<p>Primary care providers are charged with distinguishing children with an underlying growth problem from those with healthy variant short stature. Knowing the heights of the biological parents aids in making that decision. This study sought to determine the feasibility and functionality of an electronic mid-parental height (MPH) auto-calculator in the clinical assessment of child growth in a pediatric primary care setting. Clinicians completed surveys for 62% of 6803 children (mean height 13 ± 7 percentile) with recorded parent heights. Collecting parent height data required <30 seconds in 91% of encounters. The MPH tool confirmed clinicians' initial growth assessment in 79% of cases and changed it in 4%; the remainder did not use the tool. Clinicians who changed assessment were more likely (P < .0001) to pursue more comprehensive evaluation. The MPH tool was a quick, functional resource as a component of an electronic health record system in actual, busy, pediatric primary care practices.</p>
<p><strong>PURPOSE: </strong>To determine the association between dietary zinc intake and incident calcium kidney stones and examine the relationship between dietary zinc intake and urinary zinc excretion among adolescents.</p>
<p><strong>MATERIAL AND METHODS: </strong>This study was a nested case-control study conducted within a large pediatric healthcare system. Three 24-hour dietary recalls and spot urine chemistries were obtained for 30 participants aged 12-18 years with a first idiopathic calcium-based kidney stone and 30 healthy controls, matched on age, sex, race, and month of enrollment. Conditional logistic regression models were used to estimate the odds ratio (OR) between daily zinc intake and incident calcium kidney stones, adjusting for dietary phytate, protein, calcium, sodium, and oxalate. Multivariable linear regression was used to estimate the association between dietary and urine zinc, adjusting for urine creatinine and dietary phytate and calcium.</p>
<p><strong>RESULTS: </strong>Cases had lower daily zinc intake (8.1mg) than controls (10mg; p=0.029). Daily zinc intake of boys and girls with calcium stones was 2mg and 1.2mg lower, respectively, than the daily intake of zinc recommended by the Institute of Medicine. There was a 13% lower odds of incident stones for every 1mg higher daily zinc intake (OR, 0.87; 95% CI, 0.75-0.99). There was an estimated 4.5μg/dL increase in urine zinc per 1mg increase in dietary zinc (p=0.009), with weak evidence of a smaller increase in urine zinc in cases than in controls (interaction p=0.08).</p>
<p><strong>CONCLUSIONS: </strong>Lower dietary zinc intake was independently associated with incident calcium nephrolithiasis in this population of adolescents.</p>
<p><strong>OBJECTIVE: </strong>To improve human papillomavirus (HPV) vaccination rates, we studied the effectiveness of targeting automated decision support to families, clinicians, or both.</p>
<p><strong>METHODS: </strong>Twenty-two primary care practices were cluster-randomized to receive a 3-part clinician-focused intervention (education, electronic health record-based alerts, and audit and feedback) or none. Overall, 22, 486 girls aged 11 to 17 years due for HPV vaccine dose 1, 2, or 3 were randomly assigned within each practice to receive family-focused decision support with educational telephone calls. Randomization established 4 groups: family-focused, clinician-focused, combined, and no intervention. We measured decision support effectiveness by final vaccination rates and time to vaccine receipt, standardized for covariates and limited to those having received the previous dose for HPV #2 and 3. The 1-year study began in May 2010.</p>
<p><strong>RESULTS: </strong>Final vaccination rates for HPV #1, 2, and 3 were 16%, 65%, and 63% among controls. The combined intervention increased vaccination rates by 9, 8, and 13 percentage points, respectively. The control group achieved 15% vaccination for HPV #1 and 50% vaccination for HPV #2 and 3 after 318, 178, and 215 days. The combined intervention significantly accelerated vaccination by 151, 68, and 93 days. The clinician-focused intervention was more effective than the family-focused intervention for HPV #1, but less effective for HPV #2 and 3.</p>
<p><strong>CONCLUSIONS: </strong>A clinician-focused intervention was most effective for initiating the HPV vaccination series, whereas a family-focused intervention promoted completion. Decision support directed at both clinicians and families most effectively promotes HPV vaccine series receipt.</p>