Academic Pediatrics最新文献

Purpose: To examine associations between childhood disability, its various types (physical, cognitive, emotional), and serious school discipline (suspensions/expulsions) in adolescence.

Methods: We conducted analyses of secondary data from the Future of Families & Child Wellbeing Study, a population-based urban birth cohort followed across six waves in 20 large US cities, to investigate associations between childhood disability and serious school discipline in adolescence. Disability status included disabling physical, cognitive, and emotional conditions reported by the child's mother between ages 1-9. Serious school discipline was measured at youth aged 15 as suspensions or expulsions in the past two years based on reports by the mother and the youth. Associations were examined using logistic regression models adjusting for confounding factors, presented as average marginal effects.

Results: Of the 2,504 adolescents in the analysis sample, one-third (33%) were identified as having a measurable disability and these youth were more likely to have experienced receiving serious school discipline, based on mother and youth reports. Adolescents with cognitive or emotional conditions had a significantly higher likelihood of receiving serious school discipline compared to those that did not have those conditions, while those with physical disability did not.

Conclusions: In this study of US urban youth, teens with cognitive or emotional conditions had a higher likelihood of experiencing serious school discipline, while youth with physical disability did not, suggesting that youth with less visible disability conditions are more likely to be penalized at school. These findings point to the urgent need for improved interventions for these youth.

Objective: Pediatricians are uniquely positioned to identify suicide-related risk, yet clinical practices as to when, how, and who gets screened may vary due to differences in policy statements on youth suicide risk screening in primary care. To address these differences, we examined agreement between reports of past suicide ideation (SI) and suicide attempt (SA) across multiple assessment methods and over time. We further explored associations across sociodemographic factors and severity of mental health symptoms on reporting patterns on these methods for adolescents at elevated risk.

Methods: Adolescents (N = 162) with SI and/or SA were recruited from multiple clinical sites in and around New York City. Adolescents completed interviews and self-report measures validated to assess suicide-related risk, depressive symptoms, and anxiety symptoms.

Results: Agreement between questions on verbal interviews over time was fair (κ = 0.38), with adolescents under-reporting lifetime SI as time from a crisis went by. Agreement between questions on self-report measures was moderate (κ = 0.51), with adolescents under-reporting past-month SI on a depression screen compared to a suicide-specific screen. Participants with less severe mental health-related symptoms were significantly less likely to report past-month SI consistently.

Conclusions: This study highlights important trends in suicide-related reporting patterns among adolescents at elevated risk for suicide and may have important implications for clinical practice guidelines. To capture more adolescents at risk for suicide, results not only support a universal screening approach using suicide-specific tools but may suggest the need to increase screening frequency in pediatric primary care.

Objective: This study aimed to identify the independent associations of positive childhood experiences (PCEs) on brain health (cognitive function, behavioral and emotional problems) among early adolescents.

Methods: Data from the two-year follow-up visit from the Adolescent Brain and Cognitive Development (ABCD) study were analyzed (N = 5449, mean age: 12.0 ± 0.7, age range = 10.6-13.4 years). Adverse childhood experiences (ACEs) were measured by parent report at baseline, and PCEs were measured by parent report at year 2. Dependent variables included cognitive function domains (NIH Toolbox) and the child behavior checklist (CBCL) subscales at year two. Multivariate linear regression analyses were performed for each dependent variable, with the number of PCEs and ACEs as independent variables, adjusting for age, sex, race/ethnicity, puberty stage, and family income.

Results: PCEs were associated with better cognitive function on tasks of picture vocabulary (b=0.29, 95% CI 0.15 to 0.43), flanker (b=0.14, 0.00 to 0.28), reading recognition (b=0.19, CI 0.08 to 0.31), and picture sequence memory (b=0.44, CI 0.21 to 0.67). The PCEs:ACEs interaction showed that greater PCEs predicted a weaker association of ACEs on the CBCL subscales: anxious-depressed (b=-0.06, -0.10 to -0.01), withdrawn (b=-0.06, -0.09 to -0.04), aggressive behavior (b=-0.11, -0.17 to -0.06), rule-breaking behaviors (b=-0.06, -0.09 to -0.04), social problems (b=-0.04, -0.07 to -0.01), somatic complaints (b=-0.03, -0.06 to 0.00), and total CBCL problems (b=-0.46, -0.69 to -0.23).

Conclusions: Exposure to PCEs supports cognition and is protective against psychopathology, even among children exposed to ACEs.

Background: Pediatric primary care providers are expected to deliver suicide prevention strategies that may include screening, assessment, intervention, and specialist referral. Training is often provided to increase knowledge and confidence, and to shape clinician behavior with suicide prevention activities. The effectiveness of suicide prevention training, specifically for pediatric primary care, has been minimally explored.

Objectives: The aim of this scoping review is to describe the current state of the literature on the acceptability and effectiveness of suicide prevention training in pediatric primary care settings.

Data sources: Medical librarian search included PubMed, Ovid Medline, APA PsycINFO (EBSCO), CINAHL (EBSCO), Embase (Elsevier), Google Scholar, and the Cochrane Library using MESH terms: adolescent, child, pediatrics, suicide prevention, depression, outpatient, primary care, and general practice.

Results: 4274 peer-reviewed studies were identified from databases and screened for inclusion. 62 studies were retrieved for full-text review. 16 articles met inclusion criteria. Results identified one randomized control trial of suicide prevention training.

Conclusions: Suicide prevention training appears to enhance the knowledge and confidence of pediatric primary care providers in the short term. However, further research is necessary to assess the impact of this training on provider behavior change and patient outcomes. This review provides an overview of the current landscape of research on suicide prevention training in pediatrics and offers recommendations for future investigators.

Background: Examination maneuvers used to diagnose developmental hip dysplasia (DDH) translate poorly to video and written curricula. This poses a challenge to teaching the infant hip exam to orthopedic, family medicine, and pediatric trainees. This work investigated the impact of the MiHip simulation-based training program on residents' knowledge, confidence, and exam skills in the simulated setting, and translation of these skills to the clinical setting.

Methods: Fifty-four pediatric (n=39) and family medicine (n=15) residents participated in a non-randomized, stepped-wedge study during 2-4 week newborn rotations. Residents participated in simulation-based training facilitated by a pediatric orthopedic surgeon. Prior to and following training, residents completed a 10-item quiz and reported their confidence toward their DDH skills. Residents' and attendings' hip exam diagnoses were captured on 1,063 newborns. Residents' knowledge, confidence, and DDH diagnosis sensitivity were compared pre- and post-training. Chart analysis of 21 newborns that underwent a hip ultrasound compared residents' and practicing physicians' diagnoses' agreement with ultrasound findings.

Results: Following training, residents' knowledge, confidence and diagnosis skills improved modestly, P<0.001. In the clinical setting, residents' confidence (P<0.001) and skill improved for residents with (sensitivity Δ=.29) and without (Δ =.18) previous simulation-based training experience. Resident diagnoses demonstrated higher agreement with hip ultrasounds than practicing primary care physicians, (M_trainee=88.9%, M_PCP=25.0%, P = 0.003, φ=.63).

Conclusion: The hands-on training with the MiHip simulator improved resident knowledge and DDH examination confidence, and ultimately, improved diagnostic accuracy in the clinical setting. Further work is required to assess the larger clinical impact on orthopedic referral rates.

Objective: To improve pediatric residents' skills in the diagnosis and treatment of children with ADHD by giving real-time feedback utilizing Bug-in-the-Ear technology (BIE).

Methods: This prospective, controlled study had 2 treatment groups and 3 standardized patient (SP) sessions. Session-1 was baseline. In Session-2, the intervention group (IG) received feedback via BIE and the control group (CG) received traditional feedback. Session-3 (3 months later) assessed maintenance of skills, and neither group used BIE. Sessions were recorded and scored by research assistants trained with a novel scoring system called the Clinical Practice Index (CPI). The CPI is an observational instrument based on current AAP ADHD guidelines and DSM-5 criteria for ADHD and was reviewed by content experts in ADHD. CPI scores were analyzed using Repeated Measures ANOVA.

Results: Twenty-five pediatric residents participated; 13 in the CG and 12 in the IG. Maximum obtainable CPI score was 44 points. The IG showed a significant increase in their CPI score from Session-1 to Session-3 (8.27, p<0.001). The CG's CPI scores from Session-1 to Session-3 did not change significantly (2.85, p=0.536). The IG and CG CPI scores were significantly different at Session-2 (11.7, p<0.001), but not Session-3 (5.03, p=0.1407).

Conclusion: Immediate feedback via BIE showed significant improvement in the IG's skills in Session-2 and the IG's mean difference between Session-1 and Session-3. One exposure of BIE was not sufficient for the IG to maintain their skills, and further research is warranted to determine the number of BIE exposures needed for greater maintenance of skills.

Background and objectives: Human trafficking (HT) is a public health issue, with adolescents disproportionately at risk for reasons spanning multiple biopsychosocial domains. We explored youth HT survivors' healthcare barriers, experiences, and needs.

Methods: In this qualitative multi-methods study, 24 participants (≤26 years old) with HT experience receiving services from non-profit organizations in San Diego, California completed an electronic survey and were invited to participate in online interviews. Thematic analysis for interview responses was performed using constant comparative methodology. Authors created codes and connections between codes, and refined findings by discussion.

Results: All participants endorsed labor trafficking, 96% endorsed sex trafficking and 46% reported seeing a health care professional (HCP) while exploited. Nine survey respondents completed follow-up interviews: 100% endorsed labor and sex trafficking and 44% seeing a HCP. Interview participants' barriers to presenting to healthcare and receiving needed help were categorized into patient-focused - lack of awareness of exploitation and medical needs, emotional bonds to the trafficker, and misperceptions about their ability to obtain care); vs healthcare system-focused - negative experiences and need for consistency with HCPs, and desire for targeted resources and effective care.

Conclusions: Barriers to healthcare for trafficked youth included factors the healthcare system could change versus those that could be reduced with universal patient education. Participants named lack of legal guardian support and proof of insurance as barriers to healthcare access while being exploited. Participants noted conventional mental health interventions for recovery are not appropriate and lack survivor-led guidance; participants offered alternatives about how they would receive effective care.