Academic Pediatrics最新文献

Objective: Parents of children born preterm are at risk of neglecting their own medical needs following the birth of a medically complex child. This study examines the self-reported health of parents of preterm children born with low birthweight (LBW; 1500-2499 g) or very low birthweight (VLBW; <1500 g) compared with parents of term children of normal weight (term; ≥2500 g).

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.

Conclusions: 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 neonatal intensive care unit (NICU) discharge and well-child visits.

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 1681 participants aged 13-17 from across the United States. The systematic, multifaceted 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 3 institutions. Questions explored participants' perceptions of 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: Twenty-seven 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 4 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: 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.