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Accumulating Robust Evidence for Reducing Vaccine Hesitancy in Early Pregnancy. 积累可靠证据,减少孕早期对疫苗的犹豫。
IF 24.7 1区 医学 Q1 PEDIATRICS Pub Date : 2024-10-21 DOI: 10.1001/jamapediatrics.2024.4346
Stefania Triunfo, Luisa Boselli
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引用次数: 0
Guiding Child Health Policy With Science: The JAMA Pediatrics Health and the 2024 US Election Theme. 用科学指导儿童健康政策:JAMA 儿科健康与 2024 年美国大选主题》。
IF 24.7 1区 医学 Q1 PEDIATRICS Pub Date : 2024-10-21 DOI: 10.1001/jamapediatrics.2024.4463
Alison A Galbraith, Aaron E Carroll
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引用次数: 0
Accumulating Robust Evidence for Reducing Vaccine Hesitancy in Early Pregnancy-Reply. 积累可靠证据,减少孕早期对疫苗的犹豫不决--回复。
IF 26.1 1区 医学 Q1 PEDIATRICS Pub Date : 2024-10-21 DOI: 10.1001/jamapediatrics.2024.4349
Elyse O Kharbanda,Malini B DeSilva,Gabriela Vazquez-Benitez
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引用次数: 0
National Trends in Infant Mortality in the US After Dobbs 多布斯之后美国婴儿死亡率的全国趋势
IF 26.1 1区 医学 Q1 PEDIATRICS Pub Date : 2024-10-21 DOI: 10.1001/jamapediatrics.2024.4276
Parvati Singh, Maria F. Gallo
This time series analysis assesses trends in infant mortality after the Dobbs decision overturned the constitutional right to abortion.
这项时间序列分析评估了多布斯案判决推翻宪法规定的堕胎权后婴儿死亡率的趋势。
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引用次数: 0
Accumulating Robust Evidence for Reducing Vaccine Hesitancy in Early Pregnancy. 积累可靠证据,减少孕早期对疫苗的犹豫。
IF 26.1 1区 医学 Q1 PEDIATRICS Pub Date : 2024-10-21 DOI: 10.1001/jamapediatrics.2024.4346
Stefania Triunfo,Luisa Boselli
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引用次数: 0
Free Summer Programming and Body Mass Index Among Schoolchildren From Low-Income Households 免费暑期活动与低收入家庭学童的体重指数
IF 26.1 1区 医学 Q1 PEDIATRICS Pub Date : 2024-10-14 DOI: 10.1001/jamapediatrics.2024.3693
Michael W. Beets, Sarah Burkart, Christopher Pfledderer, Elizabeth Adams, R. Glenn Weaver, Bridget Armstrong, Keith Brazendale, Xuanxuan Zhu, Brian Chen, Alexander McLain
ImportanceChildren experience accelerated gains in body mass index (BMI) during the summer months when school is not in session. Children from low-income households are most susceptible. Accelerated BMI gain in summer may be due to the removal of the health-promoting structure provided by schools. During summer, a common form of health-promoting structure is summer day camps (SDCs). Summer day camps are predominately fee for service, which creates a financial barrier for children from low-income households. One solution to mitigate accelerated BMI gain is providing free access to an existing SDC.ObjectiveTo investigate whether providing free access to an existing community SDC can mitigate accelerated BMI z score (zBMI) gain in elementary school–age children.Design, Setting, and ParticipantsThis randomized clinical trial was conducted during the summers of 2021, 2022, and 2023 in the southeastern United States. Participants were children (kindergarten through fourth grade) from predominantly low-income households who were randomized to attend an SDC operated by a parks and recreation commission or continue summer as usual (control).InterventionFree SDC every weekday (Monday through Friday) for 8 to 10 weeks.Main Outcomes and MeasuresThe primary outcome was between-group differences in change of zBMI measured before school ended (May) and on return to school from summer (late August). Secondary analyses examined the dose response of zBMI change with parent-reported child attendance at SDCs during the summer for all children (intervention and control).ResultsA total of 422 children (mean [SD] age, 8.2 [1.5] years; 202 [48%] female, 220 [52%] male, 292 [69%] at or below 200% federal poverty level, 127 [30%] with food insecurity) were randomized to 1 of 2 conditions: summer as usual (control, n = 199) or free SDC (n = 223). Intent-to-treat analysis indicated mean (SE) change in zBMI at the end of the summer was 0.046 (0.027) for the control and −0.048 (0.025) for the intervention group, representing a significant between-group difference of −0.094 (95% CI, −0.166 to −0.022). Dose-response analyses indicated that every 1 day per week increase in attending an SDC resulted in a −0.034 to −0.018 zBMI reduction, which translates to a gain of 0.046 to 0.080 zBMI for children never attending summer programming vs −0.09 to −0.04 zBMI reduction for children attending summer programming every weekday.Conclusions and RelevanceProviding children free access to existing community summer programming can have a meaningful effect on children’s zBMI gain during the summer. Future studies should replicate these findings across different regions and identify the optimal dose of programming to mitigate unhealthy zBMI gains.Trial RegistrationClinicalTrials.gov Identifier: NCT04072549
重要性在学校停课的暑假期间,儿童的体重指数(BMI)会加速上升。低收入家庭的儿童最容易受到影响。夏季体重指数加速上升可能是由于取消了学校提供的促进健康的结构。在夏季,一种常见的促进健康的结构形式是夏令营(SDCs)。夏令营主要是收费服务,这给低收入家庭的儿童造成了经济障碍。研究免费使用现有的社区日间夏令营是否能缓解小学适龄儿童体重指数 z 值(zBMI)的加速增长。这项随机临床试验于 2021 年、2022 年和 2023 年夏季在美国东南部进行。参与者是来自低收入家庭为主的儿童(幼儿园至四年级),他们被随机分配到由公园和娱乐委员会运营的 SDC 或照常过暑假(对照组)。主要结果和测量主要结果是在放学前(5 月)和暑假返校时(8 月底)测量的 zBMI 变化的组间差异。结果共有 422 名儿童(平均 [SD] 年龄,8.2 [1.5] 岁;202 [48%] 名女性,220 [52%] 名男性,292 [69%] 名处于或低于 200% 的联邦贫困水平,127 [30%] 名存在食物不安全问题)被随机分配到两种条件中的一种:夏季照常(对照组,n = 199)或免费 SDC(n = 223)。意向治疗分析表明,夏季结束时,对照组 zBMI 的平均变化(SE)为 0.046 (0.027),干预组为 -0.048 (0.025),组间差异显著,为 -0.094 (95% CI, -0.166 to -0.022)。剂量-反应分析表明,每周参加 SDC 的时间每增加一天,zBMI 就会减少-0.034 到-0.018,这意味着从未参加过暑期活动的儿童的zBMI增加了 0.046 到 0.080,而每个工作日参加暑期活动的儿童的zBMI减少了-0.09 到-0.04。未来的研究应在不同地区重复这些发现,并确定最佳的编程剂量,以减轻不健康的 zBMI 增长:NCT04072549
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引用次数: 0
State Social Expenditures and Preterm Birth and Low Birth Weight in the US 美国各州的社会支出与早产和出生体重不足问题
IF 26.1 1区 医学 Q1 PEDIATRICS Pub Date : 2024-10-14 DOI: 10.1001/jamapediatrics.2024.4267
Lawrence Chang, Henry T. Puls, Michael C. Monuteaux, Jeffrey D. Colvin, Paul J. Chung, Lois K. Lee
ImportanceAdverse birth outcomes in the US, including preterm birth and low birth weight, are strongly tied to socioeconomic disadvantage and disproportionately impact infants of Black mothers. Increasing investments in social programs represents a potential policy approach to addressing disparities in birth outcomes.ObjectiveTo examine state-level associations of government expenditures on social programs with rates of preterm birth and low birth weight both overall and by race.Design, Setting, and ParticipantsThis cross-sectional, ecological study was conducted among liveborn infants in the 50 US states between January 1, 2011, and December 31, 2019. Data analysis was performed from May 2022 to May 2024.ExposuresYearly state and local government expenditures per low-income person on social programs in the following categories: state refundable Earned Income Tax Credit; cash assistance; childcare assistance; housing and community development; and public health.Main Outcomes and MeasuresYearly state-level rates of preterm birth (gestational age &amp;lt;37 weeks) and low birth weight (&amp;lt;2500 g).ResultsFrom January 1, 2011, to December 31, 2019, there were 35.1 million live births in the US, of which 3.4 million (9.8%) were preterm and 2.8 million (8.1%) were low birth weight. Median (IQR) state social expenditures per low-income person were $1546 ($1074-$2323). Greater total state social expenditures were associated with lower overall rates of preterm birth (adjusted prevalence ratio [aPR] for every increase of $1000 per low-income person, 0.99; 95% CI, 0.97-0.999) but not with overall rates of low birth weight. In secondary analyses, greater state social expenditures were associated with lower preterm birth rates for infants of Black mothers (aPR, 0.96; 95% CI, 0.92-0.999). Greater state expenditures specifically on cash assistance (aPR, 0.64; 95% CI, 0.43-0.94) and housing and community development (aPR, 0.91; 95% CI, 0.84-0.98) were associated with lower preterm birth rates for infants of Black mothers.Conclusions and RelevanceIn this cross-sectional, ecological study, greater state-level expenditures on social programs were associated with reduced rates of preterm birth, particularly for infants of Black mothers. State and local governments may consider bolstering investments in cash assistance and housing and community development to address maternal and infant health disparities.
重要性在美国,包括早产和出生体重不足在内的不良出生结果与社会经济劣势密切相关,对黑人母亲所生婴儿的影响尤为严重。增加对社会项目的投资是解决出生结果差异的一种潜在政策方法。目标研究州一级政府在社会项目上的支出与早产率和低出生体重率之间的关系,包括总体关系和种族关系。数据分析在 2022 年 5 月至 2024 年 5 月期间进行。暴露州和地方政府每年为每个低收入者在以下类别社会项目上的支出:州可退还所得税抵免;现金援助;儿童保育援助;住房和社区发展;以及公共卫生。主要结果和衡量标准每年州一级的早产率(胎龄&amp;lt;37周)和低出生体重率(&amp;lt;2500克)。结果从2011年1月1日到2019年12月31日,美国共有3510万活产婴儿,其中340万(9.8%)为早产儿,280万(8.1%)为低出生体重儿。每个低收入者的州社会支出中位数(IQR)为 1546 美元(1074-2323 美元)。州社会总支出越高,早产的总体比率越低(每个低收入者每增加 1000 美元的调整流行率 [aPR],0.99;95% CI,0.97-0.999),但与出生体重不足的总体比率无关。在二次分析中,州社会支出越多,黑人母亲的婴儿早产率越低(aPR,0.96;95% CI,0.92-0.999)。州政府在现金援助(aPR,0.64;95% CI,0.43-0.94)以及住房和社区发展(aPR,0.91;95% CI,0.84-0.98)方面的支出越多,黑人母亲的婴儿早产率越低。结论和相关性在这项横断面生态研究中,州政府在社会计划方面的支出越多,早产率就越低,尤其是黑人母亲的婴儿。州政府和地方政府可以考虑加强对现金援助、住房和社区发展的投资,以解决母婴健康差异问题。
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引用次数: 0
Risk of Suicidal Ideation or Attempts in Adolescents With Obesity Treated With GLP1 Receptor Agonists 使用 GLP1 受体激动剂治疗肥胖症青少年的自杀意念或自杀未遂风险
IF 26.1 1区 医学 Q1 PEDIATRICS Pub Date : 2024-10-14 DOI: 10.1001/jamapediatrics.2024.3812
Liya Kerem, Joshua Stokar
ImportanceGlucagon-like peptide 1 receptor agonists (GLP1R) are increasingly being used for the treatment of obesity in adolescents. It is currently unknown whether GLP1R treatment is associated with suicidal ideation or attempts in this population.ObjectiveTo investigate the association between GLP1R initiation and suicidal ideation or attempts in adolescents with obesity.Design, Setting, and ParticipantsRetrospective propensity score–matched cohort study using electronic health records from the TriNetX global federated network between December 2019 and June 2024. The analysis included data from 120 health care organizations, mainly from the USA. Participants were adolescents aged 12 to 18 years with a diagnosis of obesity and evidence of an antiobesity GLP1R prescription or lifestyle intervention without GLP1R within the following year. Cohorts were balanced for baseline demographic characteristics, psychiatric medications and comorbidities, and diagnoses associated with socioeconomic status and health care access using propensity score matching.ExposureInitial prescription of GLP1R (study cohort) or lifestyle intervention without GLP1R (control cohort).Main Outcomes and MeasuresIncidence of suicidal ideation or attempts based on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes recorded in patient electronic health records during 12 months of follow-up. Diagnoses of upper respiratory tract infections (URTI) were used as negative control outcomes, and gastrointestinal symptoms (GI) were used as positive control outcomes.ResultsA total of 4052 adolescents with obesity and a concomitant antiobesity intervention were identified for the GLP1R cohort and 50 112 were identified for the control cohort. Propensity score matching resulted in 3456 participants in each balanced cohort. Prescription of GLP1R was associated with a 33% reduced risk for suicidal ideation or attempts over 12 months of follow-up (1.45% vs 2.26%; hazard ratio [HR], 0.67; 95% CI, 0.47-0.95; P = .02) and a higher rate of GI symptoms (6.9% vs 5.4%; HR, 1.41; 95% CI, 1.12-1.78; P = .003) but no difference in rates of URTI diagnoses.Conclusions and RelevanceIn this study, adolescents with obesity prescribed a GLP1R had a lower incidence of suicidal ideation or attempts compared with matched patients not prescribed GLP1R who were treated with lifestyle intervention. These results suggest a favorable psychiatric safety profile of GLP1R in adolescents. The detected reduction in HRs for suicidal ideation among adolescents with obesity prescribed GLP1R suggests potential avenues for future research.
重要性胰高血糖素样肽 1 受体激动剂(GLP1R)越来越多地被用于治疗青少年肥胖症。目前尚不清楚 GLP1R 治疗是否与该人群中的自杀意念或自杀未遂有关。目的 研究肥胖症青少年中 GLP1R 启动与自杀意念或自杀未遂之间的关联。分析包括来自 120 家医疗机构的数据,主要来自美国。参与者为 12 至 18 岁的青少年,他们被诊断患有肥胖症,并有证据表明在接下来的一年内服用过抗肥胖 GLP1R 处方或接受过不含 GLP1R 的生活方式干预。主要结果和测量指标在12个月的随访期间,根据患者电子健康记录中记录的《国际疾病和相关健康问题统计分类第十版》代码,自杀意念或自杀未遂的发生率。上呼吸道感染(URTI)诊断结果作为阴性对照结果,胃肠道症状(GI)诊断结果作为阳性对照结果。结果 GLP1R队列中共有4052名青少年患有肥胖症并同时接受了抗肥胖干预,对照队列中共有50 112名青少年患有肥胖症并同时接受了抗肥胖干预。通过倾向得分匹配,每个平衡队列中均有 3456 名参与者。处方 GLP1R 与随访 12 个月期间自杀意念或自杀未遂风险降低 33% 相关(1.45% vs 2.26%;危险比 [HR],0.67;95% CI,0.47-0.95;P = .02),与胃肠道症状发生率升高相关(6.9% vs 5.4%;HR,1.41;95% CI,1.12-1.78;P = .结论和相关性在这项研究中,与未服用 GLP1R 并接受生活方式干预治疗的匹配患者相比,服用 GLP1R 的肥胖症青少年自杀意念或自杀未遂的发生率较低。这些结果表明,GLP1R 在青少年中具有良好的精神安全性。在服用了 GLP1R 的肥胖症青少年中,发现自杀意念的 HRs 有所降低,这为今后的研究提供了潜在的途径。
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引用次数: 0
Optimizing Public Policies for Pregnancy and Infant Outcomes. 优化公共政策,促进妊娠和婴儿健康。
IF 26.1 1区 医学 Q1 PEDIATRICS Pub Date : 2024-10-14 DOI: 10.1001/jamapediatrics.2024.4264
Scott A Lorch,Michelle M Peña,Diana Montoya-Williams
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引用次数: 0
Naloxone Access Laws and Opioid-Related Overdose Deaths in Youths. 纳洛酮使用法与青少年阿片类药物过量死亡。
IF 26.1 1区 医学 Q1 PEDIATRICS Pub Date : 2024-10-14 DOI: 10.1001/jamapediatrics.2024.3701
Michael S Toce,Kenneth A Michelson,Scott E Hadland,Michael C Monuteaux,Florence T Bourgeois
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引用次数: 0
期刊
JAMA Pediatrics
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