Academic Pediatrics最新文献

{"title":"Post-Pandemic Youth Mental Health: A Serial Cross-Sectional Survey of Illinois Parents with Four Timepoints.","authors":"Marie E Heffernan, Carly G Menker, Ashley Keese, Anne Bendelow, Mia Casale, Colleen Cicchetti, Lauren S Wakschlag, Matthew M Davis, Michelle L Macy","doi":"10.1016/j.acap.2025.103127","DOIUrl":"https://doi.org/10.1016/j.acap.2025.103127","url":null,"abstract":"<p><strong>Objectives: </strong>Youth mental health was declining before the COVID-19 pandemic and worsened during the pandemic, yet less is known for the post-pandemic period. We examined parents' reports of youth mental health between 2022-2024.</p><p><strong>Methods: </strong>We administered serial cross-sectional surveys to four independent samples of Illinois parents in 6/2022, 5/2023, 10/2023, 3/2024, in English and Spanish, through the QualtricsXM panel (convenience sample of adults who agree to take surveys). Parents read a list of 14 youth mental health symptoms and indicated, for one randomly selected 2-17 year-old child, if the child experienced each symptom less often, the same amount, or more often than a year ago; or never. Parents indicated their own stress levels.</p><p><strong>Results: </strong>At each timepoint, symptoms of irritability were most commonly reported, with different expression across developmental periods: tantrums in early childhood; easy frustration in school-age children. Approximately half of parents reported their child experienced >=1 mental health symptom more often at each timepoint (6/2022: 49.7%, 5/2023: 51.6%, 10/2023: 53.9%, 3/2024: 48.7%). Multivariable logistic regressions indicated parent stress was associated with higher odds of the child having >=1 mental health symptom more often (6/2022 aOR:3.37, 5/2023 aOR:2.07, 10/2023 aOR:1.76, 3/2024 aOR:3.31).</p><p><strong>Conclusions: </strong>At four survey timepoints over two years, approximately half of 2-17 year-old youth experienced mental health symptoms more often than they had before. This was most evident via transdiagnostic irritability symptoms. Screening for mental health, beginning in toddlerhood, and preventive interventions for parents and youth are potential mechanisms to mitigate the youth mental health crisis.</p><p><strong>Clinical trial registration: </strong>not applicable.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103127"},"PeriodicalIF":2.8,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977586","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":"Pediatric Leaders' Perspectives on Climate Change Advocacy.","authors":"Taryn Sirias, Jason J Lau, Amanda Leon, Amanda Millstein, Naomi S Bardach","doi":"10.1016/j.acap.2025.103134","DOIUrl":"https://doi.org/10.1016/j.acap.2025.103134","url":null,"abstract":"<p><strong>Objective: </strong>Climate change is a leading global threat to pediatric health, but there is limited knowledge about appropriate professional actions in response. The American Academy of Pediatrics (AAP) recommends pediatricians engage in climate advocacy. Our objective is to explore pediatrician perceptions of their role in climate advocacy and to elucidate barriers and facilitators to fulfilling that role.</p><p><strong>Methods: </strong>We conducted semi-structured interviews analyzed using qualitative thematic analysis, collected via teleconferencing software from September 2023 to February 2024. Participants were 18 practicing pediatricians serving as state or chapter AAP Members-At-Large, or committee leaders; recruitment was via email solicitation to those in Environmental Protection Agency eco-regions nationally.</p><p><strong>Exclusions: </strong>non-practicing pediatricians; those in climate change or environmental health AAP roles RESULTS: 18 pediatricians (13 identifying as women [72%], 8 as White [44%], 10 working in academic settings [56%], 14 in General Pediatrics [78%]) were interviewed. Participants endorsed climate change advocacy as an appropriate pediatric role, especially to address health inequities. We identified three approaches to climate change advocacy: healthcare, community-based, and legislative advocacy. We identified five factors in feasibility: barriers included lack of time and politicization of climate change; facilitators included the pediatricians' ability to have difficult conversations, institutional support, and starting local.</p><p><strong>Conclusion: </strong>Pediatric leaders regard climate advocacy as an important role for pediatricians who wish to promote health equity and child and family health. The barriers and facilitators to participating in different types of climate advocacy we identify provide potentially actionable approaches to supporting pediatricians in addressing climate change.</p><p><strong>What's new: </strong>This study is the first qualitative exploration of United States pediatrician perspectives on climate change policy advocacy. These findings explore advocacy's importance for mitigating climate change's impacts on pediatric health and may guide future interventions to enhance pediatricians' advocacy engagement.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103134"},"PeriodicalIF":2.8,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977597","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":"EPA to Milestones Advisor for Pediatric Subspecialties: Developing a Comprehensive Approach to Competency-Based Assessment.","authors":"Laura C Page, Debra Boyer, YoungNa Lee-Kim, Mary E Moffatt, Brenda Nuncio Lujano, Darcy Weidemann, Alan Schwartz, David A Turner, Deborah Hsu","doi":"10.1016/j.acap.2025.103122","DOIUrl":"https://doi.org/10.1016/j.acap.2025.103122","url":null,"abstract":"<p><strong>Objective: </strong>This project sought to define the relationship between the Accreditation Council of Graduate Medical Education (ACGME) Milestones 2.0 and Entrustable Professional Activities (EPAs) for each of 15 pediatric subspecialties and create a novel tool that could automate the generation of expected milestone behaviors for a given EPA level of supervision.</p><p><strong>Methods: </strong>Workgroups for each of the pediatric subspecialties selected Milestone 2.0 subcompetencies that were essential to performing each EPA through a modified Delphi approach. Additionally, the groups assigned predicted Milestone levels expected for each EPA Level of Supervision.</p><p><strong>Results: </strong>Forty percent (6/15) of subspecialties mapped all Milestone subcompetencies to their EPAs. Although variations existed among subspecialties, trainees were generally not expected to have achieved 'expertise' or (Milestone level 5) to be ready for practice without supervision (EPA Level of Supervision 5). Group assignments of anticipated Milestones levels for each EPA Level of Supervision were used to create an online tool intended to suggest milestone levels for a subspecialty fellow based on EPA Level of Supervision ratings.</p><p><strong>Conclusions: </strong>Strengthening pediatric subspecialty educators' understanding of the roles of Milestones 2.0 and EPAs in fellow education is critical to achieve goals of competency-based medical education. This work, which includes a novel tool that predicts milestone levels based on EPA Level of Supervision ratings, represents an important step in delineating the relationship between Milestones 2.0 and EPAs.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103122"},"PeriodicalIF":2.8,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977607","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":"Applying an Entrustable Professional Activity to Standardize LGBTQ+ Health Curricula and Assessment.","authors":"Beth Wueste, Lauren T Roth","doi":"10.1016/j.acap.2025.103132","DOIUrl":"https://doi.org/10.1016/j.acap.2025.103132","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103132"},"PeriodicalIF":2.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977556","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":"A Simulation-Based Training in Suicide Prevention for Pediatric Residents.","authors":"Alexandra Huttle, Elise M Falluco, Stephanie Rohrig, Jennifer DiPace, Kevin Ching, Melanie Wilson-Taylor, Janet Chen, Cori Green","doi":"10.1016/j.acap.2025.103129","DOIUrl":"https://doi.org/10.1016/j.acap.2025.103129","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103129"},"PeriodicalIF":2.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977513","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":"Development and Implementation of a Pilot Women's Leadership Curriculum for Pediatric Trainees.","authors":"Meredith Mitchell, Deborah DiazGranados, Michael Ryan, Michelle Olson","doi":"10.1016/j.acap.2025.103124","DOIUrl":"https://doi.org/10.1016/j.acap.2025.103124","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103124"},"PeriodicalIF":2.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977567","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":"Developmental Foundations of a Pediatric Mental Health Risk Calculator for Young Children.","authors":"Leigha A MacNeill, Yudong Zhang, Gina M Giase, Jillian Lee Wiggins, Elizabeth S Norton, Justin D Smith, Matthew M Davis, Julia G Raven, Roshaye B Poleon, Qiongru Yu, Christopher D Smyser, Cynthia E Rogers, Joan L Luby, Norrina B Allen, Lauren S Wakschlag","doi":"10.1016/j.acap.2025.103128","DOIUrl":"10.1016/j.acap.2025.103128","url":null,"abstract":"<p><strong>Objective: </strong>To advance clinical utility of an emerging risk calculator for identifying when to worry and when to act when young children show signs of mental health concerns in pediatric care, we: (1) replicate an early childhood mental health risk algorithm (DECIDE); (2) determine preliminary predictive utility of additional child and parenting assets, advancing a strengths-based framework to reduce the likelihood of biased identification.</p><p><strong>Methods: </strong>Data were from two independent studies: The national Future of Families and Child Wellbeing Study (FFCWS; N=2,763) and the regional Mental Health, Earlier Synthetic Cohort study (MHESC; N=323). Predictors were assessed in toddlerhood/early preschool age. Internalizing/externalizing problems were measured in older preschoolers, serving as outcomes. Epidemiologic risk prediction methods were applied to: (1) replicate the DECIDE risk algorithm domains comprised of demographics, child irritability, and adverse childhood experiences; and (2) examine the added predictive utility of child and parenting assets. Predictive utility was based on area under the curve (AUC) and/or the integrated discrimination improvement (IDI).</p><p><strong>Results: </strong>The DECIDE algorithm was replicated in FFCWS and MHESC (AUC=.70 for both studies; IDI=.07 in FFCWS and.06 in MHESC). IDIs indicated predictive utility for child assets beyond the existing DECIDE algorithm in both studies, and for parenting assets in FFCWS.</p><p><strong>Conclusions: </strong>Robust validation of predictive algorithms is critical for assessing generalizability. Reducing bias in early mental health risk algorithms via a strengths-based approach is key to equitable decision-making. This work lays the foundation for implementation of early mental health decision tools in routine care of young children.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103128"},"PeriodicalIF":2.8,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876655","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":"Parent-Engaged Development of the Emergency Pediatric Inclusive Communication Framework.","authors":"Colleen K Gutman, Antionette McFarlane, K Casey Lion, Carma L Bylund, Carla L Fisher, Paul L Aronson, Rosemarie Fernandez","doi":"10.1016/j.acap.2025.103125","DOIUrl":"10.1016/j.acap.2025.103125","url":null,"abstract":"<p><strong>Background: </strong>Implicit racial biases are well documented in the pediatric emergency department (ED). Physician communication may be a modifiable behavior through which biases contribute to health disparities. We aimed to establish expert consensus regarding the ways in which physician communication is likely to be influenced by racial bias and lead to inequity in the pediatric ED.</p><p><strong>Methods: </strong>We used a modified Delphi approach to establish consensus among a panel of experts (parents of pediatric ED patients of color [n =3], physicians and researchers with relevant expertise [n = 10]). The consensus process involved two rounds of moderated panel discussion followed by an online questionnaire. Assessed physician behaviors were generated from the panel discussions and from our prior qualitative research with physicians and parents from the pediatric ED. Panelists used 5-point Likert scales to rank the likelihood that physician behaviors were racially biased and the extent to which this contributed to inequity.</p><p><strong>Results: </strong>Of 49 assessed physician behaviors, 28 met consensus as likely to be racially biased, including 12 assumptions that inform physician communication (assumptions about parent social capacity, parent emotions, and the physician's role in the parent-physician interaction) and 16 communication behaviors (empathic communication, listening, information sharing, and engagement in decisions).</p><p><strong>Conclusion: </strong>Guided by communication accommodation theory and patient-centered communication, our findings support a conceptual framework demonstrating pathways through which implicit racial biases lead to child health inequity. This research creates a foundation for subsequent efforts aimed at identifying and mitigating the effects of implicit racial bias in the ED.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103125"},"PeriodicalIF":2.8,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12403203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Children of Caregivers with Abuse-Related ACEs have Higher Infection Rate and Higher Infection-Related Healthcare Utilization.","authors":"Melissa E Day, Qing Duan, Mary Carol Burkhardt, Melissa Klein, Elizabeth P Schlaudecker, Andrew F Beck","doi":"10.1016/j.acap.2025.103123","DOIUrl":"https://doi.org/10.1016/j.acap.2025.103123","url":null,"abstract":"<p><strong>Background: </strong>Abuse-related caregiver adverse childhood experiences (ACEs) have been found to be associated with increased pediatric oral antibiotic prescriptions. However, no studies have examined links between such ACEs and frequency of infections or infection-related healthcare utilization.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study including patients from two pediatric primary care sites, serving predominantly non-Hispanic Black, publicly-insured pediatric patients. Outcomes were number of infectious diagnoses (0, 1, or ≥2) and infection-related clinical encounters in children 0-4 years old. The presence of any abuse-related caregiver ACEs (physical, verbal, or sexual abuse experienced directly or witnessed by the caregiver) was our exposure of interest. Chi-squared and negative binomial regression analyses were used to determine associations with frequency of infections and infection-related encounters, respectively. Pertinent covariates included a census tract-level material community deprivation index (linked to geocoded addresses) and answers to a standardized social risk screen.</p><p><strong>Results: </strong>We included 1,970 children 0-4 years old (49% female, 78% Black, 2.6% Hispanic). Children of caregivers with abuse-related ACEs had a higher rate of having ≥2 infectious diagnoses (37%) compared to their counterparts without abuse-related ACEs (29%, p=0.010). The presence of any abuse-related caregiver ACE was associated with a 15% higher rate of infection-related clinical encounters (IRR 1.15, 95%CI 1.0048-1.32) when adjusting for community deprivation and social risk screen responses.</p><p><strong>Conclusions: </strong>Children 0-4 years with caregivers reporting abuse-related ACEs have a higher rate of infections and infection-related healthcare utilization. Future studies are needed to evaluate underlying biological and behavioral mechanisms for these observations.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103123"},"PeriodicalIF":2.8,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876654","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":"Human papillomavirus vaccination by country of birth and sex among adolescents receiving care in community-based clinics.","authors":"Jennifer A Lucas, Miguel Marino, Cirila Estela Vasquez Guzman, Kristin Lyon-Scott, Amelie G Ramirez, Gretchen Mertes, Zoe Larson, Roopradha Datta, Wyatt P Bensken, John Heintzman","doi":"10.1016/j.acap.2025.103126","DOIUrl":"https://doi.org/10.1016/j.acap.2025.103126","url":null,"abstract":"<p><strong>Background: </strong>Human papillomavirus (HPV) is a common sexually-transmitted infection that can lead to the development of multiple cancers, including those that disproportionately burden Latinos. However, it remains uncertain how ethnicity and country of birth relate to HPV vaccination among younger Latinos. Therefore, this study examines differences in HPV vaccine uptake among pediatric patients by ethnicity and country of birth.</p><p><strong>Methods: </strong>We used data from OCHIN Epic electronic health records from United States community-based clinics in 27 states (2012-2022). This retrospective open cohort of patients included 250,462 females and 238,516 males aged 9-17 years. The main independent variable was ethnicity/country of birth: Latino/a (by country of birth) or non-Hispanic white. Outcomes included HPV vaccination initiation and completion, and analyzed using logistic regression adjusting for relevant covariates.</p><p><strong>Results: </strong>Regardless of sex, all Latino/a groups had higher odds of vaccine initiation and completion compared to non-Hispanic white adolescents. Initiation prevalence ranged 44.4% and 40.8% in Non-Hispanic white girls and boys, to 78.7% for both Guatemalan-born and Salvadoran-born girls, and 79.3% in Guatemalan-born boys. The highest prevalence of completion was among Dominican-born girls (55.8%) and boys (56.5%), and the lowest was in non-Hispanic white girls (30.9%) and boys (25.4%).</p><p><strong>Conclusion: </strong>This study shows that among patients receiving care in community-based clinics, Latino adolescents, especially those who were foreign-born, had higher HPV vaccine initiation and completion compared to non-Hispanic white patients of the same age. Community strengths that might lead to increased vaccination rates should be examined and leveraged to design interventions across care settings.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103126"},"PeriodicalIF":2.8,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876656","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}