Academic Pediatrics最新文献

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THE EQUITY PAUSE: USING QUALITATIVE RESEARCH TO EXAMINE ITS MEANING AND APPLICATION IN MEDICAL EDUCATION

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2025-01-01 DOI: 10.1016/j.acap.2024.102655

Caroline Paul MD , Heather Howell MD , Chanelle Coble-Sadaphal MD , Renee Heller BS , Julia Festa MD , Caitlin Plovnick BA, MS, MFA , Gary Beck Dallaghan PhD

引用次数: 0

SOCIAL MEDIA FOR CHILD ADVOCACY: PEDIATRICS RESIDENTS’ ATTITUDES AND USE OF SOCIAL MEDIA FOR ADVOCACY

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2025-01-01 DOI: 10.1016/j.acap.2024.102633

Vivien Sun MD, Brandii Criss MD, Lisa Chamberlain MD, Janine Bruce DPhil, Carrie Rassbach MD

引用次数: 0

READINESS FOR UNSUPERVISED PRACTICE FOR THE 17 ABP GENERAL PEDIATRICS EPAS: ARE GRADUATING RESIDENTS READY TO PROVIDE THE CARE PATIENTS NEED?

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2025-01-01 DOI: 10.1016/j.acap.2024.102676

Daniel Schumacher MD, PhD, MEd , David Turner MD , Benjamin Kinnear MD, MEd , Ariel Winn MD , Catherine Michelson MD, MMSc , Alan Schwartz PhD

引用次数: 0

ARE PEDIATRIC SUBSPECIALTY FELLOWS READY FOR UNSUPERVISED PRACTICE AFTER TWO YEARS OF TRAINING?

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2025-01-01 DOI: 10.1016/j.acap.2024.102652

Sarah Pitts MD , Alan Schwartz PhD , Ruchika Karnik MD , Pamela High MD, MS , Diane Stafford MD , Tandy Aye MD , Melissa Langhan MD, MHS , Donald Boyer MD, MSEd , Richard Mink MD, MACM

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

Academic Pediatrics

Pub Date : 2025-01-01 DOI: 10.1016/j.acap.2024.08.016

Madeleine Sumner AB , Gillian A.M. Tarr PhD , Jianling Xie MD MPH , Ahmed Mater MD , Kathleen Winston MSc , Jocelyn Gravel MD, MSc , Naveen Poonai MSc, MD , Brett Burstein MDCM, PhD, MPH , Simon Berthelot MD, MSc , Roger Zemek MD , Robert Porter MD, MSc , Bruce Wright MD , April Kam MD MScPH , Jason Emsley MSc, MD, PhD , Vikram Sabhaney MD , Darcy Beer MD , Gabrielle Freire MDCM, MHSc , Anne Moffatt MD , Stephen B. Freedman MDCM, MSc , on behalf of Pediatric Emergency Research Canada

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

Potentially Avoidable Emergency Department Transfers for Acute Pediatric Respiratory Illness 小儿急性呼吸道疾病可能避免的急诊科转院。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2025-01-01 DOI: 10.1016/j.acap.2024.07.020

Kaileen Jafari MD , Apeksha Gupta MPH, MS , Derya Caglar MD , Emily Hartford MD, MPH

Background

Acute pediatric respiratory illness is one of the most common reasons for emergency department (ED) transfer; however, few studies have examined predictors of potentially avoidable ED transfer (PAT) in this subpopulation. This study aimed to characterize patterns and predictors of PATs in children with acute respiratory illness.

Methods

Cross-sectional analysis of 8,402,577 visits for patients ≤17 years from 2018 to 2019 Health Care Utilization Project State ED and Inpatient Datasets from New York, Maryland, Wisconsin, and Florida. ED transfers matched to a visit at a receiving facility with a primary diagnosis of pneumonia, croup/other upper respiratory infection (URI), bronchiolitis, or asthma were included. PAT was defined as discharge from receiving ED or within 24 hours of inpatient admission without specialized procedures, as previously described. PATs were compared with necessary transfers using a 3-level generalized linear mixed model with adjustment for patient and hospital covariates.

Results

Among 4409 matched respiratory transfers, 25.5% were potentially avoidable. Most PATs originated from EDs within the third highest quartile of annual pediatric ED visits (n = 472, 42.0%). In the multivariable model, the likelihood of PAT was higher for patients with croup/other URI ((odds ratio) OR 2.72 (2.09–3.5) and if referring ED was in the highest quartile of annual pediatric ED volumes (OR 0.48 95% (confidence interval) CI 0.26–0.88).

Conclusions

Pediatric respiratory transfers with a diagnosis of croup/other URI were the most likely to be potentially avoidable. Future implementation efforts to reduce PATs should consider focusing on croup management in EDs in the lower 3 quartiles of pediatric volume.

背景：急性儿科呼吸道疾病是急诊科（ED）转院的最常见原因之一，但很少有研究对该亚群中潜在可避免的急诊科转院（PAT）进行预测。本研究旨在描述急性呼吸道疾病患儿转院的模式和预测因素：方法：对 8,402,577 名就诊患者进行横断面分析：在 4,409 例匹配的呼吸道转运病例中，25.5% 的病例可能是可以避免的。大多数 PAT 来自儿科急诊室年就诊量第三高四分位数的急诊室（472 人，42.0%）。在多变量模型中，如果患者患有咳嗽/其他URI（OR 2.72 (2.09 -3.5)），且转诊急诊室位于儿科急诊室年门诊量的最高四分位数（OR 0.48 95% CI 0.26-0.88），则发生PAT的可能性更高：结论：诊断为咳嗽/其他URI的儿科呼吸道转院最有可能避免。未来减少 PAT 的实施工作应考虑将重点放在儿科急诊量较低的三个四分位数的急诊室的分组管理上。

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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

Academic Pediatrics

Pub Date : 2025-01-01 DOI: 10.1016/j.acap.2024.08.012

Jordee M. Wells MD, MPH , Tyler Gorham PhD, MPH , Skyler E. Kalady MD , Deena J. Chisolm PhD

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。

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引用次数: 0

Geographic Patterns of Youth Suicide in San Diego County 圣地亚哥县青少年自杀的地域模式。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2025-01-01 DOI: 10.1016/j.acap.2024.08.164

Derek Tam MD, MPH , Seema Shah MD, MPH , Steven Campman MD , Margaret Nguyen MD

Objective

Our objectives were to evaluate for any cluster patterns of youth suicide deaths and characterize the level of child opportunity in the communities where suicide deaths occurred.

Methods

Decedents <18 years were identified from San Diego County Medical Examiner death reports from 2000 to 2020. We mapped decedents’ residential Zone Improvement Plan (ZIP) codes and calculated suicide rates per 10,000 youths. ZIP codes identified in overlapping spatial statistical approaches — the spatial scan statistic and Local Moran with Empirical Bayes (EB) rates — were considered a cluster for the final analysis. We obtained Child Opportunity Index (COI) scores for each ZIP code to determine if there were differences in: 1) ZIP codes with suicide deaths compared to ZIPs with no deaths 2) differences in distribution of suicide death rates across quintiles of COI.

Results

Scan statistic identified 25 ZIP codes within a cluster (RR 2.6, P = 0.00066). Local Moran with EB rates identified two ZIP codes as a high-high cluster (P < 0.05). The location identified as a cluster in both approaches was in Alpine. The median COI for ZIP codes with suicide deaths was higher at 63.5 (IQR 38–83) compared to 47 (IQR 22.5–75.5) for ZIP codes without suicide deaths. There was a significant difference in suicide rates between Very Low and Moderate levels of Overall opportunity (P = .013).

Conclusion

We identified a cluster of youth suicides in one of the most populous counties in the country. These findings serve to inform policies and prevention programs that aim to mitigate youth suicide mortality.

目标我们的目标是评估青少年自杀死亡的任何集群模式，并描述自杀死亡发生社区的儿童机会水平：死者扫描统计发现有 25 个邮政编码属于一个群集（RR 2.6，p = 0.00066）。当地莫兰与 EB 率将两个邮政编码确定为高-高群集（p < 0.05）。在这两种方法中被确定为群集的地点都位于阿尔派恩。有自杀死亡病例的邮政编码的 COI 中位数较高，为 63.5（IQR 38-83），而无自杀死亡病例的邮政编码的 COI 中位数为 47（IQR 22.5-75.5）。总体机会水平极低和中等之间的自杀率存在明显差异（p =.013）：我们在美国人口最多的县之一发现了青少年自杀群。这些发现有助于为旨在降低青少年自杀死亡率的政策和预防计划提供信息。

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引用次数: 0

A QUALITY IMPROVEMENT PROJECT TO INCREASE PROVIDER-DIRECTED DROWNING PREVENTION ANTICIPATORY GUIDANCE IN THE PRIMARY CARE CLINIC SETTING

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2025-01-01 DOI: 10.1016/j.acap.2024.102684

Ashnaa Rao MD , Robert Eagle MD , Alexa Modrell MD , Meggan Roman DO , David Robertson MD , Luca Farrugia MD , Austin Cooper DO , Bhavan Modi MD , Tanner Duncan DO , Saurabh Patil DO , Amanda Chung MD , Tiffaney Isaacson BS , Bianca Cardiel BSW , Joanna Kramer DO

引用次数: 0

DOES INTEGRATING A DIVERSITY, EQUITY, AND INCLUSION CURRICULUM INCREASE PEDIATRIC RESIDENTS’ CONFIDENCE IN TREATING PATIENTS FROM DIFFERENT BACKGROUNDS AT OUR LADY OF THE LAKE CHILDREN’S HOSPITAL?

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2025-01-01 DOI: 10.1016/j.acap.2024.102686

Christina Abi Kheir MD, Kyra Stepney DO, Hunter Collins PhD, Christine Joseph DO, Priyal Upadhyay MD, Michael Bolton MD, Melissa Roy MD

引用次数: 0

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