Pediatrics最新文献_第2页

Persistent Poverty and Pediatric Cancer Survival. 持续贫困与儿童癌症生存。

IF 8 2区医学

Pediatrics Pub Date : 2025-04-21 DOI: 10.1542/peds.2024-069973

Emma Hymel,Josiane Kabayundo,Krishtee Napit,Shinobu Watanabe-Galloway

{"title":"Persistent Poverty and Pediatric Cancer Survival.","authors":"Emma Hymel,Josiane Kabayundo,Krishtee Napit,Shinobu Watanabe-Galloway","doi":"10.1542/peds.2024-069973","DOIUrl":"https://doi.org/10.1542/peds.2024-069973","url":null,"abstract":"BACKGROUNDCancer is the leading cause of death by disease among US children. While previous studies have examined the impact of poverty on pediatric cancer outcomes, most relied on single time point measures, which may not capture the long-term, systemic effects of poverty. Persistent poverty, defined as having 20% or more of an area's population below the poverty level for 30 years, represents a more comprehensive measure of sustained socioeconomic disadvantage.METHODSIn this population-based study, we used Surveillance, Epidemiology, and End Results (SEER)-22 Registries Incidence Data with Census Tract Attributes Database data. Primary cases of cancer diagnosed among children from 2006 to 2020 were included. Cox proportional hazards models were used to compute the association between persistent poverty and (1) early mortality (death from cancer within 3 months of diagnosis) and (2) overall cancer-specific mortality.RESULTSIn total, 97 132 children were included in our study; 12.63% resided in a persistent-poverty neighborhood at diagnosis. In the adjusted models, living in a persistent-poverty neighborhood was associated with a higher risk of early mortality (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.10-1.45) and a higher risk of overall cancer death (aHR, 1.15; 95% CI, 1.10-1.21). Persistent poverty was associated with survival for children with leukemias (aHR, 1.20; 95% CI, 1.09-1.31), central nervous system tumors (aHR, 1.14; 95% CI, 1.04-1.26), and hepatic tumors (aHR, 1.37; 95% CI, 1.01-1.85).CONCLUSIONSOur study observed increased risk of cancer death among children in persistent-poverty neighborhoods. Continued investment and research are critical to developing effective strategies that reduce disparities and improve outcomes for pediatric cancer patients affected by persistent poverty.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"77 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Disparities in Linkage to Care Among Children With Hepatitis C Virus in the United States. 美国丙型肝炎病毒感染儿童与护理相关的差异

IF 8 2区医学

Pediatrics Pub Date : 2025-04-18 DOI: 10.1542/peds.2024-068565

Megan Rose Curtis,Sarah Munroe,Breanne E Biondi,Andrea L Ciaranello,Benjamin P Linas,Rachel L Epstein

{"title":"Disparities in Linkage to Care Among Children With Hepatitis C Virus in the United States.","authors":"Megan Rose Curtis,Sarah Munroe,Breanne E Biondi,Andrea L Ciaranello,Benjamin P Linas,Rachel L Epstein","doi":"10.1542/peds.2024-068565","DOIUrl":"https://doi.org/10.1542/peds.2024-068565","url":null,"abstract":"BACKGROUND AND OBJECTIVESPediatric HCV cases have increased in the United States. Guidelines recommend beginning treatment of HCV for children as young as 3 years old. However, no studies have evaluated pediatric linkage to HCV care and direct-acting antiviral (DAA) uptake on a national level. This study aims to characterize the HCV care cascade among a national cohort of children with HCV.METHODSThis retrospective cohort analysis included children born between 2000 and 2018 who were diagnosed with HCV between the ages of 0 and 18 years. We analyzed TriNetX Research Network data, a US national electronic health records network. Primary HCV care cascade outcomes included the number of children diagnosed with HCV infection, linked to care, and prescribed DAAs. We assessed the association between race and ethnicity with linkage to care using logistic regression.RESULTSAmong 928 children with HCV, 297 (32.0%) linked to HCV care and 111 (12.0%) were prescribed a DAA. Hispanic/Latinx children had double and white children had triple the odds of linkage compared with Black children (odds ratio [OR], 2.20; 95% CI, 1.05-4.59; OR, 3.44; 95% CI, 1.89-6.28) after adjusting for sex, birth cohort, and region.CONCLUSIONSPediatric access to HCV care remains low. Fewer than 1 in 3 children linked to HCV care and fewer than 1 in 8 were treated. This study uncovers racial and ethnic disparities in HCV care access. Targeting interventions toward increasing linkage to care could represent an opportunity to advance HCV elimination goals and reduce disparities.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"91 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Altered Mental Status and First-Time Seizure in Teen With a Subacute Inguinal Mass. 青少年亚急性腹股沟肿块的精神状态改变和首次癫痫发作。

IF 8 2区医学

Pediatrics Pub Date : 2025-04-17 DOI: 10.1542/peds.2024-069855

Kassondra M Little,Emily Speck,Christian D Pulcini,Marianna Paradise,Molly Rideout,William V Raszka

{"title":"Altered Mental Status and First-Time Seizure in Teen With a Subacute Inguinal Mass.","authors":"Kassondra M Little,Emily Speck,Christian D Pulcini,Marianna Paradise,Molly Rideout,William V Raszka","doi":"10.1542/peds.2024-069855","DOIUrl":"https://doi.org/10.1542/peds.2024-069855","url":null,"abstract":"A healthy 13-year-old boy who resides in rural Vermont presented after witnessed, generalized seizure-like activity for approximately 2 minutes. He had been well until the development of right inguinal pain and rash 2 weeks before presentation, which had progressed to a 5-cm irregular, red, tender, and raised area that was unresponsive to 5 days of cephalexin. At the time of presentation, he was afebrile and hemodynamically stable and only responsive to localized stimuli. Initial laboratory evaluation, toxicology screening, and computed tomography of the head were all unremarkable. Ultrasonography of the inguinal lesion showed an abscess with subcutaneous edema and reactive lymphadenopathy. He did not have evidence of stroke or status epilepticus. Because of his persistent altered mental status, the patient was admitted to the pediatric intensive care unit, and pediatric infectious disease was consulted. A detailed history revealed he had extensive recent animal exposures that included bear, deer, dogs, chickens, and kittens. Cerebrospinal fluid (CSF) analysis showed 5 leukocytes (26% polymorphonuclear leukocyte), normal glucose, and slightly elevated protein. Video electroencephalogram demonstrated bilateral cerebral dysfunction, whereas the brain magnetic resonance imaging and magnetic resonance venogram scan results were normal. CSF culture and polymerase chain reaction results for bacterial and viral pathogens were negative. Fluid collected from the inguinal lesion showed neutrophils but no organisms. The following discussion describes this patient's full course, differential diagnoses, diagnostic workup with clinical reasoning, and final diagnosis.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"136 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Breastfeeding and Health Outcomes for Infants and Children: A Systematic Review. 母乳喂养与婴幼儿健康结局：系统综述。

IF 8 2区医学

Pediatrics Pub Date : 2025-04-17 DOI: 10.1542/peds.2025-071516

Carrie D Patnode,Nora B Henrikson,Elizabeth M Webber,Paula R Blasi,Caitlyn A Senger,Janelle M Guirguis-Blake

{"title":"Breastfeeding and Health Outcomes for Infants and Children: A Systematic Review.","authors":"Carrie D Patnode,Nora B Henrikson,Elizabeth M Webber,Paula R Blasi,Caitlyn A Senger,Janelle M Guirguis-Blake","doi":"10.1542/peds.2025-071516","DOIUrl":"https://doi.org/10.1542/peds.2025-071516","url":null,"abstract":"CONTEXTOur understanding of the benefits of breastfeeding and the consumption of human milk for specific infant outcomes and the magnitude of those benefits continues to evolve.OBJECTIVEReview the evidence on the association between breastfeeding and child health outcomes.DATA SOURCESSystematic literature searches in MEDLINE, Embase and CINAHL for English-language articles published from 2006 to August 14, 2024.STUDY SELECTIONExisting systematic reviews (ESRs) and primary studies comparing various breastfeeding exposures and child health outcomes among term infants in developed countries.DATA EXTRACTIONAbstracted data on study design, demographics, breastfeeding exposures and referents, and outcomes. Results of ESRs were synthesized alongside those of newer primary studies.RESULTSTwenty-nine ESRs and 145 primary studies were included. An association indicating a reduced risk from more versus less breastfeeding was apparent for moderate-to-severe respiratory and gastrointestinal infections, otitis media, allergic rhinitis, asthma, malocclusion, inflammatory bowel disease, type 1 diabetes, rapid weight gain and growth, obesity, systolic blood pressure, childhood leukemia, and infant mortality. There was no clear threshold of breastfeeding duration that appeared to be most beneficial for any outcome. There was little data on any associations varied by mode of breastfeeding or source of breastmilk.LIMITATIONSObservational studies with risks of bias related to confounding, missing data and a lack of consistency in measurement and reporting of breastfeeding exposures.CONCLUSIONSBreastfeeding is associated with beneficial effects for several infant and child outcomes. Further research that addresses the limitations of existing studies is needed to continue to inform national initiatives.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"12 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Implementing Screening and Counseling for Adolescent Mental Health and Substance Use. 实施青少年心理健康和药物使用的筛查和咨询。

IF 8 2区医学

Pediatrics Pub Date : 2025-04-16 DOI: 10.1542/peds.2024-070314

Sheila V Patel,Laura Hart,Graham Booth,Wendi Rotunda,Shannon Kugley,Meagan Pilar,Manny Schwimmer,Christiane Voisin,Stephen Koesters,Meera Viswanathan,Gerald Gartlehner

{"title":"Implementing Screening and Counseling for Adolescent Mental Health and Substance Use.","authors":"Sheila V Patel,Laura Hart,Graham Booth,Wendi Rotunda,Shannon Kugley,Meagan Pilar,Manny Schwimmer,Christiane Voisin,Stephen Koesters,Meera Viswanathan,Gerald Gartlehner","doi":"10.1542/peds.2024-070314","DOIUrl":"https://doi.org/10.1542/peds.2024-070314","url":null,"abstract":"CONTEXTThe proportion of US adolescents experiencing mental health or substance use disorders continues to rise. Pediatricians are expected to deliver evidence-based screening and counseling, but multiple barriers impede implementation.OBJECTIVEThis systematic review assessed the effectiveness of implementation strategies-activities to enhance implementation, service, and health outcomes-to support integration of screening and counseling for mental health and substance use disorders (MHSUD) into primary care for children and adolescents.DATA SOURCESWe searched multiple databases for literature published since 2010.STUDY SELECTIONEligible studies compared any strategy to support implementation of a recommended intervention to prevent MHSUD among individuals ≤18 years in primary care to another strategy or no strategy.DATA EXTRACTIONWe extracted data on study designs, populations, settings, clinical interventions, barriers and facilitators to implementation, implementation interventions and comparators, and results.RESULTSEleven studies focused on implementing screening and counseling for depression, eating disorders, substance use disorders, and general behavioral health risk factors. Implementation approaches were multifaceted and consisted of incorporating behavioral health providers into primary care, facilitating learning collaboratives, providing support to clinicians, and using technology. These approaches generally resulted in increased screening, taking steps to address a positive screen, and initiation of treatment compared to using only minimal or no strategy.LIMITATIONSMultifaceted and overlapping implementation approaches evaluated in few studies with limited evidence on patient outcomes constrained our ability to make inferences.CONCLUSIONSThe identified implementation approaches may improve some aspects of identifying and addressing MHSUD in primary care. The evidence, however, is limited.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"544 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Beyond Screening: Rethinking How We Identify and Address Social Needs in Health Care. 超越筛查：重新思考我们如何识别和解决医疗保健中的社会需求。

IF 8 2区医学

Pediatrics Pub Date : 2025-04-16 DOI: 10.1542/peds.2025-070604

Lucy E Marcil,Deana Around Him,Emily S Miller

引用次数: 0

Neighborhood Child Opportunity Index and Household-Level Social Needs. 邻里儿童机会指数与家庭社会需求。

IF 8 2区医学

Pediatrics Pub Date : 2025-04-16 DOI: 10.1542/peds.2024-069735

Michael J Luke,Chén C Kenyon,Andrew F Beck,Zoe Bouchelle,Stephanie G Menko,Philip V Scribano,Aditi Vasan

{"title":"Neighborhood Child Opportunity Index and Household-Level Social Needs.","authors":"Michael J Luke,Chén C Kenyon,Andrew F Beck,Zoe Bouchelle,Stephanie G Menko,Philip V Scribano,Aditi Vasan","doi":"10.1542/peds.2024-069735","DOIUrl":"https://doi.org/10.1542/peds.2024-069735","url":null,"abstract":"BACKGROUND AND OBJECTIVESNew regulations require hospitals to screen patients for health-related social needs (HRSNs). Neighborhood indices, like the Child Opportunity Index (COI), may help identify families at risk of experiencing HRSNs and inform targeting of health system-based resources and support. However, it is unknown how well the neighborhood-level COI predicts household-level HRSNs.METHODSIn this cross-sectional study of 1096 patients admitted to a quaternary children's hospital from July 2022 to August 2023, we combined data on household-level HRSNs from standardized screening with data on each patient's neighborhood COI. We used logistic regression to estimate odds of experiencing HRSNs among families in the 2 lowest COI quintiles (low/very low), relative to the 3 highest quintiles (moderate/high/very high). We then calculated positive and negative predictive values of low/very low COI in identifying household-level HRSNs and compared rates of resource connection among those with low/very low COI vs moderate/high/very high COI.RESULTSLow/very low COI was associated with greater odds of reporting household-level HRSNs (odds ratio, 2.62; 95% CI, 2.04-3.36). COI showed low positive predictive value (3% to 31%) in identifying HRSNs and high negative predictive value for each need (91% to 99%) except mental health (76%). Resource connection rates were not significantly different across COI strata.CONCLUSIONSFamilies in disadvantaged neighborhoods have greater odds of reporting HRSNs, but COI is a poor proxy for household-level screening. Findings suggest that health systems can use COI to focus HRSN screening and interventions on communities with the likely highest prevalence of reported HRSNs.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"3 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143840989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

A Novel Variant in Pulmonary Alveolar Microlithiasis With Disseminated Pseudomonas Infection. 肺泡微石病伴播散性假单胞菌感染的一种新变异。

IF 8 2区医学

Pediatrics Pub Date : 2025-04-16 DOI: 10.1542/peds.2024-068882

Jacob McCoy,Anna-Theresa Lobos,Joseph de Nanassy,Lucy Perrem

引用次数: 0

Evidence for Mental Health and Substance Use Practice Change Strategies. 精神健康和物质使用实践改变策略的证据。

IF 8 2区医学

Pediatrics Pub Date : 2025-04-16 DOI: 10.1542/peds.2025-071189

Robert B Penfold

引用次数: 0

Improving Delayed Cord Clamping Across Tennessee Through a Statewide Quality Collaborative. 通过全州质量协作改善田纳西州的延迟脐带夹紧。

IF 8 2区医学

Pediatrics Pub Date : 2025-04-15 DOI: 10.1542/peds.2024-066158

Scott O Guthrie,Howard E Herrell,Patricia A Scott,Bonnie J Miller,Sharon Wadley,Brenda Barker

{"title":"Improving Delayed Cord Clamping Across Tennessee Through a Statewide Quality Collaborative.","authors":"Scott O Guthrie,Howard E Herrell,Patricia A Scott,Bonnie J Miller,Sharon Wadley,Brenda Barker","doi":"10.1542/peds.2024-066158","DOIUrl":"https://doi.org/10.1542/peds.2024-066158","url":null,"abstract":"OBJECTIVEThe objective of this initiative was to increase the proportion of infants born in participating hospitals receiving the benefits of delayed cord clamping (DCC) for at least 60 seconds to a minimum of 90% for each facility.METHODSIn January 2022, a quality improvement (QI) initiative was launched across 5 pilot hospitals, later expanding to 22 additional hospitals in May 2022. The goal of the initiative was to ensure that all newborns at each facility experienced a delay of at least 60 seconds before umbilical cord clamping. Monthly data collection continued through June 2023, tracking the number of live births, the number of infants whose cords were clamped after 60 seconds, and race/ethnicity. Balancing measures, including the number of infants with a 5-minute appearance, pulse, grimace, activity, and respiration (Apgar) score of up to 3 and hypothermia (temperature of <36.5 °C), were recorded monthly. Structure and process measures critical for improving DCC rates were also identified and monitored.RESULTSAt project completion, 61 642 out of 74 241 (83%) infants received a delay of at least 60 seconds in cord clamping. The aggregate baseline mean for DCC was 76%. Special cause variation (a favorable shift) was observed, resulting in an adjusted mean rate of 87% for DCC. The impact was consistent across both level I/II and level III/IV facilities.CONCLUSIONSThis report highlights the successful implementation of DCC practices through the state's perinatal QI collaborative. Evidence-based QI initiatives can significantly enhance uptake of recommended practices and improve infant care during birth.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"16 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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