Academic Pediatrics最新文献

Academic Pediatrics has been the official journal of the Association of Pediatric Program Directors (APPD) since 2009. The View from the APPD section of the journal provides an important venue to highlight APPD members' scholarship regarding issues impacting residency and fellowship training. Since 2020, the annual commentary (Re)View from the APPD summarizes articles published in View over the past year including their alignment with overall APPD mission, values, and organizational priorities.^1-5 The APPD's mission is to ensure the health and well-being of all children and serve pediatric programs by leading: 1) the advancement of medical education; 2) the development of a diverse workforce; 3) the cultivation of an inclusive clinical learning environment; and 4) the promotion of educational innovation and research.⁶ The drafting of this year's annual commentary falls just prior to the Winter Olympics, a fitting time to reflect on the inspirational and meaningful efforts undertaken by some amazing athletes throughout the world and APPD members alike. Here is a review of 2025's outstanding performances showcasing APPD mission-aligned work published in the View!

Objectives: Although early identification of behavioral and mental health (B/MH) conditions is important, integration of B/MH screening in pediatric practices may be challenging. This study reports factors associated with B/MH standardized screening and characterizes barriers and facilitators to screening identified by primary care and subspecialty pediatricians who reported that they did not use standardized screening tools.

Methods: This cross-sectional, mixed methods study surveyed pediatricians who enrolled in the American Board of Pediatrics Maintenance of Certification program 01/012023-12/31/2023. Demographic and practice characteristics associated with B/MH screening were identified using multivariable logistic regression. Descriptive statistics were used to summarize prespecified survey responses and qualitative content analysis was used to examine free text responses describing barriers and facilitators.

Results: Of 5,003 pediatricians who met inclusion criteria, 1,026 (20.5%) reported not screening for B/MH conditions using standardized tools. Subspecialists were significantly less likely to report screening than general pediatricians (odds ratio [OR]=0.19, 95%CI:0.16-0.22). In adjusted analysis, older pediatricians (40-49 years: aOR=1.25,95%CI:1.01-1.55; ≥50 years: aOR=1.52, 95%CI:1.22-1.89) and those practicing in the West (aOR=1.27, 95%CI:1.02-1.58) reported higher odds of screening, while pediatricians in urban areas (inner-city: aOR=0.64, 95%CI:0.52-0.80; non-inner city: aOR=0.67,95%CI:0.54-0.82) and with academic appointments (aOR=0.73, 95%CI:0.61-0.88) reported lower odds of screening. Among those not utilizing standardized screening tools, the most commonly reported barriers were lack of practice prioritization and perceived responsibility, while the most common facilitator was designated staff to conduct screening.

Conclusions: Approximately one-in-five pediatricians reported that they did not perform standardized screening for B/MH conditions, describing several multi-level barriers which warrant targeted intervention.

Introduction: Parenting self-efficacy (PSE) is correlated with positive parenting and child outcomes, but may be reduced in stressful settings. Community factors affecting PSE are not well understood. The community of Flint, Michigan, endured significant stressors, including the Flint Water Crisis (FWC), and disproportionate effects of the COVID-19 pandemic. This study examines how these superimposed stressors affect PSE in families in Flint.

Methods: This study was a secondary, cross-sectional analysis of 291 infants and caregivers. Baseline surveys included sociodemographics, stress, and PSE. Primary predictors were FWC and COVID-19 distress. Primary outcome was PSE. Bivariate analyses were used to examine the association between FWC and COVID-19 distress with PSE, and multiple linear regression to control for sociodemographics.

Results: Both increased COVID-19 distress and FWC distress had significant inverse association with PSE in bivariate analyses, and predicted PSE (COVID-19 distress, β -.18, p <.01, and FWC distress, β -.18, p <.05) in multiple linear regression. A significant interaction was found between FWC distress and COVID-19 distress. Simple slope analyses indicated that COVID-19 distress predicted reduced PSE only for high FWC-distress group (β -.22, p <.01).

Discussion: Results show COVID-19 distress and FWC distress both had independent negative associations with PSE, but FWC distress moderated the effect of COVID-19 distress on PSE, indicating that families more affected by previous stressors were more vulnerable to the effects of COVID-19 distress, while those less affected were resilient to subsequent stressors. Future interventions should target disinvestment, prevent community stressors, and support exposed families.

Objectives: The reported prevalence of intracranial injuries (ICI) in asymptomatic infants undergoing physical abuse evaluations varies widely. To inform neuroimaging decisions, we sought to (1) describe ICI prevalence among asymptomatic infants evaluated for abuse, (2) assess the impact of different definitions of "asymptomatic" on ICI prevalence across different age groups and (3) assess whether hospital-level neuroimaging rates impact prevalence of identified ICI.

Methods: We conducted a cross-sectional study of infants <12 months without seizures or altered mental status (AMS) undergoing subspecialty evaluations for physical abuse from 02/2021 through 12/2022 within CAPNET, a multicenter child abuse research network. We report ICI prevalence among infants without seizures or AMS and across three subpopulations with progressively stricter definitions of "asymptomatic."

Results: Of 1947 infants without seizures or AMS, 1513 (77.7%) underwent neuroimaging. Of these infants, 13.7% had ICI. After excluding infants with signs of blunt head injury, ICI prevalence decreased to 5.4%. After additionally excluding infants with neurologic signs or symptoms, ICI prevalence was 5.0%. With additional exclusion of infants with non-specific symptoms, ICI prevalence was 4.7%.

Conclusions: ICI prevalence in asymptomatic infants depends upon the definition of "asymptomatic". When strictly defined, asymptomatic ICI occurs in approximately 1 in 21 infants undergoing evaluations for abuse. Among infants without signs of blunt head trauma, infants <6 months have higher risk of ICI compared to older infants.

Objective: Pediatric care management has the potential to streamline care delivery across fragmented child-serving sectors, but successfully engaging families is challenging. This study aimed to understand barriers and facilitators to family engagement from the perspectives of care managers in a pediatric integrated service delivery model for children with health and social needs.

Methods: Three virtual focus groups were conducted with care managers from North Carolina Integrated Care for Kids (NC InCK), a federal demonstration model to integrate cross-sector care for Medicaid-enrolled children under twenty-one years. The focus group questions were developed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Rapid qualitative analysis methods were used for analysis.

Results: Eleven care managers were included across three focus groups. Four themes emerged: 1) Rapport Building Strategies; 2) Simplifying Program Detail and Providing Information One Step at a Time; 3) Firewalls - Barriers in Technology and Information; and 4) Retention: One and Done. Care managers identified several barriers to engaging families, including effectively communicating the program's benefits, building trust via cold-calls, and facilitating long-term retention beyond an initial encounter. They revealed that rapport-building strategies could enhance family engagement by providing tangible resources early in the engagement and offering basic needs assistance to support the whole family, such as rent assistance.

Conclusion: This study illuminated barriers and facilitators to the family engagement process through the lens of care managers. Our findings support evidence to inform family engagement strategies for children with multi-sector needs, filling a gap in the pediatric care management literature.

Objective: Sepsis is a major cause of pediatric mortality that can be mitigated by early intervention. Residents are often the first physicians to assess septic patients and must both recognize sepsis and effectively communicate the diagnosis to the interprofessional team - achieving both individual and team situational awareness. To inform resident educational interventions that may improve clinical outcomes, we must first understand the drivers of current practice. We sought to assess differences in rates in pediatric resident recognition of sepsis on an individually completed questionnaire versus verbalization of a concern for sepsis to the interprofessional team during a virtual reality (VR) simulation. We additionally compared resident performance to providers with expertise in pediatric critical care or emergency medicine.

Methods: This retrospective observational cohort study is a secondary analysis of 68 VR simulations involving provider-nurse teams assessing and managing a pediatric patient with sepsis. Provider responses verbalizing a concern for sepsis during the simulation were compared to responses on an individual questionnaire asking for the diagnosis of concern.

Results: In our sample, residents (n=33) verbalized their concern for sepsis less frequently than experts (p=0.03) and verbalized that concern less frequently than their rate of endorsing a concern for sepsis on the questionnaire (p=0.004).

Discussion: These findings suggest that while pediatric residents recognize sepsis, barriers may persist to verbalizing that concern in the moment - hampering development of team level situational awareness. Educational curricula for residents targeting team communication skills may improve team level situation awareness and ultimately patient outcomes.