Papers by Barry Zuckerman
Environmental Health Perspectives, 2016
Journal of Developmental & Behavioral Pediatrics, 2010
Dr. McClintock reviewed her schedule for the following week when she observed there were eight he... more Dr. McClintock reviewed her schedule for the following week when she observed there were eight health supervision visits in 9 month old children. She recalled that these healthy children, whom she followed since birth, were up-to-date on their immunizations. As she reflected on the visits, it occurred to Dr. McClintock that this might be an ideal opportunity to use the time to assess developmental status and behavioral interactions. She could also ask questions about the families, including childcare arrangements, satisfaction with parenting and marriage relationships. Dr. McClintock considered the best use of the time available in order to have the most meaning to the children and their families. What lines of questioning or what screening tests might be most useful during the 9-month office visit?
Pediatric Blood & Cancer, 2011
Infant Behavior and Development, 1996
This prospective longitudinal study was designed to evaluate whether the four-month Movement Asse... more This prospective longitudinal study was designed to evaluate whether the four-month Movement Assessment of Infants (MAI), predicted two-year cognitive and motor developmental status measured by the Mental (MDI) and Psychomotor (PDI) Scales of the Bayley Scales of Infant Development (BSID). The subjects were 134 infants born at term who were considered at developmental risk due to biological and social risk factors. Different masked examiners assessed the infants at each age. Infants' average MAI total risk scores (MAI TRS) at four months were negatively correlated with their BSID MDI scores (r = -0.23, p = 0.007) but not PDI scores at two years. Infants classified as high risk on the MAI (TRS >13) were approximately three times more likely than infants with a lower risk MAI classification (TRS < or =13) to have a high-risk MDI (< or =84) classification. Lower MAI risk status at four months was a predictor of cognitive functioning falling within normal limits for age (MDI >84) at two years, with 76% negative and 50% positive predictive values. The MAI appears to be valid for use with infants born at term who are at risk of developmental delay and may be a useful tool to help clinicians make decisions about intervention services.
American Journal of Respiratory and Critical Care Medicine, 2015
Journal of Developmental and Behavioral Pediatrics, 1996
To determine factors associated with satisfaction and burnout in pediatric department chairs. A 1... more To determine factors associated with satisfaction and burnout in pediatric department chairs. A 1-time online survey of 250 current and former pediatric chairs who were members of Association of Medical School Pediatric Department Chairs anytime between 1993 and 2005. The questionnaire included demographics, satisfaction levels, stress experienced, and time spent on various work activities. We also included the Maslach Burnout Inventory-Human Services Survey and the abbreviated Workplace Climate Questionnaire. Burnout was defined as high scores on the depersonalization or emotional exhaustion subscales of the Maslach Burnout Inventory-Human Services Survey. Our response rate was 62%; most chairs (65%) reported being very satisfied with their job. Approximately 30% of chairs for <5 years experienced burnout, compared with 15% of chairs who held their positions for >5 years (P < .05). Factors associated with burnout included years as chair (odds ratio [OR], 0.9; 95% CI, 0.80-0.99), >1 night worked per week (OR, 5.9; 95% CI, 1.5-22.9), high workload (OR, 3.0; 95% CI, 1.3-6.7), and lack of supportive work environment (OR, 2.2; 95% CI, 1.1-4.2). Steps should be taken to decrease burnout in chairs, including policies that promote physician well being as integral to successful departments.
Pediatrics, 2014
Prevention is the cornerstone of pediatric practice, with immunization the prototype strategy bec... more Prevention is the cornerstone of pediatric practice, with immunization the prototype strategy because of its significant effectiveness in preventing selected infections. Other targets of prevention such as obesity, injuries, birth defects, and drug and alcohol use are important but lack simple, evidence-based, and equally effective strategies. We suggest that in response to the improvement in the effectiveness and safety of longacting reversible contraceptives (LARCs; eg, intrauterine devices [IUDs], contraceptive implants), pediatricians have a special opportunity to prevent unintended pregnancy, not only in adolescents but in all women of childbearing age who bring their children into our offices for pediatric care. This commentary provides information about unintended pregnancy and the safety and effectiveness of LARC methods. We suggest specific opportunities for pediatricians to engage and motivate women to actively choose their reproductive futures and when to have their children.
To determine if there is a relationship between center-based child care attendance from ages 3 to... more To determine if there is a relationship between center-based child care attendance from ages 3 to 5 y and future overweight at ages 6-12 y. Longitudinal, observational study of child experience and future body mass index. A total of 1244 US children aged 6-12 y included in the 1997 Panel Study of Income Dynamics Child Development Supplement. Parent-reported child care attendance from ages 3 to 5 y, trichotomized as 'none', 'limited' (>0 but <15 h/week), and 'extensive' (> or =15 h/week). Overweight defined as a body mass index > or =95th percentile for age and gender. Candidate covariates (selected a priori): gender, race, age, poverty status, birth weight, hours of television per day, Behavior Problems Index score >90th percentile, and Home Observation for Measurement of the Environment-Short Form (HOME-SF) cognitive stimulation score. Of the potential confounding variables, race, HOME-SF cognitive stimulation score, and age significantly altered the relationship between child care attendance and overweight in the multiple logistic regression model. With these covariates in the final model, limited center-based child care attendance from ages 3 to 5 y was independently associated with a decreased risk of overweight at ages 6-12 y (adjusted odds ratio=0.56, 95% confidence interval 0.34, 0.93) relative to no child care attendance. Extensive center-based child care attendance was not associated with future overweight. Limited center-based child care attendance during the preschool years was independently associated with a decreased risk of future overweight relative to no child care attendance. Additional studies are needed to clarify these findings.
Public Health Reports, 2001
The development of a new technology, called tandem mass spectrometry (tandem MS), has challenged ... more The development of a new technology, called tandem mass spectrometry (tandem MS), has challenged governments worldwide to consider expanding universal newborn screening for rare metabolic disorders. In 1997 the Massachusetts Department of Public Health developed a public process to meet this challenge. After addressing significant medical, legal, ethical, and logistical issues raised by tandem MS, Massachusetts incorporated one new disorder into the mandatory newborn screen and developed an optional pilot program for 20 additional disorders. The Massachusetts experience has wide relevance for other nations and states. As screening protocols are contemplated for entire populations-for newborns and others- it will remain essential that the public participate in an open process of reviewing the justification for and logistics of screening.
PEDIATRICS, 2004
Healthy Steps (HS) represents a significant innovation in the way pediatric primary care can be d... more Healthy Steps (HS) represents a significant innovation in the way pediatric primary care can be delivered. Based on the standards and principles of Bright Futures and the American Academy of Pediatrics Health Supervision Guidelines, HS enhances and expands traditional pediatric care by including a child development specialist (Healthy Steps specialist) as part of the pediatric practice team. Services offered by this person, typically a nurse, early childhood educator, or social worker, include more time to spend discussing preventive issues during well-child visits, home visits, a telephone information line exclusively addressing developmental and behavioral concerns, new written materials, and more seamless linkages to community resources and parent support groups.
PEDIATRICS, 2004
Background. The list of recommended pediatric preventive services has grown considerably in the p... more Background. The list of recommended pediatric preventive services has grown considerably in the past decade, and clinician variability, clinician distribution, and other correlates of provision of these basic preventive services (BPS) are not known.
PEDIATRICS, 2009
Inflammation has been associated with preterm delivery and adverse neonatal outcomes such as cere... more Inflammation has been associated with preterm delivery and adverse neonatal outcomes such as cerebral palsy and chronic lung disease. However, no study to date has simultaneously examined a wide range of inflammatory mediators and their relationship to gestational age. We sought to describe the distribution of immune biomarkers in cord blood across gestational age and to investigate the association between biomarker level patterns and preterm birth. As part of a large-scale molecular epidemiological study of preterm birth conducted at Boston Medical Center, this study analyzed both clinical and biomarker data from 927 births. Twenty-seven biomarkers were simultaneously quantified by immunoassay. The associations between the quartiles of 27 biomarkers and 3 gestational groups (< or =32, 33-36, and > or =37 weeks) were analyzed. Biomarkers found to be significant were further analyzed for dose-response correlation with preterm birth by logistic regression, adjusted for pertinent demographic and clinical factors. The 27 biomarkers could be classified into 1 of 3 groups: (1) biomarkers increased in preterm birth (interleukin [IL]-2, IL-4, IL-5, IL-8, IL-10, monocyte chemoattractant protein 1, macrophage inflammatory protein [MIP]-1alpha, MIP-1beta, soluble IL-6 receptor alpha, tumor necrosis factor alpha, soluble tumor necrosis factor receptor I, and TREM-1 [triggering receptor expressed on myeloid cells 1]); (2) biomarkers decreased in preterm birth (brain-derived neurotrophic factor, IL-1beta, IL-18, matrix metalloproteinase 9, and neurotrophin 3); and (3) biomarkers not associated with preterm birth (IL-6, IL-12, IL-17, granulocyte/macrophage colony-stimulating factor, interferon gamma, macrophage migration inhibitory factor, neurotrophin 4, RANTES [regulated on activation, normal T-cell expressed and secreted], transforming growth factor beta, and tumor necrosis factor beta). Biomarkers have different directions of association with prematurity; for significant biomarkers, the strength of association increases with biomarker concentration. Our results provide important information that could be used to guide additional studies aimed at determining mechanisms that contribute to preterm birth.
PEDIATRICS, 2003
Background. About 19 million people in the United States are limited in English proficiency, but ... more Background. About 19 million people in the United States are limited in English proficiency, but little is known about the frequency and potential clinical consequences of errors in medical interpretation.
PEDIATRICS, 2006
The goal was to determine how violence exposure affects the relationship between maternal depress... more The goal was to determine how violence exposure affects the relationship between maternal depression, cognitive ability, and child behavior. A multivariate regression analysis of data for a nationally representative sample of kindergarten students was performed. Maternal depression and violence exposure were measured with standardized parent interviews. Standardized T scores were derived from direct testing of children in reading, mathematics, and general knowledge; child behavior was reported by teachers. A total of 9360 children had neither maternal depression nor violence exposure, 779 violence only, 1564 depression only, and 380 both. Maternal depression alone was associated with poorer mean T scores for reading, mathematics, and general knowledge. However, this effect was attenuated by nearly 25% for reading and general knowledge with adjustment for violence. Children with concurrent exposure to depression and violence had lower mean T scores for reading, mathematics, and general knowledge, as well as more-concerning behaviors, than did those exposed to either factor alone. Across all outcome measures, boys seemed more affected than girls. Violence compounds the effect of maternal depression on school functioning and behavior. Research and intervention planning for children affected by maternal depression should consider violence exposure.
PEDIATRICS, 1999
Women with histories of interpersonal violence are poorly identified because of barriers in self-... more Women with histories of interpersonal violence are poorly identified because of barriers in self-disclosure. This study identified differences on maternal health and child behavior between women who report filing a restraining order (RO) and those who do not among a nonreferred sample of women living in high-crime neighborhoods. During a maternal interview mothers were asked whether they ever filed a RO, the victim/defendant relationship, the number of times, and the year of the filing. Four types of violence were coded independently based on maternal narratives: verbal harassment, verbal threats or intimidation, physical assault, and destruction of property. We controlled for differences between RO and non-RO groups regarding demographic background, partner characteristics, other types of maternal past victimization, and use of alcohol and illicit drugs. Outcomes for mothers include partner aggression (Conflict Tactics Scale-R), perception of health and bodily pain (SF-36 Health Survey), distress symptoms (SCL90-R), posttraumatic stress (PTS)-related symptoms, and partial posttraumatic stress disorder (PTSD) diagnosis (modified Diagnostic Interview Schedule PTSD-Module). Outcomes for the child include partner aggression (Conflict Tactic Scale-R), behavior problems (CBC 2-3 or Child Behavior Checklist), and PTS-related symptoms (PTS-related symptom checklist). One hundred sixty patients between 3.0 to 6.1 years who resided within five residential ZIP codes with a high rate of local crime in the City of Boston were drawn from a pediatric care clinic practice. Patients were participants of a larger study about the impact of community violence on mother-child relations. Sixty-four (40%) of 160 mothers reported a history of filing a RO against a current boyfriend or husband (39%), ex-boyfriend or husband (44%), someone known (8%), or other (9%), with a mean of 3.9 years (standard deviation = 3.5 years) since RO filing. After controlling for covariates of marital status, immigrant status, public assistance, and lifetime sexual victimization, we found a significant multivariate analysis of covariance group effect on maternal outcomes. Analysis of covariance analyses indicated that mothers in the RO group experienced higher current partner verbal aggression and physical violence to mother, poorer health, and higher PTS-related symptoms, compared with mothers in the non-RO group. More mothers in the RO group met partial lifetime PTSD diagnosis. Unadjusted for maternal covariates, the multivariate analysis of variance analyses on child outcomes (partner aggression to child, behavior problems, and PTS-related symptoms) indicated a nonsignificant group effect. Among dyads residing in high-risk crime areas, the incidence of RO histories is substantive considering this was a nonshelter, nonreferred sample. The inquiry about the history of a RO may provide a new and efficient marker to quality of current partner relationship, maternal health, and maternal stress-related symptomatology.
PEDIATRICS, 2014
Examine prospective associations between parent-reported early childhood self-regulation problems... more Examine prospective associations between parent-reported early childhood self-regulation problems and media exposure (television and video viewing) at 2 years. We hypothesized that children with poor self-regulation would consume more media, possibly as a parent coping strategy. We used data from 7450 children in the Early Childhood Longitudinal Study-Birth Cohort. When children were 9 months and 2 years old, parents completed the Infant Toddler Symptom Checklist (ITSC), a validated scale of self-regulation. With daily media use at 2 years as our outcome, we conducted weighted multivariable regression analyses, controlling for child, maternal, and household characteristics. Children watched an average of 2.3 hours per day (SD 1.9) of media at age 2 years. Infants with poor self-regulation (9-month ITSC score ≥3) viewed 0.23 hour per day (95% confidence interval [CI] 0.12-0.35) more media at 2 years compared with those with 9-month ITSC score of 0 to 2; this remained significant in adjusted models (0.15 hour per day [95% CI 0.02-0.28]). Children rated as having persistent self-regulation problems (ITSC ≥3 at both 9 months and 2 years) were even more likely to consume media at age 2 (adjusted β 0.21 hour per day [95% CI 0.03-0.39]; adjusted odds ratio for >2 hours per day 1.40 [95% CI 1.14-1.71]). These associations were slightly stronger in low socioeconomic status and English-speaking households. Early childhood self-regulation problems are associated with mildly increased media exposure, even after controlling for important confounding variables. Understanding this relationship may provide insight into helping parents reduce their children's screen time.
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Papers by Barry Zuckerman