Academic Pediatrics最新文献

Objective: No assessment instrument with validity evidence exists to assess resident competence in communicating medical ambiguity. Here, validity evidence was collected for STATUS (Scalable Tolerating Ambiguity/Uncertainty Tool Utilizing Simulation).

Methods: Using avatar patients and two simulated cases, investigators created a guidebook and trained ten faculty in STATUS use. Pediatric residents completed two video-recorded simulated cases. Residents self-assessed tolerance for communicating medical ambiguity. Two faculty reviewed each video, assessing participants for communicating medical ambiguity. Validity evidence collected included: content, response process, internal structure, and relationship to other variables. Generalizability theory analysis was conducted to understand the assessment tools' reliability.

Results: Of 89 eligible residents, forty-three (48.3%) had sessions recorded. Eighty-six videos were analyzed. Faculty rater training increased inter-rater reliability by 0.34 units. The Φ-coefficient was 0.72 for the resident self-assessment tool and 0.26 for the faculty rater assessment tool. The decision study found that with 11 faculty raters and 11 scenarios, the Φ-coefficient would be 0.70. Resident self-assessment negatively associated faculty rater assessment with a Spearman correlation of -0.21 overall, indicating a possible weak correlation.

Conclusion: Results provide sufficient reliability to measure resident self-assessment of tolerance for communicating medical ambiguity. More scenarios would likely result in higher reliability for faculty assessment.

Objective: Early Head Start (EHS) supports early relational health (ERH) among low-income parent-child dyads through center-based and home-visiting services. Children born preterm and/or with functional impairments may benefit from these services due to unique developmental needs. We aimed to: 1) Describe child, family, and program characteristics among children born preterm or with functional impairment enrolled in EHS; 2) Investigate associations between prematurity and functional impairment and ERH outcomes; 3) Explore whether EHS programming modifies these associations.

Study design: We used data from the 2018 EHS Family and Child Experiences Study. We calculated descriptive characteristics of children stratified by prematurity and functional impairment. We used regression to study associations between these conditions and ERH while accounting for child and family characteristics and investigated interactions between these conditions and EHS program characteristics.

Results: Our sample included 2,084 children (10% preterm, 9% with ≥1 functional impairment). Compared to full term children, preterm children had lower social emotional competence (B -1.07, SE 0.40). Compared to those without, children with ≥1 functional impairment had lower parent-child relationship closeness (B -1.79, SE 0.69) and child social emotional competence (B -1.81, SE 0.52), and higher parent-child relationship conflict (B 1.76, SE 0.65) and child social emotional problem behaviors (B 2.31, SE 0.93). Communication/language skills were lower among preterm children receiving center-based compared to home-based EHS services (B -3.65, SE 1.76).

Conclusions: Medical/developmental conditions affect ERH among low-income dyads. Future studies should examine whether community-based services like EHS adequately support ERH among this population.

Objective: To engage caregivers of young children in a community health fair setting around interest in learning about firearm-related topics, including secure storage, and identify preferred sources, formats, and settings for receiving firearm safety information.

Methods: We surveyed 176 (63% firearm-owning) caregivers of young children attending "Pop-Up Safety Town", a clinic-community partnership designed to engage caregivers around injury prevention. Descriptive statistics, T-tests, 2-proportion z-tests, and repeated measures ANOVA were calculated to characterize preferences for learning about firearm safety topics, firearm-related beliefs, attitudes, and behaviors, and differences between firearm owners and non-owners.

Results: Overall, caregivers reported more interest in firearm safety strategies and other home defense options compared to secure storage; firearm-owning caregivers reported more interest in safe storage compared to non-owners. Across caregivers, firearm safety trainers and police officers were the most-preferred sources for learning about firearm safety. Caregivers endorsed email newsletters and short videos (e.g., YouTube/TikTok) as preferred formats for receiving firearm safety information. Schools were the preferred setting for all caregivers. Overall, firearm owners reported greater comfort discussing gun safety topics with children and adults compared to non-owners. Caregivers supported talking with other adults about gun safety and varied in beliefs about whether young children could find a gun if it was hidden or out of reach.

Conclusions: Findings suggest caregivers of young children are amenable to discussing firearm safety beyond the clinical setting. Employing trusted messengers of firearm safety information may complement existing clinic-based efforts to engage caregivers in discussions around secure storage.

Objective: To assess patient and family outcomes of psychological interventions provided by behavioral health clinicians (BHCs) integrated into community-based pediatric primary care practices. Little is known about the feasibility, acceptability, and effectiveness of this treatment strategy in real-world settings.

Methods: The sample comprised 5,487 patients in ∼80 practices who received psychological interventions from ∼100 integrated BHCs over two years. Patients of all ages identified by universal screening or verbal patient/family report as having a developmental or behavioral health (BH) problem of any kind were eligible for intervention. Post-intervention patient clinical improvement was assessed using a clinician-completed standardized clinical global impressions scale. Family satisfaction was assessed using a family-completed standardized patient experience survey.

Results: Patients receiving intervention were predominantly >age 7 and had BH problems (predominantly stress-related, anxiety, depressive, attention, or behavior) that were predominantly mild-moderate in severity. The mean number of intervention visits was 5.6 (range: 3-41; mode: 3). Post-intervention, 72.9% of patients with >3 intervention visits were improved and 28.9% were much or very much improved. After adjusting for potential moderators, lesser odds of improvement were significantly associated with age <7 or 12-15 years; symptomatic illness at initial presentation; a disorder other than anxiety; SSRI medication; complex chronic medical disease; and only 3 BHC visits. Overall, 79.3% of families responding to a survey were highly likely to recommend the services to family/friends.

Conclusion: The findings suggest that psychological interventions delivered in the context of integrated BH in a community-based pediatric primary care setting were feasible, valued, and effective.

Objectives: The purpose of this study was to analyze United States (US) federal government projections on the supply, demand, and adequacy of the general pediatrician workforce.

Study design: Cross-sectional study of general pediatricians using projections from the Health Resources and Services Administration from 2025 to 2037. Geographic disparities were elucidated with Chi-squared tests and trends analyzed with linear regression.

Results: From 2025 to 2037, there was growth in pediatrician demand (67,450 to 68,770, 2.0% increase, P<0.001) and attrition in pediatrician supply (62,250 to 55,840, 10.3% decrease, P<0.001). As a result, pediatrician adequacy was projected to decrease over the study period (92.3% to 81.2%, P<0.001). By 2037, pediatrician adequacy was lowest in the South compared to the Northeast (86.1% vs 110%, P<0.001) and in non-metropolitan areas compared to metropolitan areas (52.7% vs 84.1%, P<0.001). By 2037, the states with the lowest pediatrician adequacy were Idaho (45.2%), Nevada (45.7%), and Arizona (55.7%). General pediatrics ranked fourteenth out of twenty-one medical specialties for physician workforce adequacy in 2037.

Conclusion: Pediatrician supply is expected to decrease while demand is projected to increase resulting in significant decreases in pediatrician workforce adequacy to 2037. The greatest pediatrician shortages were observed in non-metropolitan areas and the South. Future work is needed to improve general pediatrician workforce adequacy in identified geographies.

Objectives: The purpose of this study is to describe dietary restrictions among a sample of breastfeeding women in the United States, focusing on maternal-reported infant reactions to breastmilk, and examine the association between dietary restrictions and breastfeeding continuation.

Methods: A total of 891 women who were <12 months postpartum and had ever breastfed were recruited using Facebook/Instagram from July 2023-February 2024. Using a doubly robust, data-adaptive, nonparametric estimator, we estimated the adjusted association between adopting dietary restrictions and risk of discontinuing breastfeeding in the following month.

Results: About one-sixth of women reported an infant allergy to breastmilk and about 13% restricted their diet while breastfeeding. Dietary restriction (for any reason) was associated with a 4.8 times increased risk of stopping breastfeeding (relative risk (RR): 4.8, 95% CI 2.9, 10.8) within the next month. Among those reporting infant breastmilk allergy, dietary restriction was associated with a 5.7 times increased risk of stopping breastfeeding (RR: 5.7, 95% CI 2.2, 15.2).

Conclusion(s): Food restriction diets are common among some postpartum populations and associated with subsequent increased risk of breastfeeding discontinuation. Given the potential risks of dietary restriction while breastfeeding or postpartum, providers and women should carefully weigh costs and benefits.

Objective: Despite recent progress on breastfeeding indicators in the U.S., breastfeeding remains stigmatized in certain contexts; for example, breastfeeding beyond infancy and breastfeeding in public. The purpose of this study was to assess and identify correlates of attitudes toward breastfeeding in social settings and breastfeeding beyond infancy among U.S. mothers.

Method: In this cross-sectional study, a nationwide sample of U.S. mothers of children between the ages of 1 and 4 years (N=881) completed an online survey. We used multivariable logistic regression to assess associations between sociodemographic and infant feeding intention variables and odds of: 1) low support for breastfeeding in social settings, 2) agreeing it is appropriate to breastfeed a 1-to-2-year-old toddler, and 3) agreeing it is appropriate to breastfeed a 2-to-4-year-old child.

Results: Intention to exclusively formula-feed was associated with low support for breastfeeding in social settings (OR=1.89, 95% CI [1.23, 2.89]) and reduced odds of agreeing it is appropriate to breastfeed a 1-to-2-year-old toddler (OR= 0.32, 95% CI [0.21, 0.50) or 2-to-4-year-old child (OR=0.35, 95% CI [0.20, 0.61). Non-Hispanic Black (NHB) and Hispanic race/ethnicity were associated with increased odds of low support for breastfeeding in social settings (OR=2.20, 95% CI [1.39, 3.47 and OR=1.58, 95% CI [1.05-2.38], respectively). However, Hispanic ethnicity was associated with increased support for breastfeeding a 2-to-4-year old child (OR=1.64, 95% CI [1.07-2.50]).

Conclusions: There are opportunities to shift attitudes toward breastfeeding in public and breastfeeding beyond infancy. Future research should investigate the directionality of the relationship between these attitudes and infant feeding intentions.