Faculty Bibliography

OBJECTIVES: To assess the prevalence of low health literacy among adolescents, young adults, and child caregivers in the United States, the readability of common child-health information, and the relationship between literacy and child health. DATA SOURCES: MedLine, Educational Resources Information Center, National Library of Medicine, PsychInfo, Harvard Health Literacy Bibliography, and peer-reviewed abstracts from the Pediatric Academic Societies Annual Meetings. STUDY SELECTION: A systematic review using the following key words: health literacy, literacy, reading skill, numeracy, and Wide Range Achievement Test. MAIN OUTCOME MEASURES: Descriptive studies that used at least 1 valid measure of health literacy, studies that assessed the readability of child health information, and observational or experimental studies that included a validated measure of health literacy, literacy, or numeracy skills and an assessment of child health-related outcomes. RESULTS: A total of 1267 articles were reviewed, and 215 met inclusion and exclusion criteria. At least 1 in 3 adolescents and young adults had low health literacy; most child health information was written above the tenth-grade level. Adjusted for socioeconomic status, adults with low literacy are 1.2 to 4 times more likely to exhibit negative health behaviors that affect child health, adolescents with low literacy are at least twice as likely to exhibit aggressive or antisocial behavior, and chronically ill children who have caregivers with low literacy are twice as likely to use more health services. CONCLUSIONS: Low caregiver literacy is common and is associated with poor preventive care behaviors and poor child health outcomes. Future research should aim to ameliorate literacy-associated child health disparities

OBJECTIVE: To determine whether mothers with plans related to shared reading and baby books in the home at the time of delivery of their newborns would be more likely to engage in shared reading behaviors at age 6 months. METHODS: This was a cohort study with enrollment after birth and follow-up at 6 months in an urban public hospital. Predictors included mothers' attitudes and resources related to shared reading during the postpartum period. Outcomes included mothers' shared reading activities and resources at 6 months, as assessed by the StimQ-READ measure. RESULTS: A total of 173 mother-infant dyads were assessed. In multiple regression analyses adjusting for sociodemographics and maternal depression and literacy, StimQ-READ score at 6 months was increased in association with all 3 postpartum predictors: plans for reading as a strategy for school success (adjusted mean 1.7-point increase in 6-month score; 95% confidence interval [95% CI], 0.3-3.0), plans to read in infancy (3.1-point increase; 95% CI, 1.6-4.6), and having baby books in the home (2.3-point increase; 95% CI, 0.9-3.6). In multiple logistic regression analysis, mothers with 2 or more attitudes and resources had an adjusted odds ratio of 6.2 (95% CI, 2.0-18.9) for having initiated reading at 6 months. CONCLUSIONS: Maternal attitudes and resources in early infancy related to shared reading are important predictors of reading behaviors by 6 months. Cumulative postnatal attitudes and resources are the strongest predictors of later behaviors. Additional research is needed regarding whether guidance about shared reading in early infancy or pregnancy would enhance programs such as Reach Out and Read

D. If the baby looks sick, send him to the emergency room for a spinal tap and a full sepsis workup and admit him to the hospital for intravenous antibiotics while waiting to see if any of the cultures are positive for bacteria. 'Pediatricians really wrestle with this issue,' said Dr. William V. Raszka, professor of pediatrics at the University of Vermont College of Medicine and director of the Pediatric Infectious Diseases Service at Vermont Children's Hospital

(I am reporting this with my son's explicit permission.) But as I waited, I thought of that seventh grader, and of the other middle-schoolers who have told me things that left me agonizing about the ethics and the wisdom of confidentiality in this age group. The child did not want her mother to know, and the pediatrician, who had known her since infancy, negotiated a compromise: the doctor would advise the mother that the girl needed counseling, and as long as she went to counseling, and discussed the drinking and her underlying issues with the counselor, the pediatrician would not tell her mother about the liquor

Sometimes I dream of general anesthesia. I've never had it-in fact, between having a reasonably high threshold for pain and a typical doctor's anxiety about letting myself be a patient, I've tended to go for rather minimal pain control, fighting every step of the way to stay in charge and call what shots I can (no pun intended). But a couple of years ago, I was given some midazolam, a short-acting benzodiazepine and a relative of Valium, to relax me before a minor surgical procedure. The minute the drug went in through the IV, I closed my eyes and the world went away, and that half-hour, or hour, or hour and a half (who knows?) disappeared from my life. So ever since then, I occasionally wonder how I would feel about handing over the whole enterprise-anxiety, sensation, consciousness, and memory