Academic Pediatrics最新文献_第6页

Variability in Invasive Bacterial Infection Proportions Among Febrile Infants Aged 8–90 Days Using Administrative Data 利用行政数据分析 8-90 天发热婴儿中侵入性细菌感染比例的差异。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-20 DOI: 10.1016/j.acap.2024.102608

Jeffrey P. Yaeger MD, MPH , Kevin A. Fiscella MD, MPH

Objective

Despite decades of research, knowledge is limited regarding sociodemographic risk factors (eg, sex, rural/urban residence) for invasive bacterial infections (IBIs; bacteremia, bacterial meningitis) in young febrile infants and outcomes of current management strategies. Population-based administrative datasets can provide epidemiological insights not possible with clinical data but are limited because diagnosis codes alone may not accurately reflect culture-positive bacteremia or meningitis infections. Thus, using different IBI case definitions, we report IBI and missed IBI proportions in a population of febrile infants aged 8–90 days.

Methods

For this cross-sectional study, we used New York State’s all-payer database to identify healthy, full-term infants with fever aged 8–90 days evaluated in emergency departments from 2012 to 2023. We defined IBIs and missed IBIs using previously published diagnosis codes and then restricted original case definitions to inpatient encounters with variable lengths-of-stay. For each approach, we calculated total and age-stratified IBI and missed IBI proportions and used chi square statistics to compare proportions within and across age groups.

Results

Of 67,115 infants who met inclusion criteria (15,191 [23%] aged 8–28 days), total IBI and missed IBI proportions varied from 11.5–32.3/1000 febrile infants and 4.2–8.0/100 IBIs, respectively. Although IBI proportions decreased significantly with advancing age, missed IBI proportions significantly increased.

Conclusions

IBI and missed IBI proportions varied widely by case definition. Missed IBI proportions increased with advancing age in a step-wise fashion regardless of case definition. Validation studies are needed to compare IBI diagnosis codes with culture results to understand the accuracy of identifying IBIs with administrative data.

目的：尽管进行了数十年的研究，但有关发热婴幼儿侵入性细菌感染（IBIs；菌血症、细菌性脑膜炎）的社会人口风险因素（如性别、农村/城市居住地）以及当前管理策略的结果的知识仍然有限。基于人口的行政数据集可以提供临床数据无法提供的流行病学见解，但其局限性在于仅靠诊断代码可能无法准确反映培养阳性菌血症或脑膜炎感染。因此，我们采用不同的 IBI 病例定义，报告了 8-90 天发热婴儿中 IBI 和漏诊 IBI 的比例：在这项横断面研究中，我们使用了纽约州的所有付费者数据库，以确定 2012-2023 年间在急诊科接受评估的 8-90 天健康足月发热婴儿。我们使用之前公布的诊断代码定义了 IBI 和漏诊 IBI，然后将原始病例定义限制在住院时间可变的住院病例中。对于每种方法，我们都计算了总的和年龄分层的 IBI 和漏诊 IBI 比例，并使用卡方统计来比较不同年龄组内和不同年龄组间的比例：在符合纳入标准的 67,115 名婴儿（15,191 人（23%）年龄在 8-28 天）中，总 IBI 和漏诊 IBI 比例分别为 11.5-32.3/1,000 发热婴儿和 4.2-8.0/100 IBI。虽然随着年龄的增长，IBI 比例明显下降，但漏报的 IBI 比例却明显上升：结论：不同病例定义的 IBI 和漏诊 IBI 比例差异很大。无论病例定义如何，遗漏的 IBI 比例随着年龄的增长呈阶梯式上升。需要进行验证研究，将 IBI 诊断代码与培养结果进行比较，以了解利用管理数据识别 IBI 的准确性。

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引用次数: 0

My Father's Daughter and Doctor. 我父亲的女儿和医生

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-19 DOI: 10.1016/j.acap.2024.102610

Christy M Lucas

引用次数: 0

A Narrative Review of Key Studies in Medical Education in 2023: Applying the Current Literature to Educational Practice and Scholarship 2023 年医学教育主要研究综述》：将当前文献应用于教育实践和学术研究。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-19 DOI: 10.1016/j.acap.2024.102605

Uchechi Oddiri MD , Michael S. Ryan MD, MEHP , Jolene E. Collins MD, MACM , Peggy Han MD , Melissa Klein MD, MEd , Allison N.J. Lyle MD, MA , Heidi M. Kloster MD

Pediatric clinician educators face the challenge of juggling clinical practice with teaching responsibilities. The balancing act is even more challenging when one considers the need to stay current with evidence from clinical and medical education literature. In this narrative review of 2023 medical education literature, the Academic Pediatric Association Education Committee’s Top Articles team summarizes high-yield articles that possess the potential to significantly influence pediatric clinician educator teaching and practice. A standardized blinded rubric was applied to identify the most impactful articles from 19 medical education and specialty journals. Final selections were categorized into six domains: artificial intelligence and technology, belonging in the learning environment, bias in the workplace, clinical learning, curriculum and assessment, and family and community partnerships. The reviewers summarize key findings from the top articles and describe implications for pediatric clinician educator practice.

儿科临床教育工作者面临着兼顾临床实践和教学责任的挑战。如果考虑到需要与临床和医学教育文献中的证据保持同步，平衡工作就更具挑战性。在这篇对 2023 年医学教育文献的叙述性综述中，学术儿科协会教育委员会的热门文章团队总结了那些有可能对儿科临床教育工作者的教学和实践产生重大影响的高产文章。我们采用了标准化的盲法评分标准，从 19 种医学教育和专业期刊中筛选出最具影响力的文章。最终选出的文章分为六个领域：人工智能与技术、学习环境中的归属感、工作场所中的偏见、临床学习、课程与评估以及家庭与社区合作。审稿人总结了热门文章的主要发现，并阐述了对儿科临床教育工作者实践的影响。

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引用次数: 0

Quality Initiative to Increase Early Initiation and Series Completion of Human Papillomavirus Vaccine and its Impact on Health Disparities 提高人类乳头瘤病毒疫苗早期接种和系列接种率的质量倡议及其对健康差异的影响》（Quality Initiative to Increase Early Initiation and Series Completion of HPV Vaccine and its Impact on Health Disparities）。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-17 DOI: 10.1016/j.acap.2024.102609

Caitlin J. Miller BA , Amudha Boopathi MD , Sara R. Slovin MD, MSPH , Zhongcui Gao MS , Kristin Maiden PhD , Melissa Ray LPN , Jonathan M. Miller MD

Objective

Human papillomavirus (HPV) infection is associated with a large burden of disease prevalence, morbidity, and known disparities. HPV vaccination rates remain lower than other childhood immunizations, despite vaccine safety and effectiveness. The objective of this quality improvement (QI) intervention was to improve HPV vaccination rate by 15% over 3-years through early initiation and analyze trends across health disparities.

Methods

QI study in ages 9 to 13 at Nemours Primary Care from 2019 to 2022, which includes rural and urban regions and diverse populations. Interventions included updating electronic health records to begin at age 9, practice-level feedback, and updated education. Primary outcome measure was the Healthcare Effectiveness Data Information Set (HEDIS) rate for HPV vaccination (proportion completed by age 13). Process measure was early HPV vaccine initiation rate (proportion aged 9–10 with at least one dose). Year-end early HPV vaccine initiation rates were analyzed to assess trends by race and ethnicity, geography, insurance, and Child Opportunity Index (COI).

Results

The number of eligible 9 and 10 year olds ranged from 16,466 to 17,925 annually. HEDIS rates improved over three years from 49.2% to 59.5% (P < 0.0001). Early initiation increased from 13.2% in 2019 to 42.2% in 2022 (P < 0.0001) and improved significantly across demographic variables (P < 0.0001). Groups with the lowest baseline early vaccination rates increased significantly.

Conclusion

HPV vaccine completion by 13 increased significantly with QI supporting early initiation. Demographic analyses showed the highest degree of improvement in populations with the lowest baseline rates. This supports altering Centers for Disease Control and Prevention (CDC) recommendation for HPV vaccination initiation at ages 9–12.

目标：人乳头瘤病毒感染与疾病流行、发病率和已知的差异等巨大负担有关。尽管疫苗安全有效，但 HPV 疫苗接种率仍低于其他儿童免疫接种。这项 QI 干预的目标是通过早期开始接种，在 3 年内将 HPV 疫苗接种率提高 15%，并分析不同健康差异的趋势：方法：从 2019 年到 2022 年，在 Nemours 初级保健中心对 9 到 13 岁的儿童进行 QI 研究，其中包括农村和城市地区以及不同的人群。干预措施包括更新电子病历以从 9 岁开始、实践层面的反馈以及更新教育。主要结果衡量指标是 HPV 疫苗接种的 HEDIS 率（13 岁前完成接种的比例）。过程测量是早期 HPV 疫苗接种率（9-10 岁至少接种一剂的比例）。对年终早期 HPV 疫苗接种率进行了分析，以评估不同种族和民族、地域、保险和儿童机会指数 (COI) 的趋势：结果：每年符合条件的 9 岁和 10 岁儿童人数从 16,466 人到 17,925 人不等。HEDIS 比率在三年内从 49.2% 提高到 59.5%（p < 0.0001）。早期接种率从 2019 年的 13.2% 提高到了 2022 年的 42.2%（p < 0.0001），并且各人口统计学变量均有显著改善（p < 0.0001）。基线早期疫苗接种率最低的群体明显增加：结论：随着支持早期开始接种的 QI 的增加，13 岁以下儿童完成 HPV 疫苗接种的比例明显增加。人口统计学分析表明，基线接种率最低的人群接种率提高幅度最大。这支持改变疾病预防控制中心关于在 9-12 岁开始接种 HPV 疫苗的建议。

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引用次数: 0

Adverse Childhood Experiences and Insufficient Sleep. 童年的不良经历和睡眠不足。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-15 DOI: 10.1016/j.acap.2024.102606

Sarah Forthal, Susan Lin, Keely Cheslack-Postava

引用次数: 0

An Untold Story: The Feelings of Pediatric Residents Early in the COVID-19 Pandemic and What They Can Teach Us Today 一个不为人知的故事：科威德-19 大流行初期儿科住院医师的感受及其对我们今天的启示。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-07 DOI: 10.1016/j.acap.2024.102602

Ariel S. Winn MD , Monique M. Naifeh MD, MPH , Sarah Hilgenberg MD , Ndidi I. Unaka MD, MEd , H. Mollie Grow MD, MPH , Ross E. Myers MD , Alan Schwartz PhD, JD , Rhett Lieberman MD, MPH , Daniel J. Schumacher MD, PhD

Objective

To understand the feelings of pediatrics residents early in the COVID-19 pandemic and to offer insights still relevant today.

Methods

We performed a thematic analysis exploring resident feelings early in the pandemic using free-text responses on a national survey distributed between May and June 2020. We analyzed responses from the following multi-part free text question embedded in the larger survey, “Which of the following feelings have you experienced in your role as a pediatric resident during the COVID-19 pandemic” with response prompts including relief, guilt, pride, sadness, worry, fear, and other.

Results

While many feelings that respondents shared were common to society at large, some were specific to their intersecting roles as health care workers, pediatricians, and trainees. Some issues uncovered have continued relevance today including varied interactions with program and institutional leadership, training away from established support networks and during an important life stage, and societal concerns.

Conclusions

This study uncovered vulnerabilities inherent to being a trainee such as limited control over one’s own schedule or institutional policies and training away from established supports. Their feelings shine light on the moral distress experienced in residency and the role program and institutional leadership can play in the experiences of residents.

目的了解 COVID-19 大流行早期儿科住院医师的感受，并提供对当今仍有意义的见解：我们利用 2020 年 5 月至 6 月间发布的一项全国性调查中的自由文本回复进行了专题分析，以探讨住院医师在大流行早期的感受。我们分析了嵌入在大型调查中的以下多部分自由文本问题的回答："在 COVID-19 大流行期间，您作为儿科住院医师经历了以下哪些感受"，回答提示包括缓解、内疚、自豪、悲伤、担忧、恐惧和其他：结果：虽然受访者分享的许多感受是整个社会共有的，但有些感受是他们作为医护人员、儿科医生和实习生的交叉角色所特有的。所发现的一些问题在今天仍然具有现实意义，包括与项目和机构领导的各种互动、远离已有的支持网络和在重要的人生阶段接受培训，以及社会关注的问题：本研究揭示了受训人员固有的弱点，如对自己的日程安排或机构政策的控制有限，以及在远离既定支持网络的情况下接受培训。他们的感受揭示了住院医师在实习期间所经历的道德困扰，以及项目和机构领导在住院医师经历中所扮演的角色。

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引用次数: 0

The Effect of Mandatory Medicaid Health Maintenance Organizations on Health Access, Utilization, and Health Outcomes for Children 强制性医疗补助 HMO 对儿童医疗服务的获取、使用和健康结果的影响。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-07 DOI: 10.1016/j.acap.2024.102604

Patience Toyin-Thomas MD, PhD , George Wehby PhD

Objective

Mandatory enrollment into Medicaid-contracted health maintenance organizations (HMOs) is the most common form of Medicaid managed care (MMC), but the effects of this enrollment on children are unclear. We leveraged variation in MMC implementation within and across states over time to examine the effect of mandatory Medicaid HMO enrollment on children’s access, utilization, and health outcomes.

Methods

Using Medical Expenditure Panel Survey data from 2000 to 2018 and multivariable regression models, we estimated the effects of living in a county with mandatory Medicaid HMO enrollment only, compared to other MMC types and fee-for-service (FFS) combined in 1 comparison group, on outcomes for children under 18 years. We also evaluated potential effect heterogeneity across age, race and ethnicity, and for children with special health care needs (CSHCNs).

Results

There were small and nonsignificant associations between mandatory HMO enrollment and most outcome measures. However, mandatory HMO enrollment was associated with a 1.8%-point decline in the likelihood of having a usual source of care, 95% confidence interval (CI) [−0.035, −0.001], a 4.2%-point increase in the likelihood of delayed access to care, 95% CI [0.012, 0.072], and a 2.2%-point reduction in the likelihood of having any outpatient physician visits, 95% CI [−0.043, −0.0004], compared to other MMC and FFS combined in 1 group. Mandatory HMO enrollment was associated with more difficulty seeing a specialist for CSHCNs.

Conclusions

Overall, there is little evidence that mandatory Medicaid HMO enrollment has discernable and consistent effects across a broad range of outcomes. Evaluating how mandatory Medicaid HMOs affect more nuanced health care measures, especially for children with greater health care needs, remains an important future research question.

目的：强制加入医疗补助签约健康维护组织（HMO）是医疗补助管理性医疗（MMC）最常见的形式，但这种加入对儿童的影响尚不清楚。我们利用各州内部和各州之间在 MMC 实施方面随时间推移而产生的差异，来研究强制性医疗补助 HMO 注册对儿童就医、使用和健康结果的影响：利用 2000 年至 2018 年的医疗支出小组调查数据和多变量回归模型，我们估算了生活在仅有强制性医疗补助 HMO 注册的县与其他 MMC 类型和 FFS 合并为一个比较组相比，对 18 岁以下儿童的影响。我们还评估了不同年龄、种族/民族以及有特殊医疗保健需求的儿童（CSHCNs）的潜在效应异质性：结果：强制性 HMO 注册与大多数结果指标之间的关联较小且不显著。然而，与其他 MMC 和 FFS 在一组中的组合相比，强制 HMO 注册与拥有惯常护理来源的可能性下降 1.8 个百分点（95% CI[-0.035,-0.001]）、延迟获得护理的可能性增加 4.2 个百分点（95% CI[0.012,0.072]）和拥有任何门诊医生就诊的可能性降低 2.2 个百分点（95% CI[-0.043,-0.0004]）有关。强制加入 HMO 与 CSHCN 看专科医生更难有关：总体而言，几乎没有证据表明强制性医疗补助计划 HMO 的加入会对广泛的结果产生明显且一致的影响。评估强制性医疗补助 HMO 如何影响更细微的医疗保健措施，尤其是对医疗保健需求更大的儿童的影响，仍是未来研究的重要问题。

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引用次数: 0

Assembling the Pediatric Emergency Medicine Social Care Toolkit: A Modified Delphi Study 组装儿科急诊医学社会关怀工具包：改良德尔菲研究。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-07 DOI: 10.1016/j.acap.2024.102599

Hannah Barber Doucet MD, MPH , Raymen Rammy Assaf MD, MPH, MA , Kristol Das MD, MPH , Natalie J. Tedford MD, MSPH , Danielle Graff MD, MSc , Eric W. Fleegler MD MPH

Background

The pediatric emergency department is a high-value site for screening and resource referral for health-related social needs. However, best practices for this unique environment remain unclear. This study’s objective was to introduce a consensus-based social care training toolkit for the pediatric emergency medicine (PEM) setting.

Methods

We conducted a modified Delphi study to establish consensus on social care practice and develop a user-friendly toolkit. Initially, five priority areas (sections) were identified. Participants reviewed literature and shared their expertise to draft preliminary sections of the toolkit. Two rounds of the modified Delphi process were conducted, involving a ranking system, significant qualitative feedback, and a final approval stage, resulting in the finalized toolkit.

Results

Seventeen participants were included in the Delphi process, including pediatric and general EM faculty and trainees, as well as a social worker and public health professor. Forty-two content items were ranked in the first Delphi round. Based on a combination of score cut-off and extensiveness of qualitative comments, items were either minorly edited and kept (29%) or sent back to their section for review (71%). The second Delphi round integrated further suggested edits, and all participants in this final round approved the publicly available version of the toolkit.

Conclusion

By utilizing diverse sources of information and a consensus-driven process of the modified Delphi, we generated best practice recommendations for the design, implementation, and training of social care programs in the PEM setting.

背景：儿科急诊室是筛查与健康相关的社会需求并进行资源转介的高价值场所。然而，针对这一独特环境的最佳实践仍不明确。本研究的目的是为儿科急诊医学（PEM）环境引入基于共识的社会关怀培训工具包：我们进行了一项改良的德尔菲研究，以就社会关怀实践达成共识，并开发一个用户友好型工具包。最初，我们确定了五个优先领域（部分）。参与者查阅文献，分享专业知识，起草工具包的初步章节。经过两轮修改后的德尔菲流程，包括排序系统、重要的定性反馈以及最后的批准阶段，最终确定了工具包：17名参与者参与了德尔菲过程，其中包括儿科和普通急诊科的教师和受训人员，以及一名社会工作者和公共卫生教授。在第一轮德尔菲过程中，对 42 个内容项目进行了排序。根据分数分界线和定性评论的广泛性，对项目进行了小幅编辑和保留（29%），或发回其部门进行审查（71%）。第二轮德尔菲讨论进一步采纳了编辑建议，最后一轮讨论的所有参与者都批准了工具包的公开版本：通过利用不同的信息来源和改良德尔菲法的共识驱动过程，我们为 PEM 环境中社会护理项目的设计、实施和培训提出了最佳实践建议。

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引用次数: 0

Pediatric Practices' Experiences with Massachusetts' Medicaid Accountable Care Organizations. 儿科医疗机构对马萨诸塞州医疗补助责任医疗组织的体验。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-05 DOI: 10.1016/j.acap.2024.102601

Shriya Jamakandi, Joan Li, Alyna T Chien, Matthew Alcusky, Michaela Kerrissey

Objective: To examine the experience of Medicaid Accountable Care Organizations (ACOs) that include pediatric practices, including their motivations and experiences working together.

Methods: This mixed methods study is set within the first two years of the Massachusetts Medicaid ACO Program, which created 17 Medicaid ACOs across the Commonwealth in 2018. It combines qualitative interviews from organizational leaders across three Medicaid ACOs with pediatric representation (N=28; purposive sample; 2018) with a 44-item primary care practice leader survey (N=225 after 64% response rate; statewide stratified random sample of primary care practices; 2019). Interviews gathered information about organizational motivations and experiences with becoming a Medicaid ACO; the survey asked five domains of questions describing the experience of pediatric- and adult-focused primary care practices in joining Medicaid ACOs (e.g., how much practices solved problems jointly with the ACO). We used ordinary least squares regression to describe differences in experiences across pediatric vs. non-pediatric practices.

Results: Leaders of Medicaid ACO with pediatric representation expressed a desire to voice pediatric concerns regarding state Medicaid payment policy and to integrate social services as part of routine medical care. Relative to the experience of adult-focused primary care practice leaders, pediatric-focused practices reported less collaboration within the Medicaid ACO (95% confidence interval 0.81 to 0.05; p = 0.03) and less change toward standardization of policies such as physician compensation (95% confidence interval 0.61 to 0.02; p = 0.04).

Conclusions: Initial Medicaid ACO experiences can differ based on the degree to which organizations joining Medicaid ACO programs serve pediatric populations.

Article summary: Early in Massachusetts' implementation of Medicaid Accountable Care Organizations (ACO), pediatric-focused practices reported less collaboration and standardization within their Medicaid ACOs than adult-focused practices.

目的研究包括儿科诊所在内的医疗补助责任医疗组织（ACO）的经验，包括其合作动机和经验：这项混合方法研究以马萨诸塞州医疗补助 ACO 计划的头两年为背景，该计划于 2018 年在全联邦范围内创建了 17 个医疗补助 ACO。研究结合了对三个有儿科代表的医疗补助 ACO 的组织领导者的定性访谈（N=28；目的性抽样；2018 年）和 44 个项目的初级保健实践领导者调查（N=225，回复率为 64%；全州初级保健实践分层随机抽样；2019 年）。访谈收集了有关成为医疗补助 ACO 的组织动机和经验的信息；调查提出了五个领域的问题，描述了以儿科和成人为重点的初级医疗实践加入医疗补助 ACO 的经验（例如，实践与 ACO 共同解决问题的程度）。我们使用普通最小二乘法回归来描述儿科与非儿科实践经验的差异：有儿科代表参加的医疗补助 ACO 的领导者表示，希望表达儿科对州医疗补助支付政策的关切，并将社会服务作为常规医疗服务的一部分。与以成人为主的初级医疗实践领导者的经验相比，以儿科为主的实践者在医疗补助 ACO 中的合作较少（95% 置信区间为 0.81 至 0.05；p = 0.03），对医生报酬等政策的标准化改变较少（95% 置信区间为 0.61 至 0.02；p = 0.04）：文章摘要：在马萨诸塞州实施医疗补助责任医疗组织（ACO）的初期，以儿科为重点的医疗机构与以成人为重点的医疗机构相比，其医疗补助ACO内部的合作和标准化程度较低。

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引用次数: 0

Associations Between Preschooler Screen Time Trajectories and Executive Function 学龄前儿童屏幕时间轨迹与执行功能之间的关联。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-05 DOI: 10.1016/j.acap.2024.102603

Caroline Fitzpatrick PhD , Elena Florit PhD , Annie Lemieux MSc , Gabrielle Garon-Carrier PhD , Lucia Mason PhD

Objective

To examine associations between preschooler screen time trajectories and executive functions and effortful control at age 5.

Methods

Prospective, community-based convenience sample of 315 parents of preschoolers (54% male), studied at the ages of 3.5 (2020), 4.5 (2021), and 5.5 (2022). Parent-reported screen use at the ages of 3.5, 4.5, and 5.5 was used to estimate preschooler screen use trajectories. Using latent growth modeling, we identified low (mean = .9 h/d, 23%), medium (mean = 3.0 h/d, 56%), and high (mean = 6.38 h/d, 21%) screen time groups.

Children completed assessments of inhibitory control and cognitive flexibility at age 5.5. Both tasks are from the National Institute of Health Toolbox. Parents reported child effortful control at the age of 3.5 and 5.5 using the Children’s Behavior Questionnaire, educational attainment, and parenting stress.

Results

Children in the average (b = −5.24) and high (b = .9.30) screen time trajectories scored significantly lower on inhibitory control than those in the low screen time group. Children in the average and high screen time groups also scored higher than children in the low screen time group on cognitive flexibility (b = −4.50) and (b = −10.12), respectively. Finally, children in the average and high screen time groups scored lower than children in the low screen time groups on effortful control (b = −.41) and (b = −.61), respectively.

Conclusions

The present study shows that stability in high levels of screen use is common among preschoolers and may forecast higher risk of cognitive difficulty and lower levels of cognitive control by the time of school entry.

Summary

High levels of preschooler screen use were associated with lower scores on assessments of inhibitory control, cognitive flexibility, and effortful control.

目的：研究学龄前儿童屏幕时间轨迹与 5 岁时执行功能和努力控制之间的关系：研究学龄前儿童屏幕时间轨迹与 5 岁时执行功能和努力控制之间的关系：在学龄前儿童 3.5 岁（2020 年）、4.5 岁（2021 年）和 5.5 岁（2022 年）时，对 315 名学龄前儿童的家长（54% 为男性）进行前瞻性社区便利抽样调查。家长报告的 3.5 岁、4.5 岁和 5.5 岁时的屏幕使用情况被用来估计学龄前儿童的屏幕使用轨迹。通过潜在增长模型，我们确定了屏幕使用时间低（平均=0.9 小时/天，23%）、中（平均=3.0 小时/天，56%）和高（平均=6.38 小时/天，21%）组别。儿童在 5.5 岁时完成了抑制控制和认知灵活性评估。这两项任务均来自美国国立卫生研究院工具箱。家长使用儿童行为问卷、教育程度和养育压力报告了儿童在 3.5 岁和 5.5 岁时的努力控制情况：平均（b=-5.24）和高（b=.9.30）屏幕时间轨迹组儿童的抑制控制得分明显低于低屏幕时间组儿童。在认知灵活性（b=-4.50）和（b=-10.12）方面，平均和高屏幕时间组儿童的得分也分别高于低屏幕时间组儿童。最后，在努力控制（b=-.41）和（b=-.61）方面，平均和高屏幕时间组儿童的得分低于低屏幕时间组儿童：小结：学龄前儿童大量使用屏幕与抑制控制、认知灵活性和努力控制评估得分较低有关。

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引用次数: 0