Person: Perrin, James
Loading...
Email Address
AA Acceptance Date
Birth Date
Research Projects
Organizational Units
Job Title
Last Name
Perrin
First Name
James
Name
Perrin, James
20 results
Search Results
Now showing 1 - 10 of 20
Publication Adverse Drug Events in Pediatric Outpatients(Elsevier BV, 2007-09) Kaushal, Rainu; Goldmann, Donald A.; Keohane, Carol A.; Christino, Melissa; Honour, Melissa; Hale, Andrea S.; Zigmont, Katherine; Lehmann, Lisa Soleymani; Perrin, James; Bates, David W.Objective.-To determine rates and types of adverse drug events (ADEs) in the pediatric ambulatory setting. Methods.-A prospective cohort study at 6 office practices in the greater Boston area was conducted over 2-month periods. Duplicate prescription review, telephone surveys 10 days and 2 months after visit, and chart reviews were done. A 2-physician panel classified the severity, preventability, and ability to ameliorate (ie, if the severity or duration of the side effect could have been mitigated by improved communication) ADEs. Results.-We identified 57 preventable ADEs (rate 3%; 95% confidence intervals [CI], 3%-4%) and 226 nonpreventable ADEs (rate 13%; 95% CI, 11%-15%) in the medical care of 1788 patients. Of the ADEs, 152 (54%) were able to be ameliorated. None of the preventable ADEs were life threatening, although 8 (14%) were serious. Forty (70%) of the preventable ADEs were related to parent drug administration. Improved communication between health care providers and parents and improved communication between pharmacists and parents, whether in the office or in the pharmacy, were judged to be the prevention strategies with greatest potential.Conclusions.-Patient harm from medication use was common in the pediatric ambulatory setting. Errors in home medication administration resulted in the majority of preventable ADEs. Approximately one fifth of ADEs were potentially preventable and many more were potentially able to be ameliorated. Rates of ADEs due to errors are comparable in children and adults despite less medication utilization in children.Publication Adolescents’ use of the built environment for physical activity(BioMed Central, 2015) Oreskovic, Nicolas; Perrin, James; Robinson, Alyssa I; Locascio, Joseph; Blossom, Jeff; Chen, Minghua L; Winickoff, Jonathan; Field, Alison E.; Green, Chloe; Goodman, ElizabethBackground: Physical activity is a health-enhancing behavior, but few adolescents achieve the recommended levels of moderate-to-vigorous physical activity. Understanding how adolescents use different built environment spaces for physical activity and activity varies by location could help in designing effective interventions to promote moderate-to-vigorous physical activity. The objective of this study was to describe the locations where adolescents engage in physical activity and compare traditional intensity-based measures with continuous activity when describing built environment use patterns among adolescents. Methods: Eighty adolescents aged 11–14 years recruited from community health and recreation centers. Adolescents wore accelerometers (Actigraph GT3X) and global positioning system receivers (QStarz BT-Q1000XT) for two separate weeks to record their physical activity levels and locations. Accelerometer data provided a continuous measure of physical activity and intensity-based measures (sedentary time, moderate-to-vigorous physical activity). Physical activity was mapped by land-use classification (home, school, park, playground, streets & sidewalks, other) using geographic information systems and this location-based activity was assessed for both continuous and intensity-based physical activity derived from mixed-effects models which accounted for repeated measures and clustering effects within person, date, school, and town. Results: Mean daily moderate-to-vigorous physical activity was 22 minutes, mean sedentary time was 134 minutes. Moderate-to-vigorous physical activity occurred in bouts lasting up to 15 minutes. Compared to being at home, being at school, on the streets and sidewalks, in parks, and playgrounds were all associated with greater odds of being in moderate-to-vigorous physical activity and achieving higher overall activity levels. Playground use was associated with the highest physical activity level (β = 172 activity counts per minute, SE = 4, p < 0.0001) and greatest odds of being in moderate-to-vigorous physical activity (odds ratio 8.3, 95% confidence interval 4.8-14.2). Conclusion: Adolescents were more likely to engage in physical activity, and achieved their highest physical activity levels, when using built environments located outdoors. Novel objective methods for determining physical activity can provide insight into adolescents’ spatial physical activity patterns, which could help guide physical activity interventions. Promoting zoning and health policies that encourage the design and regular use of outdoor spaces may offer another promising opportunity for increasing adolescent physical activity.Publication Measuring Quality of Life in Pediatric Patients With Inflammatory Bowel Disease: Psychometric and Clinical Characteristics(Ovid Technologies (Wolters Kluwer Health), 2008) Perrin, James; Kuhlthau, Karen; Chughtai, Aziz; Romm, Diane; Kirschner, Barbara S; Ferry, George D; Cohen, Stanley A; Gold, Benjamin D; Heyman, Melvin B; Baldassano, Robert N; Winter, HarlandObjective: To extend development of a pediatric inflammatory bowel disease (IBD) health-related quality of life (HRQoL) measure by determining its factor structure and associations of factors with generic HRQoL measures and clinical variables. Patients and Methods: Cross-sectional survey of children and adolescents ages 8 years to 18 years and their parents attending any of 6 US IBD centers, recruited from either existing registry of age-eligible subjects or visits to participating centers. The survey included generic (Pediatric Quality of Life Inventory) and IBD-specific (Impact Questionnaire) quality of life measures, disease activity, and other clinical indicators. We carried out factor analysis of Impact responses, comparing resulting factors with results on the generic HRQoL and the clinical measures. Results: We included 220 subjects (161 with Crohn disease and 59 with ulcerative colitis). Initial confirmatory factor analysis did not support the 6 proposed Impact domains. Exploratory factor analysis indicated 4 factors with good to excellent reliability for IBD responses: general well-being and symptoms, emotional functioning, social interactions, and body image. Two items did not load well on any factor. The 4 factors correlated well with the Pediatric Quality of Life Inventory and subscales. Children with higher disease activity scores and other indicators of clinical activity reported lower HRQoL. Conclusions: This study provides further characteristics of a HRQoL measure specific to pediatric IBD and indicates ways to score the measure based on the resulting factor structure. The measure correlates appropriately with generic HRQoL measures and clinical severity indicators.Publication Pediatric Response to Court-Mandated Medicaid Behavioral Screening in Massachusetts(Ovid Technologies (Wolters Kluwer Health), 2013) Van Cleave, Jeanne; Morales, Dianali Rivera; Perrin, JamesObjective: In 2007 in Massachusetts, a settlement of a class-action lawsuit on behalf of Medicaid beneficiaries mandated that primary care practices perform developmental, behavioral and mental health screening using formal tools. We aimed to assess perspectives from providers and practice staff about implementing developmental and mental health screening in response to the judicial ruling. Methods: In this qualitative study, we conducted semi-structured interviews with eighteen physicians and staff from eleven pediatric and medicine-pediatric primary care practices in Eastern Massachusetts between April 2009–November 2010. Using an interview guide we asked about barriers and facilitators to implementing developmental and mental health screening, how practices selected tools and what processes or changes made screening routine. Clinicians were asked how screening changed the quality and/or content of well-child care visits. Interviews were transcribed and coded. Using thematic analysis, we generated overarching themes. Results: Participants were motivated to comply with the mandate, and most practices reported implementing routine screening for developmental and mental health problems over several months. While certain aspects of screening were endorsed, many perceived that screening added little to quality of care, primarily because tools lacked sensitivity and specialty resources were too scarce to address concerns adequately. Practices’ receptivity to change and physicians’ sense of duty to comply facilitated implementation. No practice developed processes specifically to track and follow up abnormal results. Conclusions: Implementation of mandated developmental and mental health screening could be facilitated by providing assistance with practice change, improving the quality of screening tools, and assuring adequate referral resources.Publication Social and Economic Consequences of Overweight in Adolescence and Young Adulthood(New England Journal of Medicine (NEJM/MMS), 1993) Gortmaker, Steven; Must, Aviva; Perrin, James; Sobol, Arthur; Dietz, William H.Publication Utility of Psychosocial Screening at a School-based Health Center(Wiley-Blackwell, 2000) Gall, Gail; Pagano, Maria E.; Desmond, M. Sheila; Perrin, James; Murphy, J. MichaelSchool-based health centers (SBHC) have substantial potential to improve the recognition and treatment of adolescents’ mental health problems. This study was undertaken as a quality improvement project to evaluate utility of the Pediatric Symptom Checklist when completed by youth (PSC-Y) among 383 adolescents seen at a SBHC, and the extent to which identification of psychosocial dysfunction and referral to mental health services improved academic functioning. Adolescents identified by the PSC-Y were significantly more likely to be insured by Medicaid, be a teen-age parent, and to have higher rates of absenteeism and tardiness in comparison to those not identified. Adolescents identified with the PSC-Y who were referred to mental health services significantly decreased their rates of absences and tardiness. Study results provide support for the utility of psychosocial screening and referral in the SBHC environment in facilitating recognition and treatment of adolescent mental health problems and improving student academic functioning.Publication Child Health Status and Parental Employment(American Medical Association (AMA), 2001) Kuhlthau, Karen; Perrin, JamesObjective: To understand the relationship between several measures of child health status and the employment of parents. Design: A cross-sectional study using 1994 National Health Interview Survey on Disability data. Participants: A nationally representative sample of children and their parents. Outcome Measures: Maternal and paternal employment (measured separately). Intervention: We use a series of logistic regression models with maternal and paternal employment as the dependent variables and the health status of the child with the poorest health status in the family as the primary independent variable. Models additionally include sociodemographic correlates of employment. Results: Having a child with poor health status, as measured by general reported health, hospitalizations, activity limitations, and chronic condition or disability status, is associated with reduced employment of mothers and fathers. For example, the odds ratios of being employed for having a child with an activity limitation are 0.75 for mothers (95% confidence interval, 0.67-0.85) and 0.66 for fathers (95% confidence interval, 0.53-0.82). Conclusions: Having a child with poor health status is associated with reduced maternal and paternal employment. Further studies are needed to determine whether poor child health status causes reductions in parental labor force participation. If such a causal relationship exists, it has important implications for social policy, employment policy, and clinical anticipatory guidance.Publication Barriers to Specialty Care and Specialty Referral Completion in the Community Health Center Setting(Elsevier BV, 2013) Zuckerman, Katharine E.; Perrin, James; Hobrecker, Karin; Donelan, KarenObjective To assess the frequency of barriers to specialty care and to assess which barriers are associated with an incomplete specialty referral (not attending a specialty visit when referred by a primary care provider) among children seen in community health centers. Study design: Two months after their child’s specialty referral, 341 parents completed telephone surveys assessing whether a specialty visit was completed and whether they experienced any of 10 barriers to care. Family/community barriers included difficulty leaving work, obtaining childcare, obtaining transportation, and inadequate insurance. Health care system barriers included getting appointments quickly, understanding doctors and nurses, communicating with doctors’ offices, locating offices, accessing interpreters, and inconvenient office hours. We calculated barrier frequency and total barriers experienced. Using logistic regression, we assessed which barriers were associated with incomplete referral, and whether experiencing ≥4 barriers was associated with incomplete referral. Results: A total of 22.9% of families experienced incomplete referral. 42.0% of families encountered 1 or more barriers. The most frequent barriers were difficulty leaving work, obtaining childcare, and obtaining transportation. On multivariate analysis, difficulty getting appointments quickly, difficulty finding doctors’ offices, and inconvenient office hours were associated with incomplete referral. Families experiencing ≥4 barriers were more likely than those experiencing ≤3 barriers to have incomplete referral. Conclusion: Barriers to specialty care were common and associated with incomplete referral. Families experiencing many barriers had greater risk of incomplete referral. Improving family/community factors may increase satisfaction with specialty care; however, improving health system factors may be the best way to reduce incomplete referrals.Publication Health Care Services for Children and Adolescents(JSTOR, 1992) Perrin, James; Guyer, Bernard; Lawrence, Jean M.The authors of this paper identify risks to health and other factors that determine the need for health care services among children and adolescents. They document service utilization patterns in the areas of well-child care and immunizations, acute ambulatory care and hospital services, and injury prevention. They also acknowledge the special health care needs of adolescents and of children with chronic illnesses. It appears that neither the traditional personal health service delivery system nor the public health system alone can effectively provide all of the health services children need. Collaboration between public health and personal health service providers is essential to future efforts to improve the health of children and adolescents. Recommendations include development of community-based preventive care programs in all parts of the country, extension of current traditional primary care capabilities, assurance of access to primary care services, enhancement of public health activities, expansion of specialized adolescent health programs, and coordination of a comprehensive set of medical and other services for children with chronic illness and their families. The authors conclude that, to be effective, future health system reforms must be implemented through a coordinated program of care rather than through competing systems of services.Publication The Food and Drug Administration's Deliberations on Antidepressant Use in Pediatric Patients(American Academy of Pediatrics (AAP), 2005) Leslie, L. K.; Newman, Thomas; Chesney, P. Joan; Perrin, JamesOn February 2, 2004, the Food and Drug Administration organized a joint meeting of the Neuro-Psychopharmacologic Advisory Committee and Pediatric Subcommittee of the Anti-Infective Drugs Advisory Committee to examine the occurrence of suicidality in clinical trials that investigate the use of the newer anti-depressant drugs in pediatric patients. Committee members reconvened on September 13–14, 2004, and concluded that there was a causal link between the newer antidepressants and pediatric suicidality. This article provides a summary of the Food and Drug Administration deliberations for the pediatric clinician. We also provide research, regulation, education, and practice implications for care for children and adolescents who may be eligible for treatment with these medications.