Academic Pediatrics最新文献

Background: Primary care physicians (PCPs) may rely upon factors other than screening test scores in making referral decisions to developmental services. This study investigated which patient, provider, and screening test factors predict a PCP's IDEA Part C Early Intervention (EI) referral after a positive screening test result.

Methods: Child demographics, developmental screening test results and EI referral decisions were collected via medical record review of 2,756 15-, 18-, 24- and 30-month well-child checks conducted at 7 community primary care clinics in 4 Oregon counties, in 2020-2021. A provider survey collected PCP demographic and professional characteristics. We tested the association of receipt of EI referral with screening test (Ages & Stages-3 [ASQ-3] and Modified Checklist for Autism in Toddlers - Revised [MCHAT-R]) scores, provider demographic information, child demographic data (sex, language, race/ ethnicity), using multivariable logistic regression.

Results: 54.1% of children with positive MCHAT-R screens, and 42% of children with positive ASQ-3 screens received EI referrals. Multivariable analyses showed that MCHAT-R score, ASQ-3 Communication and Gross Motor scores were associated with referral after a positive screen. Child sex, race, ethnicity, and language, and provider demographics had no multivariable association with referral. Referral rates varied substantially by site and individual provider.

Conclusion: The majority of toddlers with positive developmental screens were not receiving EI referrals from their PCP during the COVID-19 pandemic. Screening test thresholds and clinical thresholds for EI referral differ substantially, and some portions of the ASQ-3 do not seem to impact provider referral decisions. These findings may help inform physician training on developmental screening in primary care, specifically during times of unprecedented healthcare challenges.

Background: Children and youth with special health care needs (CYSHCN) may be at greater risk for accidental physical trauma. Interventions should be informed by the literature indicating incident characteristics and at-risk subpopulations.

Objective: To conduct a scoping review of accidental physical trauma in CYSHCN to characterize published literature and identify gaps.

Data sources: Peer-reviewed literature within CINAHL, Embase, and PubMed, 1998 to February 2021.

Study eligibility criteria: Studies that included individuals younger than 19 with special health care need(s) with accidental injuries classified as trauma.

Study appraisal and synthesis methods: The study team extracted: research method, author field, special health care needs, geographic scope, author country, demographics, incident characteristics, and injury characteristics.

Results: We included 85 articles from an initial yield of 10,481. Pediatrics (32%) was the most-represented field among authors published on this topic. Publications most often considered developmental conditions (77.7%), including Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD). Studies differed in how often they reported demographic characteristics: gender (96.5%); social determinants of health/socioeconomic status (41.2%) or race and ethnicity (25.9%). Few articles included injury time of day (10.6%) and day of week (2.4%); 40% did not include information about the place of injury.

Limitations: Our search term development focused on diagnosis rather than need; we did not search reference lists or grey literature.

Conclusions and implications of key findings: This review reveals key gaps in the literature pertaining to incident characteristics and place of injury for CYSHCN. Those advising families and/or planning interventions focused on mitigating risk for CYSHCN have limited evidence upon which to rely for certain conditions.

Systematic review registration number: PROSPERO registration is not applicable to scoping reviews.

Objective: To examine associations between cognitive stimulation in the home at 6 months and maternal feeding styles at 24 months, direct intervention effects of Smart Beginnings (SB) on feeding styles, and potential indirect effects of SB on feeding styles via earlier intervention effects on cognitive stimulation.

Methods: Single-blind, two-site randomized clinical trial (RCT) of the SB intervention. SB integrates PlayReadVIP, a universal, pediatric primary care-based program, and Family Check-Up (FCU), a targeted secondary home-based parenting intervention. Mother-infant dyads (N = 327) were randomized at birth to standard pediatric care or the SB intervention. Linear regression analyses determined associations between cognitive stimulation at 6 months and maternal feeding styles at 24 months, a secondary data analysis. Direct intervention impacts on feeding styles, a secondary RCT outcome, were also assessed and mediation analyses explored intervention effects on feeding styles via earlier intervention impacts on cognitive stimulation.

Results: Cognitive stimulation was significantly associated with higher responsive and lower indulgent feeding styles. SB mothers were less likely to exhibit pressuring styles compared with controls (Effect Size [ES]=-0.12, P = 0.02). Although no direct intervention effects were found on responsive or indulgent feeding styles, indirect effects of SB were evident on these feeding styles through intervention-induced increases in cognitive stimulation in the SB group.

Conclusions: This study found positive linkages between cognitive stimulation in the home and later feeding styles. Additionally, the SB intervention was associated with less pressured feeding and indirect pathways mediated by intervention effects on cognitive stimulation. Implications for early childhood parenting interventions are discussed.

Background: A significant proportion of U.S. families are affected by substance use disorders. Both child- and adult- serving systems are called upon to care for families, yet the disciplines involved inherently have different priorities, preventing a true family-centered care model.

Objectives: The purpose of the scoping review was to explore the alignment of current national guidance related to the medical care of families affected by substance use disorders (SUD). In the review, we examined 1) the quality of the documents, 2) the documents' positions within the continuum of family-centered care and the promotion of multidisciplinary collaboration, and 3) potential gaps in the promotion of services for families.

Study appraisal and synthesis methods: We chose a priori to manually examine the websites of national medical and public health associations for clinical practice and policy recommendations. We included documents published between 2016-2023 with selected keywords, totaling seven documents for review. We operationalized and rated each document's recommendations based on their promotion of "family-centered care" and "multidisciplinary collaboration."

Results: The quality of each document varied, with an average score of 5.2 out of 7. The average family-centeredness rating was 3.0 out of 7; five of the seven documents prioritized the parent's care over the child's. The average multidisciplinary collaboration rating was 2.8 out of 7.

Conclusions and implications of key findings: Overall, we found low to moderate family-centered and multidisciplinary collaboration scores. Collectively, these findings suggest that despite these practices emerging as optimal for the care of families affected by SUD, the promotion of these practices has yet to be fully adopted in guidance statements by national medical disciplines.

Objective: Organization-sponsored interventions have the potential to promote, and destigmatize seeking help for, wellbeing. Our study objective was to explore the acceptability and feasibility of a coaching intervention to improve wellbeing among faculty.

Methods: We conducted a pilot, pre/post design, study in a convenience sample of pediatric faculty at an academic medical center. Participants were offered <6 live virtual coaching sessions at the participant's discretion. In addition, a novel wellbeing individual development plan (WB-IDP) was distributed to participants. Primary outcomes were feasibility of the intervention, defined as completing >1 coaching session and acceptability measured by anonymous feedback and use of the WB-IDP. Secondary outcomes were wellbeing (WHO Wellbeing Index (WHO-5)), stress (Perceived Stress Scale (PSS)), and work engagement (Utrecht Work Engagement Scale (UWES)), at baseline, 3, and 6 months.

Results: All enrollees (N=28) completed at least one, 18/28 (64%) completed at least 4, and 9/28 (32%) completed 6 coaching sessions. Of 28 participants, 11 (39%) started a WB-IDP and 5/28 (18%) completed and implemented the plan. The aggregate WHO-5 score showed a statistically significant change from baseline (53.3) to month 6 (64.3) (P <.01). Fourteen 14/27 (52%) participants had an improvement of ≥10 points in WHO-5 score between baseline and month 6. No other significant changes were observed.

Conclusion: Individualized certified coaching for wellbeing was successfully implemented and associated with a significant increase in wellbeing. We speculate that wellbeing coaching can be promoted by faculty development programs in university and healthcare settings and has potential to improve organizational outcomes.

Objective: This study estimates and compares variation in the probability of child unmet need for mental health care and difficulties accessing care for each state in the United States. Estimates are also generated and compared for three socioeconomic and demographic subgroups nationwide: racial and ethnic group, household income, and insurance type.

Methods: Using a retrospective, cross-sectional design, this study pooled 2016-2019 National Survey of Children's Health data. National, state, and subgroup adjusted probabilities of caregiver-reported child unmet need for mental health care and ease of access to mental health care were generated from logistic regression models with marginal post-estimation.

Results: Adjusted national probabilities of caregiver-reported child unmet mental health need and difficulty in accessing care were 0.21 and 0.46, respectively. State probabilities of unmet need ranged from 0.08 to 0.32. One state was significantly above the national estimate; nine states were below it. State probabilities of difficulty accessing mental health care ranged from 0.28 to 0.57; nine states' probabilities were significantly below the national estimate and two states were significantly above it. Estimates of unmet mental health need and difficulty accessing care varied more widely across states than across racial or ethnic groups, income groups, insurance groups.

Conclusions: Geographic inequities in children's mental health care access persist; in some cases, they are larger than sociodemographic inequities.

Objective: Coordination to get everyone in the room at the same time for family-centered rounds (FCR) is challenging. The objective of this study was to determine if using a virtual queue that notifies nurses and families in real time when to expect the rounding team could impact their presence on rounds.

Methods: We observed rounds on two neonatal intensive care unit (NICU) teams for 6 weeks before and after implementation of a novel rounding software, Q-rounds, that shares real-time updates on when the team will arrive and allows families to répondez s'il vous plaît (RSVP) to join remotely when they cannot be there in person. Observers collected metrics pertinent to FCR including nurse and family presence (in-person or remotely) and duration of rounds and used Chi-square and two group t-tests for analysis.

Results: Rounds were observed for 165 patient encounters pre-implementation and 179 patient encounters post-implementation, with an average rounding duration of 10.3 minutes (SD 6.5) and 10.4 minutes (SD 6.3) per patient respectively (P = 0.91). The proportion of nurses who were present for the entirety of the rounding discussion increased from 18.8% to 58.2% (P < 0.001). Family presence on rounds increased from 20.0% (95% CI, 13.9-26.1) to 43.0% (95% CI, 35.8-50.3; P < 0.001). The percentage of families that participated in rounds remotely increased from 15.2% to 55.8% (P < 0.001).

Conclusions: This observational study showed that the use of a novel rounding software was associated with a significant increase in family presence for rounds and nurse presence for the entirety of rounds without increasing rounding duration.

Objective: We assessed adolescent relationship abuse (ARA) prevalence and ARA intervention acceptability and perceived benefit among hospitalized adolescents and young adults (AYA).

Methods: This was a planned secondary analysis of a cross-sectional survey exploring sexual and reproductive health among a convenience sample of AYA (14-25 years) hospitalized in medical/surgical units at two Midwest children's hospitals. Survey items assessed history of dating, lifetime prevalence of four types of ARA (physical abuse, sexual abuse, reproductive coercion, sexual exploitation), and demographics.

Results: Among 324 participants, 72.5% reported dating and, among those with history of dating, 17% reported one or more types of ARA. ARA was more common among those who reported foregone health care in the preceding 12 months. There was no difference in likelihood of dating and ARA between those with and without a chronic health condition. Approximately half felt it is helpful for clinicians to discuss dating relationships with adolescents (58.6%) and acceptable to do this during a hospitalization (50.6%). Conversations with clinicians about dating relationships were more likely to be reported helpful by those who had dated (63.9% reporting dating vs 50.6% not reporting dating, P 0.04) and those who reported prior ARA (79.5% reporting ARA vs 60.4% not reporting ARA, P 0.02).

Conclusions: Hospitalization may represent a unique opportunity to support healthy AYA dating relationships. Further work is needed to further explore acceptability and feasibility of such interventions.

Objectives: Our objectives were to examine the following: physician survey response rates across a 20-year period; the impact of a token incentive on response rates; whether survey nonresponse bias is present and if it is associated with response rate; and the impact of a token incentive on nonresponse bias.

Methods: We utilized data from 68 American Academy of Pediatrics (AAP) pediatrician surveys from 2000 to 2019 and an AAP administrative database, which included information for both respondents and non-respondents (target sample). Linear regression examined response rates over time. To assess nonresponse bias, a t-test or Wilcoxon rank test compared respondents and the target sample by age, gender, and US Census region. Linear regression or Spearman correlation examined the association of response rate and nonresponse bias. Interrupted time series analyses tested the introduction of a $2 token incentive on both response rates and nonresponse bias.

Results: Overall mean survey response rate was 56.2%. Response rates declined across survey years (β = -0.58, P < 0.001). The $2 incentive generated an 8.7% response rate increase (P < 0.001). The respondent groups had more female pediatricians than the target samples (62.5% vs 60.1%, P < 0.001). Age nonresponse bias was associated with lower response rates (β = -0.47, P < 0.001). The $2 incentive was associated with nonresponse bias shifts toward older, away from female, and away from Northeastern respondents.

Conclusions: Our study demonstrates an overall decline in pediatrician survey response rates and a meaningful impact of a token incentive on response rates and nonresponse bias, underscoring the importance of measuring nonresponse bias whenever possible.