Academic Pediatrics最新文献

{"title":"Equity in Pediatric Hospital-Based Safety and Quality Improvement","authors":"Gabrina L. Dixon MD, MEd ,&nbsp;Michelle-Marie Peña MD ,&nbsp;Angela M. Ellison MD, MSc ,&nbsp;Tiffani J. Johnson MD, MSc","doi":"10.1016/j.acap.2024.01.026","DOIUrl":"10.1016/j.acap.2024.01.026","url":null,"abstract":"<div><div>There are well-documented inequities in the quality of care and health outcomes of minoritized youth. Patient safety and quality improvement (QI) work with an equity focus has been identified as an important strategy to remedy these existing inequities. In this article, we will present evidence of inequities in pediatric hospital-based care, describe root causes with a focus on structural racism, highlight existing frameworks for applying equity principles to patient safety and QI, and provide best practices and recommendations on evaluating patient safety and QI data towards advancing equity in pediatric hospital-based care.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 7","pages":"Pages S184-S188"},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479963","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":"We Tell the Story: Building Collective Resilience Against Racism From Early Childhood","authors":"Ashaunta T. Anderson MD, MPH, MSHS ,&nbsp;Adiaha Spinks-Franklin MD, MPH ,&nbsp;Nia Heard-Garris MD, MBA, MSc ,&nbsp;Tiffani J. Johnson MD, MSc","doi":"10.1016/j.acap.2023.09.015","DOIUrl":"10.1016/j.acap.2023.09.015","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 7","pages":"Pages S214-S216"},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480019","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":"Addressing the Health Impacts of Racism on Children and Youth: Equity Until Equality","authors":"Harolyn M.E. Belcher MD, MHS ,&nbsp;Marie V. Plaisime PhD, MPH ,&nbsp;Nikeea Copeland-Linder PhD, MPH","doi":"10.1016/j.acap.2024.05.005","DOIUrl":"10.1016/j.acap.2024.05.005","url":null,"abstract":"<div><div>Race is a sociopolitical construct based on physical characteristics, not a biological construct. Racism is a system that ascribes value and resources based on the sociopolitical construct called “race.” In the United States and other countries around the world, racism is associated with disparate health outcomes and shortened life expectancies. Health equity employs health-related systems (eg, health care providers, insurance companies, hospitals, research, pharmaceutical companies) across multiple sectors (eg, housing, education, business, government) to allocate resources and services to correct and promote political and social determinants associated with health and wellness. Applying health equity practices and policies ensures that each child, youth, and adult receives comprehensive, evidence-informed, culturally relevant, and needs-based services to achieve optimum health. This article provides an overview of the impact of racism embedded in systems and policies that challenge optimal health for children and youth and offers evidence-supported paths forward to advance health and wellness in the United States. Until each child and adolescent enjoys optimal and equal health outcomes, health equity practices and social justice are mandatory.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 7","pages":"Pages S119-S125"},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479945","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":"Leveraging Pediatric Departmental Infrastructure to Promote Anti-racism","authors":"Jason Deen MD, FAAP, FAAC,&nbsp;Leslie Walker-Harding MD, FAAP, FSAHM","doi":"10.1016/j.acap.2023.06.028","DOIUrl":"10.1016/j.acap.2023.06.028","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 7","pages":"Pages S220-S221"},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479969","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":"Reawakening a Reckoning: Health Equity’s Disheartening Disappearing Act","authors":"Benjamin Danielson MD ,&nbsp;Renée Boynton-Jarrett MD, ScD","doi":"10.1016/j.acap.2024.07.011","DOIUrl":"10.1016/j.acap.2024.07.011","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 7","pages":"Pages S224-S226"},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480016","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":"An Exploration of the Impact of Racism and Discrimination on the Mental Health of Latinx Youth","authors":"Ashley Cureton PhD, MSW ,&nbsp;Fernanda Lima Cross PhD, MSW ,&nbsp;Sarah Polk MD, ScM, MHS","doi":"10.1016/j.acap.2023.12.011","DOIUrl":"10.1016/j.acap.2023.12.011","url":null,"abstract":"<div><div><span>Latinx youth are at high risk of health and health care disparities<span>. They are particularly vulnerable to mental health challenges due to the interplay of racism, health, and health care, which can be overwhelming for Latinx youth and their families to navigate. In this article, we provide an overview of the socio-demographics of Latinx youth living in the United States. Next, drawing on Borrell’s framework for the effect of self-racial categorization, we review health disparities commonly experienced by Latinx youth with a more detailed description of mental health. We also explore the impact of racism and colorism on Latinx youth mental health and </span></span>health care. Finally, we propose multiple strategies across levels to reduce the aforementioned disparities.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 7","pages":"Pages S139-S146"},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479947","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":"Bias, Prejudice, Discrimination, Racism, and Social Determinants: The Impact on the Health and Well-Being of Latino Children and Youth","authors":"Fernando S. Mendoza MD, MPH ,&nbsp;Jennifer A. Woo Baidal MD, MPH ,&nbsp;Cristina R. Fernández MD, MPH ,&nbsp;Glenn Flores MD","doi":"10.1016/j.acap.2023.12.013","DOIUrl":"10.1016/j.acap.2023.12.013","url":null,"abstract":"<div><div>This narrative review focuses on the impact of bias, prejudice, discrimination, racism (BPDR), social determinants of health, and structural racism on Latino children’s health and well-being. The race/ethnicity, country of origin, immigrant/generational status, limited English proficiency (LEP), acculturation level, and social class of Latino children and their parents can heighten or modify the impact of BPDR. These differences have been shown to affect BPDR among Latino adults and presumably for their children. Surveys of Latino adolescents reveal that 60% have experienced discrimination, with first- and second-generation teens having a higher prevalence. These experiences are magnified by adverse social determinants/structural racism. BPDR can impact Latino children prenatally through adolescence. Bias involving neonatal, primary, and inpatient pediatric services has been reported. In 2021, Latino children were 19% less likely to complete preventive care, and 32% of LEP children had no medical home. School-age Latino children experience system inequities associated with chronic physical and mental health conditions. BPDR is also seen in educational performance but can be buffered by a strong racial/ethnic self-identity. To address BPDR/structural racism for Latino children, we suggest pediatricians: 1) increase the Latino child-health workforce to address BPDR internally and externally, 2) advocate for data collection on and monitoring of Latino children’s disparities and racism metrics in pediatric services, to improve quality of care for Latino children and their families, and 3) advocate for child health equity. Together, these steps will help eliminate BPDR for Latino children and ensure they obtain their full potential.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 7","pages":"Pages S196-S203"},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479959","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":"Social Behaviors Associated with SARS-CoV-2 Test Positivity Among Children Evaluated in Canadian Emergency Departments, 2020 to 2022: A Cross-Sectional Survey Study.","authors":"Madeleine Sumner, Gillian A M Tarr, Jianling Xie, Ahmed Mater, Kathleen Winston, Jocelyn Gravel, Naveen Poonai, Brett Burstein, Simon Berthelot, Roger Zemek, Robert Porter, Bruce Wright, April Kam, Jason Emsley, Vikram Sabhaney, Darcy Beer, Gabrielle Freire, Anne Moffatt, Stephen B Freedman","doi":"10.1016/j.acap.2024.08.016","DOIUrl":"10.1016/j.acap.2024.08.016","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate how social behaviors relate to SARS-CoV-2 test positivity across pediatric age groups.</p><p><strong>Methods: </strong>Multicenter, cross-sectional study recruiting children <18 years old tested for SARS-CoV-2 infection in emergency departments between 2020 and 2022. We used multivariate logistic regression to assess how self-reported social behaviors affect SARS-CoV-2 test positivity across four age groups. Causal mediation analysis quantified how mask-wearing and presence of an infected close contact mediated the SARS-CoV-2 risk of given behaviors.</p><p><strong>Results: </strong>Seven thousand two hundred and seventy two children were enrolled and 1457 (20.0%) tested positive for SARS-CoV-2. Attending a social gathering was associated with increased odds (aOR 1.64, 95% CI: 1.05, 2.57) of SARS-CoV-2 positivity among children aged 5-<12 years. Those attending in-person school/daycare were less likely to test positive for SARS-CoV-2 across all age categories. Attending childcare was associated with 16.3% (95% CI: -21.0%, -11.2%) and 9.0% (95% CI: -11.6%, -6.5%) reductions in the probability of testing positive for SARS-CoV-2 infection, with 53.5% (95% CI: 39.2%, 73.9%) and 22.8% (95% CI: 9.7%, 36.2%) of the effects being mediated by the presence of a close contact among <1 year and 1-<5 year age groups, respectively. Masking in public mediated the association between childcare attendance and SARS-CoV-2 positivity in children aged <1 year.</p><p><strong>Conclusions: </strong>Attending social gatherings increased the risk of SARS-CoV-2 test positivity in 5-<12-year-old children, but in-person daycare/school was associated with a reduced odds of testing positive across all ages. Settings with high public health adherence (ie, schools) reduced the risk of testing positive for SARS-CoV-2, possibly from reduced close contact with SARS-CoV-2 positive individuals.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114515","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":"Racial, Ethnic, and Language Inequities in Ambulatory Pediatrics Patient Family Experience.","authors":"Margaret N Jones, Michael Ponti-Zins, Melinda MacDougall, Shelley Ehrlich, Ndidi Unaka, Samuel Hanke, Jareen Meinzen-Derr, Mary C Burkhardt, Alexandra Corley, Ryan Adcock, Sana Amanullah, Jamilah Hackworth, Kristen Copeland, Jessica A Kahn, Andrew F Beck","doi":"10.1016/j.acap.2024.08.015","DOIUrl":"10.1016/j.acap.2024.08.015","url":null,"abstract":"<p><strong>Objective: </strong>To determine the association of patient race, patient-provider racial congruence, patient ethnicity, and family primary language with patient family experience (PFE) survey responses.</p><p><strong>Methods: </strong>Cross-sectional review of PFE survey responses from all ambulatory medical encounters at a large, urban children's hospital system June 1, 2020-May 31, 2022. Exposures were patient race, patient-provider racial congruence, patient ethnicity, and family primary language. We adjusted analyses for neighborhood-level socioeconomic deprivation, patient sex and age, encounter specialty, and location of care. Outcomes were PFE survey scores for five questions focused on overall experience, respect, and safety; categorized using industry standard metric of presence of a \"top-box\" score, defined as a nine or 10 for questions on an 11-point scale or as four on a four-point scale.</p><p><strong>Results: </strong>We included 89,175 surveys (15.6% response rate). The odds of having optimal, \"top-box\" responses for several assessed questions were lower for patients identified as Asian (eg, adjusted odds ratio [OR] 0.46; 95% confidence interval [CI] 0.40, 0.52) or Black (eg, OR 0.65; CI 0.60, 0.70) compared to White, and for Hispanic (eg, OR 0.84; CI 0.72, 0.97) compared to non-Hispanic. Similarly, the odds of having \"top-box\" scores were lower for Spanish-primary-language (eg, OR 0.38; CI 0.30, 0.48) compared to English-primary-language patients. Patient-provider racial congruence had higher odds of \"top-box\" responses for two of five assessed questions (eg, OR 1.18; CI 1.04, 1.35).</p><p><strong>Conclusions: </strong>We found previously unreported inequities in ambulatory pediatric PFE outcomes, with worse experiences reported by Asian, Black, Hispanic, and Spanish-language patients.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114514","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":"Promoting Senior Resident Autonomy; Tools to empower senior residents on inpatient wards.","authors":"","doi":"10.1016/j.acap.2024.08.014","DOIUrl":"https://doi.org/10.1016/j.acap.2024.08.014","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114508","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}