Pediatrics最新文献

{"title":"Embedding Pediatric Obesity Treatment in Community-Based Settings: Opportunities and Challenges.","authors":"Sarah L Maxwell, Amy L Beck","doi":"10.1542/peds.2024-069092","DOIUrl":"https://doi.org/10.1542/peds.2024-069092","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383154","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}

{"title":"Using Parks and Recreation Providers to Enhance Obesity Treatment: A Randomized Controlled Trial.","authors":"Sarah C Armstrong, Cody D Neshteruk, Jennifer S Li, William E Kraus, Svati Shah, Mary Story, Nancy Zucker, Jason Jones, Eliana M Perrin, Alexandra R Zizzi, Joshua Burrows, Brooke E Wagner, McAllister Windom, Tracy Truong, Hwanhee Hong, Asheley C Skinner","doi":"10.1542/peds.2024-068427","DOIUrl":"https://doi.org/10.1542/peds.2024-068427","url":null,"abstract":"<p><strong>Objective: </strong>Intensive health behavior and lifestyle treatment (IHBLT) is recommended for children aged 6-18 years with obesity. The objective was to evaluate the effectiveness of Fit Together, a health care and parks and recreation partnership to deliver IHBLT.</p><p><strong>Methods: </strong>A randomized controlled trial was conducted from 2018 to 2021. Youths (aged 5-17 years) with obesity were recruited from primary care clinics and randomized to a waitlist control or Fit Together (ie, clinical obesity care plus group-based lifestyle sessions at a local recreation center). Primary outcomes, child body mass index relative to the 95th percentile (BMIp95) and submaximal heart rate, were collected at baseline and 6 months. Generalized estimating equation models were used to assess changes in primary outcomes for those affected and not affected by COVID-19 study disruptions.</p><p><strong>Results: </strong>Participants (n = 255) had a mean (SD) age of 10.0 (3.0) years, were 39% Hispanic, and were 38% non-Hispanic Black. Intervention youths not affected by COVID-19 disruptions experienced a significant decrease in BMIp95 (β = -3.05; 95% confidence interval [CI], -5.08 to -1.01) compared with controls. There was no difference in BMIp95 between intervention and control youths affected by COVID-19 disruptions (β = -3.25; 95% CI, -7.98 to 1.48). For the entire cohort, intervention youths had a significant decrease in BMIp95 compared with control youths (β = -3.32; 95% CI, -5.69 to -0.96). Submaximal heart rate was only available for the nondisrupted group, but there was no difference between intervention and control youths (β = -7.18; 95% CI, -16.12 to 1.76).</p><p><strong>Conclusion: </strong>Effective child obesity treatment can be implemented in local communities through a partnership between clinical practices and parks and recreation providers. Future research will explore this model in combination with newer, more effective obesity treatments.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383156","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}

{"title":"Addressing Inequities in Amblyopia Treatment Outcomes.","authors":"Sylvia H Yoo, Damian Kl Archer, Joseph S Zickafoose, Dolly A Padovani-Claudio","doi":"10.1542/peds.2024-069410","DOIUrl":"https://doi.org/10.1542/peds.2024-069410","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365313","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}

{"title":"Pediatrician Work Hours: 2013-2022.","authors":"William L Cull, Mary Pat Frintner, Tylar W Kist, Gary L Freed, Bobbi J Byrne","doi":"10.1542/peds.2024-068339","DOIUrl":"https://doi.org/10.1542/peds.2024-068339","url":null,"abstract":"<p><p></p><p><strong>Objective: </strong>To examine individual variation in total and direct patient care work hours annually across a decade and identify associations of work hours with pediatrician characteristics and measures of work-life balance.</p><p><strong>Methods: </strong>Using data from the American Academy of Pediatrics Pediatrician Life and Career Experience Study (PLACES), a national longitudinal study, we examined total work and direct patient care hours reported by the same pediatricians each year, 2013-2022. Yearly participation ranged from 75% to 94%. We examined work-hour patterns using mixed-effects linear regression for longitudinal data. We also developed pediatrician profiles based on work hours and direct patient care time and explored associations with multiple measures of work-life balance.</p><p><strong>Results: </strong>Analyses included 12 864 observations from 1696 pediatricians. Mean hours per week across years were 42.8 for total and 33.3 for direct patient care work. A mixed-effects model examined total work hours. The largest associations showed men working more than women (B = 7.22; 95% CI, 6.04-8.39) and subspecialists from large subspecialties working more than general pediatricians (B = 7.20; 95% CI, 6.11-8.29). There was a slight decrease in total hours found across years (B = -0.12; 95% CI, -0.21 to -0.03). Pediatricians who worked more hours reported lower work-life balance. Pediatricians working a greater portion of their time in direct patient care did not report worse work-life balance.</p><p><strong>Conclusions: </strong>Direct patient care made up three-fourths of total work hours, and pediatricians reported a slight annual decrease in hours worked. Men, subspecialists, and hospitalists were likely to work more hours, and higher work hours were negatively associated with work-life balance.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365318","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}

{"title":"An Open-Source Smartphone Otoacoustic Emissions Test for Infants.","authors":"Nada Ali, Justin Chan, Anna Meehan, Brent Collett, Sarah Benki-Nugent, Randall A Bly, Shyam Gollakota, Juliana Bonilla-Velez, Emily R Gallagher","doi":"10.1542/peds.2024-068068","DOIUrl":"https://doi.org/10.1542/peds.2024-068068","url":null,"abstract":"<p><strong>Objective: </strong>Universal hearing screening is essential for early identification of infants with hearing loss, yet there is a lack of low-cost, scalable equipment suitable for resource-constrained settings. Here we test a low-cost smartphone device for infant hearing screening.</p><p><strong>Methods: </strong>Infants aged 0 to 6 months were recruited from 3 ambulatory clinics at Seattle Children's Hospital with a high prevalence of hearing loss. We compared results from a low-cost open-source distortion product otoacoustic emission (OAE) probe and smartphone app with results from a commercially available OAE device. Hearing status was confirmed using newborn hearing screening, diagnostic testing, or both. Primary outcomes were referral rate as well as sensitivity, specificity, positive predictive value, and negative predictive value compared with known hearing status.</p><p><strong>Results: </strong>Among N = 76 infants, the mean age at screening was 3.1 ± 1.9 months and 13% had hearing loss. Referral rates were 24% and 26% for the smartphone and conventional devices, respectively. Both devices demonstrated 100% sensitivity (95% CI, 0.69-1.00) and negative predictive value (95% CI, 0.94-1.00). Specificity was 88% (95% CI, 0.78-0.95) and 85% (95% CI, 0.74-0.92) for the smartphone and conventional devices, respectively. Positive predictive value was 56% (95% CI, 0.31-0.78) for the smartphone and 50% (95% CI, 0.27-0.73) for the conventional device.</p><p><strong>Conclusion: </strong>The smartphone-based OAE device effectively screened hearing in high-prevalence infants. Thus, smartphone-based OAE detection may be a promising low-cost solution to the challenge of building scalable universal newborn and infant hearing screening programs in resource-constrained settings.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256302","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}

{"title":"2025 Recommendations for Preventive Pediatric Health Care: Policy Statement.","authors":"","doi":"10.1542/peds.2025-071066","DOIUrl":"https://doi.org/10.1542/peds.2025-071066","url":null,"abstract":"<p><p>The 2025 Recommendations for Preventive Pediatric Health Care (Periodicity Schedule) has been approved by the American Academy of Pediatrics (AAP). Each child and family is unique; therefore, these recommendations are designed for the care of children who are receiving nurturing parenting, have no manifestations of any important health problems, and are growing and developing in a satisfactory fashion. Developmental, psychosocial, and chronic disease issues for children and adolescents may require more frequent counseling and treatment visits separate from preventive care visits. Additional visits also may become necessary if circumstances suggest concerns. The AAP continues to emphasize the great importance of continuity of care in comprehensive health supervision and the need to avoid fragmentation of care.1.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365308","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}

{"title":"Cost Analysis of a Scalable Clinician Communication Intervention to Increase HPV Vaccine Initiation.","authors":"Brayan V Seixas, Peter G Szilagyi, Gerald F Kominski, Sharon G Humiston, Alisa J Stephens-Shields, Russell Localio, Abigail Breck, Mary Kate Kelly, Robert W Grundmeier, Christina S Albertin, Laura P Shone, Jennifer Steffes, Cynthia M Rand, Chloe Hannan, Dianna E Abney, Greta McFarland, Srikanth Kadiyala, Alexander G Fiks","doi":"10.1542/peds.2024-066742","DOIUrl":"https://doi.org/10.1542/peds.2024-066742","url":null,"abstract":"<p><p></p><p><strong>Background and objective: </strong>For a previous longitudinal cluster randomized controlled trial (2018-2019), we randomized 48 primary care pediatric practices to online communication training vs usual care. Online communication training reduced missed opportunities (MOs) for initial human papillomavirus (HPV) vaccination at well-child care (WCC) visits by 6.8 percentage points among children aged 11-17 years. The current study estimated implementation costs of the communication training intervention at WCC visits.</p><p><strong>Methods: </strong>We analyzed monthly surveys completed by intervention practice lead clinicians to track clinician plus office staff personnel hours devoted to implementing the intervention. We converted personnel time into 2019 US dollars using national median hourly wages for physicians and other health care workers; we tracked nonpersonnel costs. We calculated costs per practice (overall and by practice size) and estimated costs per averted MO for HPV vaccine initiation using an effectiveness estimate determined by grouped logistic regression at the practice level.</p><p><strong>Results: </strong>Practices varied from 1 to 24 clinicians (mean = 7.5) and from 241 to 8866 visits (mean = 2353) during the 6-month intervention. Total intervention costs varied substantially across the 24 intervention practices from $370 to $6653, with a mean of $2003 (95% CI, $1377-$2762) and median of $1305. The incremental cost per averted MO for HPV vaccine initiation at WCC visits averaged $110 ($212 in practices with 1 or 2 physicians and $94 in practices with 3 or more physicians).</p><p><strong>Conclusions: </strong>The implementation cost per averted MO for HPV vaccine initiation at WCC visits of this online communication training intervention was modest, particularly among larger pediatric practices.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190130","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}

{"title":"Confirmed Systemic Mastocytosis in a Pediatric Patient With Widespread Cutaneous Symptoms.","authors":"Julia A Cahill, Sneha Suresh, Joel R Livingston","doi":"10.1542/peds.2024-067915","DOIUrl":"https://doi.org/10.1542/peds.2024-067915","url":null,"abstract":"<p><p>Mastocytosis is characterized by the clonal expansion of mast cells, with deposition into various organs and variable clinical presentation depending on subtype. It generally results from a mutation in the KIT gene, which encodes for production of receptor tyrosine kinases, the constitutive activity of which results in abnormal cell growth and proliferation. In pediatric patients, the cutaneous mastocytosis (CM) form predominates, and systemic mastocytosis (SM) is rarely reported. Accordingly, clinical course and management are not well described. We describe a case of SM in a 10-year-old child who was initially suspected of having widespread CM. The child had initially minimal systemic symptoms that are usually described in SM. Peripheral testing for the most common KIT mutation associated with constitutive activity, c-KIT D816V, in which aspartic acid is substituted for valine at position 816, was negative. Rising serum tryptase and increasing systemic symptoms of histamine release led to bone marrow biopsy, which was positive for the c-KIT D816V mutation and confirmed the diagnosis of indolent SM. The patient's response to treatment is briefly described, with exploration of treatment modalities described in previously reported cases. The case illustrates that, even in the absence of classic systemic symptoms, an index of suspicion for SM should be maintained, and highlights that peripheral testing for the c-KIT D816V mutation may be represent a false negative. Finally, we discuss that although antihistamines have historically formed the backbone of treatment in pediatric SM, the increasing availability of biological agents present possible new treatments with some success reported in the literature.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190126","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}

{"title":"Predicting Childhood and Adolescence Hypertension: Analysis of Predictors Using Machine Learning.","authors":"Hengyan Liu, Weibin Kou, Yik-Chung Wu, Pui Hing Chau, Thomas Wai Hung Chung, Daniel Yee Tak Fong","doi":"10.1542/peds.2024-066675","DOIUrl":"https://doi.org/10.1542/peds.2024-066675","url":null,"abstract":"<p><strong>Background: </strong>There has been a substantial burden of hypertension in children and adolescents. Given the availability of primary prevention strategies, it is important to determine predictors for early identification of children and adolescents at risk of hypertension. This study aims to attempt and validate machine learning (ML) algorithms for accurately predicting blood pressure (BP) status (normal, prehypertension, and hypertension) over 1- and 3-year periods, identifying key predictors without compromising model performance.</p><p><strong>Methods: </strong>We included a population-based cohort of primary 1 to secondary 6 students (typically aged 6 to 18 years) during the academic years of 1995 to 1996 and 2019 to 2020 in Hong Kong. Thirty-six easy-assessed predictors were initially model childhood BP status. Multiple ML algorithms, decision tree, random forest, k-nearest neighbor, eXtreme Gradient Boosting (XGBoost), and multinomial logistic regression (MLR), were used. Model evaluation was performed by various accuracy metrics. The Shapley Additive Explanations (SHAP) was used to identify key features for both predictions.</p><p><strong>Results: </strong>A total of 923 301 and 602 179 visit pairs were used for the 1- and 3-year predictions, respectively. XGBoost demonstrated the highest prediction accuracies for 1-year (macro-area under the receiver operating characteristic curve [AUROC] = 0.92, micro-AUROC = 0.91) and 3-year (macro-AUROC = 0.91, micro-AUROC = 0.90) periods. The traditional MLR approach had the lowest accuracies for 1- (macro-AUROC = 0.70, micro-AUROC = 0.68) and 3-year (macro-AUROC = 0.70, micro-AUROC = 0.68) predictions. The SHAP values identified 17 key predictors without the need for direct BP measurements or laboratory tests.</p><p><strong>Conclusion: </strong>ML prediction models can accurately predict childhood prehypertension and hypertension at 1 and 3 years, independent of BP and laboratory measurements. The identified key predictors may inform areas for personalized prevention in hypertension.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123415","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}

{"title":"A Reading Program for Adolescents in a Primary Care Clinic.","authors":"Anoushka Sinha, Elizabeth Ozer, Sara Buckelew","doi":"10.1542/peds.2023-064884","DOIUrl":"https://doi.org/10.1542/peds.2023-064884","url":null,"abstract":"<p><p></p><p><p>The COVID-19 pandemic exacerbated the ongoing adolescent mental health crisis in part by disrupting connections to schools, communities, and primary care. Reading has been shown to support mental health by fostering identification with narratives, situations, or characters and promoting empathy. Inspired by Reach Out and Read, we developed Turning Pages, a program designed to enhance the clinic experience for adolescents by offering books during annual physicals in a primary care clinic. The clinic serves a diverse population of 1750 adolescent and young adult patients, with approximately 40% covered by California's Medicaid program. Patients and clinicians recommended books that were meaningful during their adolescence, and we partnered with a local bookshop to curate a diverse and inclusive collection. At the start of each visit, medical assistants invited patients to select a book and offered an optional survey assessing program impact. A total of 326 books were acquired through the support of various grants and donations. Between May 2023 and January 2024, 295 books were distributed to adolescent patients. Of the 65 patients who completed the survey, 98% appreciated receiving a book, 81% felt it improved their clinic experience, and 68% reported feeling more connected to their medical team. Institutional support and positive feedback from patients, clinicians, and staff have ensured ongoing funding for the program. Turning Pages demonstrates potential as a sustainable program that enhances the clinic experience and strengthens connections to care.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123414","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}