Academic Pediatrics最新文献_第3页

Incorporating Maternal Blood Pressure Screening Into Routine Newborn Clinic Visits 将产妇血压筛查纳入新生儿常规门诊。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.07.004

Amanda Krauss MD , Julia Pantalone MD , Adriana Phillips MD , Gysella B. Muniz MD , Jacqueline Saladino MD , Malamo Countouris MD, MS , Alisse Hauspurg MD, MS

引用次数: 0

An Update on Pediatric Environmental Health Specialty Units: Activities and Impacts, 2015–19 儿科环境健康专科的最新情况：2015-2019 年的活动和影响。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.03.009

Objective

Pediatric Environmental Health Specialty Units (PEHSUs) address health concerns impacting children and their families related to environmental hazards by providing consultation and education to families, communities, and health care professionals. This analysis evaluated the productivity of the national PEHSU program.

Methods

PEHSUs reported data on services provided to US communities between October 1, 2014 and September 30, 2019. Descriptive statistics and qualitative analysis are presented.

Results

During this period, 6102 consultations and 4644 educational outreach activities were recorded. PEHSU faculty and staff published 462 articles, reviews, book chapters, fact sheets, commentaries, short informational pieces, and other materials between 2014 and 2019. These included 190 articles in scientific peer-reviewed journals and 29 textbook chapters to increase professional capacity in pediatric and reproductive environmental health. Lead, other metals, substances of abuse, pesticides, mold, and air pollution were frequently reported as agents of concern and educational topics. Requests for an overview of pediatric environmental health and outdoor pollutants were other frequently reported topics.

Conclusions

PEHSUs work to decrease harmful exposures and improve children’s health. They serve as expert resources for families, health care professionals, and communities on health effects related to environmental exposures. Data show the breadth and depth of concerns addressed and demonstrate the productivity and impact of this national program.

简介：儿科环境健康专业组（PEHSU）通过向家庭、社区和医疗保健专业人员提供咨询和教育，解决与环境危害有关的影响儿童及其家庭健康的问题。这项分析评估了全国 PEHSU 计划的生产力：PEHSU 报告了 2014 年 10 月 1 日至 2019 年 9 月 30 日期间为美国社区提供的服务数据。本文介绍了描述性统计和定性分析：在此期间，共记录了 6102 次咨询和 4644 次教育推广活动。2014-2019 年间，PEHSU 的教职员工发表了 462 篇文章、评论、书籍章节、概况介绍、评论、信息短文和其他材料。其中包括在科学同行评审期刊上发表的 190 篇文章和 29 篇教科书章节，以提高儿科和生殖环境健康方面的专业能力。铅、其他金属、滥用物质、杀虫剂、霉菌和空气污染经常被报告为引起关注的物质和教育主题。儿科环境健康概述和室外污染物是其他经常报告的主题：PEHSU 致力于减少有害接触并改善儿童健康。他们为家庭、医疗保健专业人员和社区提供专家资源，帮助他们了解与环境暴露有关的健康影响。数据显示了所解决的问题的广度和深度，并证明了这一全国性计划的生产力和影响力。新内容：与前十年相比，2015-2019 年，儿科环境健康专业组（PEHSUs）的年均生产力翻了一番，具体以咨询和培训活动的数量来衡量。儿科环境卫生专科病房仍然是医疗保健专业人员和社区的重要资源。

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引用次数: 0

Prioritizing Health Literacy Educational Objectives for Pediatric Residents – A Delphi Study 儿科住院医师健康素养教育目标的优先排序--德尔菲研究。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.06.014

Objective

Children of caregivers with limited health literacy are at risk of poorer health outcomes. Thus, health literacy-informed communication tools are critical to achieving a more equitable health system. However, there is no agreement on the health literacy skills pediatric residents should attain. We used Delphi methodology to establish consensus on health literacy objectives to inform development of a pediatric resident curriculum.

Methods

Our Delphi panel participated in three rounds of anonymous surveys to rank the importance of health literacy objectives in pediatric resident education. Consensus was defined as ≥70% of panelists identifying an objective as essential or 100% agreeing an objective was recommended or essential.

Results

Thirteen pediatric health literacy experts comprised a racially, geographically, and professionally-diverse panel. After three survey rounds, 27 of the initial 65 objectives met consensus. All final objectives aligned with Accreditation Council for Graduate Medical Education (ACGME) core competencies.

Conclusions

A panel of pediatric health literacy experts established consensus on health literacy objectives specific to pediatric resident training. These prioritized objectives align with ACGME core competencies, as well as evidence-based strategies like teach-back, and newer considerations like addressing organizational health literacy. They should inform future health literacy curricula and assessment within pediatric residency programs.

目的健康素养有限的照顾者的子女面临着健康状况较差的风险。因此，以健康素养为基础的沟通工具对于建立一个更加公平的医疗体系至关重要。然而，关于儿科住院医师应具备的健康素养技能，目前还没有达成一致意见。我们采用德尔菲法就健康素养目标达成共识，为儿科住院医师课程的开发提供参考：我们的德尔菲小组参与了三轮匿名调查，对儿科住院医师教育中健康素养目标的重要性进行排序。达成共识的定义是：≥70%的小组成员认为某项目标是必要的，或100%的小组成员同意某项目标是推荐的或必要的：13 位儿科健康素养专家组成了一个种族、地域和专业多元化的小组。经过三轮调查，最初的 65 项目标中有 27 项达成了共识。所有最终目标均符合美国毕业医学教育认证委员会（ACGME）的核心能力要求：儿科健康素养专家小组就儿科住院医师培训的健康素养目标达成了共识。这些优先目标符合 ACGME 的核心能力，也符合循证策略（如回教）和新的考虑因素（如解决组织健康素养问题）。它们将为未来儿科住院医师培训项目中的健康素养课程和评估提供参考。

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引用次数: 0

Pediatric Primary Care of Children With Intrauterine Opioid Exposure: Survey of Academic Teaching Practices 宫内阿片类药物暴露儿童的儿科初级保健：学术教学实践调查。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.06.007

Objective

Intrauterine opioid exposure (IOE) has increased over the last 2 decades and is associated with additional needs after birth. To date, no clinical guidelines address the primary care of children with IOE. We aimed to characterize clinician-reported screening and referral practices, barriers to effective primary care for children with IOE, and clinician- and practice-level characteristics associated with perceived barriers.

Methods

We conducted a cross-sectional survey of pediatric residents, pediatricians, and advanced practitioners at 28 primary care clinics affiliated with 7 pediatric residency programs (April–June 2022). We assessed screening and other clinical practices related to IOE and perceived barriers to addressing parental opioid use disorder (OUD). We used descriptive statistics to analyze survey responses, assessed the distribution of reported barriers, and applied a 2-stage cluster analysis to assess response patterns.

Results

Of 1004 invited clinicians, 329 (32.8%) responses were returned, and 325 pediatric residents and pediatricians were included in the final analytic sample. Almost all (99.3%) reported parental substance use screening as important, but only 11.6% screened routinely. Half of the respondents routinely refer children with IOE to early intervention services and social work. Lack of standard screening for substance use was the most frequently selected barrier to addressing parental OUD. Participants reporting fewer barriers to addressing parental OUD identified having greater access to OUD treatment programs and home visiting programs.

Conclusions

Pediatricians report variations in primary care screenings and referrals for children with IOE. Access to parental OUD treatment programs may mitigate perceived barriers to addressing parental OUD in the pediatric office.

背景和目标：宫内阿片类药物暴露（IOE）在过去二十年中有所增加，并与出生后的额外需求有关。迄今为止，尚无针对宫内阿片类药物暴露儿童初级保健的临床指南。我们旨在了解临床医生报告的筛查和转诊做法、对 IOE 患儿进行有效初级保健的障碍以及与感知障碍相关的临床医生和实践层面的特征：我们对 7 个儿科住院医师培训项目下属的 28 家初级保健诊所的儿科住院医师、儿科医生和高级医师进行了横断面调查（2022 年 4 月至 6 月）。我们评估了与 IOE 相关的筛查和其他临床实践，以及解决父母阿片类药物使用障碍 (OUD) 的认知障碍。我们使用描述性统计来分析调查回复，评估所报告障碍的分布情况，并采用两阶段聚类分析来评估回复模式：在受邀的 1004 名临床医生中，有 329 名（32.8%）回复了调查问卷，其中 325 名儿科住院医师和儿科医生被纳入最终分析样本。几乎所有受访者（99.3%）都表示父母药物使用筛查很重要，但只有 11.6% 的受访者会进行常规筛查。半数受访者会定期将患有 IOE 的儿童转介至早期干预服务和社会工作机构。缺乏标准的药物使用筛查是解决父母药物滥用问题最常见的障碍。报告在解决父母药物滥用问题方面障碍较少的参与者认为，他们有更多机会接触药物滥用治疗项目和家访项目：结论：儿科医生报告称，在对患有 IOE 的儿童进行初级保健筛查和转诊方面存在差异。在儿科门诊中，获得父母药物依赖治疗项目可能会减少解决父母药物依赖问题的障碍。

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引用次数: 0

Using Electronic Health Records to Identify Asthma-Related Acute Care Encounters 使用电子健康记录识别与哮喘相关的急性护理就诊。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.05.003

Objective

Leveraging “big data” to improve care requires that clinical concepts be operationalized using available data. Electronic health record (EHR) data can be used to evaluate asthma care, but relying solely on diagnosis codes may misclassify asthma-related encounters. We created streamlined, feasible and transparent prototype algorithms for EHR data to classify emergency department (ED) encounters and hospitalizations as “asthma-related.”

Methods

As part of an asthma program evaluation, expert clinicians conducted a multi-phase iterative chart review to evaluate 467 pediatric ED encounters and 136 hospitalizations with asthma diagnosis codes from calendar years 2017 and 2019, rating the likelihood that each encounter was actually asthma-related. Using this as a reference standard, we developed rule-based algorithms for EHR data to classify visits. Accuracy was evaluated using sensitivity, specificity, and positive and negative predictive values (PPV, NPV).

Results

Clinicians categorized 38% of ED encounters as “definitely” or “probably” asthma-related; 13% as “possibly” asthma-related; and 49% as “probably not” or “definitely not” related to asthma. Based on this reference standard, we created two rule-based algorithms to identify “definitely” or “probably” asthma-related encounters, one using text and non-text EHR fields and another using non-text fields only. Sensitivity, specificity, PPV, and NPV were >95% for the algorithm using text and non-text fields and >87% for the algorithm using only non-text fields compared to the reference standard. We created a two-rule algorithm to identify asthma-related hospitalizations using only non-text fields.

Conclusions

Diagnostic codes alone are insufficient to identify asthma-related visits, but EHR-based prototype algorithms that include additional methods of identification can predict clinician-identified visits with sufficient accuracy.

背景：利用 "大数据 "改善护理需要利用现有数据对临床概念进行操作。电子健康记录（EHR）数据可用于评估哮喘护理，但仅靠诊断代码可能会误诊哮喘相关病例：我们为电子病历数据创建了简化、可行且透明的原型算法，将急诊科（ED）就诊和住院归类为 "哮喘相关"：作为哮喘项目评估的一部分，专家临床医生进行了多阶段迭代病历审查，以评估 2017 和 2019 日历年度的 467 次儿科急诊就诊和 136 次住院治疗，并对每次就诊与哮喘相关的可能性进行评级。以此为参考标准，我们为电子病历数据开发了基于规则的算法来对就诊进行分类。使用灵敏度、特异性以及阳性和阴性预测值（PPV、NPV）对准确性进行评估：临床医生将 38% 的急诊就诊归类为 "肯定 "或 "可能 "与哮喘有关；13% 归类为 "可能 "与哮喘有关；49% 归类为 "可能与哮喘无关 "或 "肯定无关"。根据这一参考标准，我们创建了两种基于规则的算法来识别 "肯定 "或 "可能 "与哮喘相关的就诊，一种算法使用文本和非文本 EHR 字段，另一种算法仅使用非文本字段。与参考标准相比，使用文本和非文本字段的算法灵敏度、特异性、PPV 和 NPV 均大于 95%，仅使用非文本字段的算法灵敏度、特异性、PPV 和 NPV 均大于 87%。我们创建了一种双规则算法，仅使用非文本字段来识别哮喘相关的住院治疗：结论：仅靠诊断代码不足以识别哮喘相关就诊，但基于电子病历的原型算法包含了额外的识别方法，可以足够准确地预测临床医生识别的就诊。

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引用次数: 0

Pediatric Health and System Impacts of Mass Incarceration, 2009–2020: A Matched Cohort Study 2009-2020 年大规模监禁对儿科健康和系统的影响：匹配队列研究》。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.05.010

Objective

The US has the highest incarceration rate in the world; incarceration’s direct and indirect toll on the health and health care use of youth is rarely investigated. We sought to compare the health of youth with known personal or family justice involvement and a matched cohort of youth without known personal/family justice involvement.

Methods

A cross-sectional matched parallel cohort study was conducted. We queried electronic health records on youth (<21 years) with a visit in a large Midwestern pediatric hospital-based institution from January 2009 to December 2020. Youth were located by searching for justice-related (eg, prison, jail) keywords within all clinician notes. Health diagnostic profiles were measured using ICD 9/10 codes. Health care use included total admissions, inpatient days, emergent and urgent visits, and outpatient visits.

Results

Across all youth at one institution over an 11-year period, 2.2% (N = 38,263) were identified as having probable personal or family justice-involvement. Youth with personal or familial justice involvement had 1.5–16.2 times the prevalence of mental health and physical health diagnoses across all domain groupings compared to a matched sample and the total population sample. From 2009–2020, approximately two-thirds of behavioral health care and nearly a quarter of all hospital inpatient days were attributed to the 2.2% of youth with probable personal or familial justice system involvement.

Conclusion

The study illuminates the vast disparities between youth with indirect or direct contact with the criminal legal system and matched youth with no documented contact. Better investment in monitoring and prevention efforts are needed.

目的：美国是世界上监禁率最高的国家，而监禁对青少年健康和医疗保健使用的直接和间接影响却鲜有研究。我们试图比较已知有个人或家庭司法参与的青少年与没有已知个人/家庭司法参与的匹配青少年的健康状况：我们进行了一项横断面匹配平行队列研究。我们查询了 2009 年 1 月至 2020 年 12 月期间在中西部一家大型儿科医院就诊的青少年（小于 21 岁）的电子健康记录。通过在所有临床医生记录中搜索与司法相关（如监狱、牢房）的关键词，我们找到了这些青少年。使用 ICD 9/10 编码测量健康诊断概况。医疗保健使用情况包括入院总天数、住院天数、急诊和紧急就诊天数以及门诊就诊天数：在一家机构 11 年间的所有青少年中，2.2%（N=38,263）的青少年被认定可能涉及个人或家庭司法问题。与匹配样本和总人口样本相比，在所有领域分组中，有个人或家庭司法参与的青少年的心理健康和身体健康诊断率是匹配样本和总人口样本的1.5-16.2倍。从 2009 年到 2020 年，约三分之二的行为医疗服务和近四分之一的住院天数是由 2.2%的可能涉及个人或家庭司法系统的青少年造成的：这项研究揭示了与刑事法律系统有间接或直接接触的青少年与没有接触记录的匹配青少年之间的巨大差异。我们需要对监测和预防工作进行更好的投资。

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引用次数: 0

Development and Validation of a Trauma-Informed Care Communication Skills Assessment Tool 创伤知情护理沟通技能评估工具的开发与验证。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.07.008

Christine K. Thang MD , Samantha Kucaj PsyD , Cambria L. Garell MD , Kiran M. Masood MD , Aaron W. Calhoun MD , Ken Lay MA , James Lee MD , Holly Wilhalme MS , Moira A. Szilagyi MD, PhD

Background

Trauma-informed care (TIC) is growing in medical education as health care systems recognize trauma’s impact on health outcomes. TIC acknowledges and responds to the effects of trauma on physical, psychological, and emotional health. As TIC trainings are developed and delivered to health care professionals across the learner continuum, curricula need evaluation beyond learner satisfaction and knowledge to better assess changes in skills. We developed the Gap Kalamazoo Communication Skills Assessment Form for Trauma-Informed Care (GKCSAF-TIC) to evaluate pediatric trainees' communication skills in TIC. We describe the development and validity evidence of the GKCSAF-TIC in assessing pediatric residents' TIC skills during standardized patient encounters.

Methods

We developed and implemented the TIC communication skills assessment tool in a one-year prospective cohort study involving pediatric residents. We conducted simulated patient encounters conducted before and after TIC training, with two pediatric faculty attendings assessing each encounter. We gathered validity evidence using Messick’s framework, focusing on content, response process, internal structure, and relationship with other variables.

Results

We analyzed 57 standardized patient encounters with 33 pediatric interns, including 23 pre-post matched pairs. The development process and rater training supported content and response process validity. Internal consistency, measured by Cronbach’s alpha, ranged from 0.93 to 0.96, while inter-rater reliability, measured by intraclass correlations, ranged from 0.80 to 0.83. There was a significant improvement in scores from pre-training to post-training (3.7/5 to 4.05/5; P < 0.05).

Conclusion

The GKCSAF-TIC demonstrated strong preliminary validity and offers educators a valuable means to assess and provide formative feedback to pediatric trainees about TIC.

背景：随着医疗保健系统认识到创伤对健康结果的影响，创伤知情护理（TIC）在医学教育中不断发展。TIC 承认并应对创伤对身体、心理和情感健康的影响。随着 TIC 培训的开发和向医疗保健专业人员提供跨学习者连续性的培训，课程需要评估的不仅仅是学习者的满意度和知识，还需要更好地评估技能的变化。我们开发了用于创伤知情护理的差距卡拉马祖沟通技能评估表（GKCSAF-TIC），用于评估儿科受训人员在创伤知情护理中的沟通技能：描述 GKCSAF-TIC 在评估儿科住院医师在与标准化病人接触时的 TIC 技能方面的发展和有效性证据：我们在一项为期一年的儿科住院医师前瞻性队列研究中开发并实施了TIC沟通技能评估工具。我们在 TIC 培训前后进行了模拟患者接触，每次接触都由两名儿科主治医师进行评估。我们采用梅西克的框架收集有效性证据，重点关注内容、反应过程、内部结构以及与其他变量的关系：我们分析了 33 名儿科实习生的 57 次标准化病人会诊，其中包括 23 对前后配对。开发过程和评分者培训支持内容和反应过程的有效性。用克朗巴赫α衡量的内部一致性为 0.93 至 0.96，而用类内相关性衡量的评分者间可靠性为 0.80 至 0.83。从培训前到培训后，评分有了明显的提高（3.7/5 到 4.05/5；P < 0.05）：GKCSAF-TIC显示出很强的初步有效性，为教育者提供了一种评估儿科学员TIC并为其提供形成性反馈的重要方法。新内容儿科受训人员正在学习创伤知情护理，他们在临床环境中的创伤知情护理实践需要形成性反馈。GKCSAF-TIC 可用于评估受训人员在提供创伤知情护理时的沟通技巧，并为其提供形成性反馈。

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引用次数: 0

Budding Doctors and Root Causes 崭露头角的医生和根本原因。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.03.010

引用次数: 0

Neighborhood-Level Social Determinants of Health and Adolescent Mental Health 邻里层面的健康与青少年心理健康的社会决定因素。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.08.008

Sarah Oyegoke BS , Phillip M. Hughes MS , Kristin H. Gigli PhD, APRN, CPNP-AC

Objective

Mental health diagnoses among adolescents are increasing in prevalence. Existing literature considers associations between individual-level social determinants of health (SDOH) and adolescent mental health. Neighborhood-level SDOH can have a substantial impact on health. This paper examines associations between neighborhood-level SDOH and mental health diagnoses of anxiety, depression, and suicidal ideation among hospitalized adolescents.

Methods

We used 2018 and 2019 Texas Inpatient Discharge Public Use Data Files linked to the zip-code level Child Opportunity Index 2.0, a composite measure of subdomains which characterize neighborhood-level SDOH, to examine rates of mental health diagnoses and associations with patient characteristics across opportunity level quintiles.

Results

The sample included 50,011 adolescents ages 10–19 admitted to the hospital with the mental health diagnoses anxiety, depression, and/or suicide. Most had a single diagnosis; anxiety (12.9%), depression (37.5%), or suicide (13.0%). Hospitalized adolescents 10–14 years old were a plurality (44.2%) of the sample. Most adolescents were White (64.2%) and non-Hispanic (67.4%) and lived in rural areas (29.6%). Adolescents from racial minority populations and those in rural communities with mental health diagnoses had lower opportunity-levels. Higher opportunity levels were associated with greater odds of having an anxiety or suicide diagnosis while a depression diagnosis was associated with a lower opportunity-level.

Conclusions

There are significant differences in adolescent mental health diagnoses associated with neighborhood opportunity-level. While all adolescents can benefit from mental health education, screening, and early interventions, additional resources tailored to neighborhood-level opportunity may prove a more meaningful way to improve population-level mental health outcomes.

目的：青少年心理健康诊断的发病率正在上升。现有文献考虑了个人层面的健康社会决定因素（SDOH）与青少年心理健康之间的关联。然而，邻里层面的 SDOH 也会对健康产生重大影响。本文研究了住院青少年中邻里层面的 SDOH 与焦虑、抑郁和自杀意念等心理健康诊断之间的关联：我们使用了 2018 年和 2019 年德克萨斯州住院病人出院公共使用数据文件，并将其与邮政编码级别的儿童机会指数 2.0 相链接，后者是描述邻里级别 SDOH 的子域的综合测量方法，用于研究不同机会级别五分位数的心理健康诊断率以及与患者特征之间的关联：样本包括 50,011 名 10-19 岁入院并被诊断为焦虑、抑郁和/或自杀的青少年。大多数人只有一种诊断：焦虑（12.9%）、抑郁（37.5%）或自杀（13.0%）。在样本中，住院的 10 至 14 岁青少年占大多数（44.2%）。大多数青少年为白人（64.2%）和非西班牙裔（67.4%），居住在农村地区（29.6%）。来自少数种族群体和农村社区的青少年被诊断出患有精神疾病的机会水平较低。较高的机会水平与较高的焦虑或自杀诊断几率有关，而抑郁症诊断则与较低的机会水平有关：结论：青少年心理健康诊断与邻里机会水平存在明显差异。虽然所有青少年都能从心理健康教育、筛查和早期干预中受益，但针对社区机会水平的额外资源可能会被证明是改善人群心理健康结果的更有意义的方法。

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引用次数: 0

Positive Outliers: A Mixed Methods Study of Resiliency to Childhood Obesity in High-Risk Neighborhoods 积极的异常值：高风险社区儿童肥胖复原力的混合方法研究。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.03.011

Objective

Despite the high prevalence of obesity and the clustering of risk by neighborhood, few studies have examined characteristics which promote healthy child weight in neighborhoods with high obesity risk. We aimed to identify protective factors for children living in neighborhoods with high obesity risk.

Methods

We identified neighborhoods with high obesity risk using geolocated electronic health record data with measured body mass index (BMI) from well-child visits (2012–2017). We then recruited caregivers with children aged 5 to 13 years who lived in census tracts with mean child BMI percentile ≥72 (February 2020–August 2021). We used sequential mixed methods (quantitative surveys, qualitative interviews) to compare individual, interpersonal, and perceived neighborhood factors among families with children at a healthy weight (positive outliers [PO]) versus families with ≥1 child with overweight or obesity (controls). Regression models and comparative qualitative analysis were used to identify protective characteristics.

Results

Seventy-three caregivers participated in the quantitative phase (41% PO; 34% preferred Spanish) and twenty in the qualitative phase (50% PO; 50% preferred Spanish). The frequency of healthy caregiver behaviors was associated with being a PO (Family Health Behavior Scale Parent Score adjusted β 3.67; 95% CI 0.52–6.81 and qualitative data). Protective factors also included caregivers’ ability to minimize the negative health influences of family members and adhere to family routines.

Conclusions

There were few differences between PO and control families. Support for caregiver healthy habits and adherence to healthy family routines emerged as opportunities for childhood obesity prevention in neighborhoods with high obesity risk.

目的：尽管肥胖症的发病率很高，而且肥胖症的风险因社区而异，但很少有研究探讨在肥胖症高风险社区中促进儿童健康体重的特征。我们的目的是找出生活在肥胖高风险社区的儿童的保护因素：我们利用地理定位的电子健康记录数据和儿童健康检查（2012-2017 年）中测量的体重指数 (BMI)，确定了肥胖高风险社区。然后，我们招募了有 5-13 岁儿童的看护人，他们居住在儿童平均 BMI 百分位数大于 72 的人口普查区（2020 年 2 月至 2021 年 8 月）。我们采用连续的混合方法（定量调查、定性访谈），比较有健康体重儿童的家庭（正离群值，PO）与有≥1 名超重或肥胖儿童的家庭（对照组）的个人、人际和感知的邻里因素。采用回归模型和比较定性分析来确定保护性特征：73名照顾者参与了定量阶段（41%为PO；34%喜欢西班牙语），20名照顾者参与了定性阶段（50%为PO；50%喜欢西班牙语）。照顾者的健康行为频率与成为 PO 相关（家庭健康行为量表家长评分调整 β 3.67；95% CI 0.52-6.81 和定性数据）。保护性因素还包括照顾者尽量减少家庭成员对健康的负面影响和遵守家庭常规的能力：PO 家庭与对照家庭之间几乎没有差异。新发现：在儿童肥胖高风险社区，有健康体重儿童的家庭和有超重/肥胖儿童的家庭在行为和社会方面都很相似。在儿童所处的环境中，父母对健康行为的示范和支持可促进儿童体重健康。

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引用次数: 0