JAMA Pediatrics最新文献

{"title":"State-to-State Variation in Rates and Causes of Child and Adolescent Mortality in the US.","authors":"Eugenio Weigend Vargas, Philip Stallworth, Patrick M Carter, Jason E Goldstick","doi":"10.1001/jamapediatrics.2024.2894","DOIUrl":"10.1001/jamapediatrics.2024.2894","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":null,"pages":null},"PeriodicalIF":24.7,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119827","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}

{"title":"Implementation of a Secure Firearm Storage Program in Pediatric Primary Care: A Cluster Randomized Trial.","authors":"Rinad S Beidas, Kristin A Linn, Jennifer M Boggs, Steven C Marcus, Katelin Hoskins, Shari Jager-Hyman, Christina Johnson, Melissa Maye, LeeAnn Quintana, Courtney Benjamin Wolk, Leslie Wright, Celeste Pappas, Arne Beck, Katy Bedjeti, Alison M Buttenheim, Matthew F Daley, Marisa Elias, Jason Lyons, Melissa Lynne Martin, Bridget McArdle, Debra P Ritzwoller, Dylan S Small, Nathaniel J Williams, Shiling Zhang, Brian K Ahmedani","doi":"10.1001/jamapediatrics.2024.3274","DOIUrl":"10.1001/jamapediatrics.2024.3274","url":null,"abstract":"<p><strong>Importance: </strong>Increased secure firearm storage can reduce youth firearm injury and mortality, a leading cause of death for children and adolescents in the US. Despite the availability of evidence-based secure firearm storage programs and recommendations from the American Academy of Pediatrics, few pediatric clinicians report routinely implementing these programs.</p><p><strong>Objective: </strong>To compare the effectiveness of an electronic health record (EHR) documentation template (nudge) and the nudge plus facilitation (ie, clinic support to implement the program; nudge+) at promoting delivery of a brief evidence-based secure firearm storage program (SAFE Firearm) that includes counseling about secure firearm storage and free cable locks during all pediatric well visits.</p><p><strong>Design, setting, and participants: </strong>The Adolescent and Child Suicide Prevention in Routine Clinical Encounters (ASPIRE) unblinded parallel cluster randomized effectiveness-implementation trial was conducted from March 14, 2022, to March 20, 2023, to test the hypothesis that, relative to nudge, nudge+ would result in delivery of the firearm storage program to an additional 10% or more of the eligible population, and that this difference would be statistically significant. Thirty pediatric primary care clinics in 2 US health care systems (in Michigan and Colorado) were included, excluding clinics that were not the primary site for participating health care professionals and a subset selected at random due to resource limitations. All pediatric well visits at participating clinics for youth ages 5 to 17 years were analyzed.</p><p><strong>Interventions: </strong>Clinics were randomly assigned in a 1:1 ratio to receive either the nudge or nudge+.</p><p><strong>Main outcomes and measures: </strong>Patient-level outcomes were modeled to estimate the primary outcome, reach, which is a visit-level binary indicator of whether the parent received both components of the firearm storage program (counseling and lock), as documented by the clinician in the EHR. Secondary outcomes explored individual program component delivery.</p><p><strong>Results: </strong>A total of 47 307 well-child visits (median [IQR] age, 11.3 [8.1-14.4] years; 24 210 [51.2%] male and 23 091 [48.8%] female) among 46 597 children and 368 clinicians were eligible to receive the firearm storage program during the trial and were included in analyses. Using the intention-to-treat principle, a higher percentage of well-child visits received the firearm storage program in the nudge+ condition (49%; 95% CI, 37-61) compared to nudge (22%; 95% CI, 13-31).</p><p><strong>Conclusions and relevance: </strong>In this study, the EHR strategy combined with facilitation (nudge+) was more effective at increasing delivery of an evidence-based secure firearm storage program compared to nudge alone.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT04844021.</p>","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":null,"pages":null},"PeriodicalIF":24.7,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119822","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}

{"title":"Low-Dose Iron and Early Development in Breastfed Infants-Reply.","authors":"Anna Chmielewska, Magnus Domellöf","doi":"10.1001/jamapediatrics.2024.3303","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.3303","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":null,"pages":null},"PeriodicalIF":24.7,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119825","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}

{"title":"What I Have Learned in the Last 24 Years Being Editor-in-Chief.","authors":"Frederick P Rivara","doi":"10.1001/jamapediatrics.2024.3288","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.3288","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":null,"pages":null},"PeriodicalIF":24.7,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119828","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}

{"title":"Health Care Needs and Costs for Children Exposed to Prenatal Substance Use to Adulthood.","authors":"Evelyn Lee, Deborah Schofield, Mithilesh Dronavalli, Kate Lawler, Hannah Uebel, Lucinda Burns, Barbara Bajuk, Andrew Page, Yuanyuan Gu, John Eastwood, Michelle Dickson, Charles Green, Lauren Dicair, Ju Lee Oei","doi":"10.1001/jamapediatrics.2024.2281","DOIUrl":"10.1001/jamapediatrics.2024.2281","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Children exposed to substance use during pregnancy have increased health needs but whether these are influenced by engagement in out-of-home care is uncertain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the association between substance use during pregnancy, out-of-home care and hospitalization utilization, and costs from birth up to age 20 years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This was a retrospective cohort study using individual-linked population birth, hospital, and out-of-home care information of all liveborn infants from New South Wales, Australia, between 2001 and 2020 using longitudinal population-based linkage records from administrative databases. Substance use during pregnancy included newborns with neonatal abstinence syndrome (n = 5946) and intrauterine exposure to drugs of addiction (n = 1260) and other substances (eg, tobacco, alcohol, and illicit drugs or misused prescription drugs; n = 202 098). Children not exposed to substance use during pregnancy were those without known exposure to substance use during pregnancy (n = 1 611 351). Data were analyzed from July 2001 to December 2021.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes: &lt;/strong&gt;Main outcomes were hospital readmission, length of stay, and cost burden associated with substance use during pregnancy from birth up to age 20 years. Outcomes were investigated using 2-part and Poisson regression models adjusted for sociodemographic characteristics. Mediation analysis was used to evaluate whether the association of substance use during pregnancy with risk of readmission was mediated through engagement with out-of-home care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 1 820 655 live births, 935 807 (51.4%) were male. The mean (SD) age of mothers was 30.8 (5.5) years. Compared with children who were not exposed to substance use during pregnancy, those who were exposed incurred significantly higher birth hospital costs (adjusted mean difference, A$1585 per child [US$1 = A$1.51]; 95% CI, 1585-1586). If discharged alive, more children with exposure to substance use during pregnancy had at least 1 readmission (90 433/209 304 [43.4%] vs 616 425/1 611 351[38.3%]; adjusted relative risk [RR], 1.06; 95% CI, 1.06-1.07), most commonly for respiratory conditions (RR, 1.11; 95% CI, 1.09-1.12) and mental health/behavioral disorders (RR, 1.36; 95% CI, 1.33-1.41). Excess hospital costs associated with substance use during pregnancy were A$129.0 million in 2019 to 2020. Mediation analyses showed that any out-of-home care contact mediated the association between substance use during pregnancy and risk of inpatient readmission and lower health care cost (decreased by A$25.4 million). For children with neonatal abstinence syndrome, any out-of-home care contact mediated readmission risk by approximately 30%, from adjusted RR, 1.28; 95% CI, 1.19-1.35, to RR, 1.01; 95% CI, 0.98-1.02.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion and relevance: &lt;/strong&gt;Children who were exposed to su","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":null,"pages":null},"PeriodicalIF":24.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11264092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748178","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}

{"title":"Fetal Catecholamines and Neonatal Hypoglycemia-Key Questions Remain.","authors":"Qin-Yu Cai, Tai-Hang Liu, Ying-Bo Li","doi":"10.1001/jamapediatrics.2024.2181","DOIUrl":"10.1001/jamapediatrics.2024.2181","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":null,"pages":null},"PeriodicalIF":24.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616403","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}

{"title":"The Role of Family Support in Moderating Mental Health Outcomes for LGBTQ+ Youth in Primary Care.","authors":"Joseph DelFerro, Joseph Whelihan, Jungwon Min, Maura Powell, Gabrielle DiFiore, Ari Gzesh, Scott Jelinek, Karen T G Schwartz, Molly Davis, Jason D Jones, Alexander G Fiks, Brian P Jenssen, Sarah Wood","doi":"10.1001/jamapediatrics.2024.1956","DOIUrl":"10.1001/jamapediatrics.2024.1956","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Lesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ+) youth face worse mental health outcomes than non-LGBTQ+ peers. Family support may mitigate this, but sparse evidence demonstrates this in clinical settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare depression and suicide risk between LGBTQ+ and non-LGBTQ+ youth in primary care settings and to investigate whether family support mitigates these negative mental health outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study uses data from well care visits completed by adolescents aged 13 to 19 years from February 2022 through May 2023, including the Patient Health Questionnaire-9 Modified for Teens (PHQ-9-M) and the Adolescent Health Questionnaire (AHQ; an electronic screener assessing identity, behaviors, and guardian support), at 32 urban or suburban care clinics in Pennsylvania and New Jersey.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;The primary exposure was self-reported LGBTQ+ status. Family support moderators included parental discussion of adolescent strengths and listening to feelings. Race and ethnicity (determined via parent or guardian report at visit check-in), sex, payer, language, age, and geography were covariates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;PHQ-9-M-derived mental health outcomes, including total score, recent suicidal ideation, and past suicide attempt.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The sample included 60 626 adolescents; among them, 9936 (16.4%) were LGBTQ+, 15 387 (25.5%) were Black, and 30 296 (50.0%) were assigned female sex at birth. LGBTQ+ youth, compared with non-LGBTQ+ youth, had significantly higher median (IQR) PHQ-9-M scores (5 [2-9] vs 1 [0-3]; P &lt; .001) and prevalence of suicidal ideation (1568 [15.8%] vs 1723 [3.4%]; P &lt; .001). Fewer LGBTQ+ youth endorsed parental support than non-LGBTQ+ youth (discussion of strengths, 8535 [85.9%] vs 47 003 [92.7%]; P &lt; .001; and listening to feelings, 7930 [79.8%] vs 47 177 [93.1%]; P &lt; .001). In linear regression adjusted for demographic characteristics and parental discussion of strengths, LGBTQ+ status was associated with a higher PHQ-9-M score (mean difference, 3.3 points; 95% CI, 3.2-3.3 points). In logistic regression, LGBTQ+ youth had increased adjusted odds of suicidal ideation (adjusted odds ratio, 4.3; 95% CI, 4.0-4.7) and prior suicide attempt (adjusted odds ratio, 4.4; 95% CI, 4.0-4.7). Parental support significantly moderated the association of LGBTQ+ status with PHQ-9-M score and suicidal ideation, with greater protection against these outcomes for LGBTQ+ vs non-LGBTQ+ youth.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;Compared with non-LGBTQ+ youth, LGBTQ+ youth at primary care visits had more depressive symptoms and higher odds of suicidal ideation and prior suicide attempt. Youth-reported parental support was protective against these outcomes, suggesting potential benefits of family support-focused ","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":null,"pages":null},"PeriodicalIF":24.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11217892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467961","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}

{"title":"Concerns About Clinical Effectiveness of Newborn Screening for Spinal Muscular Atrophy.","authors":"Min-Fang Cheng, Chia-Hao Hsu","doi":"10.1001/jamapediatrics.2024.2591","DOIUrl":"10.1001/jamapediatrics.2024.2591","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":null,"pages":null},"PeriodicalIF":24.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788038","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}

{"title":"Drug Repurposing Via the Best Pharmaceuticals for Children Act.","authors":"Ian T T Liu, Aaron S Kesselheim","doi":"10.1001/jamapediatrics.2024.2287","DOIUrl":"10.1001/jamapediatrics.2024.2287","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":null,"pages":null},"PeriodicalIF":24.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788041","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}

{"title":"Fetal Catecholamines and Neonatal Hypoglycemia-Key Questions Remain-Reply.","authors":"Henrike Hoermann, Marcia Roeper, Sebastian Kummer","doi":"10.1001/jamapediatrics.2024.2184","DOIUrl":"10.1001/jamapediatrics.2024.2184","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":null,"pages":null},"PeriodicalIF":24.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616404","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}