Academic Pediatrics最新文献_第4页

Pediatric Utilization of Emergency Medical Services from Outpatient Offices and Urgent Care Centers 儿科利用门诊部和急诊中心提供的急诊医疗服务。

IF 3 3区医学

Academic Pediatrics Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.03.008

{"title":"Pediatric Utilization of Emergency Medical Services from Outpatient Offices and Urgent Care Centers","authors":"","doi":"10.1016/j.acap.2024.03.008","DOIUrl":"10.1016/j.acap.2024.03.008","url":null,"abstract":"<div><h3>Objective</h3><div><span>National efforts have highlighted the need for pediatric emergency readiness across all settings where children receive care. Outpatient offices and </span>urgent care centers are frequent starting points for acutely injured and ill children, emphasizing the need to maintain pediatric readiness in these settings. We aimed to characterize emergency medical services (EMS) utilization from outpatient offices and urgent care centers to better understand pediatric readiness needs.</div></div><div><h3>Methods</h3><div>We performed a retrospective cross-sectional analysis of EMS encounters using the National Emergency Medical Services Information System, a nationally representative EMS registry (2019–2022). We included four years of EMS encounters of children (<18 years old) that originated from an outpatient office or urgent care center. We described characteristics, including patient demographics, prehospital clinician impression, therapies, and procedures performed.</div></div><div><h3>Results</h3><div>Of 179,854,336 EMS encounters during the study period, 164,387 pediatric encounters originated at an outpatient setting. Most EMS encounters originated from outpatient offices. Evening and weekend EMS encounters more frequently originated from urgent care centers. The most common impressions were respiratory distress (n = 60,716), systemic illness (n = 23,583), and psychiatric/behavioral health (n = 13,273). Ninety-four percent of EMS encounters resulted in transportation to a hospital.</div></div><div><h3>Conclusions</h3><div>EMS encounters from outpatient settings most commonly originate from outpatient offices, relative to urgent care settings, where pediatric emergency readiness may be limited. It is important that outpatient settings and providers are ready for varied emergencies, including those occurring for a behavioral health concern, and that readiness guidelines are updated to address these needs.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 8","pages":"Pages 1194-1202"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140141083","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}

引用次数: 0

Place-Based Opportunity and Well Child Visit Attendance in Early Childhood 以地点为基础的机会与幼儿期儿童健康检查的出席率。

IF 3 3区医学

Academic Pediatrics Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.06.012

{"title":"Place-Based Opportunity and Well Child Visit Attendance in Early Childhood","authors":"","doi":"10.1016/j.acap.2024.06.012","DOIUrl":"10.1016/j.acap.2024.06.012","url":null,"abstract":"<div><h3>Background</h3><div>Lower neighborhood opportunity, measured by the Child Opportunity Index [COI], is associated with increased pediatric morbidity, but is less frequently used to examine longitudinal well child care. We aimed to evaluate associations between the COI and well child visit [WCV] attendance from birth – <36 months of age.</div></div><div><h3>Methods</h3><div>The Upstate KIDS population-based birth cohort includes children born 2008–2010 in New York state. The exposure, 2010 census tract COI (very low [VL] to very high [VH]), was linked to children’s geocoded residential address at birth. The outcome was attended WCVs from birth – <36 months of age. Parents reported WCVs and their child’s corresponding age on questionnaires every 4–6 months. These data were applied to appropriate age ranges for recommended WCVs to determine attendance. Associations were modeled longitudinally as odds of attending visits and as mean differences in proportions of WCVs by COI.</div></div><div><h3>Results</h3><div>Among 4650 children, 21% (n = 977) experienced VL or low COI. Children experiencing VL (adjusted OR [aOR] 0.68, 95% CI 0.61, 0.76), low (aOR 0.81, 95% CI 0.73, 0.90), and moderate COI (aOR 0.88, 95% CI 0.81, 0.96), compared to VH COI, had decreased odds of attending any WCV. The estimated, adjusted mean proportions of WCV attendance were lower among children experiencing VL (0.45, <em>P</em> < .01), low (0.53, <em>P</em> = .02), moderate (0.53, <em>P</em> = .05), and high (0.54, <em>P</em> = .03) compared to VH COI (0.56).</div></div><div><h3>Conclusions</h3><div>Lower COI at birth was associated with decreased WCV attendance throughout early childhood. Reducing barriers to health care access for children experiencing lower COI may advance equitable well child care.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 8","pages":"Pages 1220-1228"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472245","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}

引用次数: 0

Beyond ‘‘Screen & Refer’’: Understanding Families’ Use of Resources for Health-Related Social Needs Identified via Primary Care 超越 "筛查和转诊"：了解家庭对通过初级保健确定的健康相关社会需求资源的使用情况。

IF 3 3区医学

Academic Pediatrics Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.06.016

{"title":"Beyond ‘‘Screen & Refer’’: Understanding Families’ Use of Resources for Health-Related Social Needs Identified via Primary Care","authors":"","doi":"10.1016/j.acap.2024.06.016","DOIUrl":"10.1016/j.acap.2024.06.016","url":null,"abstract":"<div><h3>Objective</h3><div>As health-related social needs (HRSN) screening increases, attention to families’ resource preferences lags. This study of a pediatric primary care intervention (DULCE) with reliable HRSN screening and resource connection explored whether resources adequately addressed families’ needs and, when HRSN persisted, families' reasons for declining resources.</div></div><div><h3>Methods</h3><div>This retrospective cohort, mixed-methods study analyzed data from 989 families that received care at seven pediatric clinics implementing DULCE in three states. DULCE screens for seven HRSN around the 1-month and 4-month well-child visits; we calculated the percent of initial and ongoing positive screens. For positive rescreens, we calculated the percent that had all eligible or wanted resources and that were interested in further resources. We also analyzed case notes, which elicited families’ resource preferences, and explored demographic characteristics associated with ongoing HRSN.</div></div><div><h3>Results</h3><div>Half of enrolled families (508 of 989) initially screened positive for HRSN; 124 families had positive rescreens; 26 expressed interest in further assistance. Most families with ongoing concrete supports needs accessed all eligible resources (60–100%); 20–58% had everything they wanted. Fewer families with ongoing maternal depression and intimate partner violence accessed all eligible resources (48% and 18%, respectively); most reported having all wanted resources (76% and 90%, respectively). Families declined resources due to lack of perceived need, the HRSN resolving, or families addressed HRSN themselves. White families were more likely to rescreen positive.</div></div><div><h3>Conclusions</h3><div>Pediatric medical homes must honor family-centered decision-making while empowering families to accept beneficial resources. Health care systems should advocate for resources that families need and want.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 8","pages":"Pages 1314-1322"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477905","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}

引用次数: 0

The Associations between Neighborhood Characteristics and Childhood Overweight and Obesity in a National Dataset 全国数据集中的邻里特征与儿童超重和肥胖之间的关系。

IF 3 3区医学

Academic Pediatrics Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.05.009

{"title":"The Associations between Neighborhood Characteristics and Childhood Overweight and Obesity in a National Dataset","authors":"","doi":"10.1016/j.acap.2024.05.009","DOIUrl":"10.1016/j.acap.2024.05.009","url":null,"abstract":"<div><h3>Background</h3><div>National child obesity rates continue to climb. While neighborhood factors are known to influence childhood weight, more work is needed to further our understanding of these relationships and inform intervention and policy approaches reflective of complex real-world contexts.</div></div><div><h3>Methods</h3><div>To evaluate the associations between neighborhood components and childhood overweight/obesity, we analyzed sequential, cross-sectional data from the National Survey of Children’s Health collected annually between 2016 and 2021. To characterize the complexity of children’s neighborhood environments, several interrelated neighborhood factors were examined: amenities, detractions, support, and safety. We used ordinal logistic regression models to evaluate the associations between these exposures of interest and childhood weight status, adjusting for potential confounders.</div></div><div><h3>Results</h3><div>Our analytic sample contained 96,858 children representing a weighted population of 28,228,799 children ages 10–17 years. Child weight status was healthy in 66.5%, overweight in 16.8%, and obese in 17.2%. All four neighborhood factors were associated with child weight status. The odds of overweight or obesity generally increased with a decreasing number of amenities and increasing number of detractions, with the highest adjusted odds ratio seen with no amenities and all three possible detractions (1.71; 95% confidence interval [1.31, 2.11]).</div></div><div><h3>Conclusions</h3><div>Multiple factors within a child’s neighborhood environment were associated with child weight status in this sample representative of the US population aged 10–17 years. This suggests the need for future research into how policies and programs can support multiple components of a healthy neighborhood environment simultaneously to reduce rates of childhood overweight/obesity.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 8","pages":"Pages 1266-1275"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141187165","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}

引用次数: 0

Prolonged Early Food Insecurity and Child Feeding Practices among a Low-Income Hispanic Population: Role of Parenting Stress 低收入西班牙裔人口中长期的早期粮食不安全和儿童喂养方式：育儿压力的作用。

IF 3 3区医学

Academic Pediatrics Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.06.013

{"title":"Prolonged Early Food Insecurity and Child Feeding Practices among a Low-Income Hispanic Population: Role of Parenting Stress","authors":"","doi":"10.1016/j.acap.2024.06.013","DOIUrl":"10.1016/j.acap.2024.06.013","url":null,"abstract":"<div><h3>Objective</h3><div>To examine associations between prolonged early household food insecurity (FI) during pregnancy, infancy, and toddlerhood, and child feeding practices, and the mediating role of dysfunctional parent-child interactions.</div></div><div><h3>Methods</h3><div>We conducted secondary longitudinal analyses of data from the Starting Early Program (StEP) randomized controlled trial, which studied a primary care-based child obesity prevention program for low-income Hispanic families. Our independent variable was FI, using the USDA Food Security Module, during the third trimester of pregnancy and at child ages 10- and 19-months. Frequency of reported FI was defined by the number of periods with FI (0, 1, 2, or 3). Our dependent variables were feeding practices at child age 28-months using the Comprehensive Feeding Practices Questionnaire. Our mediating variable was dysfunctional parent-child interactions using the Parenting Stress Index subscale at age 19-months. We used linear regression to determine associations between frequency of reported FI and feeding practices adjusting for covariates, and mediation analyses to determine if dysfunctional parent-child interactions mediate these associations.</div></div><div><h3>Results</h3><div>Three hundred and forty four mothers completed assessments at child age 28-months. Of the 12 feeding practices examined, higher frequency of reported FI was positively associated with using food as a reward, restriction of food for weight control, and using food for emotional regulation, and was negatively associated with monitoring of less healthy foods. There was a significant indirect effect of frequency of reported FI on these practices through dysfunctional parent-child interactions.</div></div><div><h3>Conclusion</h3><div>Higher frequency of reported FI was associated with four feeding practices, through dysfunctional parent-child interactions. Understanding these pathways can inform preventive interventions.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 8","pages":"Pages 1296-1303"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472260","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}

引用次数: 0

Steps Forward From Co-created Entrustable Professional Activities in Pediatric Complex Care 儿科复杂护理中共同创建的受托专业活动的前进步伐。

IF 3 3区医学

Academic Pediatrics Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.07.002

引用次数: 0

Incorporating Maternal Blood Pressure Screening Into Routine Newborn Clinic Visits 将产妇血压筛查纳入新生儿常规门诊。

IF 3 3区医学

Academic Pediatrics Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.07.004

Amanda Krauss MD , Julia Pantalone MD , Adriana Phillips MD , Gysella B. Muniz MD , Jacqueline Saladino MD , Malamo Countouris MD, MS , Alisse Hauspurg MD, MS

引用次数: 0

An Update on Pediatric Environmental Health Specialty Units: Activities and Impacts, 2015–19 儿科环境健康专科的最新情况：2015-2019 年的活动和影响。

IF 3 3区医学

Academic Pediatrics Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.03.009

{"title":"An Update on Pediatric Environmental Health Specialty Units: Activities and Impacts, 2015–19","authors":"","doi":"10.1016/j.acap.2024.03.009","DOIUrl":"10.1016/j.acap.2024.03.009","url":null,"abstract":"<div><h3>Objective</h3><div>Pediatric Environmental Health Specialty Units (PEHSUs) address health concerns impacting children and their families related to environmental hazards by providing consultation and education to families, communities, and health care professionals. This analysis evaluated the productivity of the national PEHSU program.</div></div><div><h3>Methods</h3><div>PEHSUs reported data on services provided to US communities between October 1, 2014 and September 30, 2019. Descriptive statistics and qualitative analysis are presented.</div></div><div><h3>Results</h3><div>During this period, 6102 consultations and 4644 educational outreach activities were recorded. PEHSU faculty and staff published 462 articles, reviews, book chapters, fact sheets, commentaries, short informational pieces, and other materials between 2014 and 2019. These included 190 articles in scientific peer-reviewed journals and 29 textbook chapters to increase professional capacity in pediatric and reproductive environmental health. Lead, other metals, substances of abuse, pesticides, mold, and air pollution were frequently reported as agents of concern and educational topics. Requests for an overview of pediatric environmental health and outdoor pollutants were other frequently reported topics.</div></div><div><h3>Conclusions</h3><div>PEHSUs work to decrease harmful exposures and improve children’s health. They serve as expert resources for families, health care professionals, and communities on health effects related to environmental exposures. Data show the breadth and depth of concerns addressed and demonstrate the productivity and impact of this national program.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 8","pages":"Pages 1323-1332"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144506","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}

引用次数: 0

Prioritizing Health Literacy Educational Objectives for Pediatric Residents – A Delphi Study 儿科住院医师健康素养教育目标的优先排序--德尔菲研究。

IF 3 3区医学

Academic Pediatrics Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.06.014

{"title":"Prioritizing Health Literacy Educational Objectives for Pediatric Residents – A Delphi Study","authors":"","doi":"10.1016/j.acap.2024.06.014","DOIUrl":"10.1016/j.acap.2024.06.014","url":null,"abstract":"<div><h3>Objective</h3><div>Children of caregivers with limited health literacy are at risk of poorer health outcomes. Thus, health literacy-informed communication tools are critical to achieving a more equitable health system. However, there is no agreement on the health literacy skills pediatric residents should attain. We used Delphi methodology to establish consensus on health literacy objectives to inform development of a pediatric resident curriculum.</div></div><div><h3>Methods</h3><div>Our Delphi panel participated in three rounds of anonymous surveys to rank the importance of health literacy objectives in pediatric resident education. Consensus was defined as ≥70% of panelists identifying an objective as essential or 100% agreeing an objective was recommended or essential.</div></div><div><h3>Results</h3><div>Thirteen pediatric health literacy experts comprised a racially, geographically, and professionally-diverse panel. After three survey rounds, 27 of the initial 65 objectives met consensus. All final objectives aligned with Accreditation Council for Graduate Medical Education (ACGME) core competencies.</div></div><div><h3>Conclusions</h3><div>A panel of pediatric health literacy experts established consensus on health literacy objectives specific to pediatric resident training. These prioritized objectives align with ACGME core competencies, as well as evidence-based strategies like teach-back, and newer considerations like addressing organizational health literacy. They should inform future health literacy curricula and assessment within pediatric residency programs.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 8","pages":"Pages 1182-1188"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499622","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}

引用次数: 0

Pediatric Primary Care of Children With Intrauterine Opioid Exposure: Survey of Academic Teaching Practices 宫内阿片类药物暴露儿童的儿科初级保健：学术教学实践调查。

IF 3 3区医学

Academic Pediatrics Pub Date : 2024-11-01 DOI: 10.1016/j.acap.2024.06.007

{"title":"Pediatric Primary Care of Children With Intrauterine Opioid Exposure: Survey of Academic Teaching Practices","authors":"","doi":"10.1016/j.acap.2024.06.007","DOIUrl":"10.1016/j.acap.2024.06.007","url":null,"abstract":"<div><h3>Objective</h3><div>Intrauterine opioid exposure (IOE) has increased over the last 2 decades and is associated with additional needs after birth. To date, no clinical guidelines address the primary care of children with IOE. We aimed to characterize clinician-reported screening and referral practices, barriers to effective primary care for children with IOE, and clinician- and practice-level characteristics associated with perceived barriers.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional survey of pediatric residents, pediatricians, and advanced practitioners at 28 primary care clinics affiliated with 7 pediatric residency programs (April–June 2022). We assessed screening and other clinical practices related to IOE and perceived barriers to addressing parental opioid use disorder (OUD). We used descriptive statistics to analyze survey responses, assessed the distribution of reported barriers, and applied a 2-stage cluster analysis to assess response patterns.</div></div><div><h3>Results</h3><div>Of 1004 invited clinicians, 329 (32.8%) responses were returned, and 325 pediatric residents and pediatricians were included in the final analytic sample. Almost all (99.3%) reported parental substance use screening as important, but only 11.6% screened routinely. Half of the respondents routinely refer children with IOE to early intervention services and social work. Lack of standard screening for substance use was the most frequently selected barrier to addressing parental OUD. Participants reporting fewer barriers to addressing parental OUD identified having greater access to OUD treatment programs and home visiting programs.</div></div><div><h3>Conclusions</h3><div>Pediatricians report variations in primary care screenings and referrals for children with IOE. Access to parental OUD treatment programs may mitigate perceived barriers to addressing parental OUD in the pediatric office.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 8","pages":"Pages 1304-1313"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332409","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}

引用次数: 0