1
|
Oo M, Anderson-Badbade S, Grzejszczak L, Rogers P, Tavernier RLE. A Preliminary Study of Prescription for Play on Developmental Concerns. Clin Pediatr (Phila) 2024:99228241258846. [PMID: 38828996 DOI: 10.1177/00099228241258846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Affiliation(s)
- May Oo
- Weitzman Institute, Moses/Weitzman Health System, Washington, DC, USA
| | | | | | - Peyton Rogers
- Weitzman Institute, Moses/Weitzman Health System, Washington, DC, USA
| | - Rebecca L Emery Tavernier
- Weitzman Institute, Moses/Weitzman Health System, Washington, DC, USA
- University of Minnesota Medical School, Duluth, MN, USA
| |
Collapse
|
2
|
Fannin DK, Williams EDG, Fuller M, Pearson JN, Boyd BA, Drame ER, Taylor J, Dickerson AS, Spinks-Franklin A, Coles-White DJ. Unpacking the prevalence: A warning against overstating the recently narrowed gap for Black autistic youth. Autism Res 2024; 17:1072-1082. [PMID: 38804591 DOI: 10.1002/aur.3168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
Recent findings from the Centers for Disease Control and Prevention's (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network's 2020 prevalence report indicate that disparities in autism diagnoses between Black and White youth have narrowed, reflecting improved screening, awareness, and access to services (Maenner et al., 2023. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 72, 1-14.). Claims of reducing disparities beyond prevalence rates, however, are not fully supported, as indicated by the reality that Black youth whose screenings indicate autistic traits are still not being referred for full evaluation or early intervention services at the same rate as their White peers (Major et al., 2020. Autism, 24, 1629-1638; Smith et al., 2020. Pediatrics, 145, S35-S46.). Black 8-year-olds identified as autistic still experience disparate educational placements (Waitoller et al., 2010. The Journal of Special Education. 44, 29-49.) where services may not be autism-specific or have Individual Education Plan goals only focused on "behavior problems" (Severini et al., 2018. Journal of Autism and Developmental Disorders, 48, 3261-3272.), are served in the most restrictive environments (Skiba et al., 2006. Exceptional Children, 72, 411-424.) and lack consistent augmentative and alternative communication support (Pope et al., 2022. American Journal of Speech-Language Pathology, 31, 2159-2174.). Additionally, ADMM researchers report consistent disparities in the identification of co-occurring intellectual disability where Black autistic children have significantly more co-occurrences than White autistic children. The purpose of this commentary is to first examine the assertion that the narrowed gap indicates, "…improved…access to services among historically underserved groups," (p. 9) (Maenner et al., 2023. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 72, 1-14.). We will then recommend strategies to address the ongoing disparities.
Collapse
Affiliation(s)
- Danai Kasambira Fannin
- Department of Communication Sciences and Disorders, North Carolina Central University, Durham, North Carolina, USA
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ed-Dee G Williams
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Marcus Fuller
- Department of Education, University of Maryland Eastern Shore, Princess Anne, Maryland, USA
| | - Jamie N Pearson
- Department of Teacher Education and Learning Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Brian A Boyd
- School of Education, University of North Carolina, Chapel Hill, North Carolina, USA
- Frank Porter Graham Child Development Institute, Chapel Hill, North Carolina, USA
| | - Elizabeth R Drame
- Department of Teaching and Learning, University of Wisconsin, Milwaukee, Wisconsin, USA
- Division of Diversity, Equity, and Inclusion, University of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonte' Taylor
- Department of Educational Psychology, Counseling, and Special Education, Penn State University, University Park, Pennsylvania, USA
| | - Aisha S Dickerson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - D' Jaris Coles-White
- Department of Speech, Language, Hearing Science, Western Michigan University, Kalamazoo, Michigan, USA
| |
Collapse
|
3
|
Watson C, Crichlow Q, Valaiyapathi B, Szaflarski JP, Fobian AD. The effects of racial and socioeconomic disparities on time to diagnosis and treatment of pediatric functional seizures in the United States. Seizure 2024; 119:58-62. [PMID: 38796952 DOI: 10.1016/j.seizure.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024] Open
Abstract
PURPOSE The present study sought to assess the effects of racial and socioeconomic status in the United States on time to treatment and diagnosis of pediatric functional seizures (FS). METHODS Eighty adolescents and their parent/guardian completed a demographics questionnaire and reported date of FS onset, diagnosis, and treatment. Paired samples t-tests compared time between FS onset and diagnosis, onset and treatment, and diagnosis and treatment based on race (White vs racial minority), annual household income (≤$79,999 vs ≥$80,000), maternal and paternal education (≤Associate's Degree vs Bachelor's Degree), and combined parental education (≤Post-graduate training vs Graduate degree). RESULTS Adolescents with lower annual household income began treatment >6 months later than adolescents with greater annual household income (p = 0.049). Adolescents with lower maternal and paternal education (≤Associate's Degree vs Bachelor's Degree) began treatment >4 and ∼8.5 months later than adolescents with greater maternal and paternal education (p = 0.04; p = 0.03), respectively. Adolescents with lower maternal education also received a diagnosis >5 months later (p = 0.03). Adolescents without a mother or father with a graduate degree received a diagnosis and began treatment∼3 and >11 months later (p = 0.03; p = 0.01) than adolescents whose mother or father received a graduate degree, respectively. No racial differences were found. CONCLUSIONS Adolescents with lower annual household income and/or parental education experienced increased duration between FS onset and treatment and diagnosis. Research is needed to clarify the mechanisms underlying this relationship, and action is needed to reduce these disparities given FS duration is associated with poorer prognosis and greater effects on the brain.
Collapse
Affiliation(s)
- Caroline Watson
- Department of Psychology, University of Alabama at Birmingham, United States
| | - Queenisha Crichlow
- Department of Psychology, University of Alabama at Birmingham, United States
| | - Badhma Valaiyapathi
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1720 2nd Ave S, SC 1004, Birmingham, AL 35294, United States
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, United States
| | - Aaron D Fobian
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1720 2nd Ave S, SC 1004, Birmingham, AL 35294, United States.
| |
Collapse
|
4
|
Fattal J, Giljen M, Vargas T, Damme KSF, Calkins ME, Pinkham AE, Mittal VA. A Developmental Perspective on Early and Current Motor Abnormalities and Psychotic-Like Symptoms. Schizophr Bull 2024:sbae062. [PMID: 38728386 DOI: 10.1093/schbul/sbae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND AND HYPOTHESIS Psychotic-like experiences (PLEs) are prevalent in the general population and, because they represent a lower end of the psychosis vulnerability spectrum, may be useful in informing mechanistic understanding. Although it is well-understood that motor signs characterize formal psychotic disorders, the developmental trajectory of these features and their relationships with PLEs are less well-understood. STUDY DESIGN Data from 7559 adolescents and young adults (age 11-21) in the Philadelphia Neurodevelopmental Cohort were used to investigate whether early-life milestone-attainment delays relate to current adolescent sensorimotor functioning and positive and negative PLEs. Current sensorimotor functioning was assessed using the Computerized Finger Tapping task (assessing motor slowing) and Mouse Practice task (assessing sensorimotor planning). STUDY RESULTS Early developmental abnormalities were related to current adolescent-aged motor slowing (t(7415.3) = -7.74, corrected-P < .001) and impaired sensorimotor planning (t(7502.5) = 5.57, corrected-P < .001). There was a significant interaction between developmental delays and current sensorimotor functioning on positive and negative PLEs (t = 1.67-4.51), such that individuals with early developmental delays had a stronger positive relationship between sensorimotor dysfunction and PLEs. Importantly, interaction models were significantly better at explaining current PLEs than those treating early and current sensorimotor dysfunction independently (χ2 = 4.89-20.34). CONCLUSIONS These findings suggest a relationship between early developmental delays and current sensorimotor functioning in psychosis proneness and inform an understanding of heterotypic continuity as well as a neurodevelopmental perspective of motor circuits. Furthermore, results indicate that motor signs are a clear factor in the psychosis continuum, suggesting that they may represent a core feature of psychosis vulnerability.
Collapse
Affiliation(s)
- Jessica Fattal
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Maksim Giljen
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Teresa Vargas
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | | | - Monica E Calkins
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy E Pinkham
- Department of Psychology, University of Texas at Dallas, Richardson, TX, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
| |
Collapse
|
5
|
DePorre AG, Hall M, Bernstein AM, Nadler C, Puls HT. Factors Associated With Prolonged Mental Health Admissions at US Children's Hospitals. Hosp Pediatr 2024; 14:328-336. [PMID: 38584580 DOI: 10.1542/hpeds.2023-007684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND OBJECTIVES Mental health (MH) hospitalizations at medical hospitals are associated with longer length of stay (LOS) compared with non-MH hospitalizations, but patient factors and costs associated with prolonged MH hospitalizations are unknown. The objective of this paper is to assess patient clinical and demographic factors associated with prolonged MH hospitalizations and describe variation in MH LOS across US children's hospitals. METHODS We studied children aged 5 to 20 years hospitalized with a primary MH diagnosis during 2021 and 2022 across 46 children's hospitals using the Pediatric Health Information System database. Generalized estimating equations, clustered on hospital, tested associations between patient characteristics with prolonged MH hospitalization, defined as those in the 95th percentile or above (>14 days). RESULTS Among 42 654 primary MH hospitalizations, most were aged 14 to 18 (62.4%), female (68.5%), and non-Hispanic white (53.8%). The most common primary MH diagnoses were suicide/self-injury (37.4%), depressive disorders (16.6%), and eating disorders (10.9%). The median (interquartile range) LOS was 2 days (1-5), but 2169 (5.1%) experienced a hospitalization >14 days. In adjusted analyses, race and ethnicity, category of MH diagnosis, and increasing medical and MH complexity were associated with prolonged hospitalization. CONCLUSIONS Our results emphasize several diagnoses and clinical descriptors for targeted interventions, such as behavioral and inpatient MH resources and discharge planning. Expanded investment in both community and inpatient MH supports have the potential to improve health equity and reduce prolonged MH hospitalizations.
Collapse
Affiliation(s)
- Adrienne G DePorre
- Divisions of Hospital Medicine
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
| | - Matt Hall
- Divisions of Hospital Medicine
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
- Childrens Hospital Association, Lenexa, Kansas
| | - Alec M Bernstein
- Developmental and Behavioral Health
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
| | - Cy Nadler
- Developmental and Behavioral Health
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
| | - Henry T Puls
- Divisions of Hospital Medicine
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
| |
Collapse
|
6
|
Perets O, Stagno E, Yehuda EB, McNichol M, Anthony Celi L, Rappoport N, Dorotic M. Inherent Bias in Electronic Health Records: A Scoping Review of Sources of Bias. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.09.24305594. [PMID: 38680842 PMCID: PMC11046491 DOI: 10.1101/2024.04.09.24305594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Objectives 1.1Biases inherent in electronic health records (EHRs), and therefore in medical artificial intelligence (AI) models may significantly exacerbate health inequities and challenge the adoption of ethical and responsible AI in healthcare. Biases arise from multiple sources, some of which are not as documented in the literature. Biases are encoded in how the data has been collected and labeled, by implicit and unconscious biases of clinicians, or by the tools used for data processing. These biases and their encoding in healthcare records undermine the reliability of such data and bias clinical judgments and medical outcomes. Moreover, when healthcare records are used to build data-driven solutions, the biases are further exacerbated, resulting in systems that perpetuate biases and induce healthcare disparities. This literature scoping review aims to categorize the main sources of biases inherent in EHRs. Methods 1.2We queried PubMed and Web of Science on January 19th, 2023, for peer-reviewed sources in English, published between 2016 and 2023, using the PRISMA approach to stepwise scoping of the literature. To select the papers that empirically analyze bias in EHR, from the initial yield of 430 papers, 27 duplicates were removed, and 403 studies were screened for eligibility. 196 articles were removed after the title and abstract screening, and 96 articles were excluded after the full-text review resulting in a final selection of 116 articles. Results 1.3Systematic categorizations of diverse sources of bias are scarce in the literature, while the effects of separate studies are often convoluted and methodologically contestable. Our categorization of published empirical evidence identified the six main sources of bias: a) bias arising from past clinical trials; b) data-related biases arising from missing, incomplete information or poor labeling of data; human-related bias induced by c) implicit clinician bias, d) referral and admission bias; e) diagnosis or risk disparities bias and finally, (f) biases in machinery and algorithms. Conclusions 1.4Machine learning and data-driven solutions can potentially transform healthcare delivery, but not without limitations. The core inputs in the systems (data and human factors) currently contain several sources of bias that are poorly documented and analyzed for remedies. The current evidence heavily focuses on data-related biases, while other sources are less often analyzed or anecdotal. However, these different sources of biases add to one another exponentially. Therefore, to understand the issues holistically we need to explore these diverse sources of bias. While racial biases in EHR have been often documented, other sources of biases have been less frequently investigated and documented (e.g. gender-related biases, sexual orientation discrimination, socially induced biases, and implicit, often unconscious, human-related cognitive biases). Moreover, some existing studies lack causal evidence, illustrating the different prevalences of disease across groups, which does not per se prove the causality. Our review shows that data-, human- and machine biases are prevalent in healthcare and they significantly impact healthcare outcomes and judgments and exacerbate disparities and differential treatment. Understanding how diverse biases affect AI systems and recommendations is critical. We suggest that researchers and medical personnel should develop safeguards and adopt data-driven solutions with a "bias-in-mind" approach. More empirical evidence is needed to tease out the effects of different sources of bias on health outcomes.
Collapse
|
7
|
Lawson Y, Mpasi P, Young M, Comerford K, Mitchell E. A review of dairy food intake for improving health among black infants, toddlers, and young children in the US. J Natl Med Assoc 2024; 116:228-240. [PMID: 38360504 DOI: 10.1016/j.jnma.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/17/2024]
Abstract
Adequate nutrition is paramount for proper growth and musculoskeletal, neurocognitive, and immunological development in infants, toddlers, and young children. Among breastfeeding mother-child dyads, this critical window of development, is impacted by both maternal and offspring dietary patterns. For mothers, their dietary patterns impact not only their own health and well-being, but also the nutrition of their breast milk - which is recommended as the sole source of food for the first 6 months of their infant's life, and as a complementary source of nutrition until at least 2 years of age. For infants and toddlers, the breast milk, formulas, and first foods they consume can have both short-term and long-term effects on their health and well-being - with important impacts on their taste perception, microbiome composition, and immune function. According to dietary intake data in the US, infants and young children meet a greater number of nutrient requirements than older children and adults, yet numerous disparities among socially disadvantaged racial/ethnic groups still provide significant challenges to achieving adequate nutrition during these early life stages. For example, Black children are at greater risk for disparities in breastfeeding, age-inappropriate complementary feeding patterns, nutrient inadequacies, food insecurity, and obesity relative to most other racial/ethnic groups in the US. For infants who do not receive adequate breast milk, which includes a disproportionate number of Black infants, dairy-based infant formulas are considered the next best option for meeting nutritional needs. Fermented dairy foods (e.g., yogurt, cheese) can serve as ideal first foods for complementary feeding, and cow's milk is recommended for introduction during the transitional feeding period to help meet the nutrient demands during this phase of rapid growth and development. Low dairy intake may put children at risk for multiple nutrient inadequacies and health disparities - some of which may have lifelong consequences on physical and mental health. A burgeoning body of research shows that in addition to breast milk, cow's milk and other dairy foods may play critical roles in supporting physical growth, neurodevelopment, immune function, and a healthy gut microbiome in early life. However, most of this research so far has been conducted in White populations and can only be extrapolated to Black infants, toddlers, and young children. Therefore, to better understand and support the health and development of this population, greater research and education efforts on the role of milk and dairy products are urgently needed. This review presents the current evidence on health disparities faced by Black children in the US from birth to four years of age, and the role that dairy foods can play in supporting the normal growth and development of this vulnerable population.
Collapse
Affiliation(s)
- Yolanda Lawson
- Associate Attending, Baylor University Medical Center, Dallas, TX, United States
| | - Priscilla Mpasi
- ChristianaCare Health System, Assistant Clinical Director Complex Care and Community Medicine, Wilmington, DE, United States
| | - Michal Young
- Emeritus, Howard University College of Medicine, Department of Pediatrics and Child Health, Washington D.C., United States
| | - Kevin Comerford
- OMNI Nutrition Science; California Dairy Research Foundation, Davis, CA, United States.
| | - Edith Mitchell
- Sidney Kimmel Cancer at Jefferson, Philadelphia, PA, United States
| |
Collapse
|
8
|
Baum RA, Berman BD, Fussell JJ, Patel R, Roizen NJ, Voigt RG, Leslie LK. Child Health Needs and the Developmental-Behavioral Pediatrics Workforce Supply: 2020-2040. Pediatrics 2024; 153:e2023063678H. [PMID: 38300001 DOI: 10.1542/peds.2023-063678h] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Developmental-behavioral pediatrics (DBP) subspecialists care for children with complex neurodevelopmental and behavioral health conditions; additional roles include education and training, advocacy, and research. In 2023, there were 1.0 DBP subspecialists per 100 000 US children aged 0 to 17 years (range 0.0-3.8), with wide variability in DBP subspecialist distribution. Given the prevalence of DB conditions, the current workforce is markedly inadequate to meet the needs of patients and families. The American Board of Pediatrics Foundation led a modeling project to forecast the US pediatric subspecialty workforce from 2020 to 2040 using current trends in each subspecialty. The model predicts workforce supply at baseline and across alternative scenarios and reports results in headcount (HC) and HC adjusted for percent time spent in clinical care, termed "clinical workforce equivalent." For DBP, the baseline model predicts HC growth nationally (+45%, from 669 to 958), but these extremely low numbers translate to minimal patient care impact. Adjusting for population growth over time, projected HC increases from 0.8 to 1.0 and clinical workforce equivalent from 0.5 to 0.6 DBP subspecialists per 100 000 children aged 0 to 18 years by 2040. Even in the best-case scenario (+12.5% in fellows by 2030 and +7% in time in clinical care), the overall numbers would be minimally affected. These current and forecasted trends should be used to shape much-needed solutions in education, training, practice, policy, and workforce research to increase the DBP workforce and improve overall child health.
Collapse
Affiliation(s)
- Rebecca A Baum
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill/North Carolina Children's Hospital, Chapel Hill, North Carolina
| | - Brad D Berman
- Division of Developmental-Behavioral Pediatrics, University of California San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Jill J Fussell
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas
| | - Rohan Patel
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill/North Carolina Children's Hospital, Chapel Hill, North Carolina
| | - Nancy J Roizen
- Division of Developmental and Behavioral Pediatrics and Psychology, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Robert G Voigt
- Michael R. Boh Centers for Child Development, Department of Pediatrics, Ochsner Health, and University of Queensland Medical School/Ochsner Clinical School, New Orleans, Louisiana
| | | |
Collapse
|
9
|
Slopen N, Chang AR, Johnson TJ, Anderson AT, Bate AM, Clark S, Cohen A, Jindal M, Karbeah J, Pachter LM, Priest N, Suglia SF, Bryce N, Fawcett A, Heard-Garris N. Racial and ethnic inequities in the quality of paediatric care in the USA: a review of quantitative evidence. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:147-158. [PMID: 38242597 DOI: 10.1016/s2352-4642(23)00251-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 08/02/2023] [Accepted: 09/08/2023] [Indexed: 01/21/2024]
Abstract
Racial and ethnic inequities in paediatric care have received increased research attention over the past two decades, particularly in the past 5 years, alongside an increased societal focus on racism. In this Series paper, the first in a two-part Series focused on racism and child health in the USA, we summarise evidence on racial and ethnic inequities in the quality of paediatric care. We review studies published between Jan 1, 2017 and July 31, 2022, that are adjusted for or stratified by insurance status to account for group differences in access, and we exclude studies in which differences in access are probably driven by patient preferences or the appropriateness of intervention. Overall, the literature reveals widespread patterns of inequitable treatment across paediatric specialties, including neonatology, primary care, emergency medicine, inpatient and critical care, surgery, developmental disabilities, mental health care, endocrinology, and palliative care. The identified studies indicate that children from minoritised racial and ethnic groups received poorer health-care services relative to non-Hispanic White children, with most studies drawing on data from multiple sites, and accounting for indicators of family socioeconomic position and clinical characteristics (eg, comorbidities or condition severity). The studies discussed a range of potential causes for the observed disparities, including implicit biases and differences in site of care or clinician characteristics. We outline priorities for future research to better understand and address paediatric treatment inequities and implications for practice and policy. Policy changes within and beyond the health-care system, discussed further in the second paper of this Series, are essential to address the root causes of treatment inequities and to promote equitable and excellent health for all children.
Collapse
Affiliation(s)
- Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Center on the Developing Child, Harvard University, Boston, MA, USA.
| | - Andrew R Chang
- Harvard Medical School, Harvard University, Boston, MA, USA
| | | | - Ashaunta T Anderson
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Aleha M Bate
- Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Chicago, IL, USA; Stanely Manne Children's Research Institute, Chicago, IL, USA
| | - Shawnese Clark
- Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Chicago, IL, USA; Stanely Manne Children's Research Institute, Chicago, IL, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alyssa Cohen
- Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Chicago, IL, USA; Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Monique Jindal
- Department of Clinical Medicine, University of Illinois, Chicago, IL, USA
| | - J'Mag Karbeah
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Lee M Pachter
- Institute for Research on Equity and Community Health, ChristianaCare, Wilmington, DE, USA; Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA; School of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Naomi Priest
- Centre for Social Research and Methods, Australian National University, Canberra, ACT, Australia; Population Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Shakira F Suglia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nessa Bryce
- Department of Psychology, Harvard University, Boston, MA, USA
| | - Andrea Fawcett
- Department of Clinical and Organizational Development, Chicago, IL, USA
| | - Nia Heard-Garris
- Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Chicago, IL, USA; Department of Pediatrics, Chicago, IL, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
10
|
Nivens C, Schwarz EB, Rodriguez R, Hoyt-Austin A. Adverse Childhood Experiences and Developmental Delay in Young US Children. Matern Child Health J 2024; 28:5-10. [PMID: 38142261 PMCID: PMC10922342 DOI: 10.1007/s10995-023-03864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) are common and have been associated with poor developmental outcomes. We aimed to investigate the relationship between early ACE exposure, subsequent diagnosis of developmental delay, and receipt of developmental delay services by young children. In addition, we aimed to assess the impact of health-promoting behaviors such as breastfeeding and daily reading on these relationships. METHODS In this cross-sectional analysis of nationally-representative data from the 2017-2018 National Survey of Children's Health, we examined the relationship between ACEs, prior breastfeeding, daily reading, and developmental delay diagnosis among 7837 children aged 3-5 years, using multivariate logistic regression to adjust for family, personal, and sociodemographic characteristics. RESULTS We found a dose-dependent relationship between ACEs and developmental delay diagnosis; compared to those without ACEs, developmental delay was more common among those with either one ACE (aOR = 2.03, 95% CI 1.17-3.52) or two or more ACEs (aOR = 2.34, 95% CI 1.25-4.37). Neither breastfeeding (exclusively breastfed for 6 months vs. never breastfed aOR = 0.70, 95% CI 0.33-1.46) nor daily reading (no reading versus daily reading aOR = 1.15, CI 0.57-2.33) were associated with incidence of developmental delay among study participants. There was no significant difference in receipt of services intended to meet developmental needs between children with and without ACEs. DISCUSSION Children with very early ACE exposure are at increased risk for diagnosis of developmental delay. Early screening for ACEs and developmental delay may mitigate the early developmental manifestations of ACE exposure in vulnerable children.
Collapse
Affiliation(s)
- Carleigh Nivens
- Pediatric Residency Program, University of California San Francisco Benioff Oakland Children's Hospital, Oakland, CA, USA
| | - Eleanor Bimla Schwarz
- Department of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Rosa Rodriguez
- Department of Pediatrics, University of California at Davis, Sacramento, CA, USA
| | - Adrienne Hoyt-Austin
- Department of Pediatrics, University of California at Davis, Sacramento, CA, USA.
- Department of Pediatrics, University of California at Davis, 2516 Stockton Blvd Room 202, Sacramento, CA, 95817, USA.
| |
Collapse
|
11
|
Tjoeng YL, Olsen J, Friedland-Little JM, Chan T. Association Between Race/Ethnicity and Severity of Illness in Pediatric Cardiomyopathy and Myocarditis. Pediatr Cardiol 2023; 44:1788-1799. [PMID: 37329452 DOI: 10.1007/s00246-023-03203-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/30/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Previous reports demonstrate racial/ethnic differences in survival for children hospitalized with cardiomyopathy and myocarditis. The impact of illness severity, a potential mechanism for disparities, has not been explored. METHODS Using the Virtual Pediatric Systems (VPS, LLC), we identified patients ≤ 18 years old admitted to the intensive care unit (ICU) for cardiomyopathy/myocarditis. Multivariate regression models were used to evaluate the association between race/ethnicity and Pediatric Risk of Mortality (PRISM 3). Multivariate logistic and competing risk regression was used to examine the relationship between race/ethnicity and mortality, CPR, and ECMO. RESULTS Black patients had higher PRISM 3 scores on first admission (𝛽 = 2.02, 95% CI: 0.15, 3.90). There was no difference in survival across race/ethnicity over multiple hospitalizations. Black patients were less likely to receive a heart transplant (SHR = 0.65, 95% CI: 0.45-0.92). Black and unreported race/ethnicity had higher odds of CPR on first admission (OR = 1.64, 95% CI: 1.01-2.45; OR = 2.12, 95% CI: 1.11-4.08, respectively). CONCLUSION Black patients have higher severity of illness on first admission to the ICU, which may reflect differences in access to care. Black patients are less likely to receive a heart transplant. Additionally, Black patients and those with unreported race/ethnicity had higher odds of CPR, which was not mediated by severity of illness, suggesting variations in care may persist after admission.
Collapse
Affiliation(s)
- Yuen Lie Tjoeng
- Seattle Children's Hospital, Division of Pediatric Critical Care, University of Washington, 4800 Sand Point Way NE M/S RC2.820, Seattle, WA, 98105, USA.
| | - Jillian Olsen
- Boston Children's Hospital, Division of Critical Care Medicine, Harvard Medical School, Boston, Massachusetts), USA
| | - Joshua M Friedland-Little
- Seattle Children's Hospital, Division of Pediatric Cardiology, University of Washington, Seattle, Washington), USA
| | - Titus Chan
- Seattle Children's Hospital, Division of Pediatric Critical Care, University of Washington, 4800 Sand Point Way NE M/S RC2.820, Seattle, WA, 98105, USA
| |
Collapse
|
12
|
Koob C, Stuenkel M, Gagnon RJ, Griffin SF, Sease K. Identifying Risk Factors Associated with Repeated Referrals Within a Pediatric Navigation Program. J Community Health 2023; 48:1044-1051. [PMID: 37658945 DOI: 10.1007/s10900-023-01274-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/05/2023]
Abstract
Approximately 1-in-5 children have a diagnosed mental, behavioral, and/or developmental disorder or delay by age 8 in the United States. Children with such conditions often require complex, complicated diagnostic and specialty care, making them susceptible to repeated referrals and ongoing unmet healthcare needs. Patient navigation programs (PNPs) are designed to integrate care from primary care providers to community-based services, using trained navigators to help patients and their families manage referrals and connect with referred services. This study examines factors associated with repeated referrals to an active PNP to inform ongoing referral patterns and adaptations to standard navigation support within a large healthcare system in South Carolina (SC). Data is sourced from the inception of the PNP in 2017 through 2022, including 15,702 referrals. Overall, 71.07% had no repeated referrals. Children who are older, diagnosed with attention deficit disorder(s), behavioral concerns, depression, multiple referral needs, and insured by Medicaid were found to be most susceptible to repeated referrals. Conversely, children who are non-Hispanic Black, were referred at a well-child visit, and are primarily insured by private insurance or Tricare were least likely to have repeated referrals. Children who are insured by Medicaid are more likely to be younger, identify as non-Hispanic Black, Hispanic, or another race/ethnicity, and have multiple needs at time of initial referral, identifying a potentially compounded risk for those who hold multiple risk factors to experiencing repeated referrals. Findings may inform adaptations to this PNP model to adjust navigator protocol for at-risk populations and equitably optimize referral-to-service connection.
Collapse
Affiliation(s)
- Caitlin Koob
- Department of Public Health Sciences, Clemson University, 501 Edwards Hall, Clemson, SC, USA.
- Prisma Health Children's Hospital-Upstate, Greenville, SC, USA.
| | | | - Ryan J Gagnon
- Department of Parks, Recreation, Tourism, and Management, Clemson University, Clemson, SC, USA
| | - Sarah F Griffin
- Department of Public Health Sciences, Clemson University, 501 Edwards Hall, Clemson, SC, USA
| | - Kerry Sease
- Prisma Health Children's Hospital-Upstate, Greenville, SC, USA
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| |
Collapse
|
13
|
Husain SA, Yu ME, King KL, Adler JT, Schold JD, Mohan S. Disparities in Kidney Transplant Waitlisting Among Young Patients Without Medical Comorbidities. JAMA Intern Med 2023; 183:1238-1246. [PMID: 37782509 PMCID: PMC10546295 DOI: 10.1001/jamainternmed.2023.5013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/07/2023] [Indexed: 10/03/2023]
Abstract
Importance Disparities in kidney transplant referral and waitlisting contribute to disparities in kidney disease outcomes. Whether these differences are rooted in population differences in comorbidity burden is unclear. Objective To examine whether disparities in kidney transplant waitlisting were present among a young, relatively healthy cohort of patients unlikely to have medical contraindications to kidney transplant. Design, Setting, and Participants This retrospective cohort study used the US Renal Data System Registry to identify patients with end-stage kidney disease who initiated dialysis between January 1, 2005, and December 31, 2019. Patients who were older than 40 years, received a preemptive transplant, were preemptively waitlisted, or had documented medical comorbidities other than hypertension or smoking were excluded, yielding an analytic cohort of 52 902 patients. Data were analyzed between March 1, 2022, and February 1, 2023. Main Outcome(s) and Measure(s) Kidney transplant waitlisting after dialysis initiation. Results Of 52 902 patients (mean [SD] age, 31 [5] years; 31 132 [59%] male; 3547 [7%] Asian/Pacific Islander, 20 782 [39%] Black/African American, and 28 006 [53%] White) included in the analysis, 15 840 (30%) were waitlisted for a kidney transplant within 1 year of dialysis initiation, 11 122 (21%) were waitlisted between 1 and 5 years after dialysis initiation, and 25 940 (49%) were not waitlisted by 5 years. Patients waitlisted within 1 year of dialysis initiation were more likely to be male, to be White, to be employed full time, and to have had predialysis nephrology care. There were large state-level differences in the proportion of patients waitlisted within 1 year (median, 33%; range, 15%-58%). In competing risk regression, female sex (adjusted subhazard ratio [SHR], 0.92; 95% CI, 0.90-0.94), Hispanic ethnicity (SHR, 0.77; 95% CI, 0.75-0.80), and Black race (SHR, 0.66; 95% CI, 0.64-0.68) were all associated with lower waitlisting after dialysis initiation. Unemployment (SHR, 0.47; 95% CI, 0.45-0.48) and part-time employment (SHR, 0.74; 95% CI, 0.70-0.77) were associated with lower waitlisting compared with full-time employment, and more than 1 year of predialysis nephrology care, compared with none, was associated with greater waitlisting (SHR, 1.51; 95% CI, 1.46-1.56). Conclusions and Relevance This retrospective cohort study found that fewer than one-third of patients without major medical comorbidities were waitlisted for a kidney transplant within 1 year of dialysis initiation, with sociodemographic disparities in waitlisting even in this cohort of young, relatively healthy patients unlikely to have a medical contraindication to transplantation. Transplant policy changes are needed to increase transparency and address structural barriers to waitlist access.
Collapse
Affiliation(s)
- S. Ali Husain
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York
- The Columbia University Renal Epidemiology (CURE) Group, New York, New York
| | - Miko E. Yu
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York
- The Columbia University Renal Epidemiology (CURE) Group, New York, New York
| | - Kristen L. King
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York
- The Columbia University Renal Epidemiology (CURE) Group, New York, New York
| | - Joel T. Adler
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin
| | - Jesse D. Schold
- Department of Surgery, University of Colorado–Anschutz Medical Campus, Aurora
- Department of Epidemiology, School of Public Health, University of Colorado–Anschutz Medical Campus, Aurora
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York
- The Columbia University Renal Epidemiology (CURE) Group, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| |
Collapse
|
14
|
Morgan PL, Hu EH. Sociodemographic disparities in ADHD diagnosis and treatment among U.S. elementary schoolchildren. Psychiatry Res 2023; 327:115393. [PMID: 37595343 PMCID: PMC10662107 DOI: 10.1016/j.psychres.2023.115393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/20/2023]
Abstract
We examined whether some groups of U.S. elementary schoolchildren are less likely to be diagnosed and treated for ADHD in analyses of a population-based cohort (N = 10,920). We predicted ADHD diagnosis using measures of race and ethnicity, age, socioeconomic status, birthweight, individually assessed academic, behavioral, and executive functioning, family language use, mental health, health insurance coverage, marital status, school composition, and geographic region. We predicted prescription medication use among those diagnosed with ADHD. We stratified additional analyses by biological sex. Black children (aOR, 0.60), girls (aOR, 0.55), and emergent bilinguals (aOR, 0.29) were less likely to have an ADHD diagnosis than observationally similar White children, boys, or those from English-speaking households. Black children's under-diagnosis occurred among boys. Emergent bilingual children's under-diagnosis occurred among both boys and girls. Girls (aOR, 0.52) and emergent bilinguals (aOR, 0.24) with ADHD were less likely to use prescription medication. Sociodemographic disparities in ADHD diagnosis and treatment occur among U.S. elementary schoolchildren. Measured confounds including independently assessed ADHD symptomatology and impairment do not explain the disparities. The findings empirically support cultural, linguistic, and biological sensitivity in the ADHD diagnostic and treatment procedures in use for the U.S. pediatric population.
Collapse
Affiliation(s)
- Paul L Morgan
- Department of Education Policy Studies, Penn State University, University Park, Pennsylvania, PA, United States; Population Research Institute, Penn State University, University Park, PA, United States.
| | - Eric Hengyu Hu
- Department of Education Policy Studies, Penn State University, University Park, Pennsylvania, PA, United States; Population Research Institute, Penn State University, University Park, PA, United States
| |
Collapse
|
15
|
Brown CM, Dillon B, Toth C, Decker E, Alexander RN, Chandawarkar AR, Bester S, Ricket E, Snyder DA. Quality Improvement to Eliminate Disparities in Developmental Screening for Patients Needing Interpreters. Pediatr Qual Saf 2023; 8:e679. [PMID: 37551260 PMCID: PMC10402961 DOI: 10.1097/pq9.0000000000000679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 07/08/2023] [Indexed: 08/09/2023] Open
Abstract
Children from households with a preferred language other than English are less likely to receive timely identification and treatment for developmental delay than children of native English speakers. In dismantling this inequity, the role of primary care pediatrics is to establish equitable systems for screening and referral. This project, conducted in a network of twelve pediatric primary care centers, focused on eliminating a small but systematic disparity in developmental screening rates between families who did and did not require interpreters (86% versus 92%). The specific aim was to increase developmental screen completion among patients needing interpreters from 86% to 92% of age-appropriate well-child visits. Methods Data were extracted from the electronic health record (EHR) to measure the proportion of 9-, 18-, 24-, and 30-month well-child visits at which developmental screens were completed, stratified by interpreter need (n = 31,461 visits; 7500 needing interpreters). One primary care center tested small changes to standardize processes, eliminate workarounds, and leverage EHR features using the Institute for Healthcare Improvement's Model for Improvement. The QI team plotted screen completion on control charts and spread successful changes to all 12 clinics. Statistical process control evaluated the significance of changes in screening rates. Results For patients needing interpreters, screen completion rose across all clinics from 86% to 93% when the clinics implemented the new process. Screen completion for patients not needing interpreters remained at 92%. Conclusion A standardized process supported by the EHR improved developmental screening among patients needing interpreters, eliminating disparities.
Collapse
Affiliation(s)
- Courtney M. Brown
- From the Division of Primary Care Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Beth Dillon
- From the Division of Primary Care Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Christina Toth
- Center for Clinical Excellence, Nationwide Children’s Hospital, Columbus, Ohio
| | - Emily Decker
- From the Division of Primary Care Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | | | - Aarti R. Chandawarkar
- From the Division of Primary Care Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Stefanie Bester
- From the Division of Primary Care Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Elizabeth Ricket
- From the Division of Primary Care Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Dane A. Snyder
- From the Division of Primary Care Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
| |
Collapse
|
16
|
Feinberg E, Stransky ML, Augustyn M, Broder-Fingert S, Bennett A, Weitzman C, Kuhn J, Chu A, Cabral HJ, Fenick AM, Blum NJ. Effect of Family Navigation on Participation in Part C Early Intervention. Acad Pediatr 2023; 23:904-912. [PMID: 37004879 PMCID: PMC10330889 DOI: 10.1016/j.acap.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE Part C Early Intervention (EI) services have been shown to reduce autism symptoms and promote healthy development among young children. However, EI participation remains low, particularly among children from structurally marginalized communities. We investigated whether family navigation (FN) improved EI initiation following positive primary care screening for autism compared to conventional care management (CCM). METHODS We conducted a randomized clinical trial among 339 families of children (ages 15-27 months) who screened as having an increased likelihood for autism at 11 urban primary care sites in 3 cities. Families were randomized to FN or CCM. Families in the FN arm received community-based outreach from a navigator trained to support families to overcome structural barriers to autism evaluation and services. EI service records were obtained from state or local agencies. The primary outcome of this study, EI service participation, was measured as the number of days from randomization to the first EI appointment. RESULTS EI service records were available for 271 children; 156 (57.6%) children were not engaged with EI at study enrollment. Children were followed for 100 days after diagnostic ascertainment or until age 3, when Part C EI eligibility ends; 65 (89%, 21 censored) children in the FN arm and 50 (79%, 13 censored) children in the CCM arm were newly engaged in EI. In Cox proportional hazards regression, families receiving FN were approximately 54% more likely to engage EI than those receiving CCM (1.54 (95% confidence interval: 1.09-2.19), P = .02). CONCLUSIONS FN improved the likelihood of EI participation among urban families from marginalized communities.
Collapse
Affiliation(s)
- Emily Feinberg
- Hassenfeld Child Health Innovation Institute (E Feinberg and A Chu), Brown University, Providence, RI.
| | - Michelle L Stransky
- Division of General Academic Pediatrics (ML Stransky and J Kuhn), Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Mass.
| | - Marilyn Augustyn
- Center for the Urban Child and Healthy Family (M Augustyn), Boston Medical Center, Mass; Division of Developmental and Behavioral Pediatrics (M Augustyn), Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Mass.
| | - Sarabeth Broder-Fingert
- Department of Pediatrics (S Broder-Fingert), University of Massachusetts Chan Medical School, Worcester.
| | - Amanda Bennett
- Division of Developmental and Behavioral Pediatrics (A Bennett), Department of Pediatrics, Children's Hospital of Philadelphia, Pa.
| | - Carol Weitzman
- Division of Developmental Medicine (C Weitzman), Boston Children's Hospital, Mass; Department of Pediatrics (C Weitzman), Harvard Medical School, Boston, Mass.
| | - Jocelyn Kuhn
- Division of General Academic Pediatrics (ML Stransky and J Kuhn), Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Mass.
| | - Andrea Chu
- Hassenfeld Child Health Innovation Institute (E Feinberg and A Chu), Brown University, Providence, RI.
| | - Howard J Cabral
- Department of Biostatistics (HJ Cabral), Boston University School of Public Health, Mass.
| | - Ada M Fenick
- Developmental and Behavioral Pediatrics (AM Fenick), Division of General Pediatrics, Department of Pediatrics, Yale School of Medicine, New Haven, Conn.
| | - Nathan J Blum
- Division of Developmental and Behavioral Pediatrics (NJ Blum), Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
| |
Collapse
|
17
|
Uduwana S, Nemerofsky S. Umbilical cord management - the first opportunity to improve healthcare disparities. Semin Perinatol 2023:151785. [PMID: 37336672 DOI: 10.1016/j.semperi.2023.151785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
This review focuses on iron deficiency and iron deficiency anemia in women and children in the United States. These are common, fixable problems that disproportionally affect minority populations. There are many opportunities for successful screening and management. The knowledge and awareness for identification and treatment of our populations' commonest deficiency is crucial.
Collapse
Affiliation(s)
- Shanika Uduwana
- Stamford Health, Stamford, CT, United States; Albert Einstein College of Medicine, Montefiore Medical Center - Children's Hospital at Montefiore, Bronx, NY, United States
| | - Sheri Nemerofsky
- Albert Einstein College of Medicine, Montefiore Medical Center - Children's Hospital at Montefiore, Bronx, NY, United States.
| |
Collapse
|
18
|
Brewer AG, Alfieri NL, Golbeck E, Bendelow A, Macy ML, Smith TL, Cartland J, Babula S, Davis MM. Caregiver Concerns About Child Development During the COVID-19 Pandemic among those with Missed Appointments: Preliminary Results. AJPM FOCUS 2023; 2:100110. [PMID: 37362391 PMCID: PMC10198792 DOI: 10.1016/j.focus.2023.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Introduction To examine caregiver's perception of their child falling behind on developmental milestones after canceled or delayed appointments in metropolitan Chicago during stay-at-home orders, from March 21-May 7, 2020. Methods We fielded a web-based caregiver survey to understand the impact of the early weeks of the COVID-19 pandemic on children's health care experiences characterizing proportions of caregiver perceptions of children falling behind in developmental milestones by canceled or delayed appointment types. Multivariable logistic regression was used to estimate the likelihood of falling behind in milestones . Results Overall, 229 (7.5%) caregivers reported children with canceled or delayed appointments falling behind in developmental milestones. Approximately 25.4% of caregivers reported children falling behind on milestones in the Missed Therapeutic group, compared with the Other Missed group (2.9%) (p<0.001). Children in the Missed Therapeutic group (adjusted odds ratio (aOR) 10.3, 95% confidence interval (CI) 7.60-14.0)) and caregivers who experienced job loss (aOR 1.59, CI 1.11-2.28) or reduced hours or pay (aOR 1.90, CI 1.28-2.82) had higher odds of falling behind on developmental milestones. Conclusions Implementation of new strategies to address the social needs of families should be develop when disruptions in developmental or therapeutic services among children occurs, particularly among children living in households with job insecurity.
Collapse
Affiliation(s)
- Audrey G. Brewer
- Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Nina L. Alfieri
- Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emily Golbeck
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Anne Bendelow
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Data Analytics and Reporting, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Michelle L. Macy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Tracie L. Smith
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Data Analytics and Reporting, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jenifer Cartland
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Data Analytics and Reporting, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Matthew M. Davis
- Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
19
|
Nelson BB, Ratushnyak D, Richards A, Sabo RT, Wolf ER, Krist AH. Using Claims Data to Map Unmet Service Needs for Early Childhood Developmental Disabilities in Virginia. Acad Pediatr 2023; 23:457-463. [PMID: 36108999 PMCID: PMC10008751 DOI: 10.1016/j.acap.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/26/2022] [Accepted: 09/03/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Developmental disabilities (DD) affect over 10% of children 0 to 5 years of age, and early interventions are known to improve outcomes, yet barriers remain in connecting children to these services. OBJECTIVE To identify gaps in services for young children with DD and established risk conditions in Virginia. METHODS Data from the 2018 Virginia All Payers Claim Database and the American Community Survey were used to estimate the proportion of children with DD, and among those children, the proportion that received at least one intervention service. Logistic and binomial regression models were used to examine the socio-demographic associations with having developmental needs met, at the individual and zip code tabulation (ZCTA) level. RESULTS Approximately 12% of children 0 to 5 years were found to have DD or established risk condition diagnosis, and only 54% of these received intervention services during that year. Individual-level analyses suggest that odds of having developmental needs met are higher among older children, boys, and children with public insurance. ZCTA-level analyses suggested higher odds of developmental needs being met in areas with higher levels of unemployment, while areas with high proportions of people with limited English proficiency and a high school education or less had lower odds of having needs met. CONCLUSIONS Receiving early childhood developmental services in Virginia is associated with having public insurance and living in an area with higher levels of unemployment, higher education, and English-proficiency. Efforts are needed to improve delivery of services overall, specifically targeted to those areas with high levels of unmet need.
Collapse
Affiliation(s)
- Bergen B Nelson
- Children's Hospital of Richmond at VCU (BB Nelson and ER Wolf), Richmond, Va; Department of Pediatrics, Virginia Commonwealth University (BB Nelson and ER Wolf), Richmond, Va.
| | - Daniel Ratushnyak
- School of Medicine, Virginia Commonwealth University (D Ratushnyak), Richmond, Va
| | - Alicia Richards
- Department of Biostatistics, Virginia Commonwealth University (A Richards and RT Sabo), Richmond, Va; Department of Family Medicine and Population Health, Virginia Commonwealth University (A Richards, RT Sabo, and AH Krist), Richmond, Va
| | - Roy T Sabo
- Department of Biostatistics, Virginia Commonwealth University (A Richards and RT Sabo), Richmond, Va; Department of Family Medicine and Population Health, Virginia Commonwealth University (A Richards, RT Sabo, and AH Krist), Richmond, Va
| | - Elizabeth R Wolf
- Children's Hospital of Richmond at VCU (BB Nelson and ER Wolf), Richmond, Va; Department of Pediatrics, Virginia Commonwealth University (BB Nelson and ER Wolf), Richmond, Va
| | - Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University (A Richards, RT Sabo, and AH Krist), Richmond, Va
| |
Collapse
|
20
|
Solgi M, Reeder JA, Alderman SL, Zuckerman KE. An Intervention to Increase Detection of Developmental Delays in Special Supplemental Nutrition Program for Women, Infants, and Children. Acad Pediatr 2023; 23:646-650. [PMID: 36646317 DOI: 10.1016/j.acap.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Low-income children are at risk for under-detection of developmental disabilities (DDs). Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics see low-income children regularly in early childhood and could be an important source of referrals to developmental services. METHODS This was a site-randomized trial of an intervention to train WIC staff in early identification of DDs, using Center for Disease Control and Prevention's Learn the Signs Act Early (LTSAE) developmental monitoring materials. Seven county WIC agencies in Oregon enrolled: 4 intervention agencies and 3 control agencies. The intervention consisted of an on-site, half-day training regarding signs of developmental delays, use of LTSAE materials, and referral to Early Intervention and Early Childhood Special Education (EI/ECSE). Control sites received no training and continued their usual care and referral processes. Primary study outcome was number of children referred from WIC to EI/ECSE in control versus experimental counties as well as % of referrals evaluated, using data obtained from Oregon's EI/ECSE program. Data for 46 children referred to EI/ECSE were obtained. RESULTS Overall, 3 of 4 intervention sites increased their referrals to EI/ECSE, and 0 of 3 control sites increased referrals. Total referrals in the intervention arm increased from 5 to 33 in the intervention arm, but decreased from 6 to 2 in the control arm. In the intervention arm, referrals increased for both boys and girls and for all ages. CONCLUSIONS This brief intervention with WIC staff led to short-term increases in EI referrals and evaluations. Such interventions may hold promise for reducing disparities.
Collapse
Affiliation(s)
- Mohadeseh Solgi
- Portland State University - Oregon Health and Science University School of Public Health (M Solgi and KE Zuckerman), Portland, Oregon; Division of General Pediatrics, Oregon Health and Science University (M Solgi and KE Zuckerman), Portland, Oregon.
| | - Julie A Reeder
- Oregon WIC Program, Oregon Health Authority (JA Reeder), Portland, Oregon
| | | | - Katharine E Zuckerman
- Portland State University - Oregon Health and Science University School of Public Health (M Solgi and KE Zuckerman), Portland, Oregon; Division of General Pediatrics, Oregon Health and Science University (M Solgi and KE Zuckerman), Portland, Oregon
| |
Collapse
|
21
|
Liu BM, Paskov K, Kent J, McNealis M, Sutaria S, Dods O, Harjadi C, Stockham N, Ostrovsky A, Wall DP. Racial and Ethnic Disparities in Geographic Access to Autism Resources Across the US. JAMA Netw Open 2023; 6:e2251182. [PMID: 36689227 PMCID: PMC9871799 DOI: 10.1001/jamanetworkopen.2022.51182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/22/2022] [Indexed: 01/24/2023] Open
Abstract
Importance While research has identified racial and ethnic disparities in access to autism services, the size, extent, and specific locations of these access gaps have not yet been characterized on a national scale. Mapping comprehensive national listings of autism health care services together with the prevalence of autistic children of various races and ethnicities and evaluating geographic regions defined by localized commuting patterns may help to identify areas within the US where families who belong to minoritized racial and ethnic groups have disproportionally lower access to services. Objective To evaluate differences in access to autism health care services among autistic children of various races and ethnicities within precisely defined geographic regions encompassing all serviceable areas within the US. Design, Setting, and Participants This population-based cross-sectional study was conducted from October 5, 2021, to June 3, 2022, and involved 530 965 autistic children in kindergarten through grade 12. Core-based statistical areas (CBSAs; defined as areas containing a city and its surrounding commuter region), the Civil Rights Data Collection (CRDC) data set, and 51 071 autism resources (collected from October 1, 2015, to December 18, 2022) geographically distributed into 912 CBSAs were combined and analyzed to understand variation in access to autism health care services among autistic children of different races and ethnicities. Six racial and ethnic categories (American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian or other Pacific Islander, and White) assigned by the US Department of Education were included in the analysis. Main Outcomes and Measures A regularized least-squares regression analysis was used to measure differences in nationwide resource allocation between racial and ethnic groups. The number of autism resources allocated per autistic child was estimated based on the child's racial and ethnic group. To evaluate how the CBSA population size may have altered the results, the least-squares regression analysis was run on CBSAs divided into metropolitan (>50 000 inhabitants) and micropolitan (10 000-50 000 inhabitants) groups. A Mann-Whitney U test was used to compare the model estimated ratio of autism resources to autistic children among specific racial and ethnic groups comprising the proportions of autistic children in each CBSA. Results Among 530 965 autistic children aged 5 to 18 years, 83.9% were male and 16.1% were female; 0.7% of children were American Indian or Alaska Native, 5.9% were Asian, 14.3% were Black or African American, 22.9% were Hispanic or Latino, 0.2% were Native Hawaiian or other Pacific Islander, 51.7% were White, and 4.2% were of 2 or more races and/or ethnicities. At a national scale, American Indian or Alaska Native autistic children (β = 0; 95% CI, 0-0; P = .01) and Hispanic autistic children (β = 0.02; 95% CI, 0-0.06; P = .02) had significant disparities in access to autism resources in comparison with White autistic children. When evaluating the proportion of autistic children in each racial and ethnic group, areas in which Black autistic children (>50% of the population: β = 0.05; <50% of the population: β = 0.07; P = .002) or Hispanic autistic children (>50% of the population: β = 0.04; <50% of the population: β = 0.07; P < .001) comprised greater than 50% of the total population of autistic children had significantly fewer resources than areas in which Black or Hispanic autistic children comprised less than 50% of the total population. Comparing metropolitan vs micropolitan CBSAs revealed that in micropolitan CBSAs, Black autistic children (β = 0; 95% CI, 0-0; P < .001) and Hispanic autistic children (β = 0; 95% CI, 0-0.02; P < .001) had the greatest disparities in access to autism resources compared with White autistic children. In metropolitan CBSAs, American Indian or Alaska Native autistic children (β = 0; 95% CI, 0-0; P = .005) and Hispanic autistic children (β = 0.01; 95% CI, 0-0.06; P = .02) had the greatest disparities compared with White autistic children. Conclusions and Relevance In this study, autistic children from several minoritized racial and ethnic groups, including Black and Hispanic autistic children, had access to significantly fewer autism resources than White autistic children in the US. This study pinpointed the specific geographic regions with the greatest disparities, where increases in the number and types of treatment options are warranted. These findings suggest that a prioritized response strategy to address these racial and ethnic disparities is needed.
Collapse
Affiliation(s)
- Bennett M. Liu
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Kelley Paskov
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Jack Kent
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Maya McNealis
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Soren Sutaria
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Olivia Dods
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Christopher Harjadi
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Nate Stockham
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | | | - Dennis P. Wall
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| |
Collapse
|
22
|
Pope L, Light J, Franklin A. Black Children With Developmental Disabilities Receive Less Augmentative and Alternative Communication Intervention Than Their White Peers: Preliminary Evidence of Racial Disparities From a Secondary Data Analysis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2159-2174. [PMID: 36044883 PMCID: PMC9458617 DOI: 10.1044/2022_ajslp-22-00079] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Ensuring equitable access to augmentative and alternative communication (AAC) intervention services for children with complex communication needs (CCN) is crucial. Evidence suggests that racial disparities exist in access to communication interventions, disadvantaging Black children. However, no research has investigated specifically the evidence for racial disparities in AAC services for children with developmental disabilities and CCN. METHOD The current study applied post hoc data analysis methods within a preexisting, open-access data set to explore preliminary evidence of racial disparities in AAC intervention. Amount of AAC intervention was compared for Black versus white 1 preschool students at study initiation (M age = 3;8 [years;months]) and 2 years later at study completion (M age = 5;10). RESULTS Black preschool students were reported to receive significantly less AAC intervention per week as compared to their white peers, both at study initiation and 2 years later. By study end, 75% of the Black children were receiving less than 60 min of AAC intervention per week, an inadequate amount to achieve meaningful gains given their significant disabilities. CONCLUSIONS It is unclear what mechanisms may contribute to the observed disparities; however, it is critical that concrete steps are taken by individual speech-language pathologists, school districts, preservice preparation programs, and researchers to identify inequities in AAC services and take actions to rectify them. Future research is essential to investigate the potential factors contributing to inequalities and determine effective interventions to address them.
Collapse
Affiliation(s)
- Lauramarie Pope
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Janice Light
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Amber Franklin
- Department of Speech Pathology and Audiology, Miami University, Oxford, OH
| |
Collapse
|
23
|
Peyton C, Girvan O, Shellhaas RA, Lemmon ME, Rogers EE, Soul JS, Chang T, Hamlett A, Wusthoff CJ, Chu CJ, Massey SL, Thomas C, Guillet R, Franck LS, Glass HC. Impact of COVID-19 Pandemic on Developmental Service Delivery in Children With a History of Neonatal Seizures. Pediatr Neurol 2022; 129:14-18. [PMID: 35149302 PMCID: PMC8779856 DOI: 10.1016/j.pediatrneurol.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/06/2021] [Accepted: 01/13/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Children with a history of acute provoked neonatal seizures are at high risk for disability, often requiring developmental services. The coronavirus disease 2019 (COVID-19) pandemic has led to widespread changes in how health care is delivered. Our objective was to determine the magnitude of service interruption of among children born between October 2014 and December 2017 and enrolled in the Neonatal Seizure Registry (NSR), a nine-center collaborative of pediatric centers in the United States. METHODS This is a prospective cohort study of children with acute provoked seizures with onset ≤44 weeks' gestation and evaluated at age three to six years. Parents of children enrolled in the NSR completed a survey about their child's access to developmental services between June 2020 and April 2021. RESULTS Among 144 children enrolled, 72 children (50%) were receiving developmental services at the time of assessment. Children receiving services were more likely to be male, born preterm, and have seizure etiology of infection or ischemic stroke. Of these children, 64 (89%) experienced a disruption in developmental services due to the pandemic, with the majority of families (n = 47, 73%) reporting that in-person services were no longer available. CONCLUSIONS Half of children with acute provoked neonatal seizures were receiving developmental services at ages three to six years. The COVID-19 pandemic has led to widespread changes in delivery of developmental services. Disruptions in services have the potential to impact long-term outcomes for children who rely on specialized care programs to optimize mobility and learning.
Collapse
Affiliation(s)
- Colleen Peyton
- Department of Physical Therapy and Human Movement Science, Northwestern University, Chicago, Illinois.
| | - Olivia Girvan
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, California
| | | | - Monica E. Lemmon
- Department of Pediatrics and Population Health Sciences, Duke University, School of Medicine, Durham, North Carolina
| | - Elizabeth E. Rogers
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, California
| | - Janet S. Soul
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Taeun Chang
- Neurology, Children's National Hospital, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
| | - Ashley Hamlett
- NSR Parent Partner, Duke Medical Center, Durham, North Carolina
| | | | - Catherine J. Chu
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shavonne L. Massey
- Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cameron Thomas
- Department of Pediatrics, University of Cincinnati, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ronnie Guillet
- Division of Neonatology, Department of Pediatrics, Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - Linda S. Franck
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, California
| | - Hannah C. Glass
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, California
| | | |
Collapse
|