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1.  Medication Adherence Among Pediatric Patients With Sickle Cell Disease: A Systematic Review 
Pediatrics  2014;134(6):1175-1183.
OBJECTIVES:
Describe rates of adherence for sickle cell disease (SCD) medications, identify patient and medication characteristics associated with nonadherence, and determine the effect of nonadherence and moderate adherence (defined as taking 60%–80% of doses) on clinical outcomes.
METHODS:
In February 2012 we systematically searched 6 databases for peer-reviewed articles published after 1940. We identified articles evaluating medication adherence among patients <25 years old with SCD. Two authors reviewed each article to determine whether it should be included. Two authors extracted data, including medication studied, adherence measures used, rates of adherence, and barriers to adherence.
RESULTS:
Of 24 articles in the final review, 23 focused on 1 medication type: antibiotic prophylaxis (13 articles), iron chelation (5 articles), or hydroxyurea (5 articles). Adherence rates ranged from 16% to 89%; most reported moderate adherence. Medication factors contributed to adherence. For example, prophylactic antibiotic adherence was better with intramuscular than oral administration. Barriers included fear of side effects, incorrect dosing, and forgetting. Nonadherence was associated with more vaso-occlusive crises and hospitalizations. The limited data available on moderate adherence to iron chelation and hydroxyurea indicates some clinical benefit.
CONCLUSIONS:
Moderate adherence is typical among pediatric patients with SCD. Multicomponent interventions are needed to optimally deliver life-changing medications to these children and should include routine monitoring of adherence, support to prevent mistakes, and education to improve understanding of medication risks and benefits.
doi:10.1542/peds.2014-0177
PMCID: PMC4243064  PMID: 25404717
medication adherence; sickle cell disease
2.  Quality indicators and quality assessment in child health 
Archives of disease in childhood  2009;94(6):458-463.
Quality indicators are systematically developed statements that can be used to assess the appropriateness of specific healthcare decisions, services and outcomes. In this review, we highlight the range and type of indicators that have been developed for children in the UK and US by prominent governmental agencies and private organizations. We also classify these indicators in an effort to identify areas of child health that may lack quality measurement activity. We review the current state of health information technology in both countries since these systems are vital to quality efforts. Finally, we propose several recommendations to advance the quality indicator development agenda for children. The convergence of quality measurement and indicator development, a growing scientific evidence base and integrated information systems in healthcare may lead to substantial improvements for child health in the 21st century.
doi:10.1136/adc.2008.137893
PMCID: PMC2774840  PMID: 19307196
Quality; Quality indicators; General pediatrics; Health information technology
3.  Food Insecurity and Compensatory Feeding Practices among Urban Black Families 
Pediatrics  2008;122(4):e854-e860.
OBJECTIVE
This study explored the relationship between food insecurity and compensatory maternal feeding practices that may be perceived as buffers against periodic food shortages among urban Black families.
PATIENTS AND METHODS
We interviewed a convenience sample of Black mothers of children ages 2–13 years. Food security status (predictor) was assessed at the household level. Five maternal feeding practices (outcomes) were assessed. Two were based on Birch’s Child Feeding Questionnaire (CFQ): restricting access to certain desired foods and pressuring a child to eat; and 3 were derived from investigators’ clinical experience: the use of high calorie supplements, added sugar in beverages, and perceived appetite stimulants. Anthropometric data were collected from mothers and children.
RESULTS
278 mother-child dyads were analyzed, and 28% of these mothers reported being food insecure. Use of CFQ feeding practices was defined as the top quartile of responses. Use of nutritional supplements, defined as “at least 1–2 times monthly”, was common, ranging from 13%–25%. In logistic regression models adjusted for child age, BMI, and ethnicity and maternal BMI, mothers from food insecure households were significantly more likely to use high calorie supplements (OR, 2.1; 95% CI, 1.1–4.0) and appetite stimulants (OR, 3.2; 95% CI, 1.5–7.1). The odds of using the remaining compensatory feeding practices were elevated among food insecure households, but not reach statistical significance: adding sugars to beverages (OR, 2.1; 95% CI, 0.99–4.4), pressuring a child to eat (OR, 1.8; 95% CI, 0.98–3.2), and restricting access to certain foods (OR, 1.5; 95% CI 0.8–2.7).
CONCLUSIONS
Household food insecurity was independently associated with two of the five maternal compensatory feeding practices studied. Such practices may alter the feeding environment and increase the risk of overweight in children. Longitudinal research is necessary to determine how the relationship between food security and compensatory maternal feeding practices impacts child weight trajectories.
doi:10.1542/peds.2008-0831
PMCID: PMC2712923  PMID: 18829783
Food insecurity; Feeding behavior; Overweight children; African American; Haitian

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