Pediatrics最新文献

Context: Exposure to adverse childhood experiences (ACEs) is associated with adverse impacts on subsequent generations. The extent to which caregiver ACEs are associated with their child's ACE score is unclear.

Objective: To meta-analytically examine the association between caregiver and child ACE score. Potential moderators of this association were explored.

Data sources: Systematic searches were conducted using MEDLINE, Embase, PsycINFO, and CINHAL from 1998, the year the ACEs questionnaire was published, to February 19, 2024.

Study selection: Inclusion criteria were that the ACEs questionnaire was completed for both caregiver and child, an effect size was available, and the study was published in English.

Data extraction: Variables extracted included sample size and magnitude of association between caregiver ACEs and child ACEs, mean caregiver and child age, sex (% female), race and ethnicity, and informant of ACEs.

Results: Seventeen samples (4872 caregiver-child dyads) met inclusion criterion. Results revealed a large pooled-effect size between caregiver and child ACEs (r = 0.33; 95% CI, 0.25-0.41; P < .001), such that higher caregiver ACEs score was associated with higher child ACEs score. This association was stronger among studies with younger caregivers and studies that utilized caregiver-report compared with child self-report of ACEs.

Limitations: Many studies were conducted in North America with female caregiver samples, limiting generalizability beyond these populations.

Conclusions: Caregiver ACEs were strongly associated with child ACEs. Prevention and intervention efforts for caregivers should be trauma informed and focused on bolstering protective factors that may break cycles of intergenerational risk.

Pediatric home health care represents a vital system of care for children with disability and medical complexity, encompassing services provided by family caregivers and nonfamily home health care providers and the use of durable medical equipment and supplies. Home health care is medically necessary for the physiologic health of children with disability and medical complexity and for their participation and function within home, school, and community settings. While the study of pediatric home health care in the United States has increased in the last decade, its research remains primarily methodologically limited to observational studies. Dedicated funding and research efforts are needed to transform American home health care research to address multifaceted outcomes valued by families and providers as well as payers and government programs. In this paper, we review the recent literature in pediatric home health care and then propose an actional agenda that could address its missing evidence base. We posit that pediatricians should partner with family caregiving experts and patients to advance knowledge about child and family health outcomes, home health care use, new models of care, and optimal approaches to education and training while also considering meaningful approaches to address disparities. The creation of an American pediatric home health care data-sharing consortium, patient registry, and reproducible access and quality measures is also needed. Most importantly, efforts should center on patient- and family-centered health priorities, with the goal of ensuring equitable outcomes for every child and family.

Objectives: To assess whether exposure to an infant safe sleep initiative was associated with maternal report of infant safe sleep practice at home and to identify other predictive factors.

Methods: After linking Pennsylvania data on infant safe sleep initiative implementation at 27 hospitals to birth certificate and Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2017 to 2021, we generated descriptive statistics to compare infant safe sleep practice and other characteristics between respondents exposed to the initiative and all other PRAMS respondents with a hospital birth. Using multivariable logistic regression, we modeled the association between exposure to the initiative and maternal self-report of placing their infant to sleep on their back, on a separate surface, without soft objects, or room sharing without bed sharing.

Results: PRAMS respondents who gave birth in a hospital that had implemented the infant safe sleep initiative were more likely to report placing their infant on their back to sleep, on a separate sleep surface, or without soft objects compared with those who were not exposed to the initiative after adjusting for maternal characteristics and birth parameters. No significant effect was observed on room sharing without bed sharing. When the overall number of reported infant safe sleep practices reported by respondents was considered as an outcome, the association with exposure to the safe sleep initiative persisted.

Conclusion: This study demonstrates the association between exposure to a hospital-based infant safe sleep initiative and subsequent safe sleep practice at home. Additional study on the equity of such initiatives may be warranted.