Academic Pediatrics最新文献_第7页

Budding Doctors and Root Causes 崭露头角的医生和根本原因。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.03.010

引用次数: 0

Neighborhood-Level Social Determinants of Health and Adolescent Mental Health 邻里层面的健康与青少年心理健康的社会决定因素。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.08.008

Sarah Oyegoke BS , Phillip M. Hughes MS , Kristin H. Gigli PhD, APRN, CPNP-AC

Objective

Mental health diagnoses among adolescents are increasing in prevalence. Existing literature considers associations between individual-level social determinants of health (SDOH) and adolescent mental health. Neighborhood-level SDOH can have a substantial impact on health. This paper examines associations between neighborhood-level SDOH and mental health diagnoses of anxiety, depression, and suicidal ideation among hospitalized adolescents.

Methods

We used 2018 and 2019 Texas Inpatient Discharge Public Use Data Files linked to the zip-code level Child Opportunity Index 2.0, a composite measure of subdomains which characterize neighborhood-level SDOH, to examine rates of mental health diagnoses and associations with patient characteristics across opportunity level quintiles.

Results

The sample included 50,011 adolescents ages 10–19 admitted to the hospital with the mental health diagnoses anxiety, depression, and/or suicide. Most had a single diagnosis; anxiety (12.9%), depression (37.5%), or suicide (13.0%). Hospitalized adolescents 10–14 years old were a plurality (44.2%) of the sample. Most adolescents were White (64.2%) and non-Hispanic (67.4%) and lived in rural areas (29.6%). Adolescents from racial minority populations and those in rural communities with mental health diagnoses had lower opportunity-levels. Higher opportunity levels were associated with greater odds of having an anxiety or suicide diagnosis while a depression diagnosis was associated with a lower opportunity-level.

Conclusions

There are significant differences in adolescent mental health diagnoses associated with neighborhood opportunity-level. While all adolescents can benefit from mental health education, screening, and early interventions, additional resources tailored to neighborhood-level opportunity may prove a more meaningful way to improve population-level mental health outcomes.

目的：青少年心理健康诊断的发病率正在上升。现有文献考虑了个人层面的健康社会决定因素（SDOH）与青少年心理健康之间的关联。然而，邻里层面的 SDOH 也会对健康产生重大影响。本文研究了住院青少年中邻里层面的 SDOH 与焦虑、抑郁和自杀意念等心理健康诊断之间的关联：我们使用了 2018 年和 2019 年德克萨斯州住院病人出院公共使用数据文件，并将其与邮政编码级别的儿童机会指数 2.0 相链接，后者是描述邻里级别 SDOH 的子域的综合测量方法，用于研究不同机会级别五分位数的心理健康诊断率以及与患者特征之间的关联：样本包括 50,011 名 10-19 岁入院并被诊断为焦虑、抑郁和/或自杀的青少年。大多数人只有一种诊断：焦虑（12.9%）、抑郁（37.5%）或自杀（13.0%）。在样本中，住院的 10 至 14 岁青少年占大多数（44.2%）。大多数青少年为白人（64.2%）和非西班牙裔（67.4%），居住在农村地区（29.6%）。来自少数种族群体和农村社区的青少年被诊断出患有精神疾病的机会水平较低。较高的机会水平与较高的焦虑或自杀诊断几率有关，而抑郁症诊断则与较低的机会水平有关：结论：青少年心理健康诊断与邻里机会水平存在明显差异。虽然所有青少年都能从心理健康教育、筛查和早期干预中受益，但针对社区机会水平的额外资源可能会被证明是改善人群心理健康结果的更有意义的方法。

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引用次数: 0

Positive Outliers: A Mixed Methods Study of Resiliency to Childhood Obesity in High-Risk Neighborhoods 积极的异常值：高风险社区儿童肥胖复原力的混合方法研究。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.03.011

Objective

Despite the high prevalence of obesity and the clustering of risk by neighborhood, few studies have examined characteristics which promote healthy child weight in neighborhoods with high obesity risk. We aimed to identify protective factors for children living in neighborhoods with high obesity risk.

Methods

We identified neighborhoods with high obesity risk using geolocated electronic health record data with measured body mass index (BMI) from well-child visits (2012–2017). We then recruited caregivers with children aged 5 to 13 years who lived in census tracts with mean child BMI percentile ≥72 (February 2020–August 2021). We used sequential mixed methods (quantitative surveys, qualitative interviews) to compare individual, interpersonal, and perceived neighborhood factors among families with children at a healthy weight (positive outliers [PO]) versus families with ≥1 child with overweight or obesity (controls). Regression models and comparative qualitative analysis were used to identify protective characteristics.

Results

Seventy-three caregivers participated in the quantitative phase (41% PO; 34% preferred Spanish) and twenty in the qualitative phase (50% PO; 50% preferred Spanish). The frequency of healthy caregiver behaviors was associated with being a PO (Family Health Behavior Scale Parent Score adjusted β 3.67; 95% CI 0.52–6.81 and qualitative data). Protective factors also included caregivers’ ability to minimize the negative health influences of family members and adhere to family routines.

Conclusions

There were few differences between PO and control families. Support for caregiver healthy habits and adherence to healthy family routines emerged as opportunities for childhood obesity prevention in neighborhoods with high obesity risk.

目的：尽管肥胖症的发病率很高，而且肥胖症的风险因社区而异，但很少有研究探讨在肥胖症高风险社区中促进儿童健康体重的特征。我们的目的是找出生活在肥胖高风险社区的儿童的保护因素：我们利用地理定位的电子健康记录数据和儿童健康检查（2012-2017 年）中测量的体重指数 (BMI)，确定了肥胖高风险社区。然后，我们招募了有 5-13 岁儿童的看护人，他们居住在儿童平均 BMI 百分位数大于 72 的人口普查区（2020 年 2 月至 2021 年 8 月）。我们采用连续的混合方法（定量调查、定性访谈），比较有健康体重儿童的家庭（正离群值，PO）与有≥1 名超重或肥胖儿童的家庭（对照组）的个人、人际和感知的邻里因素。采用回归模型和比较定性分析来确定保护性特征：73名照顾者参与了定量阶段（41%为PO；34%喜欢西班牙语），20名照顾者参与了定性阶段（50%为PO；50%喜欢西班牙语）。照顾者的健康行为频率与成为 PO 相关（家庭健康行为量表家长评分调整 β 3.67；95% CI 0.52-6.81 和定性数据）。保护性因素还包括照顾者尽量减少家庭成员对健康的负面影响和遵守家庭常规的能力：PO 家庭与对照家庭之间几乎没有差异。新发现：在儿童肥胖高风险社区，有健康体重儿童的家庭和有超重/肥胖儿童的家庭在行为和社会方面都很相似。在儿童所处的环境中，父母对健康行为的示范和支持可促进儿童体重健康。

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引用次数: 0

The Effect of a Collaborative Pediatric Emergency Readiness Improvement Intervention on Patients’ Hospital Outcomes 儿科急诊准备改进协作干预对患者住院结果的影响。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.04.006

Objective

We hypothesized that collaborative intervention to improve weighted pediatric readiness score (WPRS) will be associated with decreased pediatric intensive care (PICU) mortality, PICU and hospital length of stay.

Methods

This study analyzes the transfer of acutely ill and injured patients from general emergency departments (GEDs) to our institution. The intervention involved customized assessment reports focusing on team performance and systems improvement for pediatric readiness, sharing best practices and clinical resources, designation of a nurse pediatric emergency care coordinator (PECC) at each GED and ongoing interactions at 2 and 4 months. Data was collected from charts before and after the intervention, focusing on patients transferred to our pediatric emergency department (ED) or directly admitted to our PICU from the GEDs. Clinical outcomes such as PICU length of stay (LOS), hospital LOS, and PICU mortality were assessed. Descriptive statistics were used for demographics, and various statistical tests were employed to analyze the data. Bivariate analyses and multivariable models were utilized to examine patient outcomes and the association between the intervention and outcomes.

Results

There were 278 patients in the pre-intervention period and 314 patients in the post-intervention period. Multivariable analyses revealed a significant association between the change in WPRS and decreased PICU LOS (β = −0.05 [95% CI: −0.09, −0.01), P = .02), and hospital LOS (β = −0.12 [95% CI: −0.21, −0.04], P = .04), but showed no association between the intervention and other patient outcomes.

Conclusions

In this cohort, improving pediatric readiness scores in GEDs was associated with significant improvements in PICU and hospital length of stay. Future initiatives should focus on disseminating pediatric readiness efforts to improve outcomes of critically ill children nationally.

目的我们假设，为提高加权儿科准备评分（WPRS）而采取的合作干预措施将有助于降低儿科重症监护室（PICU）死亡率、缩短儿科重症监护室和医院的住院时间。方法本研究分析了从普通急诊科（GED）转入本院的急诊伤病员。干预措施包括定制评估报告，重点关注团队绩效和儿科准备系统的改进、共享最佳实践和临床资源、在每个普通急诊科指定一名儿科急诊护理协调员护士（PECC），并在 2 个月和 4 个月时持续进行互动。我们从干预前后的病历中收集了数据，重点关注从 GED 转到儿科急诊部 (ED) 或直接入住 PICU 的患者。对临床结果进行了评估，如 PICU 的住院时间 (LOS)、住院时间和 PICU 死亡率。人口统计学采用描述性统计，数据分析采用各种统计检验。结果干预前有 278 名患者，干预后有 314 名患者。多变量分析显示，WPRS 的变化与 PICU LOS 的减少（β = -0.05 [95% CI: -0.09, -0.01]，P = .02）和住院 LOS 的减少（β = -0.12 [95% CI: -0.21, -0.04]，P = .04）之间存在显著关联，但干预措施与其他患者预后之间没有关联。今后应重点推广儿科准备工作，以改善全国重症儿童的预后。

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引用次数: 0

Associations between Positive Childhood Experiences (PCEs), Discrimination, and Internalizing/Externalizing in Pre-Adolescents 青春期前青少年的积极童年经历（PCEs）、歧视和内化/外化之间的关系。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.07.006

Kristen R. Choi PhD, PMHNP-BC , Lilian Bravo PhD, RN , Jaime La Charite MD, MPH , Elizabeth Cardona BS , Thomas Elliott MD, MS , Kortney F. James PhD, PNP , Lauren E. Wisk PhD , Erin C. Dunn ScD, MPH , Altaf Saadi MD, MS

Objective

This study aimed to investigate the relationships between four types of perceived discrimination (based on race and ethnicity, nationality/country of origin, gender identity, weight/body size), individually and cumulatively; positive childhood experiences (PCEs); and behavioral symptoms among pre-adolescent youth.

Methods

This study was a secondary analysis of data from the Adolescent Brain Cognitive Development (ABCD) Study, a US-based cohort study of pre-adolescent youth in the United States (N = 10,915). Our outcome was emotional/behavioral symptoms measured by the Child Behavior Checklist. Primary exposures were four types of discrimination, a count of 0–5 PCEs, and other adverse childhood experiences (ACEs). Multiple logistic regression models were used to estimate the relationship between perceived discrimination and clinical-range behavioral symptoms, including the role of PCEs and ACEs.

Results

Weight discrimination was the most frequent exposure (n = 643, 5.9%). Race and weight perceived discrimination were associated with clinical-range externalizing and internalizing symptoms, respectively, but these associations were non significant once other ACEs were added to models. Cumulative discrimination was associated with clinical-range Child Behavior Checklist (CBCL) scores, even when accounting for other ACEs (aOR = 1.47, 95% CI = 1.2–1.8). PCEs slightly reduced the strength of this relationship and were independently associated with reduced symptoms (aOR = 0.82, 95% CI = 0.72–0.93).

Conclusions

Results of this national study suggest cumulative discrimination can exert emotional/behavioral health harm among youth. PCEs were independently associated with reduced behavioral symptoms. There is a need for further research on how to prevent discrimination and bolster PCEs by targeting upstream social inequities in communities.

研究目的本研究旨在调查四种感知到的歧视（基于种族/人种、国籍/原籍国、性别认同、体重/体型）单独和累积与积极童年经历（PCEs）和青春期前青少年行为症状之间的关系：本研究是对美国青少年大脑认知发展（ABCD）研究数据的二次分析，该研究是一项针对美国青春期前青少年的队列研究（N=10915）。我们的研究结果是以儿童行为检查表（Child Behavior Checklist）测量的情绪/行为症状。主要暴露是四种类型的歧视、0-5 个 PCEs 计数以及其他不良童年经历 (ACEs)。多重逻辑回归模型用于估计感知到的歧视与临床范围行为症状之间的关系，包括 PCE 和 ACE 的作用：结果：体重歧视是最常见的暴露（n=643，5.9%）。种族和体重歧视分别与临床范围的外化症状和内化症状相关，但在将其他ACE加入模型后，这些相关性并不显著。累积性歧视与临床范围的 CBCL 分数相关，即使考虑到其他 ACEs 也是如此（aOR=1.47，95% CI=1.2-1.8）。PCEs 稍微降低了这种关系的强度，并与症状减轻独立相关（aOR=0.82，95% CI=0.72-0.93）：这项全国性研究的结果表明，累积性歧视会对青少年的情绪/行为健康造成伤害。PCEs 与行为症状的减少有独立关联。有必要进一步研究如何通过针对社区中的上游社会不平等现象来预防歧视和加强 PCEs。

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引用次数: 0

Selective Serotonin Reuptake Inhibitor Prescribing Within an Integrated Pediatric Primary Care Behavioral Health Program. 儿科初级保健行为健康综合项目中的选择性羟色胺再摄取抑制剂处方。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-10-28 DOI: 10.1016/j.acap.2024.10.008

Louis Vernacchio, Jonas Bromberg, Emily T Correa, Margaret Fry, Heather J Walter

Objective: Selective serotonin reuptake inhibitor (SSRI) prescribing is increasingly being integrated into primary care, but few data are available about prescribing patterns by pediatric primary care clinicians (PCCs) following implementation of integrated behavioral health (BH) care.

Methods: Using administrative claims data, we performed a cross-sectional analysis of SSRI prescribing within a statewide pediatric primary care network over 10 years after the initiation of an integrated BH program, calculating the rate of PCC and specialist SSRI prescribing. Using electronic health record data, we analyzed a proposed set of quality metrics for SSRI initiation.

Results: Over 10 years, SSRI prescribing by PCCs increased from 56 fills/1000 patient-years to 446; over the same time period, prescribing by specialists for the network's patients rose from 233 fills/1000 patient-years to 380. In 2013, PCCs prescribed 19% of all SSRIs, while by 2022, they prescribed 54% of the total (P < 0.001 for change for PCCs compared to specialists). Among 16,272 initial SSRI prescribing events by PCCs, 99.6% prescribed a recommended SSRI; 97.5% used an appropriate starting dose; 55.2% documented a validated symptom rating scale at initiation; 53.4% had a contact within 14 days; 67.8% had a follow-up visit within 60 days; and 37.4% documented a symptom rating scale within 60 days.

Conclusions: In the first 10 years of a pediatric integrated BH program, SSRI prescribing by PCCs increased over 7-fold and surpassed specialist prescribing for the patient population. PCCs chose medications and starting doses appropriately but could improve their use of validated symptom rating scales and consistent follow-up.

目的：选择性 5-羟色胺再摄取抑制剂（SSRI）处方越来越多地被纳入初级保健中，但关于儿科初级保健临床医生（PCC）在实施综合行为健康（BH）保健后的处方模式的数据却很少：我们利用行政报销数据，对综合 BH 计划启动后 10 年间全州儿科初级保健网络内的 SSRI 处方情况进行了横断面分析，计算了初级保健中心和专科医生的 SSRI 处方率。通过使用电子健康记录数据，我们分析了一套拟议的 SSRI 启动质量指标：10年间，PCC开具的SSRI处方从56份/千名患者-年增加到446份/千名患者-年；同期，专科医生为网络内患者开具的处方从233份/千名患者-年增加到380份/千名患者-年。2013 年，儿科专科医生开出的处方占所有 SSRIs 的 19%，而到 2022 年，他们开出的处方占总数的 54%（PConclusions：在儿科综合 BH 计划实施的前 10 年中，初级保健中心开具的 SSRI 处方增加了七倍多，超过了专科医生为患者开具的处方。PCC 在选择药物和起始剂量时非常恰当，但在使用有效症状评分量表和持续随访方面还有待改进。

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引用次数: 0

Food and Housing Insecurity, COVID-19 Pandemic Effects on Health-Related Activities, and Care Plans for Children with Obesity. 粮食和住房不安全、COVID-19 大流行病对健康相关活动的影响以及肥胖儿童护理计划。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-10-28 DOI: 10.1016/j.acap.2024.10.010

Kelsey A Egan, Jennifer G Fiore, Man Luo, Sheila Kelly, William G Adams, Elsie M Taveras, Meg Simione, Caroline J Kistin

Objective: To understand the association between food insecurity (FI) and housing insecurity (HI) risk, the effects of the COVID-19 pandemic on health-related activities among children with overweight or obesity, and caregivers' and clinicians' challenges and priorities related to pediatric weight management.

Methods: We conducted surveys with caregivers of children with overweight and obesity and pediatric clinicians at two academic medical centers in the Greater Boston area. We used multivariable logistic regression models to examine associations between FI and HI risk and the effects of the COVID-19 pandemic on health-related activities and descriptive statistics to summarize caregivers' and clinicians' challenges and priorities related to pediatric weight management.

Results: We analyzed data from surveys with 344 caregivers and 100 pediatric clinicians. Overall, 37% of caregivers endorsed both FI+HI, 18% FI alone, 10% HI alone, and 35% neither FI/HI. In the adjusted logistic regression models, combined FI+HI (reference: neither FI/HI) was significantly associated with higher odds of sleeping less (aOR 2.96 [95% confidence interval (CI): 1.46, 6.01]) and higher odds of spending less time outside (aOR 2.10 [95% CI: 1.06, 4.16]). Top priorities for pediatric weight management identified by both caregivers and clinicians were related to physical activity and availability of outdoor spaces.

Conclusions: Endorsement of both FI+HI was associated with children getting less sleep and spending less time outside during the COVID-19 pandemic. Future innovations in care plans for children with overweight and obesity should be adapted to a family's social context and should incorporate caregivers' and clinicians' challenges and priorities.

目的了解粮食不安全（FI）与住房不安全（HI）风险之间的关联、COVID-19 大流行病对超重或肥胖儿童健康相关活动的影响，以及护理人员和临床医生在儿科体重管理方面面临的挑战和优先事项：我们对超重和肥胖儿童的看护者以及大波士顿地区两家学术医疗中心的儿科临床医生进行了调查。我们使用多变量逻辑回归模型来研究 FI 和 HI 风险之间的关联以及 COVID-19 大流行对健康相关活动的影响，并使用描述性统计来总结护理人员和临床医生在儿科体重管理方面面临的挑战和优先事项：我们对 344 名护理人员和 100 名儿科临床医生的调查数据进行了分析。总体而言，37% 的护理人员同时认可 FI+HI，18% 仅认可 FI，10% 仅认可 HI，35% 既不认可 FI 也不认可 HI。在调整后的逻辑回归模型中，同时认可 FI+HI （参考：既不认可 FI/HI）与较少睡眠（aOR 2.96 [95% 置信区间 (CI)：1.46, 6.01]）和较少户外活动（aOR 2.10 [95% CI：1.06, 4.16]）的几率显著相关。护理人员和临床医生认为儿科体重管理的首要任务与体育锻炼和户外活动有关：结论：在COVID-19大流行期间，FI+HI的认可与儿童睡眠减少和户外活动时间减少有关。针对超重和肥胖儿童的护理计划的未来创新应适应家庭的社会环境，并应纳入护理人员和临床医生的挑战和优先事项。

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引用次数: 0

Variation in Use of Neuroimaging in the Care of Infants Undergoing Subspecialty Evaluations for Abuse: A Multicenter Study. 在护理因虐待而接受亚专科评估的婴儿时使用神经影像学的差异：一项多中心研究。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-10-28 DOI: 10.1016/j.acap.2024.10.009

Emily Alpert, Joanne N Wood, Justine Shults, Daniel M Lindberg, Kristine A Campbell, Aashim Bhatia, James D Anderst, Angela Bachim, Rachel P Berger, Farah W Brink, Lori D Frasier, Nancy S Harper, Natalie Laub, John Melville, Jan Leonard, M Katherine Henry

Objectives: 1) To quantify hospital-level variation in use of neuroimaging to screen for intracranial injury (ICI) among infants without overt signs or symptoms of head trauma undergoing subspecialty evaluations for physical abuse; 2) to assess for disproportionality in neuroimaging based on race and ethnicity and insurance type.

Methods: This was a cross-sectional study of infants age <12 months receiving subspecialty child abuse evaluations from February 2021 to December 2022 at 10 sites in CAPNET, a multicenter child abuse research network. Infants were included if they underwent a skeletal survey and lacked overt signs of possible ICI or blunt head injury. Outcome was completion of neuroimaging (computed tomography [CT] or magnetic resonance imaging [MRI]). Multivariable logistic regression was used to assess associations between demographic, clinical, and hospital factors with neuroimaging use.

Results: Of 1114 infants, 746 (67%) underwent neuroimaging ranging from 51% to 80% across CAPNET hospitals. In multivariable analysis, young age, presence of rib fracture(s), and site had significant associations with neuroimaging. Insurance type and race and ethnicity did not contribute significantly to the model. After adjustment for case-mix, there was significant variation across hospitals, with neuroimaging use ranging from 51% (95% CI: 43%, 59%) to 79% (95% CI 71%, 88%).

Conclusion: We identified significant variation in neuroimaging use across CAPNET hospitals, highlighting the need for guideline development and care standardization during the care of infants undergoing abuse evaluations.

目的：(1) 量化接受身体虐待亚专科评估的无明显头部外伤体征或症状的婴儿中使用神经影像学筛查颅内损伤（ICI）的医院水平差异；(2) 评估基于种族/民族和保险类型的神经影像学比例失调情况：这是一项针对婴儿年龄的横断面研究：在 1,114 名婴儿中，746 名（67%）接受了神经影像学检查，CAPNET 各家医院的比例从 51% 到 80% 不等。在多变量分析中，年龄小、肋骨骨折和部位与神经影像学检查有显著相关性。保险类型和种族/人种对模型的影响不大。结论：我们发现 CAPNET 各家医院在神经成像方面存在显著差异，这表明在对婴儿进行虐待评估时，需要制定相关指南并实现护理标准化。

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引用次数: 0

Mapping Out Remediation: An Actionable Roadmap to Support Trainees Through Remediation. 绘制补救图：支持学员完成补救的可行路线图。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-10-28 DOI: 10.1016/j.acap.2024.10.007

N M Orlov, N Goodrich, D Mills, E Nelsen, S T Li

Objective: The goal of graduate medical education is for trainees to develop the competence needed to practice independently; however, some residents struggle to achieve competency and require remediation. Evidence around how to best facilitate remediation is lacking. The objective of this study was to understand best practices for remediation in pediatrics.

Methods: A national web-based survey of pediatric residency program directors (PDs) on remediation practices was performed. The survey included three open-ended questions about PDs' experiences with remediation. Self-reported barriers to and strategies for remediation were systematically analyzed using inductive thematic analysis to develop a theory of effective remediation in pediatric residency training.

Results: A total of 99 out of 195 (50.8%) program directors responded. Two main themes emerged: developing a personalized plan that ensures competency attainment and fostering psychological safety. Twelve categories outline actionable steps that PDs can take to make the remediation process successful.

Conclusions: Built from insight from pediatric PDs, we propose a conceptual model for effective remediation that accounts for competency attainment while safeguarding the emotional health of the resident. The conceptual model breaks the remediation process down into four phases: identification of the learner who struggles, planning the remediation process, implementation of the plan, and assessing the outcome of the process.

新内容：这一定性分析提供了一种可操作的、循序渐进的补救方法：医学研究生教育的目标是培养受训者独立执业所需的能力；然而，一些住院医师在达到能力要求方面举步维艰，需要进行补救。关于如何最好地促进补救措施的证据尚缺。本研究旨在了解儿科补救的最佳实践：方法：对儿科住院医师培训项目主任（PDs）进行了一项关于补救措施的全国性网络调查。调查包括3个开放式问题，内容涉及儿科住院医师在补习方面的经验。采用归纳主题分析法对自我报告的补救障碍和补救策略进行了系统分析，以建立儿科住院医师培训中有效补救的理论：结果：195 位项目主任中有 99 位（50.8%）做出了回应。结果：在 195 位项目主任中，共有 99 位（50.8%）进行了回复。他们提出了两大主题：制定个性化计划，确保达到能力要求；促进心理安全。12个类别概述了项目主任可采取的可行步骤，以确保补救过程取得成功：根据儿科住院医师的见解，我们提出了一个有效补救的概念模型，既能保证住院医师达到能力要求，又能保护住院医师的情感健康。该概念模型将补救过程分为四个阶段：识别有困难的学习者、规划补救过程、实施计划以及评估补救过程的结果。

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引用次数: 0

Police Avoidance Among Black Youth. 黑人青少年逃避警察的情况。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-10-18 DOI: 10.1016/j.acap.2024.10.006

Dylan B Jackson, Rebecca L Fix, Alexander Testa, Lindsey Webb, Tamar Mendelson, Sirry Alang, Lisa Bowleg

Objectives: Police violence is a public health crisis that disproportionately impacts youth of color, particularly Black youth. These disparities may also compel Black youth to engage in police avoidance (ie, efforts to circumvent police contact and surveillance). Even so, research on Black youths' engagement in police avoidance is lacking. The present study is the first to investigate factors that may underpin police avoidance among Black youth.

Methods: Data come from the Survey of Police-Adolescent Contact Experiences (SPACE), a recent, cross-sectional, non-probability survey of Black youth (around 52% male) aged 12-21 in Baltimore City, Maryland (n = 345).

Results: Findings indicate that youth 1) identifying as bisexual or queer, 2) perceiving lower safety at home and in their neighborhoods, 3) reporting more negative attitudes about police, and 4) engaging in delinquent behaviors reported significantly greater police avoidance. Furthermore, youth who reported a greater number of known persons stopped by the police (eg, family members, friends, neighbors) and had personally experienced officer intrusion during direct or witnessed stops (eg, harsh language, threats of force, use of force) also exhibited greater police avoidance.

Conclusions: Lesbian, gay, bisexual, and queer (LGBQ) identity, reduced perceptions of environmental safety, negative attitudes about police, delinquent behaviors, and multiple types of police exposure may shape police avoidance among Black youth. Findings have the potential to inform targeted strategies to mitigate racial and LGBQ disparities in adolescent well-being.

Clinical trial registration: None.

目标：警察暴力是一种公共健康危机，对有色人种青少年，尤其是黑人青少年的影响尤为严重。这些差异也可能迫使黑人青少年参与躲避警察的行为（即努力避开警察的接触和监视）。即便如此，有关黑人青年参与躲避警察的研究仍然缺乏。本研究首次调查了可能支撑黑人青年避警行为的因素：数据来自《警察与青少年接触经历调查》（SPACE），该调查是最近对巴尔的摩市 12 至 21 岁的黑人青少年（约 52% 为男性）（n = 345）进行的一项横断面非概率调查：调查结果显示：1）自称双性恋或同性恋的青少年；2）认为家庭和邻里安全感较低；3）对警察持更消极的态度；4）有不良行为的青少年对警察的回避程度明显更高。此外，报告有更多被警察拦截的熟人（如家人、朋友、邻居）以及在直接或目睹拦截过程中亲身经历过警察侵犯（如粗言秽语、武力威胁、使用武力）的青少年也表现出更多的警察回避行为：结论：LGBQ 身份、环境安全感降低、对警察的负面态度、不良行为以及多种类型的警察接触可能会导致黑人青少年逃避警察。研究结果有可能为制定有针对性的策略提供信息，以减少青少年福祉中的种族和 LGBQ 差异：临床试验注册：无。

{"title":"Police Avoidance Among Black Youth.","authors":"Dylan B Jackson, Rebecca L Fix, Alexander Testa, Lindsey Webb, Tamar Mendelson, Sirry Alang, Lisa Bowleg","doi":"10.1016/j.acap.2024.10.006","DOIUrl":"10.1016/j.acap.2024.10.006","url":null,"abstract":"<p><strong>Objectives: </strong>Police violence is a public health crisis that disproportionately impacts youth of color, particularly Black youth. These disparities may also compel Black youth to engage in police avoidance (ie, efforts to circumvent police contact and surveillance). Even so, research on Black youths' engagement in police avoidance is lacking. The present study is the first to investigate factors that may underpin police avoidance among Black youth.</p><p><strong>Methods: </strong>Data come from the Survey of Police-Adolescent Contact Experiences (SPACE), a recent, cross-sectional, non-probability survey of Black youth (around 52% male) aged 12-21 in Baltimore City, Maryland (n = 345).</p><p><strong>Results: </strong>Findings indicate that youth 1) identifying as bisexual or queer, 2) perceiving lower safety at home and in their neighborhoods, 3) reporting more negative attitudes about police, and 4) engaging in delinquent behaviors reported significantly greater police avoidance. Furthermore, youth who reported a greater number of known persons stopped by the police (eg, family members, friends, neighbors) and had personally experienced officer intrusion during direct or witnessed stops (eg, harsh language, threats of force, use of force) also exhibited greater police avoidance.</p><p><strong>Conclusions: </strong>Lesbian, gay, bisexual, and queer (LGBQ) identity, reduced perceptions of environmental safety, negative attitudes about police, delinquent behaviors, and multiple types of police exposure may shape police avoidance among Black youth. Findings have the potential to inform targeted strategies to mitigate racial and LGBQ disparities in adolescent well-being.</p><p><strong>Clinical trial registration: </strong>None.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102594"},"PeriodicalIF":3.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0