Academic Pediatrics最新文献

{"title":"The Current State of Pediatric Emergency Care Coordinators- A Role Essential for High Quality Pediatric Care.","authors":"Christine Aspiotes, Hilary Hewes, Rachel Crady, Katherine Remick, Stephen Janofsky, Joyce Li","doi":"10.1016/j.acap.2025.102821","DOIUrl":"https://doi.org/10.1016/j.acap.2025.102821","url":null,"abstract":"<p><strong>Objective: </strong>High pediatric readiness is associated with decreased mortality. Pediatric emergency care coordinators (PECC) are associated with improved pediatric readiness. The presence of PECCs in emergency departments (EDs) after COVID is unknown. Our objectives were 1) to describe and analyze the PECC status in 2021 compared to 2013 and 2) describe the association of change in PECC status with pediatric readiness scores.</p><p><strong>Methods: </strong>We performed a retrospective cohort study comparing the 2013 and 2021 NPRP Assessments. PECC status was defined as: retained, lost, gained or never based on the presence of either a nurse or physician PECC in 2021 compared to 2013. Hospital and ED characteristics were assessed by PECC status using multivariable logistic analysis. Main outcomes include association of PECC change on adjusted Weighted Pediatric Readiness Score (aWPRS) and NPRP domain scores analyzed using Kruskal-Wallis. We calculated the aWPRS by removing points associated with a PECC (up to 19) from the overall Weighted Pediatric Readiness Score (WPRS) and normalizing to total 100 points.</p><p><strong>Results: </strong>There were 2825 EDs that completed both assessments. General EDs were more likely to have lost a PECC compared to other ED types (p<0.001). The loss of a PECC was associated with a 7-point lower overall aWPRS and a statistically significant lower score in all pediatric readiness domains (p<0.001) compared to EDs that retained or gained a PECC.</p><p><strong>Conclusion: </strong>Hospitals that lost a PECC in 2021 compared to 2013 had a lower overall aWPRS and in individual domains suggesting the importance of a PECC in pediatric readiness initiatives.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102821"},"PeriodicalIF":3.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044492","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":"Predicting Adolescent Depression and Suicide Risk Based on Preadolescent Behavioral Health Screening in Primary Care","authors":"Jason D. Jones PhD ,&nbsp;Molly Davis PhD ,&nbsp;Sara Reagan BS ,&nbsp;Claire Hatkevich PhD ,&nbsp;Jan Leonard MSPH ,&nbsp;Karen T.G. Schwartz PhD ,&nbsp;Jasmine Figueroa MS ,&nbsp;Jami F. Young PhD","doi":"10.1016/j.acap.2025.102833","DOIUrl":"10.1016/j.acap.2025.102833","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the degree to which a broadband behavioral health screener administered in preadolescence in primary care (PC) could serve as an early risk indicator for depression and suicide risk in adolescence.</div></div><div><h3>Methods</h3><div>Participants included 9329 patients who attended well visits at 9 and 12 years old in a large pediatric PC network. The sample was 49% female, 64% White, 18% Black, 4% Asian, 14% other races, and 6% Hispanic/Latinx. Caregivers completed the Pediatric Symptom Checklist (PSC-17) about their child at age 9; youth completed the Patient Health Questionnaire-9 Modified for Teens (PHQ-9-M) at age 12.</div></div><div><h3>Results</h3><div>After adjusting for demographic covariates, patients scoring above the risk cutoffs on the PSC-17 total scale and subscales (internalizing, externalizing, and attention) at age 9 had significantly greater odds of elevated depression and/or suicide risk on the PHQ-9-M at age 12 (odds ratios: 2.41–4.23, <em>P</em> &lt; .001). Approximately one third of patients with depression (sensitivity: 37.1%) or suicide (sensitivity: 33.3%) risk at age 12 were identified as at risk on the PSC-17 at age 9.</div></div><div><h3>Conclusions</h3><div>Results suggest that the PSC-17, a well-researched screener widely used in pediatrics, has moderate predictive value with respect to depression and suicide risk during adolescence. More research is needed on the feasibility and potential benefits of broadband behavioral health screening in preadolescence to promote early identification and prevention efforts.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102833"},"PeriodicalIF":3.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007037","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":"Erratum to “An Exploration of the Impact of Racism and Discrimination on the Mental Health of Latinx Youth” [Acad Pediatr. 2024;24(suppl 7):S139–S146]","authors":"Ashley Cureton PhD, MSW ,&nbsp;Fernanda Lima Cross PhD, MSW ,&nbsp;Sarah Polk MD, ScM, MHS","doi":"10.1016/j.acap.2025.102813","DOIUrl":"10.1016/j.acap.2025.102813","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 4","pages":"Article 102813"},"PeriodicalIF":3.0,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821300","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":"Updates in Combined Pediatrics-Anesthesiology Residency Training","authors":"Elena Brandford MD ,&nbsp;Tammy Wang MD ,&nbsp;Clarice Nguyen MD ,&nbsp;Juan Pablo Forero MD ,&nbsp;Caroline E. Rassbach MD, MA Ed","doi":"10.1016/j.acap.2025.102830","DOIUrl":"10.1016/j.acap.2025.102830","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102830"},"PeriodicalIF":3.0,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056701","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":"Factors Associated With Patient- and Family-Centered Care in the Hispanic Pediatric Population: A Secondary Analysis","authors":"Jared LeBron MHS, BA ,&nbsp;Sarah Ronis MD, PhD","doi":"10.1016/j.acap.2025.102828","DOIUrl":"10.1016/j.acap.2025.102828","url":null,"abstract":"<div><h3>Objective</h3><div>Despite the documented benefits of patient- and family-centered care (PFCC), Hispanic children experience significantly lower rates of PFCC compared to non-Hispanic children. This study aimed to identify specific factors associated with the receipt of PFCC among Hispanic children.</div></div><div><h3>Methods</h3><div>Using data from the 2020–21 National Survey of Children's Health, cross-sectional secondary analyses were conducted to examine caregiver-reported clinician- and practice-level contributors to disparities in PFCC, specifically focusing on family-centered care (FCC) and shared decision-making (SDM) among US Hispanic versus non-Hispanic children and youth. Descriptive statistics were used to characterize social, demographic, and health care experiences. Stratified multivariable logistic regression analyses evaluated, among Hispanic children, associations of FCC/SDM with key covariates. All analyses were weighted to account for the complex survey design.</div></div><div><h3>Results</h3><div>Among 93,669 respondents (representing approximately 72.7 million noninstitutionalized US children and youth, 25.7% identifying as Hispanic or Latino), caregivers of Hispanic children were significantly less likely to report experiencing FCC and SDM if they had gaps in insurance coverage (FCC adjusted odds ratio [aOR] = 0.53, 95% Confidence Interval (CI): 0.37, 0.76; SDM aOR = 0.38, 95% CI: 0.18, 0.80) or lived in households where English was not the primary language (FCC aOR = 0.68, 95% CI: 0.52, 0.89; SDM aOR = 0.53, 95% CI: 0.33, 0.87). Additionally, not having a personal doctor was associated with lower odds of reporting FCC (aOR = 0.44, 95% CI: 0.34, 0.57).</div></div><div><h3>Conclusions</h3><div>A lack of stable relationships with personal doctors and limited availability of language-appropriate services were significantly associated with lower reports of PFCC and SDM among Hispanic children. These associations highlight potential targets for further research and quality improvement.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102828"},"PeriodicalIF":3.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059982","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 Impact of the Coronavirus Disease 2019 Pandemic on Parental Childhood Vaccine Attitudes in the United States","authors":"David M. Higgins MD, MPH ,&nbsp;Mersine A. Bryan MD, MPH ,&nbsp;Sean T. O’Leary MD, MPH ,&nbsp;Douglas J. Opel MD, MPH","doi":"10.1016/j.acap.2025.102829","DOIUrl":"10.1016/j.acap.2025.102829","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102829"},"PeriodicalIF":3.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038964","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":"Perceived Quality of Care and Pediatricians’ Moral Distress Caring for Children With Mental Health Conditions","authors":"JoAnna K. Leyenaar MD, PhD, MPH, ,&nbsp;Cori M. Green MD, MS ,&nbsp;Adam Turner MPH, PMP ,&nbsp;Laurel K. Leslie MD, MPH","doi":"10.1016/j.acap.2025.102825","DOIUrl":"10.1016/j.acap.2025.102825","url":null,"abstract":"<div><h3>Objective</h3><div>This study describes general and subspecialty pediatricians’ experience of moral distress in providing care to children with mental health conditions, variation in moral distress across subspecialties, and associations between perceived care quality, practice characteristics, and moral distress.</div></div><div><h3>Methods</h3><div>This study analyzed survey data collected during 2022 American Board of Pediatrics Maintenance of Certification enrollment. Questions included perceived frequency with which high-quality care was provided to children with mental health conditions (with suboptimal care quality defined as the lowest 2 response options on a 5-point Likert scale) and 4 potential sources of moral distress; high moral distress was defined as a top quartile composite score. Multivariable logistic regression was used to estimate associations between perceived suboptimal care quality, practice characteristics, and high moral distress.</div></div><div><h3>Results</h3><div>A total of 5363 eligible pediatricians (55.2%) participated in the survey, including 3254 (60.7%) general pediatricians and 2109 (39.3%) subspecialists. Overall, 1147 (22.7%) reported perceived suboptimal care quality. Composite moral distress scores were highest for emergency medicine (n = 106, 45.9% in highest quartile), child abuse (n = 9, 39.1% in highest quartile), and hospital medicine physicians (n = 109, 32.5% in highest quartile). In regression analysis, high moral distress was associated with perceived suboptimal care quality, female gender, subspecialty, rurality, public insurance in practice, and academic appointment.</div></div><div><h3>Conclusions</h3><div>Approximately 1-in-5 pediatricians perceived suboptimal care quality for children with mental health conditions; this was associated with greater moral distress and several practice characteristics. Improving mental health care access, resources, and pediatricians’ capacities to provide high-quality care may benefit clinicians as well as children.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102825"},"PeriodicalIF":3.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031296","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":"Impacts of the Smart Beginnings Parenting Program on Early Childhood Special Education Evaluation and Service Referral","authors":"Leah J. Hunter PhD ,&nbsp;Ashleigh I. Aviles PhD ,&nbsp;Elizabeth B. Miller PhD ,&nbsp;Caitlin F. Canfield PhD ,&nbsp;Katherine Guyon-Harris PhD ,&nbsp;Pamela A. Morris-Perez PhD ,&nbsp;Alan L. Mendelsohn MD ,&nbsp;Daniel S. Shaw PhD","doi":"10.1016/j.acap.2025.102826","DOIUrl":"10.1016/j.acap.2025.102826","url":null,"abstract":"<div><h3>Objective</h3><div>Little is known about how parenting interventions might influence families’ access to related health care services during early childhood. This study describes the effects of a parenting intervention, Smart Beginnings (SB), on referrals to early intervention (EI) or early childhood special education (ECSE) after evaluation within a predominantly Black/Latine sample with low incomes. SB is a tiered intervention integrating a universal parenting program delivered in primary care clinics (PlayReadVIP) with a targeted home-visiting program (Family Check-Up).</div></div><div><h3>Methods</h3><div>Data were drawn from a randomized controlled trial of SB, with sites in NYC and Pittsburgh, PA. The 280 families (132 treatment, 148 control) were 43% Black, 47% Latine, 37% Spanish-speaking, and 100% Medicaid-eligible. Hierarchical logistic regressions examined associations between expressive vocabulary and problem behaviors (internalizing and externalizing symptoms) at 2 years, and the impact of the SB intervention on the likelihood of EI/ECSE evaluation and service referrals based on evaluation results by 4 years.</div></div><div><h3>Results</h3><div>Across sites, children’s lower expressive vocabulary and higher problem behaviors at 2 years predicted receiving EI/ECSE evaluation and service referrals by age 4. Assignment to the SB intervention reduced the likelihood of evaluations leading to referrals for EI/ECSE service.</div></div><div><h3>Conclusions</h3><div>Results from this randomized controlled trial showed that children with early behavior and language challenges were more likely to receive EI/ECSE evaluation and services by preschool-age. Children assigned to SB were less likely to be referred for services. Studying factors that predict EI/ECSE involvement for children from historically marginalized populations can help promote equity in early care systems.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102826"},"PeriodicalIF":3.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797042","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":"Policy Approaches to Achieve Health Equity for Immigrant Children","authors":"Ben D’Avanzo MPA ,&nbsp;Gabrielle Lessard JD ,&nbsp;Jenny Rejeske MS ,&nbsp;Wendy Cervantes MA ,&nbsp;Isha Weerasinghe MSc","doi":"10.1016/j.acap.2025.102824","DOIUrl":"10.1016/j.acap.2025.102824","url":null,"abstract":"<div><div>In this paper, we aim to make comprehensive policy recommendations to support children in immigrant families, including access to permanent immigration status, culturally responsive mental health care services, creating safe spaces in settings that serve children and families, centering the needs of children in the immigration system, expanding immigrant access to public programs, and ensuring robust research on the importance of such policies. Immigrant children face unique challenges in achieving adequate health care across many conditions and circumstances, driven by policy decisions that can be addressed. Opportunities exist for those working to improve the health of children to educate policymakers and present additional research demonstrating the value of these policy changes.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102824"},"PeriodicalIF":3.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797045","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":"Illustrating the Role of Infant Well-Child Visits in the Association Between Transportation Insecurity and Acute Health Care Use","authors":"Jewel Park MD, MPH ,&nbsp;Michelle Gorecki MD, MPH ,&nbsp;Aaron Flicker MS, MA ,&nbsp;Allison Reyner MS ,&nbsp;Adrienne Henize JD ,&nbsp;Melissa Klein MD, MEd ,&nbsp;Andrew F. Beck MD, MPH","doi":"10.1016/j.acap.2025.102827","DOIUrl":"10.1016/j.acap.2025.102827","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the role of well-child visits (WCVs) in mediating associations between transportation insecurity and acute health care usage among infants.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of 4114 infants seen for newborn visits at 3 primary care centers between February 1, 2019 and March 31, 2021. Each infant was followed through 15 months of age. The outcome of interest was acute health care usage, defined by high-acuity emergency department (ED) visits or hospitalization. The exposure was transportation insecurity as reported by parents through standardized questionnaires administered during WCVs. We stratified analyses by WCV attendance (≥6 WCVs vs &lt;6 WCVs in the first 15 months of life) to assess whether WCVs mediated associations between acute health care usage and transportation insecurity.</div></div><div><h3>Results</h3><div>Of 4114 eligible infants, 8.7% endorsed transportation insecurity. Patients reporting transportation insecurity, compared to those who did not, had higher rates of incomplete WCV attendance (60.3% vs 44.2%, <em>P</em> &lt; 0.001), ED visitation (38.0% vs 28.7%; <em>P</em> &lt; 0.001), and hospitalization (19.8% vs 14.1%; <em>P</em> = 0.004). Transportation insecurity, compared to no transportation security, was significantly associated with having &lt;6 WCVs (adjusted odds ratio [aOR] 1.64, 95% confidence interval [CI] 1.29, 2.09), ED visitation (aOR 1.45, 95% CI 1.14, 1.85), and hospitalization (aOR 1.52, 95% CI 1.13, 2.04). However, WCV attendance did not mediate associations between transportation insecurity and ED visits or hospitalizations.</div></div><div><h3>Conclusions</h3><div>Transportation insecurity was associated with fewer WCVs; however, WCV attendance did not mediate associations between acute health care usage and transportation insecurity. Future research could focus on mechanisms linking transportation insecurity to suboptimal health outcomes.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102827"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781374","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}