Pediatrics最新文献_第7页

Age, Adverse Childhood Experiences, and Health Care Utilization. 年龄、童年的不良经历和医疗保健的使用。

IF 8 2区医学

Pediatrics Pub Date : 2024-10-18 DOI: 10.1542/peds.2023-064838

Charles V Golden,Raymen R Assaf,Ricardo Aguilar,Tatiana Moreno,Heather Huszti,Michelle Fortier,Theodore Heyming,Uma Rao,Louis Ehwerhemuepha,Michael Weiss

{"title":"Age, Adverse Childhood Experiences, and Health Care Utilization.","authors":"Charles V Golden,Raymen R Assaf,Ricardo Aguilar,Tatiana Moreno,Heather Huszti,Michelle Fortier,Theodore Heyming,Uma Rao,Louis Ehwerhemuepha,Michael Weiss","doi":"10.1542/peds.2023-064838","DOIUrl":"https://doi.org/10.1542/peds.2023-064838","url":null,"abstract":"OBJECTIVESTo assess whether the association of adverse childhood experiences (ACEs) with pediatric health care utilization differs by age.METHODSIn this retrospective cohort study, we included patients completing primary care ACEs screening between January 2020 and September 2021. Pediatric ACEs and Related Life Events Screener Part 1 scores were categorized 0, 1 to 3, or ≥4 (none, low, and high, respectively). Two multivariable logistic regression models assessed emergency department (ED) and inpatient utilization across all ages 6 months after screening.RESULTSAmong 37 315 patients, 15.7% visited the ED and 2.5% were hospitalized within 6 months of ACEs screening. Using no ACEs as the reference, infants and toddlers with any ACEs had lower odds of ED and inpatient utilization, whereas older children with any ACEs had higher odds of ED (age-low ACEs: 0.04, P value < .001; age-high ACEs: 0.08, P value < .001) and inpatient (age-low ACEs: 0.06, P value < .001; age-high ACEs: 0.15, P value < .001) utilization and increased each successive year of age.CONCLUSIONSThe association of ACEs with health care utilization is dependent on age and is more complex than previously described. These trends may inform specific therapeutic strategies for pediatric patients by age.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449345","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

Cancer, Consents, and Chaos: Navigating Health Literacy at the Time of a New Oncology Diagnosis. 癌症、同意书和混乱：肿瘤新诊断时的健康知识导航》。

IF 8 2区医学

Pediatrics Pub Date : 2024-10-17 DOI: 10.1542/peds.2024-067248

Ajibike Lapite

引用次数: 0

Legal Involvement in Pediatric Cancer Treatment Refusal: A Qualitative Study. 儿科癌症治疗拒绝中的法律介入：定性研究。

IF 8 2区医学

Pediatrics Pub Date : 2024-10-17 DOI: 10.1542/peds.2024-066180

Amy E Caruso Brown,Laura M Beskow,Daniel J Benedetti

{"title":"Legal Involvement in Pediatric Cancer Treatment Refusal: A Qualitative Study.","authors":"Amy E Caruso Brown,Laura M Beskow,Daniel J Benedetti","doi":"10.1542/peds.2024-066180","DOIUrl":"https://doi.org/10.1542/peds.2024-066180","url":null,"abstract":"OBJECTIVESTo characterize the spectrum of legal options considered in cases of treatment refusal, nonadherence, and abandonment (TRNA); clinicians' thought processes regarding legal intervention; and perceived consequences of legal involvement.METHODSWe conducted in-depth, semistructured interviews with 30 pediatric oncologists between May and September of 2019 regarding experiences with TRNA. The interview guide covered types of conflicts encountered; factors and strategies considered in response; effects of TRNA cases, personally and professionally; the role of ethical frameworks and legal requirements; and resources needed to manage TRNA cases. Interviews were transcribed and coded iteratively using thematic analysis.RESULTSParticipants represented a range of institutional sizes, geographic locations, and years in practice. Twenty-five of 30 interviewees discussed legal consideration with regard to TRNA. Most participants first engaged the legal system through child protective service agencies. They considered patient age, treatment efficacy, quality of life (burden of treatment), and prognosis; family resources and social context; and preservation of therapeutic relationships and possible consequences of reporting. Experiences and outcomes of legal involvement varied.CONCLUSIONSClinicians struggle with the tension between obligations to report medical neglect and fears that reporting may result in more harm than benefit to the child in question. We urgently need more dialog between health care professionals and child protective services and legal professionals. Stakeholders from both groups would benefit from a greater understanding of the other's thought processes; clarity regarding the relevant facts; and mutual progress toward creative, evidence-based solutions to working out these complex challenges.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448077","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

Challenges and Opportunities in Transitioning Autistic Individuals Into Adulthood. 自闭症患者向成年过渡的挑战与机遇。

IF 8 2区医学

Pediatrics Pub Date : 2024-10-16 DOI: 10.1542/peds.2024-067195

Anne M Roux,Kyle Chvasta,Kiley J McLean,Meghan Carey,Georgina Perez Liz,Liza Tomczuk,Kristina Lopez,Evva Assing-Murray,Paul T Shattuck,Lindsay L Shea

{"title":"Challenges and Opportunities in Transitioning Autistic Individuals Into Adulthood.","authors":"Anne M Roux,Kyle Chvasta,Kiley J McLean,Meghan Carey,Georgina Perez Liz,Liza Tomczuk,Kristina Lopez,Evva Assing-Murray,Paul T Shattuck,Lindsay L Shea","doi":"10.1542/peds.2024-067195","DOIUrl":"https://doi.org/10.1542/peds.2024-067195","url":null,"abstract":"BACKGROUND AND OBJECTIVESApproximately 1.2 million autistic youth will reach the legal age of adulthood over the next decade. Given dynamic changes in the socioecological context of the transition to adulthood, we produced an updated transitions research agenda reflecting the perspectives of autistic young adults, care partners (parents), and professionals who use autism research.METHODSWe conducted 9 focus groups: 4 young adult, 4 care partner, and 1 professional, with 59 total participants. Young adults were grouped by self-reported identity: (1) racial and ethnic minority, (2) lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other identities, and (3) nonspeaking, in addition to a general group. We selected care partners who supported youth with varying intensity of support needs. We used rapid qualitative inquiry methods to extract key points from answers to semistructured interview questions.RESULTSDelays in diagnosis and transition processes, and placement on wait lists resulted in significant obstacles to successful transitions. Parents assumed a dominant role by coordinating services, navigating systems and identifying opportunities for community participation, and providing direct supports. There was an overarching need for inclusion of autistic people in transitions research and consideration of cultural differences in priorities and values. Participants prioritized investigation of variation in transitions among autistic youth with intersecting identities, navigation support (eg, peer mentors), efficacy of services and supports (eg, transition and employment services), differences in available services by location, and problems within specific benefits programs.CONCLUSIONSResearch should focus on understanding population-level factors of system performance on outcomes and support needs, service delivery among marginalized groups, and transformation of complex service ecosystems.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443781","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

Mapping Futures: Early Access to Mentorship Programs in Science and Medicine. 描绘未来：科学与医学导师计划的早期准入。

IF 8 2区医学

Pediatrics Pub Date : 2024-10-16 DOI: 10.1542/peds.2024-066717

Beth Wueste,Tatiana Ndjatou,Weichen Ling,Abena Knight,Ana Clara Mauro,Molly Rideout,Sybil Pentsil

引用次数: 0

Is Now the Time for Clonidine as a First-Line Agent for Neonatal Opioid Withdrawal Syndrome? 现在是将氯尼丁作为新生儿阿片类药物戒断综合征一线药物的时候了吗？

IF 8 2区医学

Pediatrics Pub Date : 2024-10-15 DOI: 10.1542/peds.2024-068359

Elisha M Wachman,Hayley Friedman

引用次数: 0

Clonidine as Monotherapy for Neonatal Opioid Withdrawal Syndrome: A Randomized Trial. 氯尼丁作为新生儿阿片类药物戒断综合征的单一疗法：随机试验

IF 8 2区医学

Pediatrics Pub Date : 2024-10-15 DOI: 10.1542/peds.2023-065610

Henrietta S Bada,Philip M Westgate,Thitinart Sithisarn,Kimberly Yolton,Richard Charnigo,Massroor Pourcyrous,Fei Tang,Julia Gibson,Jennifer Shearer-Miller,Peter Giannone,Markos Leggas

{"title":"Clonidine as Monotherapy for Neonatal Opioid Withdrawal Syndrome: A Randomized Trial.","authors":"Henrietta S Bada,Philip M Westgate,Thitinart Sithisarn,Kimberly Yolton,Richard Charnigo,Massroor Pourcyrous,Fei Tang,Julia Gibson,Jennifer Shearer-Miller,Peter Giannone,Markos Leggas","doi":"10.1542/peds.2023-065610","DOIUrl":"https://doi.org/10.1542/peds.2023-065610","url":null,"abstract":"OBJECTIVEWe sought to determine whether clonidine, a non-opioid α-2-adrenergic agonist, would effectively treat neonatal opioid withdrawal syndrome (NOWS).METHODSThis was an intention-to-treat randomized clinical trial. Enrollment criteria included prenatal opioid exposure, age ≤7 days, gestational age ≥35 weeks, no other medical condition, and need for pharmacotherapy. Primary outcomes were length of treatment and neurobehavioral performance.RESULTSA total of 1107 patients were screened for enrollment (645 ineligible, 91 parents or staff unavailable, 216 declined, 155 consented). Of 155 infants, 120 required treatment and were randomized to receive oral clonidine (n = 60) at 1 µg/kg/dose or morphine (n = 60), 0.06 mg/kg/dose, every 3 hours. Infants with no improvement had their doses increased by 25% of the initial dose every 12 to 24 hours. Those without improvement by the fourth dose increase, received adjunct therapy. Length of treatment did not differ between morphine and clonidine, with median (95% confidence interval [CI]) days, respectively, of 15 (13-17) and 17 (15-19), P = .48. More clonidine-treated infants (45%) needed adjunct therapy versus 10% in the morphine group, adjusted odds ratio (95% CI) = 8.85 (2.87-27.31). After treatment completion, the NICU Network Neurobehavioral Scales summary scores did not differ between clonidine-treated and morphine-treated infants.CONCLUSIONSLength of pharmacologic treatment and final neurobehavioral performance were not significantly different between the clonidine- and morphine-treated groups. Clonidine appears to be an effective non-opioid medication to treat NOWS. Future studies are needed to determine the optimal clonidine dosage for a quicker response and obviation of adjunct therapy.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142439170","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

Predictors in Youth of Adult Cardiovascular Events. 青少年心血管事件的预测因素

IF 8 2区医学

Pediatrics Pub Date : 2024-10-14 DOI: 10.1542/peds.2024-066736

Joel Nuotio,Tomi T Laitinen,Costan G Magnussen,Alan R Sinaiko,Lydia A Bazzano,Stephen R Daniels,David R Jacobs,Noora Kartiosuo,Juha Koskinen,David P Burgner,Mika Kähönen,Olli T Raitakari,Julia Steinberger,Elaine M Urbina,Alison J Venn,Jorma S A Viikari,Jessica G Woo,Terence Dwyer,Markus Juonala

{"title":"Predictors in Youth of Adult Cardiovascular Events.","authors":"Joel Nuotio,Tomi T Laitinen,Costan G Magnussen,Alan R Sinaiko,Lydia A Bazzano,Stephen R Daniels,David R Jacobs,Noora Kartiosuo,Juha Koskinen,David P Burgner,Mika Kähönen,Olli T Raitakari,Julia Steinberger,Elaine M Urbina,Alison J Venn,Jorma S A Viikari,Jessica G Woo,Terence Dwyer,Markus Juonala","doi":"10.1542/peds.2024-066736","DOIUrl":"https://doi.org/10.1542/peds.2024-066736","url":null,"abstract":"BACKGROUND AND OBJECTIVESChildhood risk factors are associated with cardiovascular events in adulthood. We compared the utility of a risk model based solely on nonlaboratory risk factors in adolescence versus a model that additionally included lipids to predict cardiovascular events in adulthood.METHODSThe study comprised 11 550 participants from 7 longitudinal cohort studies in the United States, Australia, and Finland with risk factor measurements in adolescence and followed into adulthood. The adolescent risk factors were defined by using clinical standards including overweight or obesity, elevated blood pressure, smoking, and borderline high or high levels of total cholesterol and triglycerides. The main outcomes were medically adjudicated fatal or nonfatal cardiovascular disease events occurring after age 25.RESULTSOf 11 550 participants (55.1% female, mean age 50.0 ± 7.7 years), 513 (4.4%) had confirmed cardiovascular events. In a multivariable model (hazard ratio [95% confidence interval]), elevated blood pressure (1.25 [1.03-1.52]), overweight (1.76 [1.42-2.18]), obesity (2.19 [1.62-2.98]), smoking (1.63 [1.37-1.95]), and high total cholesterol (1.79 [1.39-2.31]) were predictors of cardiovascular events (P < .05). The addition of lipids (total cholesterol and triglycerides) into the nonlaboratory model (age, sex, blood pressure, BMI, and smoking) did not improve discrimination in predicting cardiovascular events (C-statistics for the lipid model 0.75 [SD 0.07] and nonlaboratory model 0.75 [0.07], P = .82).CONCLUSIONSNonlaboratory-based risk factors and lipids measured in adolescence independently predicted adult cardiovascular events. The addition of lipid measurements to nonlaboratory risk factors did not improve the prediction of cardiovascular events.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436165","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

To Screen or Not to Screen: That Is the Cholesterol Question. 筛查还是不筛查？这就是胆固醇问题。

IF 8 2区医学

Pediatrics Pub Date : 2024-10-14 DOI: 10.1542/peds.2024-068548

Samuel S Gidding

引用次数: 0

Secondhand Smoke and E-Cigarette Aerosol Exposure by Sexual Identity. 按性别特征划分的二手烟和电子烟气溶胶暴露情况。

IF 8 2区医学

Pediatrics Pub Date : 2024-10-08 DOI: 10.1542/peds.2024-066931

Juhan Lee,Andy Tan,Jonathan P Winickoff,E Melinda Mahabee-Gittens,Katelyn F Romm,Erin A Vogel,Deepa Camenga

引用次数: 0