1
|
Ravi K, Young A, Beattie RM, Johnson MJ. Socioeconomic disparities in the postnatal growth of preterm infants: a systematic review. Pediatr Res 2024:10.1038/s41390-024-03384-0. [PMID: 39025935 DOI: 10.1038/s41390-024-03384-0] [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: 03/08/2022] [Revised: 06/06/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE To determine the effect of parental socioeconomic status (SES) on the postnatal growth of preterm infants. METHODS A systematic review (PROSPERO registration CRD42020225714) of original articles from Medline, Embase, CINAHL Plus and Web of Science published 1946-2023 was undertaken. Studies were included if they reported anthropometric growth outcomes for preterm infants according to parental SES. Data extraction and assessments of bias and health equity impact were conducted using custom-designed forms. RESULTS A narrative synthesis of twelve included studies was performed. Most infants were moderate to late preterm. The settings, growth outcomes, timings of growth measurement, and SES measures were heterogenous. Six studies demonstrated an adverse effect of low parental SES on the extrauterine growth of preterm infants, five studies showed no effect, and one study showed a potentially beneficial effect. All studies had a high risk of bias, especially confounding and selection bias. The health equity impact of included studies was largely negative. CONCLUSION Limited and low-quality evidence suggests that socioeconomic minoritisation may adversely impact the growth of preterm infants, thereby widening existing socioeconomic health inequities. Observational studies informed by theorisation of the mechanistic pathways linking socioeconomic minoritisation to adverse postnatal growth are required to identify targets for intervention. IMPACT Limited evidence suggests low parental socioeconomic status (SES) adversely affects the postnatal growth of preterm infants across different settings. Early growth of preterm infants predicts neurodevelopmental outcomes and the risk of cardiovascular and metabolic disease in adulthood. Systematic screening of over 15,000 articles identified only twelve studies which reported postnatal growth outcomes for preterm infants according to parental SES. The health equity impact of the included studies was systematically assessed, and found to be negative overall. This study highlights limitations in existing evidence on the association between parental SES and postnatal growth, and delineates avenues for future research.
Collapse
Affiliation(s)
- Krithi Ravi
- Department of Anaesthesia, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Paisley, UK
- Department of Neonatal Medicine, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Aneurin Young
- Department of Neonatal Medicine, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark J Johnson
- Department of Neonatal Medicine, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.
| |
Collapse
|
2
|
Boswell EK, Crouch E. Brief Report: Rural-Urban Differences in Disability Prevalence, Healthcare Services Utilization, and Participation in Special Education. J Autism Dev Disord 2024:10.1007/s10803-024-06434-y. [PMID: 38941047 DOI: 10.1007/s10803-024-06434-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 06/29/2024]
Abstract
Previous research has found that rural children are more likely to be disabled but are less likely to receive care. Both rural and disabled children were significantly impacted by the pandemic, particularly in terms of service utilization. Therefore, this study seeks to identify rural-urban differences in the prevalence of various disability indicators and in the receipt of educational and healthcare services. Data from 12,828 children aged 2-17 who participated in the 2021-2022 National Health Interview Survey (NHIS) was used to examine rural-urban differences in three different disability indicators and in education and health services utilization. Disability indicators included the Washington Group Short Set Composite Disability Indicator, a developmental disability indicator, and a neurodivergence indicator. Bivariate analysis, via Rao-Scott chi-square tests, was used to examine rural-urban disparities. Compared to their urban counterparts, rural children were more likely to have a positive Washington Group Short Set Composite Disability Indicator (14.3% vs. 10.6%) and neurodivergence indicator (17Ð.3% vs. 14.1%). Rural children with disabilities were more likely to have received prescription medication for behavioral, mental, or emotional health or concentration in the past year than urban children (34.2% vs. 25.9%). There was no rural-urban difference in the prevalence of developmental disabilities or other forms of health care use and special education participation. This report highlights the need for further investigation into underlying causes of rural-urban disparities in the prevalence of disabilities, as well as the need for continued support for programs and policies designed to support rural children with disabilities.
Collapse
Affiliation(s)
- Emma K Boswell
- Rural and Minority Health Research Center, University of South Carolina, 220 Stoneridge Dr, Columbia, SC, 29210, USA.
| | - Elizabeth Crouch
- Rural and Minority Health Research Center, University of South Carolina, 220 Stoneridge Dr, Columbia, SC, 29210, USA
| |
Collapse
|
3
|
Smith JV, Menezes M, Brunt S, Pappagianopoulos J, Sadikova E, O Mazurek M. Understanding autism diagnosis in primary care: Rates of diagnosis from 2004 to 2019 and child age at diagnosis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241236112. [PMID: 38456360 DOI: 10.1177/13623613241236112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
LAY ABSTRACT The current demand for autism diagnostic services exceeds the ability of the workforce to assess and diagnose children in a timely manner. One solution may be to equip primary care providers (PCPs) with the tools and expertise needed to diagnose autism within their practice. PCPs are often trusted professionals who have many touchpoints with children during early development, in which they can identify early signs of autism. Recent initiatives have focused on bolstering PCPs' diagnostic capabilities; however, no studies have examined how the rates of autism diagnosis in primary care have changed over time. We aimed to evaluate whether autism diagnosis in primary care has changed over time and how diagnosis in primary care relates to a child's age at the time of diagnosis. We found that the likelihood of a child being diagnosed by a PCP decreased by about 2% with every passing year from 2004 to 2019 when accounting for demographic characteristics. In our sample, PCPs diagnosed children approximately 1 year earlier than non-PCPs (e.g., psychologists and psychiatrists). Further research is needed to understand why the proportion of children diagnosed by PCPs decreases over time. However, this decrease suggests more work is needed to get capacity-building initiatives into community primary care practice. Though we must continue to find effective ways to build community PCPs' ability to diagnose autism, the present findings support the crucial role PCPs can play in early autism diagnosis.
Collapse
Affiliation(s)
- Jessica V Smith
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Michelle Menezes
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Sophie Brunt
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Jessica Pappagianopoulos
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Eleonora Sadikova
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Micah O Mazurek
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| |
Collapse
|
4
|
Mitchell LM, Huang ES. Diffusion and Disparities: Rural Uptake of Continuous Glucose Monitors. Diabetes Care 2024; 47:344-345. [PMID: 38394638 PMCID: PMC10909676 DOI: 10.2337/dci23-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Affiliation(s)
- Lauren M. Mitchell
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL
| | - Elbert S. Huang
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL
| |
Collapse
|
5
|
Crouch E, Hung P, Benavidez G, Giannouchos T, Brown MJ. Rural-urban differences in access to care among children and adolescents in the United States. J Rural Health 2024; 40:200-207. [PMID: 37217438 DOI: 10.1111/jrh.12769] [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: 02/08/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE Rural children and adolescents face disproportionate challenges in access to health care services than their urban counterparts. Yet, recent evidence on disparities in access to health care between rural and urban children and adolescents has been limited. This study examines the associations of residence location with receipt of preventive care, foregone medical care, and continuity of insurance coverage among US children and adolescents. METHODS This study used cross-sectional data from the 2019 to 2020 National Survey of Children's Health, with a final sample size of 44,679 children. Descriptive statistics, bivariate analyses, and multivariable logistic regression models were used to examine the differences in preventive care, foregone care, and continuity of insurance coverage between rural and urban children and adolescents. FINDINGS Rural children had lower odds of receiving preventive care (aOR 0.64; 95% CI 0.56-0.74) and having continuous health insurance coverage (aOR 0.68; 95% CI 0.56-0.83) compared to urban children. The odds of foregone care were similar between rural and urban children. Children at every federal poverty level (FPL) less than 400% were less likely to receive preventive care, and more likely to forego care than children residing at 400% or above FPL. CONCLUSIONS Rural disparities in child preventive care and insurance continuity warrant ongoing surveillance and local access to care initiatives, especially for children in low-income households. Without updated public health surveillance, policymakers and program developers may not be aware of current disparities. School-based health centers are 1 avenue for meeting the unmet health care needs of rural children.
Collapse
Affiliation(s)
- Elizabeth Crouch
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Rural and Minority Health Research Center, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Peiyin Hung
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Gabriel Benavidez
- Rural and Minority Health Research Center, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Theo Giannouchos
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Rural and Minority Health Research Center, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, Columbia, South Carolina, USA
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, South Carolina, USA
| |
Collapse
|
6
|
Trends in Well-Child Visits and Routine Vaccination among Children of U.S. Military Members: An Evaluation of the COVID-19 Pandemic Effects. J Clin Med 2022; 11:jcm11226842. [PMID: 36431319 PMCID: PMC9699213 DOI: 10.3390/jcm11226842] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
The COVID-19 pandemic has drastically impacted administration of healthcare including well-child visits and routine vaccinations. The purpose of this study was to determine the impact of COVID-19 pandemic disruption on childhood health maintenance: well-child visits and scheduled vaccinations. We queried the TRICARE Management Activity's Military Health System (MHS) database for outpatient well-child visits and vaccinations for all children 0 to 23 months of age eligible for TRICARE healthcare. The median rate of well-child visits, during the COVID-19 period (March 2020-July 2021), was significantly declined for all demographic groups: all ages, parental military ranks, sex, and regions as compared to the pre-COVID-19 period (February 2019-February 2020). Similar to rates of well-child visits, the rate of vaccinations declined during the COVID-19 period as compared to the pre-COVID-19 period for all demographic groups, except children 12-23 months. Rates of well-child visits for military dependent children under 2 years of age were decreased during the 16 month COVID-19 period, with large increases seen in the first 2 months of the pandemic; the consequences of missed well-child visits and vaccination are unknown.
Collapse
|
7
|
Angier H, Wyte-Lake T, Williams S, McCrimmon S, Moreno L, E DeVoe J, Cohen D. A Qualitative Study of Two Oregon Family Medicine Clinics to Explain Parent and Child Healthcare Initiation and Engagement. J Patient Exp 2022; 9:23743735221133654. [PMID: 36353569 PMCID: PMC9638683 DOI: 10.1177/23743735221133654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Background: Parental factors are associated with children's receipt of recommended care but not adequately described. Methods: We conducted a qualitative study of patients with at least two visits who were a primary caregiver for a child who also had at least two visits at the same clinic in 1/2018-12/2019 from two Oregon family medicine clinics. We stratified patients by child age and number of caregiver visits and randomly selected caregivers. Participants were interviewed in accordance with approval by our Institutional Review Board between 12/2020 and 4/2021. The data were analyzed using a grounded theory approach. Results: 12 caregivers (termed parents) were interviewed; half were single parents and three-quarters had a history of substance use disorder and/or a mental health condition. Parents focused on the importance of keeping themselves healthy to keep their families healthy. They described similar reasons for choosing to initiate and continue care for themselves and their children at the same clinic, including: convenience, trust, relationships, and receiving whole-person and whole-family care. Many valued having a healthcare "home" for their entire family. We developed a figure that highlights three themes that capture the interrelated factors parents identified as supporting healthcare use for themselves and their families. These overarching themes included: healthcare initiation; healthcare engagement and continuity; and parent bringing child to the same clinic for healthcare. Conclusion: Our data suggests that long-standing patient-clinic relationships for parents and children can support family-focused healthcare.
Collapse
Affiliation(s)
- Heather Angier
- Department of Family Medicine, Oregon
Health & Science University, Portland, OR, USA
| | - Tamar Wyte-Lake
- Department of Family Medicine, Oregon
Health & Science University, Portland, OR, USA
| | - Shannon Williams
- Department of Family Medicine, Oregon
Health & Science University, Portland, OR, USA
| | - Sara McCrimmon
- Department of Family Medicine, Oregon
Health & Science University, Portland, OR, USA
| | - Laura Moreno
- Department of Family Medicine, Oregon
Health & Science University, Portland, OR, USA
| | - Jennifer E DeVoe
- Department of Family Medicine, Oregon
Health & Science University, Portland, OR, USA
| | - Deborah Cohen
- Department of Family Medicine, Oregon
Health & Science University, Portland, OR, USA
| |
Collapse
|
8
|
La Valle C, Johnston E, Tager-Flusberg H. A systematic review of the use of telehealth to facilitate a diagnosis for children with developmental concerns. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 127:104269. [PMID: 35636261 PMCID: PMC10521149 DOI: 10.1016/j.ridd.2022.104269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/04/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Telehealth can reduce the gap between developmental concern and diagnosis. Evaluation of telehealth methods is needed for providers to make decisions about using telediagnostic assessments. AIM This systematic review examined telehealth in facilitating a diagnosis for children with developmental concerns and assessed 1) study characteristics and type of diagnostic evaluation; 2) comparison of telehealth technologies to in-person diagnostic methods; 3) feasibility and acceptability of telehealth technologies; and 4) methodological quality. METHOD AND PROCEDURES Peer-reviewed studies from PsycINFO, CINAHL, Web of Science, PubMed, Embase, and Cochrane published January 2000-July 2021 were searched using "telehealth" AND "developmental concern" AND "diagnosis". Data extraction included study characteristics, diagnostic evaluation, technology, diagnostic accuracy, feasibility, and acceptability. Methodological quality was assessed using NHLBI tools. OUTCOMES AND RESULTS Nine studies met inclusion. Children with suspected FAS, social-emotional concerns, suspected genetic conditions, and failed hearing screenings received a telediagnosis. Evaluations included dysmorphology, feeding, neurological, developmental, audiological, and psychiatric. Seven studies used videoconferencing in real-time and two used Store-and-Forward methods. High diagnostic agreement occurred between face-to-face and remote methods. Stakeholders reported high satisfaction and feasibility. Many of the studies were rated as fair quality. CONCLUSIONS AND IMPLICATIONS Findings underscore partnership models between local providers and remote specialists. Rigorous study designs with larger samples covering a wider range of developmental domains are needed to provide a stronger empirical base for providers.
Collapse
Affiliation(s)
- Chelsea La Valle
- Department of Psychological & Brain Sciences, Boston University Center for Autism Research Excellence, 100 Cummington Mall, Boston, MA 02215, USA.
| | - Emily Johnston
- Department of Psychological & Brain Sciences, Boston University Center for Autism Research Excellence, 100 Cummington Mall, Boston, MA 02215, USA.
| | - Helen Tager-Flusberg
- Department of Psychological & Brain Sciences, Boston University Center for Autism Research Excellence, 100 Cummington Mall, Boston, MA 02215, USA.
| |
Collapse
|
9
|
DeGuzman PB, Lyons G, Huang G, Keim-Malpass J, Mazurek MO. Statewide Analysis Reveals Period of Well-Child Visit Attendance for Earlier Diagnosis of Autism Spectrum Disorder. J Pediatr 2022; 241:181-187.e1. [PMID: 34571021 DOI: 10.1016/j.jpeds.2021.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To explore the relationship between well-child visit (WCV) attendance during early childhood and age at autism spectrum disorder (ASD) diagnosis using data drawn from a statewide all-payer claims database. STUDY DESIGN We used a correlational study design with longitudinal data drawn from the Virginia All-Payer Claims Database. All children born in 2011 with a diagnosis of ASD were included (n = 253). Survival analysis determined the impact of WCV attendance on ASD diagnosis at each American Academy of Pediatrics-recommended early childhood visit, and the 5-year visit. RESULTS Survival analysis revealed a significant impact of WCV attendance at the 24-month, 3-, and 4-year visits on earlier ASD diagnosis. Children who attended the 24-month visit were diagnosed nearly 10 months earlier than those who did not. Overall, children with ASD attended fewer than 50% of visits during early childhood. CONCLUSIONS Promoting consistent WCV attendance during early childhood is an actionable strategy for improving early identification of ASD. Further exploration is needed to determine barriers to visit attendance and the impact of patterns of early childhood WCV attendance on age of ASD diagnosis. Development and implementation of interventions to promote adherence to the American Academy of Pediatrics-recommended visits is needed.
Collapse
Affiliation(s)
| | - Genevieve Lyons
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - Guoping Huang
- Department of Geography and the Environment, University of Richmond, Richmond, VA
| | | | - Micah O Mazurek
- University of Virginia School of Education and Human Development, Charlottesville, VA
| |
Collapse
|
10
|
Christian BJ. Translational Research - Discovering New Knowledge to Improve Pediatric Nursing Care of Children and Families and Change Practice. J Pediatr Nurs 2021; 58:96-99. [PMID: 33836936 DOI: 10.1016/j.pedn.2021.04.001] [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: 11/17/2022]
|