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An Exploration of the Impact of Racism and Discrimination on the Mental Health of Latinx Youth 探讨种族主义和歧视对拉丁裔青年心理健康的影响。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-09-01 DOI: 10.1016/j.acap.2023.12.011
Latinx youth are at high risk of health and health care disparities. They are particularly vulnerable to mental health challenges due to the interplay of racism, health, and health care, which can be overwhelming for Latinx youth and their families to navigate. In this article, we provide an overview of the socio-demographics of Latinx youth living in the United States. Next, drawing on Borrell’s framework for the effect of self-racial categorization, we review health disparities commonly experienced by Latinx youth with a more detailed description of mental health. We also explore the impact of racism and colorism on Latinx youth mental health and health care. Finally, we propose multiple strategies across levels to reduce the aforementioned disparities.
拉美裔青年是健康和医疗保健差异的高危人群。由于种族主义、健康和医疗保健之间的相互影响,他们尤其容易受到心理健康挑战的影响,这可能会让拉美裔青少年及其家庭感到难以承受。在本文中,我们将概述生活在美国的拉美裔青少年的社会人口状况。接下来,我们借鉴博雷尔(Borrell)关于自我种族分类影响的框架,回顾了拉美裔青少年普遍经历的健康差异,并对心理健康进行了更详细的描述。我们还探讨了种族主义和肤色歧视对拉丁裔青年心理健康和医疗保健的影响。最后,我们提出了减少上述差异的多层次策略。
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引用次数: 0
Bias, Prejudice, Discrimination, Racism, and Social Determinants: The Impact on the Health and Well-Being of Latino Children and Youth 偏见、成见、歧视、种族主义和社会决定因素:对拉丁裔儿童和青少年的健康和福祉的影响》(The Impact on the Health and Well-Being of Latino Children and Youth)。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-09-01 DOI: 10.1016/j.acap.2023.12.013
This narrative review focuses on the impact of bias, prejudice, discrimination, racism (BPDR), social determinants of health, and structural racism on Latino children’s health and well-being. The race/ethnicity, country of origin, immigrant/generational status, limited English proficiency (LEP), acculturation level, and social class of Latino children and their parents can heighten or modify the impact of BPDR. These differences have been shown to affect BPDR among Latino adults and presumably for their children. Surveys of Latino adolescents reveal that 60% have experienced discrimination, with first- and second-generation teens having a higher prevalence. These experiences are magnified by adverse social determinants/structural racism. BPDR can impact Latino children prenatally through adolescence. Bias involving neonatal, primary, and inpatient pediatric services has been reported. In 2021, Latino children were 19% less likely to complete preventive care, and 32% of LEP children had no medical home. School-age Latino children experience system inequities associated with chronic physical and mental health conditions. BPDR is also seen in educational performance but can be buffered by a strong racial/ethnic self-identity. To address BPDR/structural racism for Latino children, we suggest pediatricians: 1) increase the Latino child-health workforce to address BPDR internally and externally, 2) advocate for data collection on and monitoring of Latino children’s disparities and racism metrics in pediatric services, to improve quality of care for Latino children and their families, and 3) advocate for child health equity. Together, these steps will help eliminate BPDR for Latino children and ensure they obtain their full potential.
这篇叙述性综述主要探讨偏见、成见、歧视、种族主义(BPDR)、健康的社会决定因素以及结构性种族主义对拉丁裔儿童健康和幸福的影响。拉美裔儿童及其父母的种族/民族、原籍国、移民/世代状况、英语水平有限(LEP)、文化适应程度和社会阶层都会加剧或改变偏见和歧视的影响。这些差异已被证明会影响拉丁裔成年人的 BPDR,并可能影响其子女的 BPDR。对拉丁裔青少年的调查显示,60%的青少年曾遭受歧视,其中第一代和第二代青少年遭受歧视的比例更高。这些经历被不利的社会决定因素/结构性种族主义放大。BPDR 对拉丁裔儿童从产前到青春期都会产生影响。据报道,新生儿、初级和住院儿科服务存在偏见。2021 年,拉丁裔儿童完成预防保健的可能性降低了 19%,32% 的 LEP 儿童没有医疗之家。学龄拉丁裔儿童经历着与慢性身体和精神健康状况相关的系统不平等。BPDR 也体现在教育成绩上,但可以通过强烈的种族/族裔自我认同来缓冲。为了解决拉丁裔儿童的BPDR/结构性种族主义问题,我们建议儿科医生1)增加拉美裔儿童健康工作者队伍,从内部和外部解决BPDR问题;2)倡导收集和监测拉美裔儿童在儿科服务中的差异和种族主义指标数据,提高拉美裔儿童及其家庭的医疗质量;3)倡导儿童健康公平。这些措施将有助于消除拉丁裔儿童的 BPDR,确保他们充分发挥潜能。
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引用次数: 0
Social Behaviors Associated with SARS-CoV-2 Test Positivity Among Children Evaluated in Canadian Emergency Departments, 2020 to 2022: A Cross-Sectional Survey Study. 2020 至 2022 年加拿大急诊科接受评估的儿童中与 SARS-CoV-2 检测呈阳性相关的社交行为:一项横断面调查研究。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-30 DOI: 10.1016/j.acap.2024.08.016
Madeleine Sumner, Gillian A M Tarr, Jianling Xie, Ahmed Mater, Kathleen Winston, Jocelyn Gravel, Naveen Poonai, Brett Burstein, Simon Berthelot, Roger Zemek, Robert Porter, Bruce Wright, April Kam, Jason Emsley, Vikram Sabhaney, Darcy Beer, Gabrielle Freire, Anne Moffatt, Stephen B Freedman

Objective: To evaluate how social behaviors relate to SARS-CoV-2 test positivity across pediatric age groups.

Methods: Multicenter, cross-sectional study recruiting children <18 years old tested for SARS-CoV-2 infection in emergency departments between 2020 and 2022. We used multivariate logistic regression to assess how self-reported social behaviors affect SARS-CoV-2 test positivity across four age groups. Causal mediation analysis quantified how mask-wearing and presence of an infected close contact mediated the SARS-CoV-2 risk of given behaviors.

Results: Seven thousand two hundred and seventy two children were enrolled and 1457 (20.0%) tested positive for SARS-CoV-2. Attending a social gathering was associated with increased odds (aOR 1.64, 95% CI: 1.05, 2.57) of SARS-CoV-2 positivity among children aged 5-<12 years. Those attending in-person school/daycare were less likely to test positive for SARS-CoV-2 across all age categories. Attending childcare was associated with 16.3% (95% CI: -21.0%, -11.2%) and 9.0% (95% CI: -11.6%, -6.5%) reductions in the probability of testing positive for SARS-CoV-2 infection, with 53.5% (95% CI: 39.2%, 73.9%) and 22.8% (95% CI: 9.7%, 36.2%) of the effects being mediated by the presence of a close contact among <1 year and 1-<5 year age groups, respectively. Masking in public mediated the association between childcare attendance and SARS-CoV-2 positivity in children aged <1 year.

Conclusions: Attending social gatherings increased the risk of SARS-CoV-2 test positivity in 5-<12-year-old children, but in-person daycare/school was associated with a reduced odds of testing positive across all ages. Settings with high public health adherence (ie, schools) reduced the risk of testing positive for SARS-CoV-2, possibly from reduced close contact with SARS-CoV-2 positive individuals.

目的评估不同年龄段儿童的社会行为与 SARS-CoV-2 检测阳性率之间的关系:多中心、横断面研究,招募儿童:研究共招募了 7272 名儿童,其中 1457 名(20.0%)儿童的 SARS-CoV-2 检测呈阳性。参加社交聚会与 5 岁儿童 SARS-CoV-2 阳性的几率增加有关(aOR:1.64,95%CI:1.05,2.57)- 结论:参加社交聚会增加了儿童感染 SARS-CoV-2 的风险:参加社交聚会增加了 5- 6 岁儿童 SARS-CoV-2 检测呈阳性的风险。
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引用次数: 0
Racial, Ethnic, and Language Inequities in Ambulatory Pediatrics Patient Family Experience. 门诊儿科患者家庭体验中的种族、民族和语言不平等。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-30 DOI: 10.1016/j.acap.2024.08.015
Margaret N Jones, Michael Ponti-Zins, Melinda MacDougall, Shelley Ehrlich, Ndidi Unaka, Samuel Hanke, Jareen Meinzen-Derr, Mary C Burkhardt, Alexandra Corley, Ryan Adcock, Sana Amanullah, Jamilah Hackworth, Kristen Copeland, Jessica A Kahn, Andrew F Beck

Objective: To determine the association of patient race, patient-provider racial congruence, patient ethnicity, and family primary language with patient family experience (PFE) survey responses.

Methods: Cross-sectional review of PFE survey responses from all ambulatory medical encounters at a large, urban children's hospital system June 1, 2020-May 31, 2022. Exposures were patient race, patient-provider racial congruence, patient ethnicity, and family primary language. We adjusted analyses for neighborhood-level socioeconomic deprivation, patient sex and age, encounter specialty, and location of care. Outcomes were PFE survey scores for five questions focused on overall experience, respect, and safety; categorized using industry standard metric of presence of a "top-box" score, defined as a nine or 10 for questions on an 11-point scale or as four on a four-point scale.

Results: We included 89,175 surveys (15.6% response rate). The odds of having optimal, "top-box" responses for several assessed questions were lower for patients identified as Asian (eg, adjusted odds ratio [OR] 0.46; 95% confidence interval [CI] 0.40, 0.52) or Black (eg, OR 0.65; CI 0.60, 0.70) compared to White, and for Hispanic (eg, OR 0.84; CI 0.72, 0.97) compared to non-Hispanic. Similarly, the odds of having "top-box" scores were lower for Spanish-primary-language (eg, OR 0.38; CI 0.30, 0.48) compared to English-primary-language patients. Patient-provider racial congruence had higher odds of "top-box" responses for two of five assessed questions (eg, OR 1.18; CI 1.04, 1.35).

Conclusions: We found previously unreported inequities in ambulatory pediatric PFE outcomes, with worse experiences reported by Asian, Black, Hispanic, and Spanish-language patients.

目的确定患者种族、患者-医疗服务提供者种族一致性、患者民族和家庭主要语言与患者家庭体验(PFE)调查回复的关联:方法:对一家大型城市儿童医院系统 2020 年 6 月 1 日至 2022 年 5 月 31 日所有门诊医疗就诊的 PFE 调查回复进行横断面回顾。暴露因素包括患者种族、患者与医护人员种族一致性、患者种族和家庭主要语言。我们对邻里社会经济贫困程度、患者性别和年龄、就诊专科和就诊地点进行了调整分析。结果是针对 5 个问题的 PFE 调查得分,这些问题集中在总体体验、尊重和安全方面;采用行业标准的 "最高箱 "得分标准进行分类,在 11 分制的问题上定义为 9 分或 10 分,在 4 分制的问题上定义为 4 分:我们共收集了 89 175 份调查问卷(回复率为 15.6%)。与白人相比,亚裔(如调整后的赔率[OR]0.46;95% 置信区间[CI]0.40, 0.52)或黑人(如赔率 0.65;CI 0.60, 0.70)患者对几个评估问题做出最佳 "顶格 "回答的几率较低;与非西班牙裔相比,西班牙裔患者做出最佳 "顶格 "回答的几率较低(如赔率 0.84;CI 0.72, 0.97)。同样,与以英语为母语的患者相比,以西班牙语为母语的患者获得 "顶级箱 "评分的几率较低(如 OR 0.38;CI 0.30,0.48)。在 5 个评估问题中,有 2 个问题的 "顶格 "回答中,患者与医疗服务提供者种族一致的几率更高(例如,OR 1.18;CI 1.04,1.35):我们发现了以前未曾报道过的门诊儿科急诊急症治疗结果的不公平现象,亚裔、黑人、西班牙裔和西班牙语患者的治疗体验较差。
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引用次数: 0
Promoting Senior Resident Autonomy; Tools to empower senior residents on inpatient wards. 促进高龄住院医师自治;增强住院病房高龄住院医师能力的工具。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-27 DOI: 10.1016/j.acap.2024.08.014
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引用次数: 0
Social Determinants of Pediatric Primary Care Telehealth and In-Office Visits During the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic. SARS-CoV-2 大流行期间儿科初级保健远程保健和诊室就诊的社会决定因素。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-26 DOI: 10.1016/j.acap.2024.08.012
Jordee M Wells, Tyler Gorham, Skyler E Kalady, Deena J Chisolm

Objective: To describe the use of primary care telehealth following the rapid reduction of in-person pediatric primary care availability during the severe acute respiratory syndrome coronavirus 2 pandemic and how this varied by community-level social determinants and individual-level social needs.

Methods: We conducted a retrospective cohort study of children 0 to 17 years across 16 sites within Nationwide Children's Hospital Primary Care Network from March 22 to July 31, 2020, and a preceding comparator period (2019). The study population includes 107,629 patient encounters. We compared visit type (in-person vs telehealth), demographics, presence of individual social needs, and community social determinants using the Child Opportunity Index 2.0 (COI). To assess telehealth utilization, we compared the ratio of 2019 to 2020 primary care visits across levels of COI. We trained a linear regression model predicting the number of telehealth encounters in 2020 using individual patient characteristics and COI.

Results: Patients in census tracts with high and very high levels of opportunity maintained the highest relative encounter volume (2020:2019) at the beginning of the pandemic (0.78 and 0.73, respectively, compared to 65% for children living in very low opportunity neighborhoods; P < 0.001). Patients with caregiver-reported social needs (housing, transportation, utilities, food) had relatively greater telehealth use following the start of the public health emergency.

Conclusions: Volume of primary care visits decreased least for high and very high-opportunity neighborhoods yet individual social needs were associated with higher relative use of telemedicine. Findings suggest that telehealth was an important modality to deliver care to children with social needs but does not overcome community-level barriers.

目的描述在 SARS-CoV-2 大流行期间,儿科初级保健上门服务迅速减少后初级保健远程医疗的使用情况,以及社区层面的社会决定因素和个人层面的社会需求有何不同:我们在 2020 年 3 月 22 日至 7 月 31 日以及之前的参照期(2019 年)对全美儿童医院初级保健网络内 16 个站点的 0-17 岁儿童进行了一项回顾性队列研究。研究对象包括 107629 次就诊。我们使用儿童机会指数 2.0 (COI),比较了就诊类型(亲诊与远程医疗)、人口统计学、个人社会需求的存在以及社区社会决定因素。为了评估远程医疗的使用情况,我们比较了不同 COI 水平的 2019 年与 2020 年初级保健就诊率。我们利用患者个人特征和 COI 建立了一个线性回归模型,预测 2020 年远程医疗就诊次数:结果:在大流行开始时,机会度高和机会度非常高的人口普查区的患者保持了最高的相对就诊量(2020 年:2019 年)(分别为 0.78 和 0.73,而机会度非常低的社区儿童的就诊量为 65%;P 结论:在大流行开始时,机会度高和机会度非常高的人口普查区的患者保持了最高的相对就诊量(2020 年:2019 年):机会多和机会少的社区初级保健就诊量减少最少,但个人社会需求与远程医疗的相对使用率较高有关。研究结果表明,远程医疗是为有社会需求的儿童提供医疗服务的重要方式,但并不能克服社区层面的障碍。
{"title":"Social Determinants of Pediatric Primary Care Telehealth and In-Office Visits During the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic.","authors":"Jordee M Wells, Tyler Gorham, Skyler E Kalady, Deena J Chisolm","doi":"10.1016/j.acap.2024.08.012","DOIUrl":"10.1016/j.acap.2024.08.012","url":null,"abstract":"<p><strong>Objective: </strong>To describe the use of primary care telehealth following the rapid reduction of in-person pediatric primary care availability during the severe acute respiratory syndrome coronavirus 2 pandemic and how this varied by community-level social determinants and individual-level social needs.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of children 0 to 17 years across 16 sites within Nationwide Children's Hospital Primary Care Network from March 22 to July 31, 2020, and a preceding comparator period (2019). The study population includes 107,629 patient encounters. We compared visit type (in-person vs telehealth), demographics, presence of individual social needs, and community social determinants using the Child Opportunity Index 2.0 (COI). To assess telehealth utilization, we compared the ratio of 2019 to 2020 primary care visits across levels of COI. We trained a linear regression model predicting the number of telehealth encounters in 2020 using individual patient characteristics and COI.</p><p><strong>Results: </strong>Patients in census tracts with high and very high levels of opportunity maintained the highest relative encounter volume (2020:2019) at the beginning of the pandemic (0.78 and 0.73, respectively, compared to 65% for children living in very low opportunity neighborhoods; P < 0.001). Patients with caregiver-reported social needs (housing, transportation, utilities, food) had relatively greater telehealth use following the start of the public health emergency.</p><p><strong>Conclusions: </strong>Volume of primary care visits decreased least for high and very high-opportunity neighborhoods yet individual social needs were associated with higher relative use of telemedicine. Findings suggest that telehealth was an important modality to deliver care to children with social needs but does not overcome community-level barriers.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094047","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
Anxiety and Depression Symptoms, Adverse Childhood Experiences, and Persistent/Recurrent Pain Across Early Adolescence. 青春期早期的焦虑和抑郁症状、童年不良经历以及持续性/复发性疼痛。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-26 DOI: 10.1016/j.acap.2024.08.013
Thea Senger-Carpenter, Anao Zhang, Monica Ordway, Sarah A Stoddard, Terri Voepel-Lewis

Objective: To determine whether anxiety and depression symptoms are mechanisms through which adverse childhood experiences (ACEs) contribute toward persistent/recurrent pain (PRP) across early adolescence.

Methods: This study described the direct and indirect (i.e. mediated) effects of ACEs on PRP across early adolescence, using four years of Adolescent Brain Cognitive Development Study® data. Annual pain frequency, anxiety, and depression symptoms were measured using the Child Behavior Checklist, and youth with pain for ≥3 of the 4-year study period were classified with PRP. Early (up to age 9-10 years; reported at baseline) and recent (at age 10-11 years; reported at year 1) ACE exposures were derived from parent and youth completed surveys. Structural equation modeling estimated the direct and indirect associations among early and recent ACEs, pain outcomes, and anxiety/depression symptoms reported in the year(s) in between.

Results: Among 7,951 youth, 2,540 (31.9%) were classified with PRP. Higher levels of early ACE exposure were associated with an increased probability of having PRP (adj.β 0.65 (95% Confidence Interval [CI] 0.07, 1.22). Early ACEs also had indirect effects on PRP via higher interim anxiety (adj. β 5.36 [95% CI 3.45, 7.26]) and depression symptoms (adj. β 4.57 [95% CI 3.01, 6.13]). Early and recent ACE exposures predicted higher pain frequency scores in subsequent years, with mixed results regarding the role of anxiety and depression in the relationships between ACEs and pain frequency scores.

Conclusion: Anxiety and depression symptoms are potentially important interventional targets to lower the risk for PRP among youth exposed to ACEs.

摘要确定焦虑和抑郁症状是否是童年不良经历(ACE)导致青春期早期持续性/复发性疼痛(PRP)的机制:本研究利用四年的青少年大脑认知发展研究(Adolescent Brain Cognitive Development Study®)数据,描述了ACE对青春期早期持续性/复发性疼痛(PRP)的直接和间接(即中介)影响。使用儿童行为检查表测量每年的疼痛频率、焦虑和抑郁症状,并将在四年研究期间疼痛次数≥3 次的青少年归类为 PRP 患者。早期(9-10 岁前;基线时报告)和近期(10-11 岁;第 1 年时报告)ACE 暴露来自家长和青少年填写的调查问卷。结构方程模型估算了早期和近期 ACE、疼痛结果以及中间一年报告的焦虑/抑郁症状之间的直接和间接联系:在 7951 名青少年中,有 2540 人(31.9%)被归类为 PRP。早期 ACE 暴露水平越高,患 PRP 的概率越高(adj.β 0.65(95% 置信区间 [CI] 0.07,1.22))。早期 ACE 还通过较高的中期焦虑(adj. β 5.36 [95% CI 3.45, 7.26])和抑郁症状(adj. β 4.57 [95% CI 3.01, 6.13])对 PRP 产生间接影响。早期和近期的ACE暴露可预测随后几年中更高的疼痛频率得分,而焦虑和抑郁在ACE与疼痛频率得分之间关系中的作用结果不一:焦虑和抑郁症状可能是降低暴露于ACE的青少年PRP风险的重要干预目标。
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引用次数: 0
"Racism Happens Every Day, All the Time": Black Families' Outpatient Experiences of Racism Across a Large Pediatric System. "种族主义每天都在发生,无时无刻不在发生":黑人家庭在大型儿科系统门诊的种族主义经历。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-25 DOI: 10.1016/j.acap.2024.08.011
Margaret N Jones, Kiaira Elliott, Susan N Sherman, Ebunoluwa Falade, Rolanda L Clark, Lauren Lipps, Lenice Hill-Williams, Caneisha Williams, Kristen A Copeland, Andrew F Beck, Ndidi Unaka, Mary Carol Burkhardt, Alexandra M S Corley

Objective: To qualitatively understand and characterize the experience of racism in outpatient pediatric healthcare settings from the perspectives of Black families.

Methods: We conducted focus groups with parents or guardians of Black children, recruited from academic primary care offices at a single pediatric institution. Focus groups were facilitated virtually by Black team members using an open-ended, semi-structured focus group guide. We analyzed focus group transcripts using iterative, thematic, inductive open coding performed independently by trained coders, with final codes reached by group consensus.

Results: We conducted 6 focus groups of 3 to 5 participants each and 1 individual interview, with 24 total parents. We identified the following themes: 1) "I just felt like we was a number": Black families perceived experiences that felt impersonal and lacked empathy; 2) "Why is the doctor treating me like I don't matter?": Black families perceived experiences with poor care and worse treatment; 3) Black families experience racism across socioecological levels when interacting with pediatric health systems; 4) Positive perceived experiences can guide improvement; and 5) Improvement will require antiracist efforts across the levels of racism.

Conclusions: In this qualitative study, we found that Black families have had many poor pediatric experiences, perceive racism as affecting child health broadly across socioecological levels, and recommend a multidimensional antiracist approach to improvement. Our findings underscore the importance of elevating Black family voices in developing policies that prioritize antiracism and work to eliminate the harmful impacts of racism on child health.

目的从黑人家庭的角度,定性地了解和描述儿科门诊医疗机构中的种族主义经历:我们与黑人儿童的家长或监护人进行了焦点小组讨论,这些家长或监护人是从一家儿科机构的学术初级保健办公室招募的。焦点小组由黑人小组成员使用开放式、半结构化焦点小组指南进行虚拟协助。我们使用经过培训的编码员独立进行的迭代式、主题式、归纳式开放编码对焦点小组记录进行了分析,并通过小组共识达成了最终编码:我们开展了 6 个焦点小组,每个小组有 3 至 5 人参加,还进行了 1 次个别访谈,共有 24 位家长参加。我们确定了以下主题:1)"我只是觉得我们是一个数字":黑人家庭认为他们的经历没有人情味,缺乏同情心;2)"为什么医生把我当成无关紧要的人?3)黑人家庭在与儿科医疗系统互动时,经历了跨社会生态层面的种族主义;4)积极的感知体验可以指导改进工作;5)改进工作需要跨种族主义层面的反种族主义努力:在这项定性研究中,我们发现黑人家庭有许多糟糕的儿科经历,认为种族主义在各个社会生态层面广泛地影响着儿童健康,并建议采取多维度的反种族主义方法来进行改善。我们的研究结果强调,在制定优先考虑反种族主义的政策和努力消除种族主义对儿童健康的有害影响时,提高黑人家庭的声音非常重要。
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引用次数: 0
The association between child food allergy and family food insecurity in a nationally representative US sample. 在具有全国代表性的美国样本中,儿童食物过敏与家庭食物不安全之间的关系。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-22 DOI: 10.1016/j.acap.2024.08.010
Elsa R Treffeisen, Sara J Cromer, Marisela E Dy-Hollins, Sheng Yi Lin, Hiten Naik, Dionne A Graham, Lauren Fiechtner, Karen A Kuhlthau, Lynda C Schneider, Kathleen E Walsh

Objective: To assess whether child food allergy is associated with family food insecurity, overall, and across different income levels.

Methods: We used the 2011-2018 National Health Interview Survey, a nationally representative cross-sectional survey. The exposure was child food allergy, and our main outcome was odds of family food insecurity, which was calculated using multivariable logistic regression models adjusted for child demographics, family characteristics and survey year. We examined for effect modification by the ratio of family income to the poverty threshold using stratification and tests for statistical interaction.

Results: Among 83,287 children 6% had food allergy and 22% experienced family food insecurity. Child food allergy was associated with a 1.39-fold (95% confidence interval [CI]: 1.26, 1.53) increased odds of family food insecurity overall. Child food allergy was associated with a 1.46-fold (95% CI: 1.29, 1.66) increased odds of family food insecurity among children whose families lived below 200% of the federal poverty level, and a 1.26-fold (95% CI: 1.05, 1.51) increased odds of family food insecurity among children whose families lived at 200 to 399% of the federal poverty level, with no association among children whose families lived at or above 400% of the federal poverty level (P =.04 for interaction).

Conclusion: There is an association between child food allergy and family food insecurity, and this association is modified by the ratio of family income to the poverty threshold. Improved availability and subsidy of allergen-free foods in nutrition assistance programs and food pantries are urgently needed.

目的评估儿童食物过敏是否与整体家庭食物不安全以及不同收入水平的家庭食物不安全有关:我们采用了 2011-2018 年全国健康访谈调查,这是一项具有全国代表性的横断面调查。调查对象是儿童食物过敏,主要结果是家庭食物不安全的几率,该几率通过多变量逻辑回归模型计算,并对儿童人口统计学特征、家庭特征和调查年份进行了调整。我们通过分层和统计交互检验,检查了家庭收入与贫困线的比率对效果的影响:在 83,287 名儿童中,6% 的儿童患有食物过敏症,22% 的儿童面临家庭食物不安全问题。儿童食物过敏导致家庭食物无保障的几率增加了 1.39 倍(95% 置信区间 [CI]:1.26, 1.53)。在家庭生活水平低于联邦贫困线 200% 的儿童中,儿童食物过敏导致家庭食物不安全的几率增加 1.46 倍(95% 置信区间:1.29, 1.66);在家庭生活水平处于联邦贫困线 200% 至 399% 的儿童中,儿童食物过敏导致家庭食物不安全的几率增加 1.26 倍(95% 置信区间:1.05, 1.51);在家庭生活水平处于联邦贫困线 400% 或以上的儿童中,儿童食物过敏与家庭食物不安全的几率没有关系(交互作用 P =.04):儿童食物过敏与家庭食物不安全之间存在关联,这种关联会因家庭收入与贫困线的比率而改变。营养援助计划和食品储藏室急需改善无过敏原食品的供应和补贴。
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引用次数: 0
External validation of two clinical prediction models for pediatric pneumonia. 两种小儿肺炎临床预测模型的外部验证。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-17 DOI: 10.1016/j.acap.2024.08.009
Sriram Ramgopal, Melissa Neveu, Douglas Lorenz, Jillian Benedetti, Jack Lavey, Todd A Florin

Objective: To externally validate two prediction models for pediatric radiographic pneumonia.

Methods: We prospectively evaluated the performance of two prediction models (Pneumonia Risk Score [PRS] and CARPE DIEM models) from a prospective convenience sample of children 90 days - 18 years of age from a pediatric emergency department undergoing chest radiography for suspected pneumonia between January 1, 2022, to December 31st, 2023. We evaluated model performance using the original intercepts and coefficients and evaluated for performance changes when performing recalibration and re-estimation procedures.

Results: We included 202 patients (median age 3 years, IQR 1-6 years), of whom radiographic pneumonia was found in 92 (41.0%). The PRS model had an area under the receiver operator characteristic curve of 0.72 (95% confidence interval [CI] 0.64-0.79), which was higher than the CARPE DIEM (0.59; 95% CI 0.51-0.67) (P<0.01). Using optimal cutpoints, the PRS model showed higher sensitivity (65.2%, 95% CI 54.6-74.9) and specificity (72.7%, 95% CI 63.4-80.8) compared to the CARPE DIEM model (sensitivity 56.5 [95% CI 45.8-66.8]; specificity 60.9 [95% CI 50.2-69.2]). Recalibration and re-estimation of models improved performance, particularly for the CARPE DIEM model, with gains in sensitivity and specificity, and improved calibration.

Conclusion: The PRS model demonstrated better performance than the CARPE DIEM model in predicting radiographic pneumonia. Among children with a high rate of pneumonia, these models did not reach a level of performance sufficient to be used independently of clinical judgement. These findings highlight the need for further validation and improvement of models to enhance their utility.

目的从外部验证儿科放射性肺炎的两个预测模型:我们前瞻性地评估了两个预测模型(肺炎风险评分 [PRS] 和 CARPE DIEM 模型)的性能,样本来自 2022 年 1 月 1 日至 2023 年 12 月 31 日期间在儿科急诊室接受胸部放射摄影检查的 90 天至 18 岁疑似肺炎患儿。我们使用原始截距和系数对模型性能进行了评估,并在执行重新校准和重新估计程序时对性能变化进行了评估:我们纳入了 202 名患者(中位年龄 3 岁,IQR 1-6 岁),其中 92 人(41.0%)发现了放射性肺炎。PRS模型的接收者操作特征曲线下面积为0.72(95%置信区间[CI] 0.64-0.79),高于CARPE DIEM(0.59;95% CI 0.51-0.67)(PC结论:在预测放射性肺炎方面,PRS模型的表现优于CARPE DIEM模型。在肺炎发病率较高的儿童中,这些模型的性能水平不足以独立于临床判断。这些发现凸显了进一步验证和改进模型以提高其实用性的必要性。
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Academic Pediatrics
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