Pub Date : 2025-01-01DOI: 10.1016/j.acap.2024.08.016
Madeleine Sumner AB , Gillian A.M. Tarr PhD , Jianling Xie MD MPH , Ahmed Mater MD , Kathleen Winston MSc , Jocelyn Gravel MD, MSc , Naveen Poonai MSc, MD , Brett Burstein MDCM, PhD, MPH , Simon Berthelot MD, MSc , Roger Zemek MD , Robert Porter MD, MSc , Bruce Wright MD , April Kam MD MScPH , Jason Emsley MSc, MD, PhD , Vikram Sabhaney MD , Darcy Beer MD , Gabrielle Freire MDCM, MHSc , Anne Moffatt MD , Stephen B. Freedman MDCM, MSc , on behalf of Pediatric Emergency Research Canada
Objective
To evaluate how social behaviors relate to SARS-CoV-2 test positivity across pediatric age groups.
Methods
Multicenter, cross-sectional study recruiting children <18 years old tested for SARS-CoV-2 infection in emergency departments between 2020 and 2022. We used multivariate logistic regression to assess how self-reported social behaviors affect SARS-CoV-2 test positivity across four age groups. Causal mediation analysis quantified how mask-wearing and presence of an infected close contact mediated the SARS-CoV-2 risk of given behaviors.
Results
Seven thousand two hundred and seventy two children were enrolled and 1457 (20.0%) tested positive for SARS-CoV-2. Attending a social gathering was associated with increased odds (aOR 1.64, 95% CI: 1.05, 2.57) of SARS-CoV-2 positivity among children aged 5-<12 years. Those attending in-person school/daycare were less likely to test positive for SARS-CoV-2 across all age categories. Attending childcare was associated with 16.3% (95% CI: −21.0%, −11.2%) and 9.0% (95% CI: −11.6%, −6.5%) reductions in the probability of testing positive for SARS-CoV-2 infection, with 53.5% (95% CI: 39.2%, 73.9%) and 22.8% (95% CI: 9.7%, 36.2%) of the effects being mediated by the presence of a close contact among <1 year and 1-<5 year age groups, respectively. Masking in public mediated the association between childcare attendance and SARS-CoV-2 positivity in children aged <1 year.
Conclusions
Attending social gatherings increased the risk of SARS-CoV-2 test positivity in 5-<12-year-old children, but in-person daycare/school was associated with a reduced odds of testing positive across all ages. Settings with high public health adherence (ie, schools) reduced the risk of testing positive for SARS-CoV-2, possibly from reduced close contact with SARS-CoV-2 positive individuals.
{"title":"Social Behaviors Associated with SARS-CoV-2 Test Positivity Among Children Evaluated in Canadian Emergency Departments, 2020 to 2022: A Cross-Sectional Survey Study","authors":"Madeleine Sumner AB , Gillian A.M. Tarr PhD , Jianling Xie MD MPH , Ahmed Mater MD , Kathleen Winston MSc , Jocelyn Gravel MD, MSc , Naveen Poonai MSc, MD , Brett Burstein MDCM, PhD, MPH , Simon Berthelot MD, MSc , Roger Zemek MD , Robert Porter MD, MSc , Bruce Wright MD , April Kam MD MScPH , Jason Emsley MSc, MD, PhD , Vikram Sabhaney MD , Darcy Beer MD , Gabrielle Freire MDCM, MHSc , Anne Moffatt MD , Stephen B. Freedman MDCM, MSc , on behalf of Pediatric Emergency Research Canada","doi":"10.1016/j.acap.2024.08.016","DOIUrl":"10.1016/j.acap.2024.08.016","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate how social behaviors relate to SARS-CoV-2 test positivity across pediatric age groups.</div></div><div><h3>Methods</h3><div>Multicenter, cross-sectional study recruiting children <18 years old tested for SARS-CoV-2 infection in emergency departments between 2020 and 2022. We used multivariate logistic regression to assess how self-reported social behaviors affect SARS-CoV-2 test positivity across four age groups. Causal mediation analysis quantified how mask-wearing and presence of an infected close contact mediated the SARS-CoV-2 risk of given behaviors.</div></div><div><h3>Results</h3><div>Seven thousand two hundred and seventy two children were enrolled and 1457 (20.0%) tested positive for SARS-CoV-2. Attending a social gathering was associated with increased odds (aOR 1.64, 95% CI: 1.05, 2.57) of SARS-CoV-2 positivity among children aged 5-<12 years. Those attending in-person school/daycare were less likely to test positive for SARS-CoV-2 across all age categories. Attending childcare was associated with 16.3% (95% CI: −21.0%, −11.2%) and 9.0% (95% CI: −11.6%, −6.5%) reductions in the probability of testing positive for SARS-CoV-2 infection, with 53.5% (95% CI: 39.2%, 73.9%) and 22.8% (95% CI: 9.7%, 36.2%) of the effects being mediated by the presence of a close contact among <1 year and 1-<5 year age groups, respectively. Masking in public mediated the association between childcare attendance and SARS-CoV-2 positivity in children aged <1 year.</div></div><div><h3>Conclusions</h3><div>Attending social gatherings increased the risk of SARS-CoV-2 test positivity in 5-<12-year-old children, but in-person daycare/school was associated with a reduced odds of testing positive across all ages. Settings with high public health adherence (ie, schools) reduced the risk of testing positive for SARS-CoV-2, possibly from reduced close contact with SARS-CoV-2 positive individuals.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 1","pages":"Article 102571"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute pediatric respiratory illness is one of the most common reasons for emergency department (ED) transfer; however, few studies have examined predictors of potentially avoidable ED transfer (PAT) in this subpopulation. This study aimed to characterize patterns and predictors of PATs in children with acute respiratory illness.
Methods
Cross-sectional analysis of 8,402,577 visits for patients ≤17 years from 2018 to 2019 Health Care Utilization Project State ED and Inpatient Datasets from New York, Maryland, Wisconsin, and Florida. ED transfers matched to a visit at a receiving facility with a primary diagnosis of pneumonia, croup/other upper respiratory infection (URI), bronchiolitis, or asthma were included. PAT was defined as discharge from receiving ED or within 24 hours of inpatient admission without specialized procedures, as previously described. PATs were compared with necessary transfers using a 3-level generalized linear mixed model with adjustment for patient and hospital covariates.
Results
Among 4409 matched respiratory transfers, 25.5% were potentially avoidable. Most PATs originated from EDs within the third highest quartile of annual pediatric ED visits (n = 472, 42.0%). In the multivariable model, the likelihood of PAT was higher for patients with croup/other URI ((odds ratio) OR 2.72 (2.09–3.5) and if referring ED was in the highest quartile of annual pediatric ED volumes (OR 0.48 95% (confidence interval) CI 0.26–0.88).
Conclusions
Pediatric respiratory transfers with a diagnosis of croup/other URI were the most likely to be potentially avoidable. Future implementation efforts to reduce PATs should consider focusing on croup management in EDs in the lower 3 quartiles of pediatric volume.
背景：急性儿科呼吸道疾病是急诊科（ED）转院的最常见原因之一，但很少有研究对该亚群中潜在可避免的急诊科转院（PAT）进行预测。本研究旨在描述急性呼吸道疾病患儿转院的模式和预测因素：方法：对 8,402,577 名就诊患者进行横断面分析：在 4,409 例匹配的呼吸道转运病例中，25.5% 的病例可能是可以避免的。大多数 PAT 来自儿科急诊室年就诊量第三高四分位数的急诊室（472 人，42.0%）。在多变量模型中，如果患者患有咳嗽/其他URI（OR 2.72 (2.09 -3.5)），且转诊急诊室位于儿科急诊室年门诊量的最高四分位数（OR 0.48 95% CI 0.26-0.88），则发生PAT的可能性更高：结论：诊断为咳嗽/其他URI的儿科呼吸道转院最有可能避免。未来减少 PAT 的实施工作应考虑将重点放在儿科急诊量较低的三个四分位数的急诊室的分组管理上。
{"title":"Potentially Avoidable Emergency Department Transfers for Acute Pediatric Respiratory Illness","authors":"Kaileen Jafari MD , Apeksha Gupta MPH, MS , Derya Caglar MD , Emily Hartford MD, MPH","doi":"10.1016/j.acap.2024.07.020","DOIUrl":"10.1016/j.acap.2024.07.020","url":null,"abstract":"<div><h3>Background</h3><div>Acute pediatric respiratory illness is one of the most common reasons for emergency department (ED) transfer; however, few studies have examined predictors of potentially avoidable ED transfer (PAT) in this subpopulation. This study aimed to characterize patterns and predictors of PATs in children with acute respiratory illness.</div></div><div><h3>Methods</h3><div>Cross-sectional analysis of 8,402,577 visits for patients ≤17 years from 2018 to 2019 Health Care Utilization Project State ED and Inpatient Datasets from New York, Maryland, Wisconsin, and Florida. ED transfers matched to a visit at a receiving facility with a primary diagnosis of pneumonia, croup/other upper respiratory infection (URI), bronchiolitis, or asthma were included. PAT was defined as discharge from receiving ED or within 24 hours of inpatient admission without specialized procedures, as previously described. PATs were compared with necessary transfers using a 3-level generalized linear mixed model with adjustment for patient and hospital covariates.</div></div><div><h3>Results</h3><div>Among 4409 matched respiratory transfers, 25.5% were potentially avoidable. Most PATs originated from EDs within the third highest quartile of annual pediatric ED visits (n = 472, 42.0%). In the multivariable model, the likelihood of PAT was higher for patients with croup/other URI ((odds ratio) OR 2.72 (2.09–3.5) and if referring ED was in the highest quartile of annual pediatric ED volumes (OR 0.48 95% (confidence interval) CI 0.26–0.88).</div></div><div><h3>Conclusions</h3><div>Pediatric respiratory transfers with a diagnosis of croup/other URI were the most likely to be potentially avoidable. Future implementation efforts to reduce PATs should consider focusing on croup management in EDs in the lower 3 quartiles of pediatric volume.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 1","pages":"Article 102553"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.acap.2024.08.012
Jordee M. Wells MD, MPH , Tyler Gorham PhD, MPH , Skyler E. Kalady MD , Deena J. Chisolm PhD
Objective
To describe the use of primary care telehealth following the rapid reduction of in-person pediatric primary care availability during the severe acute respiratory syndrome coronavirus 2 pandemic and how this varied by community-level social determinants and individual-level social needs.
Methods
We conducted a retrospective cohort study of children 0 to 17 years across 16 sites within Nationwide Children’s Hospital Primary Care Network from March 22 to July 31, 2020, and a preceding comparator period (2019). The study population includes 107,629 patient encounters. We compared visit type (in-person vs telehealth), demographics, presence of individual social needs, and community social determinants using the Child Opportunity Index 2.0 (COI). To assess telehealth utilization, we compared the ratio of 2019 to 2020 primary care visits across levels of COI. We trained a linear regression model predicting the number of telehealth encounters in 2020 using individual patient characteristics and COI.
Results
Patients in census tracts with high and very high levels of opportunity maintained the highest relative encounter volume (2020:2019) at the beginning of the pandemic (0.78 and 0.73, respectively, compared to 65% for children living in very low opportunity neighborhoods; P < 0.001). Patients with caregiver-reported social needs (housing, transportation, utilities, food) had relatively greater telehealth use following the start of the public health emergency.
Conclusions
Volume of primary care visits decreased least for high and very high-opportunity neighborhoods yet individual social needs were associated with higher relative use of telemedicine. Findings suggest that telehealth was an important modality to deliver care to children with social needs but does not overcome community-level barriers.
{"title":"Social Determinants of Pediatric Primary Care Telehealth and In-Office Visits During the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic","authors":"Jordee M. Wells MD, MPH , Tyler Gorham PhD, MPH , Skyler E. Kalady MD , Deena J. Chisolm PhD","doi":"10.1016/j.acap.2024.08.012","DOIUrl":"10.1016/j.acap.2024.08.012","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the use of primary care telehealth following the rapid reduction of in-person pediatric primary care availability during the severe acute respiratory syndrome coronavirus 2 pandemic and how this varied by community-level social determinants and individual-level social needs.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of children 0 to 17 years across 16 sites within Nationwide Children’s Hospital Primary Care Network from March 22 to July 31, 2020, and a preceding comparator period (2019). The study population includes 107,629 patient encounters. We compared visit type (in-person vs telehealth), demographics, presence of individual social needs, and community social determinants using the Child Opportunity Index 2.0 (COI). To assess telehealth utilization, we compared the ratio of 2019 to 2020 primary care visits across levels of COI. We trained a linear regression model predicting the number of telehealth encounters in 2020 using individual patient characteristics and COI.</div></div><div><h3>Results</h3><div>Patients in census tracts with high and very high levels of opportunity maintained the highest relative encounter volume (2020:2019) at the beginning of the pandemic (0.78 and 0.73, respectively, compared to 65% for children living in very low opportunity neighborhoods; <em>P</em> < 0.001). Patients with caregiver-reported social needs (housing, transportation, utilities, food) had relatively greater telehealth use following the start of the public health emergency.</div></div><div><h3>Conclusions</h3><div>Volume of primary care visits decreased least for high and very high-opportunity neighborhoods yet individual social needs were associated with higher relative use of telemedicine. Findings suggest that telehealth was an important modality to deliver care to children with social needs but does not overcome community-level barriers.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 1","pages":"Article 102567"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.acap.2024.08.164
Derek Tam MD, MPH , Seema Shah MD, MPH , Steven Campman MD , Margaret Nguyen MD
Objective
Our objectives were to evaluate for any cluster patterns of youth suicide deaths and characterize the level of child opportunity in the communities where suicide deaths occurred.
Methods
Decedents <18 years were identified from San Diego County Medical Examiner death reports from 2000 to 2020. We mapped decedents’ residential Zone Improvement Plan (ZIP) codes and calculated suicide rates per 10,000 youths. ZIP codes identified in overlapping spatial statistical approaches — the spatial scan statistic and Local Moran with Empirical Bayes (EB) rates — were considered a cluster for the final analysis. We obtained Child Opportunity Index (COI) scores for each ZIP code to determine if there were differences in: 1) ZIP codes with suicide deaths compared to ZIPs with no deaths 2) differences in distribution of suicide death rates across quintiles of COI.
Results
Scan statistic identified 25 ZIP codes within a cluster (RR 2.6, P = 0.00066). Local Moran with EB rates identified two ZIP codes as a high-high cluster (P < 0.05). The location identified as a cluster in both approaches was in Alpine. The median COI for ZIP codes with suicide deaths was higher at 63.5 (IQR 38–83) compared to 47 (IQR 22.5–75.5) for ZIP codes without suicide deaths. There was a significant difference in suicide rates between Very Low and Moderate levels of Overall opportunity (P = .013).
Conclusion
We identified a cluster of youth suicides in one of the most populous counties in the country. These findings serve to inform policies and prevention programs that aim to mitigate youth suicide mortality.
目标我们的目标是评估青少年自杀死亡的任何集群模式，并描述自杀死亡发生社区的儿童机会水平：死者扫描统计发现有 25 个邮政编码属于一个群集（RR 2.6，p = 0.00066）。当地莫兰与 EB 率将两个邮政编码确定为高-高群集（p < 0.05）。在这两种方法中被确定为群集的地点都位于阿尔派恩。有自杀死亡病例的邮政编码的 COI 中位数较高，为 63.5（IQR 38-83），而无自杀死亡病例的邮政编码的 COI 中位数为 47（IQR 22.5-75.5）。总体机会水平极低和中等之间的自杀率存在明显差异（p =.013）：我们在美国人口最多的县之一发现了青少年自杀群。这些发现有助于为旨在降低青少年自杀死亡率的政策和预防计划提供信息。
{"title":"Geographic Patterns of Youth Suicide in San Diego County","authors":"Derek Tam MD, MPH , Seema Shah MD, MPH , Steven Campman MD , Margaret Nguyen MD","doi":"10.1016/j.acap.2024.08.164","DOIUrl":"10.1016/j.acap.2024.08.164","url":null,"abstract":"<div><h3>Objective</h3><div>Our objectives were to evaluate for any cluster patterns of youth suicide deaths and characterize the level of child opportunity in the communities where suicide deaths occurred.</div></div><div><h3>Methods</h3><div>Decedents <18 years were identified from San Diego County Medical Examiner death reports from 2000 to 2020. We mapped decedents’ residential Zone Improvement Plan (ZIP) codes and calculated suicide rates per 10,000 youths. ZIP codes identified in overlapping spatial statistical approaches — the spatial scan statistic and Local Moran with Empirical Bayes (EB) rates — were considered a cluster for the final analysis. We obtained Child Opportunity Index (COI) scores for each ZIP code to determine if there were differences in: 1) ZIP codes with suicide deaths compared to ZIPs with no deaths 2) differences in distribution of suicide death rates across quintiles of COI.</div></div><div><h3>Results</h3><div>Scan statistic identified 25 ZIP codes within a cluster (RR 2.6, <em>P</em> = 0.00066). Local Moran with EB rates identified two ZIP codes as a high-high cluster (<em>P</em> < 0.05). The location identified as a cluster in both approaches was in Alpine. The median COI for ZIP codes with suicide deaths was higher at 63.5 (IQR 38–83) compared to 47 (IQR 22.5–75.5) for ZIP codes without suicide deaths. There was a significant difference in suicide rates between Very Low and Moderate levels of Overall opportunity (<em>P</em> = .013).</div></div><div><h3>Conclusion</h3><div>We identified a cluster of youth suicides in one of the most populous counties in the country. These findings serve to inform policies and prevention programs that aim to mitigate youth suicide mortality.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 1","pages":"Article 102576"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.acap.2024.102686
Christina Abi Kheir MD, Kyra Stepney DO, Hunter Collins PhD, Christine Joseph DO, Priyal Upadhyay MD, Michael Bolton MD, Melissa Roy MD
{"title":"DOES INTEGRATING A DIVERSITY, EQUITY, AND INCLUSION CURRICULUM INCREASE PEDIATRIC RESIDENTS’ CONFIDENCE IN TREATING PATIENTS FROM DIFFERENT BACKGROUNDS AT OUR LADY OF THE LAKE CHILDREN’S HOSPITAL?","authors":"Christina Abi Kheir MD, Kyra Stepney DO, Hunter Collins PhD, Christine Joseph DO, Priyal Upadhyay MD, Michael Bolton MD, Melissa Roy MD","doi":"10.1016/j.acap.2024.102686","DOIUrl":"10.1016/j.acap.2024.102686","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 1","pages":"Article 102686"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143296680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.acap.2024.07.014
Andrew F. Beck MD, MPH , Barry S. Solomon MD, MPH , Leora N. Mogilner MD , Benard P. Dreyer MD , Todd A. Florin MD, MSCE , Yonit Lax MD , Lawrence M. Rhein MD, MPH , Lee M. Sanders MD, MPH , Melissa D. Klein MD, MEd
{"title":"Standing Up to Antisemitism, Together","authors":"Andrew F. Beck MD, MPH , Barry S. Solomon MD, MPH , Leora N. Mogilner MD , Benard P. Dreyer MD , Todd A. Florin MD, MSCE , Yonit Lax MD , Lawrence M. Rhein MD, MPH , Lee M. Sanders MD, MPH , Melissa D. Klein MD, MEd","doi":"10.1016/j.acap.2024.07.014","DOIUrl":"10.1016/j.acap.2024.07.014","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 1","pages":"Article 102547"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.acap.2024.07.018
Pamela J. Surkan ScD, PhD , Soim Park PhD , Ziyue Sheng MB , Ahmed Zaidi MSc , Najia Atif PhD , Lauren M. Osborne MD , Atif Rahman PhD, MBBS, FRCPsych, MRes , Abid Malik PhD, FRCPsych
Objective
Given that infant development is influenced by caregiver mental health, we tested whether an intervention to reduce antenatal anxiety could affect infant development. A secondary aim was to test depressive symptoms, maternal responsiveness, and maternal infant bonding as mediators of this relationship.
Methods
Between 2020 and 2022, pregnant women participated in a randomized controlled trial of the Happy Mother-Healthy Baby (HMHB) program based on cognitive behavioral therapy. We collected data on child development from 202 intervention and 198 control participants in a public hospital in Pakistan. Child development was measured using the Ages and Stages Questionnaires-Version 3 at six weeks postpartum. Using intent-to-treat analyses, we examined whether the intervention was associated with performance on the five ASQ-3 domains. Causal mediation analysis was used to assess depressive symptoms, bonding, and maternal-infant responsiveness as mediators.
Results
Socio-demographic characteristics were evenly distributed between study arms. Intervention arm infants showed a 2.1-point increase (95% CI: 0.12, 4.17) in communication scores compared to controls. Though not achieving statistical significance, intervention infants also showed a 2.0-point increase (95% CI: −0.06, 4.09) in gross motor development performance. Bonding, depression, and responsiveness were mediators between the intervention and infant communication (Bindirect = 1.94 (95% CI: 0.86, 3.25) depression; Bindirect = 0.57 (95% CI: 0.09, 1.16) bonding; Bindirect = 0.53 (95% CI: 0.01, 1.21) and responsiveness (Bindirect = 1.94 (95% CI: 0.86, 3.25)). Bonding, responsiveness, and depression mediated 25%, 23%, and 87% of the total association, respectively.
Conclusions
HMHB positively affected infant communication at six-week follow-up. Larger studies with longer follow-up are needed to confirm and extend these findings.
{"title":"Effects of a Prenatal Anxiety Randomized Controlled Trial Intervention on Infant Development in Pakistan","authors":"Pamela J. Surkan ScD, PhD , Soim Park PhD , Ziyue Sheng MB , Ahmed Zaidi MSc , Najia Atif PhD , Lauren M. Osborne MD , Atif Rahman PhD, MBBS, FRCPsych, MRes , Abid Malik PhD, FRCPsych","doi":"10.1016/j.acap.2024.07.018","DOIUrl":"10.1016/j.acap.2024.07.018","url":null,"abstract":"<div><h3>Objective</h3><div>Given that infant development is influenced by caregiver mental health, we tested whether an intervention to reduce antenatal anxiety could affect infant development. A secondary aim was to test depressive symptoms, maternal responsiveness, and maternal infant bonding as mediators of this relationship.</div></div><div><h3>Methods</h3><div>Between 2020 and 2022, pregnant women participated in a randomized controlled trial of the <em>Happy Mother-Healthy Baby (HMHB)</em> program based on cognitive behavioral therapy. We collected data on child development from 202 intervention and 198 control participants in a public hospital in Pakistan. Child development was measured using the Ages and Stages Questionnaires-Version 3 at six weeks postpartum. Using intent-to-treat analyses, we examined whether the intervention was associated with performance on the five ASQ-3 domains. Causal mediation analysis was used to assess depressive symptoms, bonding, and maternal-infant responsiveness as mediators.</div></div><div><h3>Results</h3><div>Socio-demographic characteristics were evenly distributed between study arms. Intervention arm infants showed a 2.1-point increase (95% CI: 0.12, 4.17) in communication scores compared to controls. Though not achieving statistical significance, intervention infants also showed a 2.0-point increase (95% CI: −0.06, 4.09) in gross motor development performance. Bonding, depression, and responsiveness were mediators between the intervention and infant communication (B<sub>indirect</sub> <!-->=<!--> <!-->1.94 (95% CI: 0.86, 3.25) depression; B<sub>indirect</sub> <!-->= 0.57 (95% CI: 0.09, 1.16) bonding; B<sub>indirect</sub> <!-->= 0.53 (95% CI: 0.01, 1.21) and responsiveness (B<sub>indirect</sub> <!-->= 1.94 (95% CI: 0.86, 3.25)). Bonding, responsiveness, and depression mediated 25%, 23%, and 87% of the total association, respectively.</div></div><div><h3>Conclusions</h3><div>HMHB positively affected infant communication at six-week follow-up. Larger studies with longer follow-up are needed to confirm and extend these findings.</div></div><div><h3>Trial registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> NCT03880032; <span><span>https://clinicaltrials.gov/ct2/show/NCT03880032</span><svg><path></path></svg></span></div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 1","pages":"Article 102551"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.acap.2024.102671
Kevin Fang MD MPH, Adriana Hernandez MD, Trinh Ha BS, Hanna Song PhD
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