Academic Pediatrics最新文献

Background: Social and economic factors are known to influence childhood injury risks and outcomes. However, the relationship between these factors and the delivery of pediatric trauma care remains unclear.

Objectives: To examine the association between social and economic factors, defined using the PROGRESS-Plus framework, and healthcare delivery among injured children and adolescents.

Data sources: We searched PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, and Academic Search Premier from inception to July 27, 2024.

Study eligibility criteria: Studies evaluating associations between one or more social and economic factors and healthcare delivery in injured children aged ≤19 years, regardless of injury type or healthcare setting.

Appraisal and synthesis methods: Two reviewers independently conducted study selection, data extraction, and risk of bias assessment using the ROBINS-E tool. We performed meta-analyses using random-effects models.

Results: Among 73 eligible studies, 28 contributed to meta-analyses. No disparities were observed in imaging or in transfer to a pediatric center. Non-Hispanic (NH) Black (OR=1.68, 95% CI: 1.51-1.87) and Hispanic (OR=1.35, 95% CI: 1.22-1.50) children were more likely to receive any analgesic in the ED, but less likely to receive opioids during ED visits or at discharge. Girls had lower odds of opioid prescription (OR=0.95, 95% CI: 0.92-0.97). Self-pay and public insurance were associated with reduced opioid access and differences in hospital admission, surgery, and access to rehabilitation services.

Limitations: Predominance of U.S.-based studies and high risk of methodological bias.

Conclusions: There are disparities in pediatric trauma care delivery. Standardized protocols may protect against disparities.

Objective: Clinical reasoning (CR) is a core competency in residency training, but its demonstration in the workplace is often influenced by interpersonal and contextual factors. This study aimed to explore resident perspectives on CR demonstration and co-develop best practices to support its visibility in clinical learning environments.

Methods: We conducted a group level assessment (GLA), a participatory, qualitative research method, with residents from a large academic institution. Over two GLA sessions (n=28), residents generated and synthesized key barriers and facilitators to CR demonstration. In a third action planning session (n=37), participants designed strategies to promote CR demonstration.

Results: Residents emphasized that psychological safety is a prerequisite for CR demonstration. Unlike more observable competencies (e.g., communication), CR can be hidden, making it uniquely sensitive to perceptions of judgment. Participants described how team dynamics, faculty behaviors, and the structure of family-centered rounds (FCR) affect CR expression. They proposed practices to enhance CR visibility, including resident-led team goals, observable "microskills" aligned with developmental level, and adaptations to FCR to create space for protected reasoning. Participants further developed strategies supervisors can use to cultivate resident CR expression.

Conclusions: Promoting CR demonstration in residency requires deliberate attention to psychological safety, transparent expectations, and a shared understanding of what CR looks like in practice. A resident-informed approach can guide local adaptations and support broader efforts to make CR more visible, teachable, and assessable in clinical learning environments.

Objective: Parents of children born preterm are at risk of neglecting their own medical needs following birth of a medically complex child. This study examines the self-reported health of parents of preterm children born with low birthweight (LBW; 1500-2,499 grams) or very low birthweight (VLBW; <1,500 grams) compared with parents of term children of normal weight (term; ≥2,500 grams).

Methods: We examined self-reported health among parents with children 0 to 3 years of age using the National Survey of Children's Health (2016-2022), a cross-sectional dataset. We used multivariable logistic regression to analyze parent's self-reported health by gestational age-birthweight categories, adjusting for child and household sociodemographics.

Results: Parents of children born VLBW had higher rates of fair/poor physical health versus parents of term children (10.9% vs. 3.9%, odds ratio [aOR] 2.92; 95% confidence interval [CI] 1.55-5.49). Parents of VLBW children had higher rates of poor/fair mental health compared to parents of term children (8.5% vs. 5.1%), but the differences were not significant in adjusted analyses. While parents of children born LBW trended toward higher odds of fair/poor health, the differences were not significant in adjusted analyses.

Conclusion: We found important differences in reported physical health among parents of children born VLBW compared to parents of children born at term with normal birthweight. This elevated health burden is critical to address, as self-reported poor health is linked to long-term negative health consequences and increased parental mortality risk. Pediatricians should consider screening for caregiver health concerns during NICU discharge and well-child visits.

Objective: To identify how primary care (PC) clinics and WIC can collaborate to support caregivers in WIC enrollment from the perspectives of PC professionals, WIC staff, and caregivers.

Methods: Semi-structured interviews were completed with PC professionals, WIC staff, and WIC eligible caregivers speaking diverse languages (English, Spanish, French, Nepali). Interviews were analyzed using inductive thematic analysis.

Results: PC professionals (n = 12), WIC staff (n = 6), and caregivers (n = 17) supported the value and feasibility of a WIC referral form from PC. PC professionals and WIC staff felt that PC can play a role in providing families knowledge about WIC, which requires PC professionals to have accurate information about the program. Caregivers were interested in learning about WIC and beginning the enrollment process in PC clinics. Bidirectional communication and information sharing between WIC and PC clinics was valued but an area of needed improvement. PC professionals and caregivers noted unique WIC knowledge and enrollment considerations for speakers of languages other than English.

Conclusions: PC clinics should establish referral systems to WIC that incorporate the needs of families speaking languages other than English. PC professionals can support enrollment through accurately identifying eligible families and sharing accurate information with families regarding WIC enrollment and benefits. Establishment of increased bidirectional communication and collaboration between WIC and PC, including training for PC professionals and accessible platforms for communication, are avenues for promoting increased PC professional knowledge and awareness.

Recruiting adolescents for research presents significant challenges across various health domains, including limited access to target populations, parental consent requirements, reluctance to disclose sensitive information, and emerging digital-specific obstacles such as fraudulent enrollments and advertising restrictions. This paper addresses how online recruitment can overcome these widely known challenges while navigating new methodological complexities. It describes online recruitment of adolescents into a vaping cessation randomized clinical trial as a case study demonstrating comprehensive strategies that successfully recruited 1,681 participants aged 13-17 from across the United States. The systematic, multi-faceted approach included: establishing youth advisory and data safety and monitoring boards to inform study design and optimize recruitment strategies; strategically selecting and optimizing digital recruitment channels (primarily Instagram) with careful attention to cost efficiency ($148 per enrolled participant); identifying and addressing fraudulent enrollments through both automated detection systems and manual verification protocols that captured 960 potentially suspicious entries; and implementing procedures for adolescent assent with IRB waiver of parental consent and ensuring decisional capacity through structured screening (73.7% pass rate). Privacy protections and advertising restrictions designed to protect minors, while necessary, required broader targeting approaches that increased recruitment costs and complexity. Despite these challenges, the trial achieved a sizable sample and enabled the first published randomized trial of a vaping cessation intervention for adolescents. This integrated framework provides actionable guidance for researchers conducting fully remote studies with adolescents, particularly those involving sensitive health behaviors where traditional recruitment methods may be insufficient or inappropriate.

Objective: To explore how medical students and faculty navigate the dynamic of the learner-physician-patient/family relationship in pediatric undergraduate medical education METHODS: The authors conducted focus groups of medical students and pediatric faculty educators from three institutions. Questions explored participants' perceptions on the role of pediatric patients and their families in student education and possible benefits and dilemmas associated with such learning. Two investigators independently coded the transcripts, reconciled discrepancies and generated themes.

Results: 27 students and 18 faculty participated in 6 focus groups that achieved thematic saturation. Codes from student and faculty focus groups were similar and integrated into four themes: appreciation of the mutual value arising from student interactions with children and their families, awareness of the unique challenges when students learn from children, recognition of the potential risks involved in student-patient/family interactions and the adoption of varying strategies to navigate educational experiences, from rationalizing to avoidance.

Conclusions: While the value of medical student involvement in the care of pediatric patients is widely recognized, challenges and risks may limit learning. Given the need for students to gain this specific skillset, programs must develop strategies to ensure learning occurs in ways that maximize the benefits to children and families including preparing students for experiences, incorporating students as active members of the team, providing close supervision, allowing individualized student participation based on competency, considering children's and families' vulnerabilities and agency to provide true consent/assent, and empowering patient/families to participate actively in teaching and learning.

Objective: To describe how Oregon's Extreme Risk Protection Order (ERPO) law has been used to address risks of harm to children.

Methods: ERPO petitions were obtained from the Oregon Judicial Department. Data were abstracted for 2018-2023. A 20% random sample of records was double-coded. Interrater agreement was >80% for key variables. Descriptive analyses compared petitions with, versus without, cited risks to children and adolescents.

Results: Of the 835 ERPO petitions filed, 143 (17%) cited risks of harm to children. Petitions citing risks of harm to children were less likely to be granted (63%) compared to those without such risks (81%). Ex-spouses/ex-intimate partners, who do not have standing under Oregon's law, made up a larger proportion of petitioners for petitions citing risks to children (16%) than those that did not involve children (5%). Petitions involving risks to children more commonly included threats to schools or universities (17%), mass violence threats (22%), and domestic violence (64%) than petitions without risks to children (1%, 9%, and 33%; respectively).

Conclusions: Oregon's ERPO law is being used to try to avert harm to children, including threats of mass violence, school shootings, and domestic violence, but gaps may remain in individuals' or families' needs. Pediatricians and other healthcare professionals may be in a unique position to identify and address risks to children and their caregivers. Understanding how ERPOs can successfully address these risks to children - and how they are failing - may raise awareness of the tool among healthcare professionals, informing both clinical practice and policy advocacy.

Objective: While disparities in adolescent sleep health are well-recognized, few studies focus on sleep regularity, a sleep parameter associated with negative physical and mental health consequences. This study aimed to evaluate the association between socio-contextual factors and sleep regularity in healthy adolescents recruited from primary care.

Methods: Data were derived from the baseline assessment for a pilot clinical trial that investigated a digital sleep intervention for teens aged 12-14. Socio-contextual factors included: cut-off utilities, food insecurity, housing insecurity, neighborhood social cohesion, amenities, and perceived safety. The primary outcome of interest was actigraphy-measured sleep regularity quantified by the sleep regularity index (SRI; range 0-100; score = 100 indicates max regularity). Multivariable linear regression, adjusted for sex and age, was performed to examine the relationships between socio-contextual measures and sleep regularity.

Results: Sample included 54 youth (mean age 12.94, 44.44% sex assigned female at birth). In the multivariable models, food and housing insecurity were significantly associated with decreased sleep regularity including worry that food would run out (β = -9.23, 95% CI: -13.62 to -4.84, P < 0.001), food running out (β = -10.56, 95% CI: -15.12 to -5.99, P < 0.001), and housing insecurity (β = -17.04, 95% CI: -31.26 to -2.82, P < 0.05). No other significant associations were found.

Discussion: Among healthy adolescents recruited from primary care, those living in food or housing insecure households experienced decreased sleep regularity. Further understanding the interplay between socio-contextual factors and sleep is necessary to inform interventions and anticipatory guidance via clinical guidelines for health care providers.