JAMA Pediatrics最新文献_第2页

Adenotonsillectomy and Health Care Utilization in Children With Snoring and Mild Sleep Apnea

IF 26.1 1区医学

JAMA Pediatrics Pub Date : 2025-03-17 DOI: 10.1001/jamapediatrics.2025.0023

Jessie P. Bakker, Fang Zhang, Raouf Amin, Cristina M. Baldassari, Ronald D. Chervin, Susan L. Garetz, Fauziya Hassan, Sally Ibrahim, Stacey L. Ishman, Erin M. Kirkham, Ariel Linden, Ron B. Mitchell, Kamal Naqvi, Carol L. Rosen, Kristie Ross, Ignacio E. Tapia, Lisa R. Young, Phoebe K. Yu, Susan Redline, Rui Wang

{"title":"Adenotonsillectomy and Health Care Utilization in Children With Snoring and Mild Sleep Apnea","authors":"Jessie P. Bakker, Fang Zhang, Raouf Amin, Cristina M. Baldassari, Ronald D. Chervin, Susan L. Garetz, Fauziya Hassan, Sally Ibrahim, Stacey L. Ishman, Erin M. Kirkham, Ariel Linden, Ron B. Mitchell, Kamal Naqvi, Carol L. Rosen, Kristie Ross, Ignacio E. Tapia, Lisa R. Young, Phoebe K. Yu, Susan Redline, Rui Wang","doi":"10.1001/jamapediatrics.2025.0023","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0023","url":null,"abstract":"ImportanceThe literature indicates that health care utilization (HCU) of children with untreated moderate-to-severe obstructive sleep apnea is greater than that of matched controls before diagnosis, and treatment is associated with a decline in HCU not observed in those who remain untreated. Research on this topic has been limited to retrospective analyses and observational cohort studies; little is known about HCU among the many children with snoring and mild sleep-disordered breathing (SDB).ObjectiveTo determine whether adenotonsillectomy in comparison with watchful waiting with supportive care is associated with fewer health care encounters and prescriptions.Design, Setting, and ParticipantsThis randomized clinical trial, Pediatric Adenotonsillectomy Trial for Snoring (PATS), was a 12-month, parallel-arm trial conducted from 2016 to 2022 in tertiary care centers in the United States. Participants were recruited from otolaryngology, sleep, pulmonary, or general pediatric clinics; aged 3 to 13 years; diagnosed with mild SDB; had a tonsillar hypertrophy grade of 2 or more; and had a body mass index z score less than 3. Children referred from a clinician outside of the local electronic medical record system were excluded. Data analysis was conducted from June 2022 to April 2024.InterventionEarly adenotonsillectomy.Main Outcomes and MeasuresEvaluation of HCU was a prespecified secondary aim of PATS. Total encounters and total prescriptions over the 12 months after randomization were analyzed.ResultsAmong 459 children who were randomized, the analytic sample included 381 children, after excluding those referred from outside the local electronic medical record system. The median (IQR) age was 6 (4-8) years; 192 participants (50%) were female and 189 (50%) male. Adenotonsillectomy was associated with a 32% reduction in total health care encounters (mean difference, −1.25 per participant per year; 95% CI, −1.96 to −0.53) and a 48% reduction in prescriptions (mean difference, −2.53 per participant per year; 95% CI, −4.12 to −0.94). The difference in encounters was primarily driven by fewer office visits and outpatient procedures rather than by reduced hospitalizations or urgent care visits.Conclusions and RelevanceThis study found that adenotonsillectomy was associated with reduced all-cause HCU in children with mild SDB, supporting early intervention for children with mild SDB. Future research focused on the cost effectiveness of adenotonsillectomy for pediatric SDB is warranted.Trial RegistrationClinicalTrials.gov Identifier: NCT02562040","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"39 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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

How Artificial Intelligence Can Promote Inclusive Health

IF 26.1 1区医学

JAMA Pediatrics Pub Date : 2025-03-17 DOI: 10.1001/jamapediatrics.2025.0096

Dimitri A. Christakis, Jacob Neely, Wyatt Spalding, Douglas J. Opel

引用次数: 0

Tailored Adherence Incentives for Childhood Asthma Medications

IF 26.1 1区医学

JAMA Pediatrics Pub Date : 2025-03-17 DOI: 10.1001/jamapediatrics.2025.0010

Chén C. Kenyon, William O. Quarshie, Rui Xiao, Mishaal Yazdani, Carina M. Flaherty, G. Chandler Floyd, Victoria A. Miller, Tyra C. Bryant-Stephens, Joseph J. Zorc, Chris Feudtner

{"title":"Tailored Adherence Incentives for Childhood Asthma Medications","authors":"Chén C. Kenyon, William O. Quarshie, Rui Xiao, Mishaal Yazdani, Carina M. Flaherty, G. Chandler Floyd, Victoria A. Miller, Tyra C. Bryant-Stephens, Joseph J. Zorc, Chris Feudtner","doi":"10.1001/jamapediatrics.2025.0010","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0010","url":null,"abstract":"ImportanceDifferential adherence to efficacious preventive medications is one potentially modifiable driver of racial disparities in childhood asthma outcomes.ObjectiveTo determine the effect of a financial incentive-enhanced intervention on adherence to inhaled asthma preventive medication in a high-risk, predominantly racially minoritized cohort of children with asthma.Design, Setting, and ParticipantsThis was a randomized clinical trial conducted from September 2019 through June 2022 at a large mid–Atlantic pediatric health system in the US. Children were eligible if they were between 5 and 12 years old, prescribed a preventive inhaler for daily use, and had at least 2 asthma exacerbations requiring systemic steroids in the preceding year. Data were analyzed from December 2022 to December 2024.InterventionInhaled medication use was monitored using electronic inhaler sensors over a 7-month period. Families who completed a 1-month run-in interval were randomized to 1 of 3 arms for a 3-month experiment interval: (1) daily text message medication reminders, weekly adherence feedback, and gain-framed, financial incentives of up to $1 per day (full intervention); (2) daily text message medication reminders and weekly adherence feedback (hybrid intervention); or (3) no reminders, feedback, or incentives (active control). Medication adherence monitoring then continued for a 3-month observation interval, where all arms reverted to active control conditions.Main Outcomes and MeasuresThe primary outcome was adherence to inhaled maintenance medication during the experiment; secondary outcomes included adherence during the observation phase. The study was powered to detect a difference in average monthly adherence between the full intervention and active control condition.ResultsOf the 106 children randomized, 99 had at least 1 month of monitoring data (56 male [57%] and 43 female [43%]; mean [SD] age, 8.0 [2.3] years). Most participants (81 [82%]) identified as non-Hispanic Black and demographic and clinical characteristics were similar across study arms. During the experiment interval, participants receiving the full intervention had a 15–percentage point (95% CI, 2-29 percentage points) higher inhaled maintenance medication adherence compared with participants in the active control. There was no evidence of adherence differences in the observation interval.Conclusion and RelevanceWhile a financial incentive-enhanced mobile health intervention led to higher inhaled preventive medication adherence as compared with the active control group, there was no evidence for enduring effect after the intervention components ceased, consistent with other studies that include financial incentives to encourage behavior change.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT03907410?term=NCT03907410&amp;amp;rank=1\">NCT03907410</jats:ext-lin","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"55 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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

JAMA Pediatrics-The Year in Review 2024.

IF 24.7 1区医学

JAMA Pediatrics Pub Date : 2025-03-17 DOI: 10.1001/jamapediatrics.2025.0101

Dimitri A Christakis

引用次数: 0

Race-Based Guidance and Nirsevimab

IF 26.1 1区医学

JAMA Pediatrics Pub Date : 2025-03-17 DOI: 10.1001/jamapediatrics.2025.0067

Joshua T. B. Williams, Florence Wu

引用次数: 0

JAMA Pediatrics Peer Reviewers in 2024. 2024 年《美国医学会儿科学杂志》同行评审员。

IF 24.7 1区医学

JAMA Pediatrics Pub Date : 2025-03-17 DOI: 10.1001/jamapediatrics.2025.0201

引用次数: 0

COVID-19 Pandemic and the Developmental Health of Kindergarteners.

IF 24.7 1区医学

JAMA Pediatrics Pub Date : 2025-03-10 DOI: 10.1001/jamapediatrics.2024.7057

Judith L Perrigo, Jordan Morales, Nicholas Jackson, Magdalena Janus, Lisa Stanley, Mitchell Wong, Neal Halfon

{"title":"COVID-19 Pandemic and the Developmental Health of Kindergarteners.","authors":"Judith L Perrigo, Jordan Morales, Nicholas Jackson, Magdalena Janus, Lisa Stanley, Mitchell Wong, Neal Halfon","doi":"10.1001/jamapediatrics.2024.7057","DOIUrl":"10.1001/jamapediatrics.2024.7057","url":null,"abstract":"Importance: Recent studies have associated the COVID-19 pandemic with negative developmental outcomes in children. However, research focused on young children remains limited, with few studies including multiple years of pre- and postpandemic onset data.Objective: To examine the impact of the COVID-19 pandemic on US kindergarteners' developmental health.Design, setting, and participants: This repeated cross-sectional panel study examined developmental health trends, as measured by the Early Development Instrument (EDI), among a convenience sample US kindergarteners from 2010 to 2023. EDI data were obtained from 390 school districts across 19 states. Data were analyzed from June December 2024.Exposure: Kindergarteners' developmental health was compared between prepandemic (2018 to 2020) and postpandemic (2021 to 2023) onset cohorts.Main outcomes and measures: Outcomes were EDI scores across time in 5 domains: (1) physical health and well-being, (2) social competence, (3) emotional maturity, (4) language and cognitive development, and (5) communication and general knowledge. The mean (95% CI) EDI scores were assessed.Results: In this sample of of 475 740 US kindergarten students, 242 869 were male (51.1%), there were 53 841 African American or Black students (11.4%), 263 037 Hispanic or Latino/a students (55.5%), and 95 258 White students (20.1%), and the mean (SD) age was 6 (0.4) years (range, 4.0-8.0 years). Compared with the immediate prepandemic onset period, the rate of change in EDI scores was significantly lower following the pandemic onset in language and cognitive development (mean change, -0.45; 95% CI, -0.48 to -0.43), social competence (mean change, -0.03; 95% CI, -0.06 to -0.01), and communication and general knowledge (mean change, -0.18; 95% CI, -0.22 to -0.15). EDI scores were significantly higher in emotional maturity (mean change, 0.05; 95% CI, 0.03 to 0.07), and no significant changes were observed in the physical health and well-being domain (mean change, 0; 95% CI, -0.01 to 0.02).Conclusions and relevance: The COVID-19 pandemic was associated with varying developmental health outcomes in kindergarteners. Negative developmental trends existed immediately before the pandemic, with most persisting or slowing postpandemic onset. These results highlight troubling trends in kindergarteners' development, both before and during the pandemic, and more information is needed to understand why developmental outcomes are worsening over time.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Age Decomposition of Mortality Rates Among Children Younger Than 5 Years in 47 LMICs.

IF 24.7 1区医学

JAMA Pediatrics Pub Date : 2025-03-10 DOI: 10.1001/jamapediatrics.2024.6908

Omar Karlsson, Thomas W Pullum, Akhil Kumar, Rockli Kim, S V Subramanian

{"title":"Age Decomposition of Mortality Rates Among Children Younger Than 5 Years in 47 LMICs.","authors":"Omar Karlsson, Thomas W Pullum, Akhil Kumar, Rockli Kim, S V Subramanian","doi":"10.1001/jamapediatrics.2024.6908","DOIUrl":"10.1001/jamapediatrics.2024.6908","url":null,"abstract":"Importance: Despite a global decline in the mortality rate of children younger than 5 years (the under-5 mortality rate), neonatal deaths continue to present a substantial challenge. The etiology behind deaths varies between the early and late neonatal periods as well as at later ages.Objective: To decompose the under-5 mortality rate in 47 low- and middle-income countries into 8 age intervals, providing a comprehensive understanding of varying vulnerability across age groups.Design, setting, and participants: This cross-sectional study used nationally representative data from 47 Demographic and Health Surveys conducted between 2014 and 2023 in low- and middle-income countries, including 1.4 million live births.Exposure: Age in days, weeks, months, or years.Main outcomes and measures: The under-5 mortality rate was decomposed by age based on a life table approach, using true cohort probabilities for the early and late neonatal periods and synthetic cohort probabilities for other age intervals, to obtain deaths per 1000 live births (ie, the cohort entering the life table) for each age interval.Results: In the pooled sample of 1 448 001 live births, there were 14 576 deaths in the early neonatal period (age 0 to 6 days); 3400 in the late neonatal period (age 7-27 days); 6760 in the early postneonatal period (age 28 days to 5 months); 4912 in the late postneonatal period (age 6-11 months); and 5145, 3990, 2674, and 1640 at ages 1, 2, 3, and 4 years, respectively. The early neonatal mortality rate accounted for 21.3 (95% CI, 20.5-22.1) deaths per 1000 births from a total under-5 mortality rate of 57.7 (95% CI, 56.2-59.3) deaths per 1000 births. The early neonatal mortality rate was significantly higher than mortality at subsequent ages (eg, median [IQR] mortality rates: early neonatal period, 18.8 [14.3-23.2] deaths per 1000 births; late neonatal period, 4.7 [3.1-5.9] deaths per 1000 births) and much higher when considering the average daily mortality rate. The early neonatal mortality rate accounted for the greatest share of under-5 mortality rate in all but 2 countries. In most countries the lowest mortality rates were observed at age 3 or 4 years. The share of deaths occurring in the late postneonatal period and later was greater in countries with greater under-5 mortality rates.Conclusions and relevance: The concentration of mortality in the first week after birth underscores a critical need for enhanced maternal and neonatal health care. Furthermore, early neonatal mortality rates should be routinely reported and included in health targets. In this study, the age of 6 months emerged as an important turning point: high-mortality countries were characterized by a greater concentration of deaths after age 6 months than countries with lower under-5 mortality rate.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Long-Term Effects of a Responsive Parenting Intervention on Child Weight Outcomes Through Age 9 Years: The INSIGHT Randomized Clinical Trial.

IF 24.7 1区医学

JAMA Pediatrics Pub Date : 2025-03-10 DOI: 10.1001/jamapediatrics.2024.6897

Ian M Paul, Jennifer M Barton, Stephanie Anzman-Frasca, Emily E Hohman, Orfeu M Buxton, Lindsey B Hess, Jennifer S Savage

{"title":"Long-Term Effects of a Responsive Parenting Intervention on Child Weight Outcomes Through Age 9 Years: The INSIGHT Randomized Clinical Trial.","authors":"Ian M Paul, Jennifer M Barton, Stephanie Anzman-Frasca, Emily E Hohman, Orfeu M Buxton, Lindsey B Hess, Jennifer S Savage","doi":"10.1001/jamapediatrics.2024.6897","DOIUrl":"10.1001/jamapediatrics.2024.6897","url":null,"abstract":"Importance: Behavioral interventions to treat childhood obesity have had limited success. Primary prevention is desirable, but whether intervention effectiveness can be sustained is unknown.Objective: To examine the effect of an intervention designed for the primary prevention of obesity and delivered through age 2 years on weight outcomes through age 9 years.Design, setting, and participants: A longitudinal observation of a single-center randomized clinical trial comparing a responsive parenting intervention vs a home safety intervention (control) among primiparous mother-child dyads who completed the assessment at age 3 years with follow-up to age 9 years. All data were analyzed from January 21 to November 15, 2024.Interventions: Research nurses conducted 4 home visits during infancy and research center visits at ages 1 and 2 years totaling less than 10 contact hours. The responsive parenting curriculum focused on feeding, sleep, interactive play, and emotion regulation.Main outcomes and measures: The primary outcome is body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) across 4 assessments from age 3 through 9 years, with the assessment of study group differences using repeated-measures analysis. A test for an interaction between sex and study group was planned. Secondary outcomes include BMI z scores and prevalence of overweight (BMI ≥85th to <95th percentile) and obesity (BMI ≥95th percentile) at 5, 6, and 9 years.Results: Of the 232 primiparous mother-child dyads (116 per group) (7 Asian [3%], 11 Black [5%], 1 Native Hawaiian or Other Pacific Islander [0.4%], 207 White [89%], and 6 children with other race and ethnicity [including Asian, Indian, Hispanic, Dominican, and other race; 2.5%]; 121 male children [52%]), 177 (76%) had anthropometric data at age 9 years. From ages 3 to 9 years, children in the responsive parenting group had a lower mean (SD) BMI than controls (16.64 [0.21] vs 17.07 [0.20]; absolute difference, -0.43; P = .049). Sex moderated this effect; female participants in the responsive parenting group had a lower mean (SD) BMI than female participants in the control group (16.32 [0.26] vs 17.32 [0.26]; absolute difference, -1.00; P = .007), with no group differences among male participants. Cross-sectional analyses revealed no differences in BMI z scores or prevalence of overweight or obesity at ages 5, 6, and 9 years between the responsive parenting group and the control group.Conclusions and relevance: An early-life responsive parenting intervention resulted in lower BMI from age 3 to 9 years compared with a control intervention. This group difference was driven by effects on female participants, with differences appearing to dissipate over time. A life-course approach may be required to sustain the benefits of early-life","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Levels of Satisfaction and Regret Are Far From Settled-Reply.

IF 24.7 1区医学

JAMA Pediatrics Pub Date : 2025-03-03 DOI: 10.1001/jamapediatrics.2025.0001

Kristina R Olson, G F Raber, Natalie M Gallagher

引用次数: 0