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Garcia RS, Hollis T, Baratta J, King Z, Faulks M, Ricketts M, Brown-Johnson C, Shankar M, Guerin A, Wong HN, Zulman DM, Floyd BD. Building Trust and Partnership with Black Pediatric Patients and their Caregivers. Acad Pediatr 2024; 24:216-227. [PMID: 37659602 DOI: 10.1016/j.acap.2023.08.016] [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: 04/05/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/04/2023]
Abstract
Systemic racism embedded within the US health care system results in disproportionately worse health outcomes for Black pediatric patients and their caregivers. One meaningful mechanism through which these health disparities persist is through discriminatory treatment and anti-Black bias from clinicians. Strengthening care provided to Black pediatric patients and their caregivers requires that clinicians adopt culturally tailored communication strategies that promote health equity and counter racism. We conducted a scoping review of evidence-based communication practices in the medical literature that improve care for Black pediatric patients. We mapped the specific practices to the Presence 5 for Racial Justice framework and identified cross-cutting themes to describe practices across the five domains. There are three cross-cutting themes that underlie the recommended practices: 1) promote unbiased implementation of clinician communication strategies (eg, providing equitable recommendations for preventive care), 2) tailor care to Black pediatric patients (eg, explore the importance of the family unit), and 3) address racism experienced by Black pediatric patients and their caregivers (eg, acknowledge any previous negative experiences with the health care system). This review highlights communication practices that clinicians can adopt to build trusting relationships, empower Black families, and promote racial justice in clinical care. Future opportunities include expanding to system level change and validating these practices with patients and clinicians.
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Affiliation(s)
- Raquel S Garcia
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Department of Medicine (RS Garcia), Duke University School of Medicine, Durham, NC
| | - Taylor Hollis
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; University of Alabama at Birmingham Heersink School of Medicine (T Hollis)
| | - Juliana Baratta
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Massachusetts Institute of Technology Sloan School of Management (J Baratta), Cambridge, Mass
| | - Zoe King
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Stanford Prevention Research Center (Z King), Stanford University School of Medicine, Palo Alto, Calif
| | - Melvin Faulks
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif
| | - Maya Ricketts
- Meharry Medical College School of Medicine (M Ricketts), Nashville, Tenn
| | - Cati Brown-Johnson
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif
| | - Megha Shankar
- Division of General Internal Medicine (M Shankar), Department of Medicine, University of California San Diego, La Jolla, Calif; Presence Center (M Shankar), Stanford University School of Medicine, Stanford, Calif
| | - Allison Guerin
- Department of Pediatrics (A Guerin), Office of Pediatric Education and Office of Diversity, Equity, Inclusion, and Justice in Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
| | - Hong-Nei Wong
- Lane Medical Library (HN Wong), Stanford University School of Medicine, Stanford, Calif
| | - Donna M Zulman
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif
| | - Baraka D Floyd
- Department of Pediatrics (BD Floyd), Division of General Pediatrics and Office of Diversity Equity, Inclusion, and Justice in Pediatrics, Stanford University School of Medicine, Palo Alto, Calif.
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Habet V, Oliveira CR. Clinical Epidemiology of Pediatric Coronavirus Disease 2019 and its Postacute Sequelae. Semin Respir Crit Care Med 2023; 44:66-74. [PMID: 36646086 PMCID: PMC9926930 DOI: 10.1055/s-0042-1759566] [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] [Indexed: 01/18/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has affected individuals of all ages across. Although children generally experience a benign illness from COVID-19, the emergence of novel variants of the virus has resulted in significant changes in the morbidity and mortality rates for this age group. Currently, COVID-19 is the eighth leading cause of pediatric deaths in the United States. In addition to acute respiratory illness, some children can develop a severe postinfectious condition known as a multisystem inflammatory syndrome in children, which can progress to rapid-onset cardiogenic shock. Recovery from COVID-19 can also be slow for some children, resulting in persistent or reoccurring symptoms for months, commonly referred to as long COVID. These postinfectious sequelae are often distressing for children and their parents, can negatively impact the quality of life, and impose a considerable burden on the health care system. In this article, we review the clinical epidemiology of pediatric COVID-19 and outline the management considerations for its acute and postacute manifestations.
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Affiliation(s)
- Victoria Habet
- Section of Critical Care, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Carlos R. Oliveira
- Section of Infectious Diseases and Global Health, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
- Section of Health Informatics, Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
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Abstract
While most children with coronavirus 2019 (COVID-19) experience mild illness, some are vulnerable to severe disease and develop long-term complications. Children with disabilities, those from lower-income homes, and those from racial and ethnic minority groups are more likely to be hospitalized and to have poor outcomes following an infection. For many of these same children, a wide range of social, economic, and environmental disadvantages have made it more difficult for them to access COVID-19 vaccines. Ensuring vaccine equity in children and decreasing health disparities promotes the common good and serves society as a whole. In this article, we discuss how the pandemic has exposed long-standing injustices in historically marginalized groups and provide a summary of the research describing the disparities associated with COVID-19 infection, severity, and vaccine uptake. Last, we outline several strategies for addressing some of the issues that can give rise to vaccine inequity in the pediatric population.
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Affiliation(s)
- Carlos R Oliveira
- Corresponding Author: Carlos R. Oliveira, M.D., Ph.D., 15 York Street, PO Box 208064, New Haven, CT 06520-8064, USA. E-mail:
| | - Kristen A Feemster
- Vaccine Education Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Division of Infectious Disease, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Erlinda R Ulloa
- Department of Pediatrics, University of California Irvine School of Medicine, Irvine, CA 92697, USA
- Division of Infectious Diseases, Children’s Health of Orange County, Orange, CA 92868, USA
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Kronman MP, Snowden JN. Historical Perspective of Pediatric Health Disparities in Infectious Diseases: Centuries in the Making. J Pediatric Infect Dis Soc 2022; 11:S127-S131. [PMID: 36112495 PMCID: PMC9494470 DOI: 10.1093/jpids/piac088] [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] [Indexed: 12/13/2022]
Abstract
Coronavirus (COVID-19) laid bare the disproportionate effects of infectious agents on vulnerable communities. However, historically, infectious diseases have long been known to affect certain communities to a greater extent than others. The mechanisms behind these differences are multifactorial, and lie less in biological susceptibility and instead more on socioeconomic factors and other social determinants of health. This article highlights health disparities in common infections such as respiratory syncytial virus, tuberculosis, HIV, syphilis, and influenza and will use lessons learned from previous pathogens and infectious disease disparities in vulnerable populations to provide context to the COVID-19 pandemic.
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Affiliation(s)
- Matthew P Kronman
- Corresponding Author: Matthew P. Kronman, MD, MSCE, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
| | - Jessica N Snowden
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA,Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Li F, Liang W, Rhodes RE, Duan Y, Wang X, Shang B, Yang Y, Jiao J, Yang M, Supriya R, Baker JS, Yi L. A systematic review and meta-analysis on the preventive behaviors in response to the COVID-19 pandemic among children and adolescents. BMC Public Health 2022; 22:1201. [PMID: 35705941 PMCID: PMC9200376 DOI: 10.1186/s12889-022-13585-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 06/03/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The purpose of this review was to synthesize the empirical evidence of relevant studies related to preventive behaviors in response to the COVID-19 pandemic among children and adolescents. Further to this, we aimed to identify the demographic, psychological, and social and environmental correlates of such behaviors. Methods Following PRISMA guidelines, eligible literature was identified by searching seven databases (PsycINFO, PubMed, MEDLINE, EMBASE, Cochrane Library, PROSPERO registry platform, and ClinicalTrials.gov website) and reference list of included studies and relevant review papers from 1st Jan 2020 to 28th Feb 2021. The standardized mean difference and correlation coefficients r were extracted to estimate the effect sizes. Analyses were conducted using R software. Results Of the 35,271 original papers, 23 eligible studies were included in the qualitative synthesis and all these studies were of moderate-to-high quality, of which 17 studies were further included into the quantitative analysis. Children and adolescents (6–20 yrs.) showed a poorer practice of COVID-19 preventive behaviors compared to younger adults (21–59 yrs.) with a small-to-medium effect size (SMD = -.25, 95%CI = -.41 to -.09). For the demographic correlates, children and adolescents’ COVID-19 preventive practice was found to be significantly associated with gender (r = .14, 95%CI = .10 to .18), while not with age (r = -.02, 95%CI = -.14 to .10). Narratively, knowledge was found to be consistently and significantly correlated. For the psychological correlates, small-to-medium overall effects were identified for the association with attitudes (r = .26, 95%CI = .21 to .31) and perceived severity (r = .16, 95%CI = .01 to .30). For the family and social correlates, a non-significant association was identified between family economic status and COVID-19 preventive behaviors (r = .004, 95%CI = -.12 to .12). Conclusions Interventions and relevant policies of promoting children and adolescent’s preventive measures should be a priority. Further, empirical studies identifying the demographic, psychological, and family and social correlates of children and adolescents’ preventive behaviors are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13585-z.
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Affiliation(s)
- Feifei Li
- Center for Health and Exercise Science Research, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China.,Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China
| | - Wei Liang
- Center for Health and Exercise Science Research, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China.,Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China
| | - Ryan E Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, Canada
| | - Yanping Duan
- Center for Health and Exercise Science Research, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China.,Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China
| | - Xiang Wang
- Department of Curriculum and Instruction, the Education University of Hong Kong, Ting Kok, Hong Kong, China
| | - Borui Shang
- Department of Social Sciences, Hebei Sport University, Shijiazhuang, China
| | - Yide Yang
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Jiao Jiao
- Dr. Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China
| | - Min Yang
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China
| | - Rashmi Supriya
- Center for Health and Exercise Science Research, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China.,Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China
| | - Julien S Baker
- Center for Health and Exercise Science Research, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China.,Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China
| | - Longyan Yi
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China.
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Oliveira CR, Niccolai LM, Sheikha H, Elmansy L, Kalinich CC, Grubaugh ND, Shapiro ED. Assessment of Clinical Effectiveness of BNT162b2 COVID-19 Vaccine in US Adolescents. JAMA Netw Open 2022; 5:e220935. [PMID: 35238933 PMCID: PMC8895259 DOI: 10.1001/jamanetworkopen.2022.0935] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/13/2022] [Indexed: 01/12/2023] Open
Abstract
Importance The emergence of the B.1.617.2 (Delta) variant of SARS-CoV-2 has led to increases in both infections and hospitalizations among adolescents. Little is known about the effectiveness of the BNT162b2 vaccine in adolescents in the general population, as opposed to a clinical trial population. Objective To estimate the effectiveness of the BNT162b2 vaccine in adolescents aged 12 to 18 years. Design, Setting, and Participants This was a matched case-control study among adolescents (aged 12-18 years) who had results from a SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) test. Immunization histories, relevant clinical data, and RT-PCR test results were obtained from the Yale New Haven Health System's medical records between June 1, 2021, and August 15, 2021, when the Delta variant caused 92% of infections in Connecticut. Case participants were defined as adolescents who had a positive test result and an associated medical encounter. Control participants were defined as those who had a negative test result and were matched to a case participant by age, county of residence, and date of testing. Exposures Adolescents were defined as fully immunized if they had received 2 doses of vaccine at least 14 days before focal time. Main Outcomes and Measures The primary outcome measured was SARS-CoV-2 infection confirmed by RT-PCR. The vaccine's effectiveness (VE) was estimated using matched odds ratios from conditional logistic regression models. Secondary measures included estimated VE by clinical symptoms, number of vaccine doses received, and elapsed time from immunization. Results A total of 6901 adolescents were tested for SARS-CoV-2. The final sample comprised 186 case participants and 356 matched control participants. The median age was 14 (IQR, 13-16) years, 262 (48%) identified as female, 81 (15%) as Black, 82 (15%) as Hispanic, and 297 (55%) as White. Overall, 134 (25%) were fully immunized (case participants, 10 [5%]; control participants, 124 [35%]). The median time between immunization and the SARS-CoV-2 test was 62 days (range, 17-129 days). Within 4 months of receiving 2 doses, VE against any infection was estimated to be 91% (95% CI, 80%-96%); against asymptomatic infection, 85% (95% CI, 57%-95%). Effectiveness after a single dose was estimated to be 74% (95% CI, 18%-92%). Conclusions and Relevance In this retrospective case-control study of US adolescents, 2 doses of BNT162b2 vaccine appeared to provide excellent protection for at least 4 months after immunization against both symptomatic and asymptomatic SARS-CoV-2 infections.
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Affiliation(s)
- Carlos R. Oliveira
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale School of Medicine, New Haven, Connecticut
- Department of Biostatistics, Section of Health Informatics, Yale School of Public Health, New Haven, Connecticut
| | - Linda M. Niccolai
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Hassan Sheikha
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale School of Medicine, New Haven, Connecticut
| | - Lina Elmansy
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale School of Medicine, New Haven, Connecticut
| | - Chaney C. Kalinich
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Nathan D. Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut
| | - Eugene D. Shapiro
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale School of Medicine, New Haven, Connecticut
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
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Tao L, Gao Y, Dou H, Wu X, Yan L, Liu D, Zhao Y, Zhao Q, Wang P, Zhang Y. Developing and Testing the Validity and Reliability of the Brief Adolescent Respiratory System Health Assessment Scale-Student Version in a Chinese Sample. Front Pediatr 2021; 9:713066. [PMID: 34485202 PMCID: PMC8416155 DOI: 10.3389/fped.2021.713066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To develop a Brief Adolescent Respiratory System Health Assessment Scale-Student Version (BARSHAS-SV) and test the validity and reliability of the scale. Methods: Considering common respiratory system diseases and respiratory system symptoms as a theoretical basis, researchers developed a Brief Adolescent Respiratory System Health Assessment Scale-Student Version-I (BARSHAS-SV-I). After six medical experts reviewed the BARSHAS-SV-I, and six adolescents tested the BARSHAS-SV-I, researchers developed an updated BARSHAS-SV-II. Researchers randomly selected two middle schools in Baoding, China. Thousand twenty nine valid questionnaires were recovered. Researchers evaluated the validity and reliability of the scale and obtained the final version of the scale (BARSHAS-SV). The exploratory factor analysis (EFA) and the confirmatory factor analysis (CFA) were used to evaluate the construct validity of the scale. The content validity index (CVI) was used to evaluate the content validity of the scale. The Cronbach's α coefficient and the mean inter-item correlation coefficient (MIIC) were used to assess the reliability of the scale. Results: BARSHAS-SV Cronbach's α = 0.910, content validity = 0.941, and factor cumulative variance contribution rate = 64.047% conducting EFA. Conducting CFA, Chi square value (χ2) = 233.806, degrees of freedom (df) = 106, Chi square value/degree of freedom (χ2/df) = 2.206, root-mean-square error of approximation (RMSEA) = 0.063, normed fit index (NFI) = 0.922, goodness of fit index (GFI) = 0.917, Tueker-Lewis index (TLI) = 0.942, comparative fit index (CFI) = 0.955, incremental fit index (IFI) = 0.956. BARSHAS-SV consisted of 4 dimensions and 17 items. Four factors were as follows: Factor 1, mild respiratory system diseases (Cronbach's α coefficient = 0.781); Factor 2, severe respiratory system diseases (Cronbach's α coefficient = 0.829); Factor 3, respiratory system symptoms (Cronbach's α coefficient = 0.835); Factor 4, treatment and recovery of respiratory system diseases (Cronbach's α coefficient = 0.845). Conclusions: BARSHAS-SV is a valid and reliable method that can be applied to assess adolescent respiratory system health status. BARSHAS-SV may help teachers and medical staff in schools to quickly and conveniently evaluate the adolescent respiratory system health status and identify respiratory issues.
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Affiliation(s)
- Lingwei Tao
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yana Gao
- Obstetrics Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Hongzhe Dou
- Blood Transfusion Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Xuekun Wu
- Outpatient Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Lu Yan
- Blood Sampling Center, Affiliated Hospital of Hebei University, Baoding, China
| | - Danyang Liu
- Orthopedics Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Yuejia Zhao
- Department of Anesthesiology, Affiliated Hospital of Hebei University, Baoding, China
| | - Qingchun Zhao
- Outpatient Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Peiyu Wang
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yumei Zhang
- School of Public Health, Peking University Health Science Center, Beijing, China
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