Academic Pediatrics最新文献

{"title":"ADHD Medication and Depressive Symptoms in Adolescents: a Retrospective Longitudinal Study.","authors":"Landon B Krantz, Tanya E Froehlich, Andrew F Beck, Stephen P Becker, Melinda C MacDougall, Shelley Ehrlich, Chidiogo U Anyigbo, Samuel Eggers, William B Brinkman","doi":"10.1016/j.acap.2025.102863","DOIUrl":"https://doi.org/10.1016/j.acap.2025.102863","url":null,"abstract":"<p><strong>Objective: </strong>To examine whether higher attention-deficit/hyperactivity disorder (ADHD) medication coverage was associated with lower depressive symptoms among adolescents who live in under-resourced neighborhoods and/or identify as a member of a minoritized group.</p><p><strong>Methods: </strong>In this retrospective cohort study, adolescents aged 12-18 years with ADHD completed a depression screener at their annual well visit. Patients were seen at a primary care office that predominantly serves minoritized, Medicaid-insured youth from under-resourced neighborhoods. We calculated ADHD medication coverage as the percentage of days in which medication was available in the prior 36 months based on prescriptions in the electronic health record (range 0% to 100%). Zero-inflated negative binomial regression models assessed whether medication coverage was associated with differences in total depression scores, measured by the Patient Health Questionnaire.</p><p><strong>Results: </strong>We included 2,569 adolescents (66.6% male, 70.9% Black, 86.6% Medicaid-insured) with 4,145 well visits. Medication coverage was poor (mean=18.5% days covered, standard deviation=26.8%). Higher medication coverage was not associated with lower depression scores in the overall sample. However, after excluding patients with 0% medication coverage, there was a significant association between higher coverage and lower depression scores. Depression symptom scores were higher in patients with mental/behavioral health comorbidities, those of female sex, and those living in neighborhoods with lower opportunity scores.</p><p><strong>Conclusions: </strong>Greater ADHD medication coverage was associated with a small, yet potentially clinically significant decrease in depression symptoms in our sample, underscoring the need to investigate the protective effect of ADHD medication on depression in more diverse populations.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102863"},"PeriodicalIF":3.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Graduating Pediatric Residents' Preparedness to Provide Mental Health Care for Children and Adolescents.","authors":"Elizabeth A Gottschlich, Tylar W Kist, Hilary M Haftel","doi":"10.1016/j.acap.2025.102858","DOIUrl":"https://doi.org/10.1016/j.acap.2025.102858","url":null,"abstract":"<p><strong>Objectives: </strong>Examine graduating pediatric residents' preparedness to provide mental health care and examine program characteristics and mental health training experiences associated with such preparedness.</p><p><strong>Methods: </strong>National random sample of 1,000 US pediatric residency graduates from the 2022 AAP Annual Survey of Graduating Residents; 428/991 (43.2%) responded. Residents rated how well their program prepared them (5-point scale, \"poor\" to \"excellent\") to care for children and adolescents with mental and behavioral health needs overall and eight specific problems. Respondents provided residency program characteristics and indicated whether their continuity clinic had an on-site mental health professional and if they completed a psychiatry rotation. Multivariable logistic regression examined program characteristics and mental health training experiences associated with reported preparedness (\"excellent\" or \"very good\") to care for patients with mental health needs overall.</p><p><strong>Results: </strong>More than half of residents (51.4%) reported feeling prepared to care for mental health needs overall. Six in ten felt prepared to care for patients with suicidal ideation or behavior (64.8%), low mood or depression (64.1%), inattention and impulsivity (59.0%), anxiety (57.2%), and signs of eating disorders (56.9%). Fewer felt prepared to address disruptive behavior and aggression (37.9%) and substance use (34.0%). Sixty-one percent had an on-site mental health professional; one-third completed a psychiatry rotation. Those who had both of these training experiences were most likely to report feeling prepared.</p><p><strong>Conclusion: </strong>Gaps remain in residents' preparedness to provide mental health care, particularly around substance use and disruptive behavior and aggression.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102858"},"PeriodicalIF":3.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FACILITATING REFLECTION: CLINICAL DEBRIEFING.","authors":"Mikelle Key-Solle, Bryan Monroe","doi":"10.1016/j.acap.2025.102861","DOIUrl":"https://doi.org/10.1016/j.acap.2025.102861","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102861"},"PeriodicalIF":3.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fathers' adverse childhood experiences, behavioral health, and fathering stress and satisfaction.","authors":"Natalie Grafft, Kirsten K Davison, Catherine Taylor, Karen S Lyons, Rebekah Levine Coley","doi":"10.1016/j.acap.2025.102860","DOIUrl":"https://doi.org/10.1016/j.acap.2025.102860","url":null,"abstract":"<p><strong>Objectives: </strong>Using a nationally representative sample, this study examined associations between fathers' adverse childhood experiences (ACEs) and fathering and whether fathers' behavioral health mediated this association.</p><p><strong>Methods: </strong>Data from 4,814 fathers who were followed from adolescence through early adulthood in the National Longitudinal Study of Adolescent to Adult Health. On average, fathers were 33 years old and self-identified as non-Hispanic White (64%) followed by non-Hispanic Black (17%) or Hispanic (12%). Fathers self-reported on 13 ACEs during waves 1-4 and two measures of behavioral health (depressive symptoms and alcohol consumption) and fathering (stress and satisfaction), assessed at wave 4 or 5. A multiple mediation model was estimated using a structural equation model to examine direct and indirect pathways between fathers' ACEs and fathering, through behavioral health.</p><p><strong>Results: </strong>There was a significant direct effect of ACEs on fathering satisfaction (B = -0.04, standard error (se) = 0.02, p <.01), as well as a significant indirect effect through fathers' depressive symptoms (B = -0.04, se = 0.01, p <.001), resulting in a total effect of -0.08 (se = 0.02, p <.001). Fathers' ACEs were also linked to heavy drinking (B = 0.01, se = 0.00, p <.05). ACEs were not associated with fathering stress.</p><p><strong>Conclusions: </strong>Findings indicate the importance of reaching and engaging ACE exposed fathers in behavioral health and parenting interventions. Given health promotion in fathers has benefits for their children, leveraging pediatric encounters to identify at-risk fathers has the potential to improve both fathers' and children's health.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102860"},"PeriodicalIF":3.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Day I Almost Lost My Son.","authors":"Chana Richter","doi":"10.1016/j.acap.2025.102862","DOIUrl":"https://doi.org/10.1016/j.acap.2025.102862","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102862"},"PeriodicalIF":3.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Equity in Health Care Access, Utilization, and Experiences for Latino Children in California by Parental Citizenship and Household Language, 2021-2022.","authors":"Clara B Barajas, Dylan H Roby, Jim P Stimpson, Ninez A Ponce, Gabriela E Lazalde, Maria-Elena De Trinidad Young, Kathryn Kietzman, Arturo Vargas Bustamante, Alexandra C Rivera-González, Brent A Langellier, Jan M Eberth, Mark Stehr, Alexander N Ortega","doi":"10.1016/j.acap.2025.102856","DOIUrl":"https://doi.org/10.1016/j.acap.2025.102856","url":null,"abstract":"<p><strong>Objectives: </strong>This study examines health care access, utilization, and experiences among Latino children in California by parental citizenship and household language.</p><p><strong>Methods: </strong>Merged data from the 2021-2022 California Health Interview Survey and the follow-up Latino Youth Health Study of the same years were analyzed. Primary outcomes were parental reports of children's health care access, utilization, and experiences in the past year. The main predictors were variables stratified by parental citizenship status (both citizen parents versus one citizen and one noncitizen parent or both noncitizen parents) and household language (English-only versus English-and-Spanish, or Spanish-only). Multivariable analyses adjusted for parental education, family income, parent-reported child's health status, child's age, and child's insurance.</p><p><strong>Results: </strong>Findings showed no significant differences in health care access across groups. However, children with both noncitizen parents and from Spanish-only households were more likely to have had well-child visits and general doctor visits than children with both citizen parents and in English-only households. Additionally, parents of children with both noncitizen parents were more likely to feel respected by doctors than those with both citizen parents. Conversely, compared to parents with both citizen parents, parents of children with one citizen and one noncitizen parent were less likely to report that doctors spent enough time with their children and less likely to express high satisfaction with their children's health care.</p><p><strong>Conclusion: </strong>Patterns of health care access, utilization, and experiences among Latino children in immigrant families in California are improving, which are likely associated with recent inclusive health policies in the state.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102856"},"PeriodicalIF":3.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Current State of Behavioral Health Training for Pediatric Residents.","authors":"Rachel Herbst, Andrea Meisman, Francis J Real","doi":"10.1016/j.acap.2025.102859","DOIUrl":"https://doi.org/10.1016/j.acap.2025.102859","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102859"},"PeriodicalIF":3.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences between Individual Social Risks, Social Needs, and Community-level Social Risk among Pediatric Patients.","authors":"Matthew S Pantell, David M Mosen, Nathan Tran, Laura M Gottlieb, Matthew P Banegas","doi":"10.1016/j.acap.2025.102851","DOIUrl":"https://doi.org/10.1016/j.acap.2025.102851","url":null,"abstract":"<p><strong>Objective: </strong>We sought to explore relationships between community-level social determinants of health (SDOH), individual-level social risk factors, and individual-level social needs - whether families desire help addressing social risk factors - among children's families in a large, diverse patient population in the Pacific Northwest.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of children ages 0-18 who received care at Kaiser Permanente Northwest, an integrated healthcare system serving patients in Oregon and Southwest Washington, between December 1, 2017 - December 31, 2019. Social data came from the Your Current Life Situation survey as recorded in patient electronic medical records, and included information on housing instability, food insecurity, transportation needs, and financial hardships. We used Chi-squared tests to compare rates of social risks, social needs, and NDI quartiles.</p><p><strong>Results: </strong>The sample included 2,313 children. Among the 59.6% of families endorsing at least one social risk, 66.9% desired assistance addressing at least one social need. Both individual-level social risks and social needs varied significantly by NDI quartile, with the highest social risk and social needs rates being in the highest NDI quartiles (most social disadvantage). However, among families in the lowest NDI quartile (most social advantage), 42.1% of families endorsed at least one risk and 23.3% of families endorsed at least one social need.</p><p><strong>Conclusions: </strong>In a diverse sample of pediatric patients, we found that a community-level SDOH index inadequately identified families endorsing social risks and social needs. Our findings support policies that incentivize individual-level social risk and social need data collection in clinical settings.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102851"},"PeriodicalIF":3.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Care Use by Immigrant Generation in Low-Income Children With Special Health Care Needs","authors":"Marina Masciale MD, MPH ,&nbsp;Todd Leroux PhD, MHPA ,&nbsp;Karla Fredricks MD, MPH ,&nbsp;Jean L. Raphael MD, MPH ,&nbsp;Claire Bocchini MD, MS ,&nbsp;Hye-Chung Kum PhD ,&nbsp;Michelle A. Lopez MD, MPH","doi":"10.1016/j.acap.2025.102852","DOIUrl":"10.1016/j.acap.2025.102852","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to describe social stressors and health care access in children with special health care needs (CSHCN) from low-income households by immigrant generation and determine the association between immigrant generation and health care utilization.</div></div><div><h3>Methods</h3><div>This was a retrospective cross-sectional study of CSHCN living at or below 200% of the federal poverty level using the National Survey of Children’s Health from 2018 to 2022. Exposures were demographics, immigrant generation (first-generation, second-generation, or nonimmigrant), social stressors, and health care factors. Outcomes were 1) one or more emergency room (ER) visits and 2) one or more hospitalizations in the past year. We compared variables across generations using chi-square testing and assessed factors associated with our outcomes using logistic regression.</div></div><div><h3>Results</h3><div>We included 16,679 CSHCN (293 first-generation, 2203 second-generation, 14,183 nonimmigrants). Compared to second-generation and nonimmigrants, more parents of first-generation CSHCN identified as Hispanic, lived in non-English speaking households, reduced work hours due to their child’s health, reported poor child health, lacked insurance for their child, and lacked a medical home for their child. ER visits and hospitalization rates were similar across all 3 generation groups. When controlling for covariates, immigrant generation was not associated with ER visits or hospitalizations.</div></div><div><h3>Conclusions</h3><div>Despite having poorer health status and less access to medical homes compared to nonimmigrants, CSHCN from immigrant families do not utilize the ER more often, which is potentially concerning for underutilization. Addressing social drivers of health in immigrant families and expanding public health insurance eligibility to all low-income CSHCN, regardless of immigration status, may ensure appropriate ER use.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102852"},"PeriodicalIF":3.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing Sudden Cardiac Death Risk Screening Within a Pediatric Primary Care Network","authors":"Naveed Rabbani MD ,&nbsp;Margaret Fry MD ,&nbsp;Louis Vernacchio MD, MSc ,&nbsp;Emily Trudell Correa MPH, MS ,&nbsp;Susannah Kisvarday MD ,&nbsp;Jonathan Hatoun MD, MPH, MS ,&nbsp;Michael Day MD ,&nbsp;Mark E. Alexander MD","doi":"10.1016/j.acap.2025.102850","DOIUrl":"10.1016/j.acap.2025.102850","url":null,"abstract":"<div><h3>Objective</h3><div>In 2021, the American Academy of Pediatrics (AAP) recommended universal, history-based sudden cardiac death risk screening, representing an expansion from history- and exam-based screening for sports preparticipation. We studied the implementation of universal cardiac risk screening within a large pediatric primary care network to better understand optimal workflow design, screening positivity rate, and potential system-based effects that may arise from expanded screening.</div></div><div><h3>Methods</h3><div>We adapted the AAP guidelines to a 3-question screener implemented into the electronic health record as a patient portal questionnaire with a back-up paper-based workflow. A noninterruptive alert provided clinical decision support. Screening positivity rates and rates of follow-up actions were measured. Screening rates were compared across patient demographics using a multivariable model.</div></div><div><h3>Results</h3><div>Between March 1, 2024, and February 28, 2025, of 72,037 eligible patients, 41,433 (58%) were screened. Of these, 3463 (8.4%) had a clinically actionable positive screen. Follow-up evaluation was ordered in 31% of cases. A multivariable model demonstrated that inactive patient portal status, teenage patient age, patient race of “Unknown,” and public insurance were associated with lower screening rates.</div></div><div><h3>Conclusions</h3><div>Implementing universal history-based sudden cardiac death risk screening in a pediatric primary care network exhibited an 8.4% positivity rate after clinician review, representing a large potential burden of cardiology referrals. Over half of eligible patients were screened, and follow-up evaluation was ordered in a minority of positive cases, signaling a gap in adoption/adherence. This implementation was associated with lower screening rates in certain disadvantaged populations.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102850"},"PeriodicalIF":3.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}