Academic Pediatrics最新文献

Objective: Families with young children have regular, frequent interactions with pediatric primary care across early childhood. Thus, pediatric primary care is an ideal setting to prevent mental and behavioral health disorders through supporting access to behavioral healthcare services. Exploring the barriers families with young children face in accessing behavioral healthcare services will support insights into potential strategies to improve access through primary care settings.

Methods: Semi-structured qualitative interviews were used to explore the perspectives of 27 caregivers of young children (i.e., ages 0-5 years) regarding access to behavioral healthcare. Participants were recruited from a large pediatric clinic affiliated with a pediatric residency program serving a high proportion of Medicaid-eligible families (>85%). Deductive and inductive methods were used to develop a codebook followed by content analysis to identify and characterize access barriers.

Results: Qualitative content analysis revealed several interconnected barriers families face accessing behavioral healthcare services for their young children. Barriers were organized into the categories of logistical, financial, and psychosocial. Logistical barriers included 1) childcare, 2) time, 3) transportation, and 4) employment-related issues. Financial barriers included 1) inadequate insurance coverage, and 2) broader financial constraints. Psychosocial barriers included 1) education and understanding of behavioral health issues, 2) anxiety or shame, 3) judgment, and 4) mistrust of healthcare providers.

Conclusions: Improving access to behavioral healthcare services through pediatric primary care settings will require a multifaceted approach that addresses logistical, financial, and psychosocial barriers. Solutions should consider systemic and individual factors, promote behavioral health education, and reduce stigma.

Introduction: Adverse childhood experiences (ACEs) are associated with poor mental health outcomes, yet little is known about discrepancies between adolescent and caregiver reports of ACE exposure. This study examines differences between adolescent self-reported and caregiver-reported ACEs and evaluates how reporting discrepancies are associated with depressive and anxiety symptoms among hospitalized adolescents.

Methods: We recruited 250 adolescent-caregiver dyads from an inpatient adolescent unit in Bronx County, New York. Adolescents and caregivers independently completed ACE questionnaires, assessing traditional (e.g., abuse, neglect) and non-traditional (e.g., community violence, discrimination) ACEs experienced by the adolescent. Adolescent self-reported depression and anxiety was measured using the Patient Health Questionnaire Modified for Adolescents (PHQ-9A) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Descriptive statistics and Pearson correlations were used to analyze the data.

Results: Adolescents reported higher mean ACE scores than caregivers for both traditional (1.66 vs. 1.24, p < 0.001) and non-traditional (1.36 vs. 0.89, p < 0.001) ACEs. Discrepancies in reporting were positively correlated with adolescent depression (r = 0.357, p < 0.001) and anxiety (r = 0.241, p < 0.001). Gender-diverse adolescents reported the highest ACE scores, and larger score differences were noted among Hispanic and mixed-race dyads.

Discussion: These findings highlight discrepancies between adolescent and caregiver reports of adolescent adversity and underscore the importance of adolescent self-report in clinical assessment. Future research should focus on evaluating interventions that support caregiver awareness, particularly in diverse populations.

Introduction: Family engagement is a priority for improving health care systems for children and youth with special healthcare needs (CYSHCN). The science of family engagement is evolving, and better understanding of the current state of research could promote improved implementation. This scoping review aimed to summarize the literature on family engagement in systems-level research for families of CYSHCN, specifically focusing on definitions/descriptions of engagement, engagement measurement, and whether and how measures correlated with outcomes.

Methods: This scoping review followed the JBI Manual for Evidence Synthesis and PRISMA-ScR guidelines. We searched MEDLINE, Embase, Web of Science and Cochrane CENTRAL, and ClinicalTrials.gov to identify studies involving family engagement in systems-level research for CYSHCN. Abstracts and selected articles were screened and family engagement related data was extracted for included articles.

Results: From 2,123 unique articles, 403 received full text review, and 50 articles met inclusion criteria. The number of included articles grew over time from 1 prior to 2000 to 27 after 2020. Family members, predominantly parents and caregivers, were involved in various research roles, with most studies having families involved in many aspects of the project. Specific roles included participation in study design, intervention delivery, implementation, and dissemination. Few studies (3) used formal measures of engagement limiting our ability to describe how engagement changed systems of care.

Conclusions: Descriptions of family engagement are varied and very few studies use measures of engagement. As the literature grows, future studies should focus on standardized and transparent reporting about engagement, including using tools to measure engagement. This review was registered on Open Science Forum at https://doi.org/10.17605/OSF.IO/Q6CN3.

Every year, one in ten children are born premature in the United States. Although survival rates for children born premature have improved, health and educational disparities remain persistent across their lifetime compared to full term peers. Recent attention has been given to the promotion of health and development for children born premature through high-risk follow up programs. However, there remains limited guidance in primary care and, in particular, guidance with an emphasis on health equity - an even more important focus given the often heightened medical and social needs of children born premature and their families. Grounded in recent, best practice recommendations, we propose a health equity-driven framework of follow-up care for the child born premature that is strengthened by a whole child, whole family approach via primary care. We describe five health equity-based best practices: family partnership, care coordination, trauma-informed care, anti-racism, and social justice. Supported by these best practices, we then describe four key topics in primary care health supervision for the child born premature: medical needs, development, social drivers of health, and family mental health.

Background: In-home allergen exposures are a critical driver of pediatric asthma burden and disparities by race and class.

Objective: We aimed to evaluate the association between tenant-reported in-home asthma triggers and pediatric emergency department (ED) asthma visits at the neighborhood level.

Methods: We conducted a retrospective cohort study of 3,209 patients under the age of 26 with 5,290 asthma-related Boston Children's Hospital ED visits between January 1, 2018 - December 31, 2019, from residential addresses in Boston area. 8,230 reports of in-home asthma triggers to the City of Boston's Inspectional Services Department between 2017 and 2019 were included. Administered medications were available from the electronic health record for a subset of patients.

Results: ED visits were significantly higher in neighborhoods with more asthma trigger reports before and after adjusting for neighborhood characteristics (IRR per IQR, 1.33; 95% CI, 1.25-1.40; adjusted IRR per IQR, 1.18; 95% CI, 1.08-1.27).

Conclusion: Pediatric asthma ED utilization rates are significantly higher in neighborhoods with higher rates of tenant reports of in-home asthma triggers.

Background: Impostor Phenomenon is prevalent, linked to physician burnout, and disproportionately affects women. Data in pediatric residents are limited, and its relationship to performance is unclear.

Methods: Four items from the Clance Impostor Phenomenon Scale were added to the 2024 Pediatric Resident Burnout-Resilience Study Consortium's survey. Responses were linked to Accreditation Council for Graduate Medical Education Milestones. Linear mixed models examined associations of demographics, burnout, resilience, and stress with impostorism. A cubic polynomial mixed model assessed unadjusted and adjusted relationships between impostorism and Milestones.

Results: 736 residents responded (response rate = 49.8%) from 25 programs. Mean impostor phenomenon score was 3.09±0.97 (1=low; 5=high): 17% "minimal", 36% "moderate," 31.4% "frequent," and 15.4% "intense" impostorism. Adjusted analyses showed no significant associations of impostorism with most demographics. Residents with gender identities other than binary reported significantly higher impostorism. impostor phenomenon was associated with lower resiliency and higher stress/burnout. While unadjusted models showed marginally lower Milestones with higher impostorism, adjusted models found no significant associations.

Conclusions: Impostor phenomenon is common in pediatric residents. No relationship with female identity was found, but residents identifying other than binary gender reported significantly higher impostorism. Educators should reassure residents experiencing impostorism that these feelings are not reflective of competence.

Objectives: Evaluate the effect of a novel multimodal educational intervention on Pediatric Hospital Medicine (PHM) attendings' skills, knowledge, attitudes, and self-reported behaviors toward shared decision making (SDM).

Methods: We conducted a prospective single center study of PHM attending physicians. Attendings participated in three SDM educational interventions: an asynchronous online module, a one-hour lecture on patient decision aids, and a 2-hour interactive workshop. Outcomes were measured pre- and post-intervention for comparison. The primary outcome was attending SDM skills measured in a simulated encounter with a standardized patient and scored by trained, blinded raters using the OPTION 5 scale. Secondary outcomes were measured by questionnaire and included: knowledge, attitudes towards SDM, and self-reported behaviors measured by the SDM-9-doc based on a case scenario. Paired analyses were conducted using Wilcoxon matched-pairs signed rank test and McNemar's chi-squared exact method to evaluate for statistically significant differences (p < 0.05) in pre- vs. post-intervention period.

Results: Of 62 attendings approached, 21 participated in the study. Attending OPTION 5 scores improved from a pre-intervention median of 37.5 (IQR 34.4, 42.5) to 47.5 (IQR 40.0, 57.5) post-intervention (p≤0.04). SDM knowledge improved but there were no statistically significant changes in attitudes; baseline attitudes were favorable towards SDM (range: 52-95%). Self-reported behaviors significantly increased for seeking patients' desired involvement in decision-making (p=0.03) but other behavioral outcomes did not differ significantly.

Conclusion: While PHM attendings had favorable attitudes toward SDM at baseline, a multimodal educational intervention for teaching PHM faculty was effective to increase SDM knowledge and observed skills.