in predicting pediatric depression. Multi-informant and risk factor screening approaches are potentially more sensitive methods for identifying depression risk, but the incremental validity of these protocols has not been adequately tested. Using a translational analytic approach and multimethod, longitudinal study design, we simultaneously tested several multi-indicator approaches to depression screening to identify an optimal algorithm for predicting depression onset in youth. Participants were 222 never-depressed children and adolescents (Mage = 10.75 years old, SDage = 1.85; female = 50.45%; 82.88% White), who completed baseline questionnaires for depressive symptoms and cognitive vulnerabilities, in addition to a morphed face task to assess pupil dilation. Mothers, meanwhile, completed baseline questionnaires and a semistructured interview to assess maternal and pediatric depression. Follow-up depression diagnostic assessments with both the mother and youth occurred every 6 months for 2 years. Receiver operating characteristics and reclassification analyses were used to test our aims. Overall, we found moderate support for a multi-informant approach, and convincing evidence that individual differences in pupil dilation uniquely predicted depression onset. Youth with subthreshold depressive symptoms and elevated pupil dilation were over twice as likely to develop a first lifetime episode of depression compared to one's risk rate based on sex and age. Our study provides one of the first screening batteries for detecting first lifetime episodes of depression in youth. The unique and incremental validity provided by pupil dilation suggests feasible biological indicators of depression risk can improve primary prevention efforts that target depression, such as universal pediatric depression screening. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cornell Assessment of Pediatric Delirium: Italian cultural validation and preliminary testing.

Paediatric delirium is associated with a longer duration of hospitalization in paediatric intensive care units, the emergence of post-traumatic symptoms and possible neurocognitive dysfunction after discharge. In preschool children, the diagnosis of delirium appears rather challenging: their pre-verbal status and the presence of cognitive skills still in development make accurate diagnosis difficult. Recently, a pediatric delirium screening tool suitable for critical preschool children has also been developed and identified in international literature, with excellent results also in critical infants under 2 years of age: the Cornell Assessment of Pediatric Delirium (CAPD). The CAPD, using a Likert scale, bases the assessment of paediatric delirium within the context of child development. This scale follows the development of the infant by comparing the detection of specific items on the scale as the anchor points that characterize the development of infants by age groups. Culturally and linguistically validation in Italian language and prior testing of the Cornell Assessment of Pediatric Delirium. Translation and Cultural Validation of the Cornell Assessment of Pediatric Delirium (CAPD) for the Evaluation/Diagnosis of Pediatric Delirium within Pediatric Intensive Care. The translation and adaptation of this instrument followed the phases of the model proposed by the World Health Organization. Prior testings, such as item descriptive analysis, item-total correlation and Cronbach's alpha, were conducted. All phases of the cultural-linguistic validation process were carried out in a satisfactory manner. For the prior testing, the scale was administered to a sample of 42 children, with age ranged 0-5 years old (66.6%), with a higher prevalence of the male gender. All items were normally distributed and there was no excessive Skeweness and Kurtosis. Each item contributed to the scale fairly well and all coefficients of item total correlation (rjx) were higher than the recommended level of 0.30. The composite reliability index was 0.94 and Cronbach's alpha was 0.96. The process has meticulously followed the recommendations in international literature. The final version was approved by the authors of the original instrument.

Screening and Treatment of Adenovirus Infection in Pediatric and Adult Allogeneic Hematopoietic Cell Transplant Recipients: Multicenter Survey of Transplant Centers in the United States

Introduction Allogeneic hematopoietic cell transplant (allo-HCT) recipients are at risk of life-threatening viral infections. Objective The objective of the AdVance US practice patterns survey was to characterize current practices in screening and treatment of adenovirus (AdV) infection in the United States (US). Methods Physicians at participating centers were provided with a link to access an online survey. The survey questions addressed current practices around management of AdV infections in allo-HCT recipients at their center, and classified patients with regard to known risks for AdV infection (e.g., T-cell depletion, cord blood, haploidentical, mismatched, GVHD). When necessary, respondents consulted with other physicians in their center to ensure consensus before submitting responses. Results 62 centers were approached, of which 15 (24%) agreed to participate in this survey prior to the first deadline for response. 11 of the participating centers treat pediatric patients and 4 treat adult patients (Figure). According to CIBMTR data and physician interview responses, the pediatric and adult centers conduct an average of 36 and 142 allo HCTs per year, respectively. Almost all (91%) pediatric centers conduct weekly routine screening for AdV after allo-HCT among higher-risk patients, and around half (55%) conduct routine screening for AdV among lower-risk patients. Routine AdV screening is conducted by 25% of adult centers for higher-risk patients, and none routinely screen lower-risk patients. Among those screening higher-risk patients for AdV, all pediatric and adult centers screen blood samples at least once weekly and the majority (90%) of pediatric centers screen blood for at least 3 months post allo-HCT; the one adult center that screens blood does so weekly for up to 6 months post-HCT. Most pediatric centers have a pre-emptive AdV treatment approach for higher-risk patients (91%) and lower-risk patients (82%), using positive blood PCR as the treatment trigger. All adult centers that screen higher-risk patients use a pre-emptive approach. The pre-emptive AdV treatment most frequently reported by pediatric and adult centers is off-label IV cidofovir in spite of well-known toxicity concerns including renal injury. Conclusions The AdVance US practice patterns survey suggests that pediatric centers are more likely than adult centers to screen for AdV, and are also more likely to have a pre-emptive AdV treatment approach compared to adult centers. Perceived risk of AdV infection is a determining factor for whether routine screening and pre-emptive treatment are implemented. For both pediatric and adult centers, AdV viremia was the most common pre-emptive treatment trigger, with off-label IV cidofovir commonly utilized for treatment in spite of toxicity concerns. Treatment practices in the centers surveyed are generally consistent with ASBMT guidelines.

Vision Screening in Children in the Canton of St.Gallen.

Pediatric vision screening has been shown to reduce the prevalence of amblyopia. To assess the current local situation in the Canton of St.Gallen, a survey study was performed. A standardized questionnaire was sent to 191 general practitioners and school doctors to obtain information on the currently applied vision screening protocols for children. The questionnaire included 17 questions with multiple answers possible. Sixty-seven participants (35%) answered the survey. Overall, 61 (91%) of the repliers confirmed that some sort of vision screening exists. According to 45 (67%) repliers, a mandatory examination exists. As to the question about the person performing the examination, multiple answers were given; 39 (44%) answered that the secretary or the medical practical assistant performs the vision tests, 15 (17%) indicated the school doctor, and 25 (28%) indicated the general practitioner or the pediatrician. Most screening tests are performed in a general practitioner's practice (32; 40%), some are done in the kindergartens (17; 21%), and others are done in a pediatrician's practice (17; 21%). The majority of children are tested at the age of 5 - 6 years (58, 87%). Sixty-one (91%) of the repliers indicated that at least the children's visual acuity is measured. Acuity is assessed with different methods, mainly, with pictures (20; 30%), numbers (23; 34%), and Snellen optotypes (33; 49%). There are no consistent regulations regarding vision screening in the Canton of St.Gallen. Actually, rather different screening scenarios exist. Tests are performed by a variety of people in different locations with diverse testing procedures. A standardization of the applied screening procedures at cantonal and national levels seems reasonable.

Implementation and evaluation of a rural community-based pediatric hearing screening program integrating in-person and tele-diagnostic auditory brainstem response (ABR)

BackgroundIn an attempt to reach remote rural areas, this study explores a community-based, pediatric hearing screening program in villages, integrating two models of diagnostic ABR testing; one using a tele-medicine approach and the other a traditional in-person testing at a tertiary care hospital.MethodsVillage health workers (VHWs) underwent a five day training program on conducting Distortion Product Oto Acoustic Emissions (DPOAE) screening and assisting in tele-ABR. VHWs conducted DPOAE screening in 91 villages and hamlets in two administrative units (blocks) of a district in South India. A two-step DPOAE screening was carried out by VHWs in the homes of infants and children under five years of age in the selected villages. Those with ‘refer’ results in 2nd screening were recommended for a follow-up diagnostic ABR testing in person (Group A) at the tertiary care hospital or via tele-medicine (Group B). The overall outcome of the community-based hearing screening program was analyzed with respect to coverage, refer rate, follow-up rate for 2nd screenings and diagnostic testing. A comparison of the outcomes of tele-versus in-person diagnostic ABR follow-up was carried out.ResultsSix VHWs who fulfilled the post training evaluation criteria were recruited for the screening program. VHWs screened 1335 children in Group A and 1480 children in Group B. The refer rate for 2nd screening was very low (0.8%); the follow-up rate for 2nd screening was between 80 and 97% across the different age groups. Integration of tele-ABR resulted in 11% improvement in follow-up compared to in-person ABR at a tertiary care hospital.ConclusionsNon-availability of audiologists and limited infrastructure in rural areas has prevented the establishment of large scale hearing screening programs. In existing programs, considerable challenges with respect to follow-up for diagnostic testing was reported, due to patients being submitted to traveling long distance to access services and potential wage losses during that time. In this program model, integration of a tele-ABR diagnostic follow-up improved follow-up in comparison to in-person follow-up. VHWs were successfully trained to conduct accurate screenings in rural communities. The very low refer rate, and improved follow-up rate reflect the success of this community-based hearing screening program.

Early Communication Skills and Special Education Outcomes at School Entry: Implications for Pediatric Care and Screening.

Objective. To examine whether children’s early communication skills at age 3 predict special education outcomes at kindergarten entry. Methods. Data from 139 children eligible for early intervention or early childhood special education services were examined. Early communication was defined separately as expressive and receptive language skills and was measured by the Vineland Adaptive Behavior Scales–Second Edition. Outcome variables were parent-reported measures of special education use and dosage as well as speech therapy receipt and dosage at kindergarten entry. Results. Better expressive language skills at age 3—but not receptive language skills—predicted a significantly reduced likelihood (odds ratio = 0.79) of receiving speech therapy at kindergarten entry. There were no effects of early communication on broader receipt of special education services as well as on special education dosage. Conclusions. Screening of specific domains of early communication skills during routine pediatric care, in conjunction with the evaluations of other professionals involved in the child’s education and health, might be an effective method for identifying children who are likely to receive speech therapy and other special education services at kindergarten entry.

Pediatric Obesity Education Educational Components

Pediatric Obesity Education Educational Components