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Genovesi S, Vania A, Caroli M, Orlando A, Lieti G, Parati G, Giussani M. Non-Pharmacological Treatment for Cardiovascular Risk Prevention in Children and Adolescents with Obesity. Nutrients 2024; 16:2497. [PMID: 39125377 PMCID: PMC11314452 DOI: 10.3390/nu16152497] [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: 07/11/2024] [Revised: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
In younger generations, excess weight has reached very alarming levels. Excess weight in adults is associated with increased mortality and morbidity from cardiovascular disease. However, it is not easy to distinguish to what extent these effects are the result of obesity itself or how much is due to the various cardiovascular risk factors that often accompany excess weight. Several risk factors, such as hypertension, dyslipidemia, hyperuricemia, glucose intolerance, and type 2 diabetes mellitus, are already present in pediatric age. Therefore, early intervention with the goal of correcting and/or eliminating them is particularly important. In the child and adolescent with obesity, the first approach to achieve weight reduction and correct the risk factors associated with severe excess weight should always be non-pharmacologic and based on changing poor eating habits and unhealthy lifestyles. The purpose of this review is to give an update on non-pharmacological interventions to be implemented for cardiovascular prevention in children and adolescents with obesity, and their effectiveness. In particular, interventions targeting each individual cardiovascular risk factor will be discussed.
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Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy;
- Istituto Auxologico Italiano, IRCCS, 20145 Milano, Italy; (A.O.); (M.G.)
| | | | | | - Antonina Orlando
- Istituto Auxologico Italiano, IRCCS, 20145 Milano, Italy; (A.O.); (M.G.)
| | - Giulia Lieti
- UO Nefrologia e Dialisi, ASST-Rhodense, 20024 Garbagnate Milanese, Italy;
| | - Gianfranco Parati
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy;
- Istituto Auxologico Italiano, IRCCS, 20145 Milano, Italy; (A.O.); (M.G.)
| | - Marco Giussani
- Istituto Auxologico Italiano, IRCCS, 20145 Milano, Italy; (A.O.); (M.G.)
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2
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Waldrop SW, Wang D, Kancherla D, Stanford FC. Current status of weight bias and stigma in pediatrics and the need for greater focus on populations at risk. Curr Opin Pediatr 2024; 36:42-48. [PMID: 37965910 PMCID: PMC10873084 DOI: 10.1097/mop.0000000000001305] [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] [Indexed: 11/16/2023]
Abstract
PURPOSE OF REVIEW Obesity is one of the most common pediatric chronic conditions in the United States, affecting approximately 20% of American youth and is more common amongst Black, Latino, and Indigenous and low socioeconomic populations. The condition places children and adolescents at increased risk of physical and mental health conditions partly mediated by the weight bias and stigmatization experienced during the potentially vulnerable periods of childhood and adolescence. RECENT FINDINGS Weight bias and the resulting stigma are pervasive in society. Children have been shown to internalize this bias and its devaluation, which have been shown to contribute to worsening metabolic and mental health outcomes independently. Studies suggest weight stigmatization more adversely affects Black, Latino, and Indigenous children, suggesting the potential for adverse synergistic effects of these historical biases on such youth. SUMMARY Addressing childhood obesity successfully across all racial, ethnic, and socioeconomic lines requires addressing weight bias and stigma. Steps toward this end include collaborative efforts to promote cross-cultural competence and upstander bias education and training for those who care for children, person-centered communication, and a culture of inclusivity across governmental, healthcare, educational, entertainment, and advertising sectors.
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Affiliation(s)
- Stephanie W. Waldrop
- Section on Nutrition Department of Pediatrics, University of Colorado School of Medicine, Nutrition Obesity Research Center at the University of Colorado, Aurora, CO, USA
| | - Daisy Wang
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Fatima Cody Stanford
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA, USA
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3
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Ronis SD, Masotya M, Birkby G, Stange KC. Social Needs Screening and Intervention in Pediatric Primary Care: Impact on Families' Experience of Care. J Prim Care Community Health 2024; 15:21501319241255917. [PMID: 38761365 PMCID: PMC11102682 DOI: 10.1177/21501319241255917] [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: 03/06/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/20/2024] Open
Abstract
INTRODUCTION/OBJECTIVES Social determinants of health (SDoH) screening and intervention in pediatric primary care depends upon caregiver disclosure of adverse household or social conditions and thus may be influenced by perceived bias or stigma. This paper examines to what extent parents' experience of their child's medical home is associated with their perceptions of a practice-based social needs intervention. METHODS We conducted a cohort study of data reported by 73 parents of children obtaining care in a medical home with an embedded SDoH navigation program. Using survey data collected in October 2021 and October 2022, we calculated descriptive statistics and non-parametric bivariate analyses of the association between engagement with the SDoH navigation program and parent-reported social needs, stress, and perception of care quality as measured by the Person-Centered Primary Care Measure (PCPCM). RESULTS Initial ratings of care quality were high (mean baseline PCPCM score = 3.63) and remained high on second interview (mean change in PCPCM score = -0.04, 95%CI -0.16, 0.09, P = .58) despite significant reductions in parents' ratings of access to care over time. Parents reported substantial stress, unmet social needs, and unmet healthcare needs, with 41 families (56%) ever using the practice-based SDoH program, including 16 (22%) who were new users in 2022. There was no association observed between PCPCM score and parent stress, unmet social needs, or use of SDoH services. CONCLUSIONS Parents' perceptions of care delivered in their child's medical home appears to be stable on repeat measurement, and independent of family context or interactions with social needs navigation services offered in the practice.
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Affiliation(s)
- Sarah D. Ronis
- UH Rainbow Center for Child Health & Policy, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Marie Masotya
- UH Rainbow Center for Child Health & Policy, Cleveland, OH, USA
| | - Genevieve Birkby
- UH Rainbow Babies and Children’s Ahuja Center for Women & Children, Cleveland, OH, USA
| | - Kurt C. Stange
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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4
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Myers CN, Chandran A, Psoter KJ, Bergmann JP, Galiatsatos P. Indicators of Neighborhood-Level Socioeconomic Position and Pediatric Critical Illness. Chest 2023; 164:1434-1443. [PMID: 37487988 PMCID: PMC10925544 DOI: 10.1016/j.chest.2023.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND With recent prioritization of equity in pediatric health outcomes, a shift to examine neighborhood-level health care disparities within pediatric populations has occurred, specifically in the context of critical illness. RESEARCH QUESTION Does an association exist between individual indicators of neighborhood-level disadvantage and incidence of PICU admission? STUDY DESIGN AND METHODS Pediatric patients younger than 18 years admitted to a PICU in a large urban tertiary pediatric hospital from January 1, 2016, through December 31, 2019, with a residential address in the city of Baltimore or Baltimore County on the day of admission were included in this ecological study. Demographic and clinical characteristics of children admitted to the PICU were summarized, with the primary outcome being PICU admission. Unadjusted negative binomial regression was used to examine the association between census tract-level PICU admissions and the previously described census tract-level indicators of neighborhood socioeconomic position. Regression models included an offset term for the population younger than 18 years for each census tract; results of models are reported as incidence rate ratios (IRRs) with corresponding 95% CIs. RESULTS We identified 2,476 PICU admissions: 1,351 patients from the city of Baltimore (10.25 per 1,000 children) and 1,125 patients from Baltimore County (6.31 per 1,000 children). Most PICU admissions (n = 906 [68%]) for the city of Baltimore represented an area deprivation index (ADI) of > 60, whereas most Baltimore County PICU admissions (n = 919 [82.3%]) represented an ADI of < 60. At the neighborhood level, the percentage of families living below the poverty line was associated with greater incidence of PICU admission in the city of Baltimore (IRR, 1.09; 95% CI, 1.00-1.18) and Baltimore County (IRR, 1.19; 95% CI, 1.05-1.36). For every $10,000 increase in median household income, PICU admission rates dropped by 9% for the city of Baltimore (IRR, 0.91; 95% CI, 0.86-0.95) and Baltimore County (IRR, 0.91; 95% CI, 0.88-0.94). Neighborhoods with vacant housing units also were associated with a higher incidence of PICU admission in the city of Baltimore (IRR, 1.10; 95% CI, 1.01-1.21) and Baltimore County (IRR, 1.46; 95% CI, 1.21-1.77), as was a 10% increase in occupied homes without vehicles (city of Baltimore: IRR, 1.14; 95% CI, 1.07-1.21; Baltimore County: IRR, 1.23; 95% CI, 1.11-1.37). INTERPRETATION Health outcomes of pediatric critical illness should be examined in the context of structural determinants of health, including neighborhood-level and environmental characteristics.
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Affiliation(s)
- Carlie N Myers
- Division of Critical Care Medicine, Cincinnati Children's Hospital, Cincinnati, OH; University of Cincinnati School of Medicine, Cincinnati, OH.
| | - Aruna Chandran
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Medicine, Baltimore, MD
| | - Kevin J Psoter
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jules P Bergmann
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Medicine, Baltimore, MD
| | - Panagis Galiatsatos
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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5
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Chapman AR, Brunelli L, Forman L, Kaempf J. Promoting children's rights to health and well-being in the United States. LANCET REGIONAL HEALTH. AMERICAS 2023; 25:100577. [PMID: 37650073 PMCID: PMC10462822 DOI: 10.1016/j.lana.2023.100577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/28/2023] [Accepted: 08/03/2023] [Indexed: 09/01/2023]
Abstract
The United States has a highly sophisticated pediatric healthcare system and spends more than any other country per capita on children's healthcare. However, not all children have access to needed and affordable health care and the life expectancy and health outcomes of children in the country are worse than in any other industrialized nation. These nations typically offer universal healthcare for children as part of a robust recognition of a children's rights framework. In 1989 the United Nations adopted the Convention on the Rights of the Child that recognizes the right of the child to the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. Currently the United States is the only United Nations member country that has not ratified the Convention on the Rights of the Child. This paper outlines the potential benefits of adopting a child rights approach based on the principles and provisions of the Convention on the Rights of the Child. The fact that countries who invest much less in healthcare compared to the United States can achieve better health outcomes provides the certainty that a solution is possible and within reach.
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Affiliation(s)
- Audrey R. Chapman
- Department of Public Health Sciences, UConn Health, Farmington, CT, USA
| | - Luca Brunelli
- Department of Pediatrics/Neonatology, University of Utah Health/Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Lisa Forman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Joseph Kaempf
- Providence Health System, Women and Children’s Services, Portland, OR, USA
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6
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Hammon L, Mondzelewski L, Robinson C, Milder E. Well-Child Care Disparities in U.S. Military Health System. Acad Pediatr 2023; 23:363-371. [PMID: 35918041 DOI: 10.1016/j.acap.2022.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe adherence rates for well-child visits among military children in the first 15 months of life and identify any disparities in adherence in a universally insured population. METHODS A retrospective cohort analysis was conducted using the Military Health System data repository which included children who were born between October 2013 and September 2016 and were eligible for TRICARE (the military health insurance program). Children were followed from zero to fifteen months of life to assess adherence with a national Health Effectiveness Data and Information Set (HEDIS) metric of 6 well visits during this period. Differences in adherence rates were evaluated across select demographic characteristics including sponsor rank, race, age, service branch, patient sex, geographic region, number of enrollment sites and provider type. Fitted logistic regression models were used to determine the probability of adherence with the HEDIS metric and identify disparities. RESULTS The final cohort included 168,830 infants. Across all variables, the mean number of well visits was 6.7 with an overall adherence rate of 86%. Child beneficiaries of junior enlisted, Black, and Air Force military members had lower adherence with the HEDIS metric. Enrollment at a single site and having a pediatrician for a primary care manager was associated with higher rates of adherence. CONCLUSIONS Sponsor rank, race, and service branch, along with provider type and number of enrollment sites were significantly associated with the probability of adherence. Further research should evaluate barriers to care that affect a universally insured population.
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Affiliation(s)
- Laura Hammon
- Department of Pediatrics (L Hammon), Naval Hospital Rota, Spain.
| | - Lisa Mondzelewski
- Department of Pediatrics (L Mondzelewski), Naval Medical Center San Diego, Calif
| | - Camille Robinson
- Division of Adolescent Medicine (C Robinson), Naval Medical Center San Diego, Calif
| | - Edmund Milder
- Division of Pediatric Infectious Diseases (E Milder), Naval Medical Center San Diego, Calif
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7
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Mohammed FN, Master CL, Arbogast KB, McDonald CC, Sharma S, Kang B, Corwin DJ. Disparities in Adherence to Concussion Clinical Care Recommendations in a Pediatric Population. J Head Trauma Rehabil 2023; 38:147-155. [PMID: 36731016 PMCID: PMC9998329 DOI: 10.1097/htr.0000000000000823] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To characterize the relationship of sociodemographic factors to adherence to provider recommendations for pediatric concussion. SETTING Primary care (PC) practices within the Children's Hospital of Philadelphia network. PARTICIPANTS Patients aged 5 to 18 years old who presented to any PC site for concussion from September 26, 2019, to December 31, 2019. DESIGN Retrospective medical record review. MAIN MEASURES The primary outcome was adherence to follow-up recommendations as defined by (1) continued follow-up until provider clearance to return to full activity; (2) no more than 2 no-show visits; and (3) for those referred to specialty care (SC), attending at least 1 visit. We compared adherence by race/ethnicity, insurance, age, sex, injury mechanism, and repeat head injury using bivariate and multivariate analyses. A secondary outcome of referral to SC was compared by sociodemographic factors. RESULTS A total of 755 patients were included. Overall, 80.5% of the patients met adherence criteria. Following adjustment, non-Hispanic Black patients and publicly insured/self-pay patients were less likely to adhere to recommendations than non-Hispanic White patients (adjusted odds ratio [AOR] = 0.60; 95% CI, 0.37-1.00) and privately insured patients (AOR = 0.48; 95% CI, 0.30-0.75), respectively. When assessing differences in referral to SC, non-Hispanic Black patients and publicly insured/self-pay patients were more likely to receive a referral than their non-Hispanic White peers (OR = 1.56; 95% CI, 1.00-2.45) and privately insured patients (OR = 1.56; 95% CI, 1.05-2.32), respectively. CONCLUSION This study highlights disparities in adherence to concussion care recommendations, with non-Hispanic Black and publicly insured/self-pay patients less likely to adhere to follow-up recommendations than non-Hispanic White and privately insured patients, respectively. These disparities may impact recovery trajectories. Future studies should aim to identify specific individual- and system-level barriers preventing adherence to care in order to ultimately inform targeted interventions to achieve equity in care delivery and outcomes.
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Affiliation(s)
- Fairuz N Mohammed
- Center for Injury Research and Prevention (Mrs Mohammed, Drs Master, Arbogast, McDonald, and Corwin, and Mss Sharma and Kang), Sports Medicine and Performance Center (Dr Master), and Division of Emergency Medicine (Drs Arbogast and Corwin), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine (Drs Master, Arbogast, McDonald, and Corwin) and School of Nursing (Dr McDonald), University of Pennsylvania, Philadelphia
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8
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Wong-See H, Calik A, Ostojic K, Raman S, Woolfenden S. Clinical Pathways for the Identification and Referral for Social Needs: A Systematic Review. Pediatrics 2023; 151:190636. [PMID: 36751899 DOI: 10.1542/peds.2022-056837] [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] [Accepted: 11/11/2022] [Indexed: 02/09/2023] Open
Abstract
CONTEXT Recognition of the importance of the social determinants of child health has prompted increased interest in clinical pathways that identify and refer for social needs. OBJECTIVE The aim of this systematic review was to determine the effectiveness of interventions that identify and refer for social needs for families with children aged 0 to 18 years attending outpatient community and ambulatory healthcare services. DATA SOURCES We searched the following databases: Medline, Embase, PsychINFO, CINAHL, Emcare, EBMR. STUDY SELECTION Studies were included if children and their families underwent a process of identification and referral for social needs in outpatient community and ambulatory healthcare services. DATA EXTRACTION Initial searches identified 5490 titles, from which 18 studies (73 707 families and children) were finally retained. RESULTS Intervention pathways were grouped into 3 categories based on whether identification and referral for social needs was conducted with only targeted community resources, a navigator, or with clinician training. The majority of studies reported positive outcomes; with an increase in social needs identification, an increase in referrals following identification, or a reduction in social needs. Child health outcome results were inconsistent. LIMITATIONS The search terms used may have provided bias toward countries in which these terms are in use. The heterogeneity of outcome measures between included studies meant a meta-analysis was not possible. CONCLUSIONS Despite evidence that clinical pathways for children and families help reduce social needs, evidence for improvements in child health is insufficient. Further studies from diverse settings are needed to inform clinical practice to optimize child health outcomes.
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Affiliation(s)
- Harmonie Wong-See
- Community Paediatrics, Sydney Local Health District, Croydon, New South Wales, Australia
| | - Anna Calik
- Liverpool Public Health Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | | | - Shanti Raman
- Community Paediatrics, Sydney Local Health District, Croydon, New South Wales, Australia.,Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Susan Woolfenden
- Community Paediatrics, Sydney Local Health District, Croydon, New South Wales, Australia.,Community Paediatrics, Sydney Local Health District, Croydon, New South Wales.,Australia Population Child Health Research Group, Discipline of Paediatrics, University of New South Wales, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 239] [Impact Index Per Article: 239.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
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10
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Executive Summary: Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:190440. [PMID: 36622135 DOI: 10.1542/peds.2022-060641] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
Affiliation(s)
- Sarah E Hampl
- Children's Mercy Kansas City Center for Children's Healthy Lifestyles & Nutrition, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Sandra G Hassink
- Medical Director, American Academy of Pediatrics, Institute for Healthy Childhood Weight, Wilmington, Delaware
| | - Asheley C Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Sarah C Armstrong
- Departments of Pediatrics and Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Sarah E Barlow
- Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Medical Center of Dallas, Dallas, Texas
| | - Christopher F Bolling
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kimberly C Avila Edwards
- Children's Health Policy & Advocacy, Ascension; Department of Pediatrics, Dell Medical School at The University of Texas at Austin, Austin, Texas
| | - Ihuoma Eneli
- Department of Pediatrics, The Ohio State University, Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | - Robin Hamre
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Madeline M Joseph
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, University of Florida Health Sciences Center-Jacksonville, Jacksonville, Florida
| | | | - Eneida Mendonca
- Departments of Pediatrics and Biostatistics & Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Marc P Michalsky
- Department of Pediatric Surgery, The Ohio State University, College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Nazrat Mirza
- Children's National Hospital, George Washington University, Washington, DC
| | - Eduardo R Ochoa
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Mona Sharifi
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Amanda E Staiano
- Louisiana State University Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Ashley E Weedn
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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11
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Wright JL, Davis WS, Joseph MM, Ellison AM, Heard-Garris NJ, Johnson TL. Eliminating Race-Based Medicine. Pediatrics 2022; 150:186963. [PMID: 35491483 DOI: 10.1542/peds.2022-057998] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
- Joseph L Wright
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Maryland
| | - Wendy S Davis
- Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, Vermont
| | - Madeline M Joseph
- Departments of Emergency Medicine and Pediatrics, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Angela M Ellison
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nia J Heard-Garris
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tiffani L Johnson
- Department of Emergency Medicine, University of California, Davis, Sacramento, California
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12
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Dental Caries, Oral Health Behavior, and Living Conditions in 6-8-Year-Old Romanian School Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060903. [PMID: 35740840 PMCID: PMC9222191 DOI: 10.3390/children9060903] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/17/2022]
Abstract
Dental caries still have a high prevalence in Romania. The aim of this paper is to determine the prevalence of caries in children (aged 6 to 8 years) correlated with individual-level predictors and socio-economic variables. A stratified, randomized nationally representative sample was established, taking into consideration the total number of preschool children and based on administrative units and residence. Self-assessment was performed by means of the Oral Health Questionnaire for Children (WHO). Examinations were conducted by 10 standardized examiners, with International Caries Detection and Assessment System (ICDAS) caries codes higher than 3 considered as dentinal caries, missing teeth as MT, and restorations as FT. DMFT and SiC indexes were calculated accordingly. The dataset for each outcome variable was analyzed by the Hurdle approach analyzed. The gender distribution was similar (47.22% male and 52.78% female), with 42.65% residing in rural areas. The mean DMFT value for the sample was 4.89 and SiC index 9.83. A negative association could be seen between DMFT and the father’s level of education (β = −0.33, SE = 0.07, p < 0.01) as well as the mother’s education (β = −0.25, SE = 0.07, p < 0.01). In conclusion, caries prevalence is very high in Romania as compared to the World Health Organization (WHO) recommendation for this age group in correlation with socio-economic factors and oral health behavior.
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13
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Yaeger JP, Alio AP, Fiscella K. Addressing Child Health Equity Through Clinical Decision-Making. Pediatrics 2022; 149:184449. [PMID: 35102415 DOI: 10.1542/peds.2021-053698] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jeffrey P Yaeger
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Amina P Alio
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
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14
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Purtell R, Tam RP, Avondet E, Gradick K. We are part of the problem: the role of children's hospitals in addressing health inequity. Hosp Pract (1995) 2021; 49:445-455. [PMID: 35061953 DOI: 10.1080/21548331.2022.2032072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
Racism is an ongoing public health crisis that undermines health equity for all children in hospitals across our nation. The presence and impact of institutionalized racism contributes to health inequity and is under described in the medical literature. In this review, we focus on key interdependent areas to foster inclusion, diversity, and equity in Children's Hospitals, including 1) promotion of workforce diversity 2) provision of anti-racist, equitable hospital patient care, and 3) prioritization of academic scholarship focused on health equity research, quality improvement, medical education, and advocacy. We discuss the implications for clinical and academic practice.Plain Language Summary: Racism in Children's Hospitals harms children. We as health-care providers and hospital systems are part of the problem. We reviewed the literature for the best ways to foster inclusion, diversity, and equity in hospitals. Hospitals can be leaders in improving child health equity by supporting a more diverse workforce, providing anti-racist patient care, and prioritizing health equity scholarship.
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Affiliation(s)
- Rebecca Purtell
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Reena P Tam
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Erin Avondet
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Katie Gradick
- Assistant Professor of Pediatrics, Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Maxwell AR, Jones NHY, Taylor S, Corathers SD, Rasnick E, Brokamp C, Riley CL, Parsons A, Kichler JC, Beck AF. Socioeconomic and Racial Disparities in Diabetic Ketoacidosis Admissions in Youth With Type 1 Diabetes. J Hosp Med 2021; 16:jhm.3664. [PMID: 34424192 DOI: 10.12788/jhm.3664] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/06/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We sought to determine whether census tract poverty, race, and insurance status were associated with the likelihood and severity of diabetic ketoacidosis (DKA) hospitalization among youth with type 1 diabetes (T1D). METHODS We conducted a retrospective population-based cohort study using Cincinnati Children's Hospital electronic medical record (EMR) data from January 1, 2011, to December 31, 2017, for T1D patients ≤18 years old. The primary outcome was admission for DKA. Secondary outcomes included DKA severity, defined by initial pH and bicarbonate, and length of stay. Exposures were the poverty rate for the youth's home census tract, parent-reported race, and insurance status. We used multivariable logistic regression to analyze effects on odds of admission. RESULTS We identified 439 patients with T1D; 152 were hospitalized. The cohort was 48% female, 25% Black, and 36% publicly insured; the median age was 14 years. For every 10% increase in a youth's census tract poverty rate, the adjusted odds of admission increased by 22% (95% CI, 1.03-1.47). Public insurance status was associated with DKA admission (adjusted odds ratio [AOR], 2.71, 95% CI, 1.62-4.55) while race was not. There were no clinically meaningful differences in pH or bicarbonate by census tract poverty, race, or insurance status; however, Black patients experienced differences in care (eg, longer length of stay). CONCLUSION Youth with T1D living in high poverty areas and on public insurance were significantly more likely to be admitted for DKA. Severity upon presentation was similar across exposures. Understanding contextual mechanisms by which disparities emerge will inform changes aimed at equitably improving care.
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Affiliation(s)
- Andrea R Maxwell
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nana-Hawa Yayah Jones
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stuart Taylor
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sarah D Corathers
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Erika Rasnick
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Cole Brokamp
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Carley L Riley
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Allison Parsons
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jessica C Kichler
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Andrew F Beck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Sava-Rosianu R, Campus G, Matichescu A, Balean O, Dumitrache MA, Lucaciu PO, Daguci L, Barlean MC, Maricutoiu L, Postolache M, Dumitrescu R, Jumanca D, Galuscan A. Caries Prevalence Associated with Oral Health-Related Behaviors among Romanian Schoolchildren. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6515. [PMID: 34204253 PMCID: PMC8296518 DOI: 10.3390/ijerph18126515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 11/26/2022]
Abstract
Oral health-related behaviors and living conditions play an important role in general and oral health. This study aimed to evaluate caries prevalence and severity in schoolchildren residing in rural and urban areas of Romania, and to correlate these with oral health-related behaviors. An estimation of the required sample size was conducted (sampling error of ±3% at a 95% confidence level), followed by the stratification of administrative units and then the selection of 49 schools. The Hurdle approach was used to analyze the dataset, requiring two sets of analyses for each outcome variable: a multilevel binary model to predict prevalence, and a multilevel Poisson analysis using only non-zero values. The mean and standard deviation (SD) for the dentinal caries index was 4.96 (5.33). Girls were more likely to have non-zero restoration codes (β = 0.14, SE = 0.08, p < 0.05). Low education levels of each parent were associated with an increased likelihood of having non-zero carious tooth surfaces (β = 0.23, SE = 0.06, p = 0.01; β = 0.22, SE = 0.06, p < 0.01). The presence of cavities was predicted by the consumption of carbonated soft drinks (β = 0.19, SE = 0.07, p < 0.01), candies (β = 0.13, SE = 0.06, p < 0.01), sweetened milk (β = 0.12, SE = 0.06, p < 0.05), tea (β = 0.16, SE = 0.08, p < 0.05), or cocoa (β = 0.13, SE = 0.06, p < 0.05). Furthermore, the non-zero values of the dentinal caries index were more likely in rural schools (β = -0.37, SE = 0.11, p < 0.01), and a negative association between the county development index and the fillings/restorations index (β = -0.01, SE = 0.01, p < 0.05) was also established. The outcome of this research highlights that the presence of caries (dentinal caries index) in Romanian schoolchildren is influenced by their socioeconomic background, as well as their specific consumption behaviors.
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Affiliation(s)
- Ruxandra Sava-Rosianu
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (R.S.-R.); (O.B.); (D.J.); (A.G.)
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3012 Bern, Switzerland;
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Viale San Pietro 3/c, 07100 Sassari, Italy
| | - Anamaria Matichescu
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (R.S.-R.); (O.B.); (D.J.); (A.G.)
| | - Octavia Balean
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (R.S.-R.); (O.B.); (D.J.); (A.G.)
| | - Mihaela Adina Dumitrache
- Oral Health and Community Dentistry Department, Faculty of Dental Medicine, UMP “Carol Davila”, 020021 Bucharest, Romania;
| | - Patricia Ondine Lucaciu
- Department of Oral Health, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Luminita Daguci
- Department of Prosthodontics, Faculty of Dentistry, University of Medicine and Pharmacy, 200585 Craiova, Romania;
| | - Magda Calina Barlean
- Department of Oro-Dental Diagnosis and Geriatric Dentistry, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
| | - Laurentiu Maricutoiu
- Department of Psychology, West University of Timisoara, 300223 Timisoara, Romania;
| | - Mariana Postolache
- Department of Program Implementation and Coordination, Romanian Ministry of Health, 010024 Bucharest, Romania;
| | - Ramona Dumitrescu
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (R.S.-R.); (O.B.); (D.J.); (A.G.)
| | - Daniela Jumanca
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (R.S.-R.); (O.B.); (D.J.); (A.G.)
| | - Atena Galuscan
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (R.S.-R.); (O.B.); (D.J.); (A.G.)
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Molloy C, Beatson R, Harrop C, Perini N, Goldfeld S. Systematic review: Effects of sustained nurse home visiting programs for disadvantaged mothers and children. J Adv Nurs 2021; 77:147-161. [PMID: 33038049 DOI: 10.1111/jan.14576] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/26/2020] [Accepted: 08/27/2020] [Indexed: 12/17/2022]
Abstract
AIMS To systematically evaluate published experimental studies of sustained nurse home visiting (SNHV) programs. This review summarizes the evidence and identifies gaps in the literature to inform practice, policy, and future research. DESIGN Restricted systematic review with narrative summary. DATA SOURCES Databases searched were Medline, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials. Year of publication was originally restricted from 2008 to the date of search (13 February 2018, with supplementary searches conducted to identify more recent publications (up to 2019). Several reputable evidence clearinghouses were also searched. REVIEW METHODS Studies were included if they used a randomized or cluster-randomized controlled trial to evaluate a home visiting program that: (a) targeted disadvantaged mothers; (b) commenced during pregnancy or prior to the child's first birthday; (c) had an intended duration of at least 12 months from the time of enrolment; and (d) was substantively delivered by nurses or midwives. Meta-analyses and reviews of studies meeting these criteria were also included. A quality appraisal was conducted for all studies. RESULTS Of 1,393 total articles, 30 met inclusion criteria. Seven specific SNHV programs were identified. Each demonstrated evidence of a positive statistical effect on at least one child or maternal outcome. CONCLUSION Sustained nurse home visiting programs benefit disadvantaged families, though effects vary across outcomes and subgroups. Further research is needed to discern the critical components of effective programs. IMPACT As SNHV programs have gained policy appeal, the need to evaluate the evidence-base supporting such interventions has become imperative. The findings of this review will assist policy-makers and practitioners in high-income countries to make evidence-informed decisions about which programs are best suited to addressing specific maternal and child outcomes for disadvantaged families. This should in turn ameliorate some of the inequalities in child development that have significant social and economic costs.
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Affiliation(s)
- Carly Molloy
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic., Australia
- University of Melbourne, Melbourne, Vic., Australia
| | - Ruth Beatson
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic., Australia
| | | | | | - Sharon Goldfeld
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic., Australia
- University of Melbourne, Melbourne, Vic., Australia
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18
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Montoya-Williams D, Peña MM, Fuentes-Afflick E. In Pursuit of Health Equity in Pediatrics. THE JOURNAL OF PEDIATRICS: X 2020; 5. [PMID: 33733084 PMCID: PMC7963264 DOI: 10.1016/j.ympdx.2020.100045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Diana Montoya-Williams
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | | | - Elena Fuentes-Afflick
- Zuckerberg San Francisco General Hospital, University of California, San Francisco, California
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Abstract
Children and adolescents who become involved with the justice system often do so with complex medical, mental health, developmental, social, and legal needs. Most have been exposed to childhood trauma or adversity, which both contribute to their involvement with the justice system and negatively impact their health and well-being. Whether youth are held in confinement or in their home communities, pediatricians play a critical role in promoting the health and well-being of justice-involved youth. Having a working knowledge of the juvenile justice system and common issues facing justice-involved youth may help pediatricians enhance their clinical care and advocacy efforts. This policy statement is a revision of the 2011 policy "Health Care for Youth in the Juvenile Justice System." It provides an overview of the juvenile justice system, describes racial bias and overrepresentation of youth of color in the justice system, reviews the health and mental health status of justice-involved youth, and identifies advocacy opportunities for juvenile justice reform.
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Affiliation(s)
- Mikah C Owen
- Department of Pediatrics, School of Medicine, University of California, Davis, Sacramento, California; and
| | - Stephenie B Wallace
- Division of Adolescent Medicine, Department of Pediatrics, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
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20
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Uchitel J, Alden E, Bhutta ZA, Goldhagen J, Narayan AP, Raman S, Spencer N, Wertlieb D, Wettach J, Woolfenden S, Mikati MA. The Rights of Children for Optimal Development and Nurturing Care. Pediatrics 2019; 144:peds.2019-0487. [PMID: 31771960 DOI: 10.1542/peds.2019-0487] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 11/24/2022] Open
Abstract
Millions of children are subjected to abuse, neglect, and displacement, and millions more are at risk for not achieving their developmental potential. Although there is a global movement to change this, driven by children's rights, progress is slow and impeded by political considerations. The United Nations Convention on the Rights of the Child, a global comprehensive commitment to children's rights ratified by all countries in the world except the United States (because of concerns about impingement on sovereignty and parental authority), has a special General Comment on "Implementing Child Rights in Early Childhood." More recently, the World Health Organization and United Nations Children's Fund have launched the Nurturing Care Framework for Early Childhood Development (ECD), which calls for public policies that promote nurturing care interventions and addresses 5 interrelated components that are necessary for optimal ECD. This move is also complemented by the Human Capital Project of the World Bank, providing a focus on the need for investments in child health and nutrition and their long-term benefits. In this article, we outline children's rights under international law, the underlying scientific evidence supporting attention to ECD, and the philosophy of nurturing care that ensures that children's rights are respected, protected, and fulfilled. We also provide pediatricians anywhere with the policy and rights-based frameworks that are essential for them to care for and advocate for children and families to ensure optimal developmental, health, and socioemotional outcomes. These recommendations do not necessarily reflect American Academy of Pediatrics policy.
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Affiliation(s)
| | - Errol Alden
- International Pediatric Association and Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.,Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Jeffrey Goldhagen
- Division of Community and Societal Pediatrics, Department of Pediatrics, College of Medicine, University of Florida, Jacksonville, Florida
| | | | - Shanti Raman
- International Pediatrics Association Standing Committee, International Society of Social Pediatrics and Child Health, Geneva, Switzerland.,Division of Community Pediatric, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nick Spencer
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Donald Wertlieb
- Eliot-Pearson Department of Child Study and Human Development, School of Arts and Sciences, Tufts University, Medford, Massachusetts
| | - Jane Wettach
- Duke Children's Law Clinic, School of Law, Duke University, Durham, North Carolina; and
| | - Sue Woolfenden
- Discipline of Paediatrics, School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mohamad A Mikati
- Division of Pediatric Neurology and .,Early Childhood Development Standing Advisory Group, International Pediatrics Association, St Louis, Missouri
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Goldhagen JL, Shenoda S, Oberg C, Mercer R, Kadir A, Raman S, Waterston T, Spencer NJ. Rights, justice, and equity: a global agenda for child health and wellbeing. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 4:80-90. [PMID: 31757760 DOI: 10.1016/s2352-4642(19)30346-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 11/16/2022]
Abstract
Worldwide challenges to child health and wellbeing are rapidly becoming existential threats to children and childhood. Inequities, armed conflict and violence, nuclear proliferation, forced migration, globalisation, and climate change are among the global issues violating children's rights to optimal survival and development. Child rights-based approaches will be required to enhance the response to the civil-political, social, economic, and cultural determinants of these global child health issues. In this Viewpoint, we present a global agenda for child health and wellbeing as a blueprint for the practice of paediatrics and child health in the domains of clinical care, systems development, and policy formulation. This global agenda is grounded in the principles of rights, justice, and equity and can address the root-cause determinants of health. The 30th anniversary of the UN Convention on the Rights of the Child is a relevant moment to recommit to shared goals for children's health and wellbeing.
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Affiliation(s)
| | | | - Charles Oberg
- University of Minnesota, Divisions of Global Pediatrics and Epidemiology & Community Health, Minneapolis, MN, USA
| | - Raúl Mercer
- Program of Social Sciences and Health, Facultad Latinoamericana de Ciencias Sociales (FLASCO), Buenos Aires, Argentina
| | - Ayesha Kadir
- Department of Paediatrics, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - Shanti Raman
- Department of Community Paediatrics, Sydney and South Western Sydney Local Health Districts, Liverpool, NSW, Australia
| | - Tony Waterston
- Institute of Child Health and Society, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Nicholas J Spencer
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
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Hopkins KA, Ott MA, Salih Z, Bosslet GT, Lantos J. When Adolescent and Parents Disagree on Medical Plan, Who Gets to Decide? Pediatrics 2019; 144:peds.2019-0291. [PMID: 31266823 PMCID: PMC7370317 DOI: 10.1542/peds.2019-0291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 01/14/2023] Open
Abstract
An adolescent with Duchenne Muscular Dystrophy wants a life-extending tracheostomy whereas parents do not want this for him.
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Affiliation(s)
- Kali A. Hopkins
- Indiana University School of Medicine, Departments of Internal Medicine and Pediatrics, Indianapolis, Indiana
| | - Mary A. Ott
- Indiana University School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, Indianapolis Indiana,,Indiana University-Purdue University Indianapolis, Department of Philosophy, Indianapolis, Indiana
| | - Zeynep Salih
- Indiana University School of Medicine, Department of Pediatrics, Division of Neonatology, Indianapolis, Indiana
| | - Gabriel T. Bosslet
- Indiana University School of Medicine, Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Occupational Medicine, Indianapolis, Indiana,,Charles Warren Fairbanks Center for Medical Ethics, Indianapolis, Indiana
| | - John Lantos
- Children’s Mercy Hospital Bioethics Center, Kansas City, Missouri
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Trent M, Dooley DG, Dougé J, Cavanaugh RM, Lacroix AE, Fanburg J, Rahmandar MH, Hornberger LL, Schneider MB, Yen S, Chilton LA, Green AE, Dilley KJ, Gutierrez JR, Duffee JH, Keane VA, Krugman SD, McKelvey CD, Linton JM, Nelson JL, Mattson G, Breuner CC, Alderman EM, Grubb LK, Lee J, Powers ME, Rahmandar MH, Upadhya KK, Wallace SB. The Impact of Racism on Child and Adolescent Health. Pediatrics 2019; 144:peds.2019-1765. [PMID: 31358665 DOI: 10.1542/peds.2019-1765] [Citation(s) in RCA: 515] [Impact Index Per Article: 103.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The American Academy of Pediatrics is committed to addressing the factors that affect child and adolescent health with a focus on issues that may leave some children more vulnerable than others. Racism is a social determinant of health that has a profound impact on the health status of children, adolescents, emerging adults, and their families. Although progress has been made toward racial equality and equity, the evidence to support the continued negative impact of racism on health and well-being through implicit and explicit biases, institutional structures, and interpersonal relationships is clear. The objective of this policy statement is to provide an evidence-based document focused on the role of racism in child and adolescent development and health outcomes. By acknowledging the role of racism in child and adolescent health, pediatricians and other pediatric health professionals will be able to proactively engage in strategies to optimize clinical care, workforce development, professional education, systems engagement, and research in a manner designed to reduce the health effects of structural, personally mediated, and internalized racism and improve the health and well-being of all children, adolescents, emerging adults, and their families.
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Affiliation(s)
- Maria Trent
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Danielle G. Dooley
- Division of General Pediatrics and Community Health and Child Health Advocacy Institute, Children’s National Health System, Washington, District of Columbia; and
| | - Jacqueline Dougé
- Medical Director, Howard County Health Department, Columbia, Maryland
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Loureiro F, Figueiredo MH, Charepe Z. Nursing care satisfaction from school‐aged children's perspective: An integrative review. Int J Nurs Pract 2019; 25:e12764. [DOI: 10.1111/ijn.12764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 02/25/2019] [Accepted: 06/02/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Fernanda Loureiro
- Escola Superior de Saúde Egas Moniz Caparica Portugal
- Center for Interdisciplinary Research in Health (CIIS)Universidade Católica Portuguesa Lisbon Portugal
| | - Maria Henriqueta Figueiredo
- Centre for Health Technologies and Services Research (CINTESIS)Escola Superior de Enfermagem do Porto Porto Portugal
| | - Zaida Charepe
- Center for Interdisciplinary Research in Health (CIIS)Universidade Católica Portuguesa Lisbon Portugal
- Centre for Health Technologies and Services Research (CINTESIS)Escola Superior de Enfermagem do Porto Porto Portugal
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25
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Semple-Hess JE, Pham PK, Cohen SA, Liberman DB. Community Resource Needs Assessment Among Families Presenting to a Pediatric Emergency Department. Acad Pediatr 2019; 19:378-385. [PMID: 30471361 DOI: 10.1016/j.acap.2018.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/13/2018] [Accepted: 11/17/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To identify community resource needs among families presenting to a pediatric emergency department (PED). METHODS A convenience sample of English- and Spanish-speaking caregivers residing in Los Angeles County who presented to the PED of a large urban children's hospital were surveyed. The needs assessment survey assessed demographics, food insecurity, and previous and anticipated need for 12 common community resources. RESULTS Of 768 caregivers who completed the survey, 75% identified as Hispanic/Latinx. Across all survey participants, 83% used at least 1 resource in the past, and 67% anticipated needing at least 1 resource in the next 12 months. Low-cost/free health clinics were the most common resources used in the past and needed for the future. Caregivers with younger children tended to need baby formula/breastfeeding and women's health resources, whereas caregivers with older children tended to need safe housing, subsidized utilities, and counseling/therapy. Many families who needed resources in the past and for the future resided south of the children's hospital where median household income was relatively lower than in other areas of the county. A pattern of heightened use emerged among caregivers who primarily spoke Spanish. On average, caregivers reported feeling comfortable approaching hospital staff about community resources. CONCLUSIONS We found significant needs for community resources among families who presented to an urban PED. Needs were particularly salient among Spanish-speaking families and families living in close proximity to the children's hospital. Findings from this study help to inform future work connecting families to community resources.
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Affiliation(s)
- Janet E Semple-Hess
- Division of Emergency and Transport Medicine (JE Semple-Hess, PK Pham, and DB Liberman), Children's Hospital Los Angeles; Department of Pediatrics (JE Semple-Hess and DB Liberman), Keck School of Medicine, University of Southern California, Los Angeles.
| | - Phung K Pham
- Division of Emergency and Transport Medicine (JE Semple-Hess, PK Pham, and DB Liberman), Children's Hospital Los Angeles; Division of Behavioral and Organizational Sciences (PK Pham), Claremont Graduate University of the Claremont Colleges, Claremont
| | - Samuel A Cohen
- Department of Preventive Medicine (SA Cohen), Keck School of Medicine, University of Southern California, Los Angeles
| | - Danica B Liberman
- Division of Emergency and Transport Medicine (JE Semple-Hess, PK Pham, and DB Liberman), Children's Hospital Los Angeles; Department of Pediatrics (JE Semple-Hess and DB Liberman), Keck School of Medicine, University of Southern California, Los Angeles
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Angier H, Huguet N, Marino M, Green B, Holderness H, Gold R, Hoopes M, DeVoe J. Observational study protocol for evaluating control of hypertension and the effects of social determinants. BMJ Open 2019; 9:e025975. [PMID: 30878987 PMCID: PMC6429873 DOI: 10.1136/bmjopen-2018-025975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Hypertension is a common chronic health condition. Having health insurance reduces hypertension risk; health insurance coverage could improve hypertension screening, treatment and management. The Medicaid eligibility expansion of the Affordable Care Act was ruled not to be required by the US Supreme Court. Subsequently, a 'natural experiment' was produced with some states expanding Medicaid eligibility while others did not. This presents a unique opportunity to learn whether and to what extent Medicaid expansion can affect healthcare access and services for patients at risk for and diagnosed with hypertension, and patients with undiagnosed hypertension. Additionally, social determinants of health (SDH), at both the individual- and community-level, influence diagnosis and care for hypertension and it is important to understand how they interact with health insurance coverage changes. METHODS/DESIGN We will use electronic health record (EHR) data from the Accelerating Data Value Across a National Community Health Center Network clinical data research network, which has data from community health centres in 22 states, some that did and some that did not expand Medicaid. Data include information on changes in health insurance, service receipt and health outcomes from 2012 through the most recent data available. We will include patients between the ages of 19 and 64 years (n=1 524 241) with ≥1 ambulatory visit to a community health centre. We will estimate differences in outcomes using difference-in-difference and difference-in-difference-in-difference approaches. We will test three-way interactions with insurance group, time and social determinants of health factors to compare the potential effect of gaining insurance on our proposed outcomes. ETHICS AND DISSEMINATION This study uses secondary data analysis and therefore approval for consent to participate was waived. The Institutional Review Board for OHSU approved this study. Approval reference number is: IRB00011858. We plan to disseminate our findings at relevant conferences, meetings and through peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03545763.
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Affiliation(s)
- Heather Angier
- Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Nathalie Huguet
- Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Miguel Marino
- Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Beverly Green
- Research, Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Heather Holderness
- Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Jennifer DeVoe
- Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Bjur KA, Wi CI, Ryu E, Derauf C, Crow SS, King KS, Juhn YJ. Socioeconomic Status, Race/Ethnicity, and Health Disparities in Children and Adolescents in a Mixed Rural-Urban Community-Olmsted County, Minnesota. Mayo Clin Proc 2019; 94:44-53. [PMID: 30611453 PMCID: PMC6360526 DOI: 10.1016/j.mayocp.2018.06.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/21/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize disparities in childhood health outcomes by socioeconomic status (SES) and race/ethnicity in a mixed rural-urban US community. METHODS This was a retrospective population-based study of children 18 years and younger residing in Olmsted County, Minnesota, in 2009. The prevalence rates of childhood health outcomes were determined using International Classification of Diseases, Ninth Revision codes. Socioeconomic status was measured using the HOUsing-based SocioEconomic Status index (HOUSES), derived from real property data. Adjusting for age and sex, logistic regression models were used to examine the relationships among HOUSES, race/ethnicity, and prevalence of childhood health outcomes considering an interaction between HOUSES and race/ethnicity. Odds ratios were calculated using the lowest SES quartile and non-Hispanic white participants as the reference groups. RESULTS Of 31,523 eligible children, 51% were male and 86% were of non-Hispanic white race/ethnicity. Overall, lower SES was associated with higher prevalence of bronchiolitis, urinary tract infection, asthma, mood disorder, and accidents/adverse childhood experiences (physical and sexual abuse) in a dose-response manner (P<.04). Prevalence rates of all childhood conditions considered except for epilepsy were significantly different across races/ethnicities (P<.002). Racial/ethnic disparities for asthma and mood disorder were greater with higher SES. CONCLUSION Significant health disparities are present in a predominantly affluent, non-Hispanic white, mixed rural-urban community. Socioeconomic status modifies disparities by race/ethnicity in clinically less overt conditions. Interpretation of future health disparity research should account for the nature of disease.
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Affiliation(s)
- Kara A Bjur
- Department of Anesthesiology, Mayo Clinic, Rochester, MN
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Euijung Ryu
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Chris Derauf
- Department of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Sheri S Crow
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Katherine S King
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Young J Juhn
- Department of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
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Angier H, Jacobs EA, Huguet N, Likumahuwa-Ackman S, Robert S, DeVoe JE. Progress towards using community context with clinical data in primary care. Fam Med Community Health 2018; 7:e000028. [PMID: 32148692 PMCID: PMC6951248 DOI: 10.1136/fmch-2018-000028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 11/03/2022] Open
Abstract
Community-level factors have significant impacts on health. There is renewed enthusiasm for integrating these data with electronic health record (EHR) data for use in primary care to improve health equity in the USA. Thus, it is valuable to reflect on what has been published to date. Specifically, we comment on: (1) recommendations about combining community-level factors in EHRs for use in primary care; (2) examples of how these data have been combined and used; and (3) the impact of using combined data on healthcare, patient health and health equity. We found publications discussing the potential of combined data to inform clinical care, target interventions, track population health and spark community partnerships with the goal of reducing health disparities and improving health equity. Although there is great enthusiasm and potential for using these data to inform primary care, there is little evidence of improved healthcare, patient health or health equity.
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Affiliation(s)
- Heather Angier
- Oregon Health & Science University, Portland, Oregon, USA
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29
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Shenoda S, Kadir A, Pitterman S, Goldhagen J, Suchdev PS, Chan KJ, Howard CR, McGann P, St Clair NE, Yun K, Arnold LD. The Effects of Armed Conflict on Children. Pediatrics 2018; 142:peds.2018-2585. [PMID: 30397166 DOI: 10.1542/peds.2018-2585] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Children are increasingly exposed to armed conflict and targeted by governmental and nongovernmental combatants. Armed conflict directly and indirectly affects children's physical, mental, and behavioral health. It can affect every organ system, and its impact can persist throughout the life course. In addition, children are disproportionately impacted by morbidity and mortality associated with armed conflict. A children's rights-based approach provides a framework for collaboration by the American Academy of Pediatrics, child health professionals, and national and international partners to respond in the domains of clinical care, systems development, and policy formulation. The American Academy of Pediatrics and child health professionals have critical and synergistic roles to play in the global response to the impact of armed conflict on children.
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Affiliation(s)
- Sherry Shenoda
- Division of Community and Societal Pediatrics, University of Florida College of Medicine–Jacksonville, Jacksonville, Florida
| | - Ayesha Kadir
- Centre for Social Paediatrics, Herlev Hospital, Herlev, Denmark; and
| | - Shelly Pitterman
- United Nations High Commissioner for Refugees, Washington, District of Columbia
| | - Jeffrey Goldhagen
- Division of Community and Societal Pediatrics, University of Florida College of Medicine–Jacksonville, Jacksonville, Florida
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30
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Cohen-Silver J, Adams S, Agrawal R, Birken C, Cohen E, Dougherty G, Houtrow A, Jegathesan T, Kandasamy S, Muskat B, Pai N, Maguire JL. Development of the Pediatric Social Risk Instrument Using a Structured Panel Approach. Clin Pediatr (Phila) 2018; 57:1414-1422. [PMID: 30003793 DOI: 10.1177/0009922818784959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Social determinants of health impact child illness. Currently, no instrument exists to identify social need during hospital admission. METHODS Using the UCLA (University of California Los Angeles)-RAND appropriateness method, consensus was reached for an instrument to identify social need in hospitalized children. A panel of 11 experts reviewed candidate indicators through 3 rounds to reach consensus. The instrument then underwent usability testing. RESULTS Three hundred and forty-seven indicators from the literature were sorted into 18 social risk themes. After 3 rounds, consensus was reached on 82 indicators. Six additional social risk themes were recommended by the panel, resulting in consensus for 18 additional indicators. Final refinement resulted in an instrument containing 86 indicators representing 11 social risk themes. Usability testing identified that the tool was well received by families. Final feedback was incorporated into a post-usability instrument. CONCLUSIONS Using the UCLA-RAND appropriateness method, a new pediatric social risk instrument was created to identify social need for hospitalized children.
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Affiliation(s)
- Justine Cohen-Silver
- 1 The Hospital for Sick Children, Toronto, Ontario, Canada.,2 Deparment of Pediatrics, St Michael's Hospital, Toronto, Ontario, Canada.,3 Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Sherri Adams
- 1 The Hospital for Sick Children, Toronto, Ontario, Canada.,2 Deparment of Pediatrics, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Catherine Birken
- 1 The Hospital for Sick Children, Toronto, Ontario, Canada.,3 Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Eyal Cohen
- 1 The Hospital for Sick Children, Toronto, Ontario, Canada.,3 Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
| | | | - Amy Houtrow
- 6 University of Pittsburgh, Pittsburgh, PA, USA
| | - Thivia Jegathesan
- 2 Deparment of Pediatrics, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Barbara Muskat
- 1 The Hospital for Sick Children, Toronto, Ontario, Canada.,3 Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Nikhil Pai
- 7 McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Jonathon L Maguire
- 1 The Hospital for Sick Children, Toronto, Ontario, Canada.,2 Deparment of Pediatrics, St Michael's Hospital, Toronto, Ontario, Canada.,3 Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada.,8 Li Ka Shing Knowledge Institute, St. Michael's Hosptial
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Watt RG, Mathur MR, Aida J, Bönecker M, Venturelli R, Gansky SA. Oral Health Disparities in Children: A Canary in the Coalmine? Pediatr Clin North Am 2018; 65:965-979. [PMID: 30213357 DOI: 10.1016/j.pcl.2018.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite being largely preventable, oral diseases are still a major public health problem in child populations in many parts of the world. Increasingly, however, oral diseases disproportionately affect socially disadvantaged groups in society. It is unjust and unfair that children and families from disadvantaged backgrounds experience high levels of oral diseases. This article analyzes oral diseases through a health disparities lens. Action to combat oral health disparities requires a radical multifaceted strategy that addresses the shared underlying root causes of oral diseases, the social determinants of health inequality.
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Affiliation(s)
- Richard G Watt
- Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
| | - Manu Raj Mathur
- Department of Dental Public Health, Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, Gurgaon, Haryana 122002, India
| | - Jun Aida
- Department of International Health, Graduate School of Dentistry, Tohoku University, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Marcelo Bönecker
- Dental Faculty, Av. Prof Lineu Prestes 2227 - University of Sao Paulo, Sao Paulo 05508-900, Brazil
| | - Renato Venturelli
- Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Stuart A Gansky
- Division of Oral Epidemiology and Dental Public Health, Center to Address Disparities in Children's Oral Health (Known As CAN DO), Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, Box #1361, San Francisco, CA 94143, USA
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32
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Desapriya E, Khoshpouri P. Investing appropriately to alleviate child poverty in Canada. CMAJ 2018; 190:E805-E806. [PMID: 29970372 DOI: 10.1503/cmaj.69470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ediriweera Desapriya
- Research associate, Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Parisa Khoshpouri
- Research assistant, Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC
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Ethics of End of Life Decisions in Pediatrics: A Narrative Review of the Roles of Caregivers, Shared Decision-Making, and Patient Centered Values. Behav Sci (Basel) 2018; 8:bs8050042. [PMID: 29701637 PMCID: PMC5981236 DOI: 10.3390/bs8050042] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/17/2018] [Accepted: 04/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background: This manuscript reviews unique aspects of end of life decision-making in pediatrics. Methods: A narrative literature review of pediatric end of life issues was performed in the English language. Results: While a paternalistic approach is typically applied to children with life-limiting medical prognoses, the cognitive, language, and physical variability in this patient population is wide and worthy of review. In end of life discussions in pediatrics, the consideration of a child’s input is often not reviewed in depth, although a shared decision-making model is ideal for use, even for children with presumed limitations due to age. This narrative review of end of life decision-making in pediatric care explores nomenclature, the introduction of the concept of death, relevant historical studies, limitations to the shared decision-making model, the current state of end of life autonomy in pediatrics, and future directions and needs. Although progress is being made toward a more uniform and standardized approach to care, few non-institutional protocols exist. Complicating factors in the lack of guidelines include the unique facets of pediatric end of life care, including physical age, paternalism, the cognitive and language capacity of patients, subconscious influencers of parents, and normative values of death in pediatrics. Conclusions: Although there have been strides in end of life decision-making in pediatrics, further investigation and research is needed in this field.
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Stein F, Remley K, Laraque-Arena D, Pursley DM. New Resources and Strategies to Advance the AAP's Values of Diversity, Inclusion, and Health Equity. Pediatrics 2018; 141:peds.2018-0177. [PMID: 29555688 DOI: 10.1542/peds.2018-0177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Karen Remley
- American Academy of Pediatrics, Itasca, Illinois;
| | | | - DeWayne M Pursley
- Beth Israel Deaconess Medical Center, Boston, Massachusetts; and.,Harvard Medical School, Harvard University, Boston, Massachusetts
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35
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Rosenthal L, Earnshaw VA, Moore JM, Ferguson DN, Lewis TT, Reid AE, Lewis JB, Stasko EC, Tobin JN, Ickovics JR. Intergenerational Consequences: Women's Experiences of Discrimination in Pregnancy Predict Infant Social-Emotional Development at 6 Months and 1 Year. J Dev Behav Pediatr 2018; 39:228-237. [PMID: 29176360 PMCID: PMC5866165 DOI: 10.1097/dbp.0000000000000529] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Racial/ethnic and socioeconomic disparities in infant development in the United States have lifelong consequences. Discrimination predicts poorer health and academic outcomes. This study explored for the first time intergenerational consequences of women's experiences of discrimination reported during pregnancy for their infants' social-emotional development in the first year of life. METHODS Data come from a longitudinal study with predominantly Black and Latina, socioeconomically disadvantaged, urban young women (N = 704, Mage = 18.53) across pregnancy through 1 year postpartum. Women were recruited from community hospitals and health centers in a Northeastern US city. Linear regression analyses examined whether women's experiences of everyday discrimination reported during pregnancy predicted social-emotional development outcomes among their infants at 6 months and 1 year of age, controlling for potentially confounding medical and sociodemographic factors. Path analyses tested if pregnancy distress, anxiety, or depressive symptoms mediated significant associations. RESULTS Everyday discrimination reported during pregnancy prospectively predicted greater inhibition/separation problems and greater negative emotionality, but did not predict attention skills or positive emotionality, at 6 months and 1 year. Depressive symptoms mediated the association of discrimination with negative emotionality at 6 months, and pregnancy distress, anxiety, and depressive symptoms mediated the association of discrimination with negative emotionality at 1 year. CONCLUSION Findings support that there are intergenerational consequences of discrimination, extending past findings to infant social-emotional development outcomes in the first year of life. It may be important to address discrimination before and during pregnancy and enhance support to mothers and infants exposed to discrimination to promote health equity across the life span.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jonathan N. Tobin
- Clinical Directors Network, New York, New York
- The Rockefeller University Center for Clinical and Translational Science, New York, New York
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Greenbaum J, Bodrick N, Flaherty EG, Idzerda SM, Laskey A“T, Legano LA, Leventhal JM, Gavril AR, Suchdev PS, Chan KJ, Howard CR, McGann PT, St. Clair NE, Yun K. Global Human Trafficking and Child Victimization. Pediatrics 2017; 140:peds.2017-3138. [PMID: 29180462 DOI: 10.1542/peds.2017-3138] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Trafficking of children for labor and sexual exploitation violates basic human rights and constitutes a major global public health problem. Pediatricians and other health care professionals may encounter victims who present with infections, injuries, posttraumatic stress disorder, suicidality, or a variety of other physical or behavioral health conditions. Preventing child trafficking, recognizing victimization, and intervening appropriately require a public health approach that incorporates rigorous research on the risk factors, health impact, and effective treatment options for child exploitation as well as implementation and evaluation of primary prevention programs. Health care professionals need training to recognize possible signs of exploitation and to intervene appropriately. They need to adopt a multidisciplinary, outward-focused approach to service provision, working with nonmedical professionals in the community to assist victims. Pediatricians also need to advocate for legislation and policies that promote child rights and victim services as well as those that address the social determinants of health, which influence the vulnerability to human trafficking. This policy statement outlines major issues regarding public policy, medical education, research, and collaboration in the area of child labor and sex trafficking and provides recommendations for future work.
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Affiliation(s)
- Jordan Greenbaum
- Stephanie V. Blank Center for Safe and Healthy Children at Children’s Healthcare of Atlanta, Atlanta, Georgia
- International Centre for Missing and Exploited Children, Alexandria, Virginia; and
| | - Nia Bodrick
- Unity Health Care, Inc, Washington, District of Columbia
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Abstract
Healthy sexual development is important for adolescents with and without disabilities, yet the topic of sexuality is often ignored in the disabled population. Adolescents with mild or moderate degrees of disability have rates of sexual activity and reproductive health needs comparable to their typically developing peers. Their need for support, risk reduction, and education in sexual health may exceed that of their peers. The medical provider may support healthy sexual development through education, anticipatory guidance, menstrual and contraceptive management, and by expanding the notion of sexuality to include a broader conceptualization of sexual behavior and expression.
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Affiliation(s)
- Cynthia Holland-Hall
- Section of Adolescent Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Elisabeth H Quint
- Obstetrics and Gynecology, University of Michigan Medical School, 1500 East Medical Center Drive, Women's L 4000, Ann Arbor, MI 48109, USA
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38
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Oberg C, Colianni S, King-Schultz L. Child Health Disparities in the 21st Century. Curr Probl Pediatr Adolesc Health Care 2016; 46:291-312. [PMID: 27712646 DOI: 10.1016/j.cppeds.2016.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The topic of persistent child health disparities remains a priority for policymakers and a concern for pediatric clinicians. Health disparities are defined as differences in adverse health outcomes for specific health indicators that exist across sub-groups of the population, frequently between minority and majority populations. This review will highlight the gains that have been made since the 1990s as well as describe disparities that have persisted or have worsened into the 21st century. It will also examine the most potent social determinants and their impact on the major disparities in mortality, preventive care, chronic disease, mental health, educational outcomes, and exposure to selected environmental toxins. Each section concludes with a description of interventions and innovations that have been successful in reducing child health disparities.
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Affiliation(s)
- Charles Oberg
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; Department of Pediatrics, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN
| | - Sonja Colianni
- Department of Pediatrics, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN
| | - Leslie King-Schultz
- Department of Pediatrics, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN
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Natale JE, Joseph JG, Rogers AJ, Tunik M, Monroe D, Kerrey B, Bonsu BK, Cook LJ, Page K, Adelgais K, Quayle K, Kuppermann N, Holmes JF. Relationship of Physician-identified Patient Race and Ethnicity to Use of Computed Tomography in Pediatric Blunt Torso Trauma. Acad Emerg Med 2016; 23:584-90. [PMID: 26914184 DOI: 10.1111/acem.12943] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 12/02/2015] [Accepted: 12/14/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective was to determine whether a child's race or ethnicity as determined by the treating physician is independently associated with receiving abdominal computed tomography (CT) after blunt torso trauma. METHODS We performed a planned secondary analysis of a prospective observational cohort of children < 18 years old presenting within 24 hours of blunt torso trauma to 20 North American emergency departments (EDs) participating in a pediatric research network, 2007-2010. Treating physicians documented race/ethnicity as white non-Hispanic, black non-Hispanic, or Hispanic. Using a previously derived clinical prediction rule, we classified each child's risk for having an intra-abdominal injury undergoing acute intervention to define injury severity. We performed multivariable analyses using generalized estimating equations to control for confounding and for clustering of children within hospitals. RESULTS Among 12,044 enrolled patients, treating physicians documented race/ethnicity as white non-Hispanic (n = 5,847, 54.0%), black non-Hispanic (n = 3,687, 34.1%), or Hispanic of any race (n = 1,291, 11.9%). Overall, 51.8% of white non-Hispanic, 32.7% of black non-Hispanic, and 44.2% of Hispanic children underwent abdominal CT imaging. After age, sex, abdominal ultrasound use, risk for intra-abdominal injury undergoing acute intervention, and hospital clustering were adjusted for, the likelihood of receiving an abdominal CT was lower (odds ratio [OR] = 0.8, 95% confidence interval [CI] = 0.7 to 0.9) for black non-Hispanic than for white non-Hispanic children. For Hispanic children, the likelihood of receiving an abdominal CT did not differ from that observed in white non-Hispanic children (OR = 0.9, 95% CI = 0.8 to 1.1). CONCLUSIONS After blunt torso trauma, pediatric patients identified by the treating physicians as black non-Hispanic were less likely to receive abdominal CT imaging than those identified as white non-Hispanic. This suggests that nonclinical factors influence clinician decision-making regarding use of abdominal CT in children. Further studies should focus on explaining how patient race can affect provider choices regarding ED radiographic imaging.
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Affiliation(s)
- JoAnne E. Natale
- Department of Pediatrics; University of California at Davis; Sacramento CA
| | - Jill G. Joseph
- Betty Irene Moore School of Nursing; University of California at Davis; Sacramento CA
| | - Alexander J. Rogers
- Departments of Emergency Medicine and Pediatrics; University of Michigan Medical Center and University of Michigan School of Medicine; Ann Arbor MI
| | - Michael Tunik
- Departments of Pediatrics and Emergency Medicine; New York University School of Medicine; New York City NY
| | | | - Benjamin Kerrey
- Department of Pediatrics; Cincinnati Children's Hospital; Cincinnati OH
| | - Bema K. Bonsu
- Department of Pediatrics; Nationwide Children's Hospital; Columbus OH
- Department of Pediatrics; University of California at San Diego; San Diego CA
| | | | - Kent Page
- University of Utah; Salt Lake City UT
| | - Kathleen Adelgais
- Department of Pediatrics and Emergency Medicine; University of Colorado; Denver CO
| | - Kimberly Quayle
- St. Louis Children's Hospital; Washington University; St. Louis MO
| | - Nathan Kuppermann
- Department of Pediatrics; University of California at Davis; Sacramento CA
- Department of Emergency Medicine; University of California at Davis; Sacramento CA
| | - James F. Holmes
- Department of Emergency Medicine; University of California at Davis; Sacramento CA
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Abstract
Almost half of young children in the United States live in poverty or near poverty. The American Academy of Pediatrics is committed to reducing and ultimately eliminating child poverty in the United States. Poverty and related social determinants of health can lead to adverse health outcomes in childhood and across the life course, negatively affecting physical health, socioemotional development, and educational achievement. The American Academy of Pediatrics advocates for programs and policies that have been shown to improve the quality of life and health outcomes for children and families living in poverty. With an awareness and understanding of the effects of poverty on children, pediatricians and other pediatric health practitioners in a family-centered medical home can assess the financial stability of families, link families to resources, and coordinate care with community partners. Further research, advocacy, and continuing education will improve the ability of pediatricians to address the social determinants of health when caring for children who live in poverty. Accompanying this policy statement is a technical report that describes current knowledge on child poverty and the mechanisms by which poverty influences the health and well-being of children.
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Stein REK, Hurlburt MS, Heneghan AM, Zhang J, Kerker B, Landsverk J, Horwitz SM. For Better or Worse? Change in Service Use by Children Investigated by Child Welfare Over a Decade. Acad Pediatr 2016; 16:240-6. [PMID: 26851614 PMCID: PMC5560869 DOI: 10.1016/j.acap.2016.01.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 01/25/2016] [Accepted: 01/29/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Children, particularly minority children, referred to child welfare because of suspected maltreatment are vulnerable and need many services. We sought to assess whether service use has improved over the past decade and whether racial-ethnic disparities in service use have decreased. METHODS We used 2 national data sets (the National Survey of Child and Adolescent Well-Being [NSCAW] I and II) collected a decade apart to assess changes over time in health, education, mental health (MH), and dental services and overall service use. RESULTS In NSCAW II more children were young, had lower Child Behavior Checklist (CBCL) scores, and were Hispanic. We found significant increases in dental services, a decrease in special education services, and a decrease in MH services on the bivariate level (all P < .01). A large proportion of the change in MH services occurred in school settings, but the pattern continued when examining only those services delivered outside of school. The greatest decrease occurred for children with CBCL scores <64. However, in multivariate analyses, older children, white non-Hispanic children, and children placed out of the home were significantly more likely to receive MH services. Rates of MH services controlling for CBCL scores showed no improvement over the decade, nor was there a decrease in racial and ethnic disparities. CONCLUSIONS These data showed no change in MH services over time for children referred for child welfare evaluation, but improvement in dental services was noted. Racial and ethnic disparities persist. Decrease in MH services occurred predominantly among children whose MH symptoms were below the clinical range.
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Affiliation(s)
- Ruth E K Stein
- Albert Einstein College of Medicine/Children's Hospital at Montefiore, New York, NY.
| | - Michael S Hurlburt
- School of Social Work, University of Southern California, Los Angeles, Calif; Child and Adolescent Services Research Center, Rady Children's Hospital, San Diego, Calif
| | - Amy M Heneghan
- Palo Alto Medical Foundation, Palo Alto, Calif; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jinjin Zhang
- Child and Adolescent Services Research Center, Rady Children's Hospital, San Diego, Calif
| | - Bonnie Kerker
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY
| | - John Landsverk
- Child and Adolescent Services Research Center, Rady Children's Hospital, San Diego, Calif
| | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY
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Affiliation(s)
- James Herbert Williams
- James Herbert Williams, PhD, MSW, is dean and Milton Morris Endowed Chair, Graduate School of Social Work, University of Denver, Craig Hall, Room 308, 2148 South High Street, Denver, CO 80208; Eric A. Des Marais, MSW, is a doctoral candidate, Graduate School of Social Work, University of Denver
| | - Eric A. Des Marais
- James Herbert Williams, PhD, MSW, is dean and Milton Morris Endowed Chair, Graduate School of Social Work, University of Denver, Craig Hall, Room 308, 2148 South High Street, Denver, CO 80208; Eric A. Des Marais, MSW, is a doctoral candidate, Graduate School of Social Work, University of Denver
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Cheng TL, Emmanuel MA, Levy DJ, Jenkins RR. Child Health Disparities: What Can a Clinician Do? Pediatrics 2015; 136:961-8. [PMID: 26459644 PMCID: PMC4621792 DOI: 10.1542/peds.2014-4126] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 12/12/2022] Open
Abstract
Pediatric primary and specialty practice has changed, with more to do, more regulation, and more family needs than in the past. Similarly, the needs of patients have changed, with more demographic diversity, family stress, and continued health disparities by race, ethnicity, and socioeconomic status. How can clinicians continue their dedicated service to children and ensure health equity in the face of these changes? This article outlines specific, practical, actionable, and evidence-based activities to help clinicians assess and address health disparities in practice. These tools may also support patient-centered medical home recognition, national and state cultural and linguistic competency standards, and quality benchmarks that are increasingly tied to payment. Clinicians can play a critical role in (1) diagnosing disparities in one's community and practice, (2) innovating new models to address social determinants of health, (3) addressing health literacy of families, (4) ensuring cultural competence and a culture of workplace equity, and (5) advocating for issues that address the root causes of health disparities. Culturally competent care that is sensitive to the needs, health literacy, and health beliefs of families can increase satisfaction, improve quality of care, and increase patient safety. Clinical care approaches to address social determinants of health and interrupting the intergenerational cycle of disadvantage include (1) screening for new health "vital signs" and connecting families to resources, (2) enhancing the comprehensiveness of services, (3) addressing family health in pediatric encounters, and (4) moving care outside the office into the community. Health system investment is required to support clinicians and practice innovation to ensure equity.
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Affiliation(s)
- Tina L Cheng
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Baltimore, Maryland;
| | | | - Daniel J Levy
- Child and Teen Wellness Center, Owings Mill, Maryland; and
| | - Renee R Jenkins
- Department of Pediatrics and Child Health, Howard University, Washington, District of Columbia
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44
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Affiliation(s)
- Sherry Shenoda
- Department of Pediatrics, University of Florida, Jacksonville, Florida; and
| | - Ayesha Kadir
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jeffrey Goldhagen
- Department of Pediatrics, University of Florida, Jacksonville, Florida; and
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Villanueva K, Badland H, Giles-Corti B, Goldfeld S. Using spatial analysis of the Australian Early Development Index to advance our understanding of 'neighbourhood effects' research on child health and development. J Paediatr Child Health 2015; 51:577-9. [PMID: 25643593 DOI: 10.1111/jpc.12822] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Karen Villanueva
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.,McCaughey VicHealth Centre for Community Wellbeing, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Hannah Badland
- McCaughey VicHealth Centre for Community Wellbeing, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Billie Giles-Corti
- McCaughey VicHealth Centre for Community Wellbeing, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sharon Goldfeld
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia
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46
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Goldhagen J, Mercer R, Robinson G, Duran E, Webb E, Ehrich J. Establishing a child rights, health equity, and social justice-based practice of pediatrics. J Pediatr 2015; 166:1098-9.e1-3. [PMID: 25819914 DOI: 10.1016/j.jpeds.2014.12.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jeffrey Goldhagen
- University of Florida, College of Medicine-Jacksonville, Jacksonville, FL
| | - Raul Mercer
- Program of Social Sciences and Health, FLACSO (Latin American School of Social Sciences), Buenos Aires, Argentina
| | - Gary Robinson
- Child Rights Education for Professionals (CRED-PRO), IICRD, University of Victoria, Victoria, British Columbia, Canada
| | - Ernesto Duran
- Observatory of Child Rights, National University, Bogota, Colombia
| | - Elspeth Webb
- Department of Child Health, Cardiff University School of Medicine, Cardiff, Wales
| | - Jochen Ehrich
- Children's Hospital, Hannover Medical School, Hannover, Germany
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Abstract
An extensive literature documents the existence of pervasive and persistent child health, development, and health care disparities by race, ethnicity, and socioeconomic status (SES). Disparities experienced during childhood can result in a wide variety of health and health care outcomes, including adult morbidity and mortality, indicating that it is crucial to examine the influence of disparities across the life course. Studies often collect data on the race, ethnicity, and SES of research participants to be used as covariates or explanatory factors. In the past, these variables have often been assumed to exert their effects through individual or genetically determined biologic mechanisms. However, it is now widely accepted that these variables have important social dimensions that influence health. SES, a multidimensional construct, interacts with and confounds analyses of race and ethnicity. Because SES, race, and ethnicity are often difficult to measure accurately, leading to the potential for misattribution of causality, thoughtful consideration should be given to appropriate measurement, analysis, and interpretation of such factors. Scientists who study child and adolescent health and development should understand the multiple measures used to assess race, ethnicity, and SES, including their validity and shortcomings and potential confounding of race and ethnicity with SES. The American Academy of Pediatrics (AAP) recommends that research on eliminating health and health care disparities related to race, ethnicity, and SES be a priority. Data on race, ethnicity, and SES should be collected in research on child health to improve their definitions and increase understanding of how these factors and their complex interrelationships affect child health. Furthermore, the AAP believes that researchers should consider both biological and social mechanisms of action of race, ethnicity, and SES as they relate to the aims and hypothesis of the specific area of investigation. It is important to measure these variables, but it is not sufficient to use these variables alone as explanatory for differences in disease, morbidity, and outcomes without attention to the social and biologic influences they have on health throughout the life course. The AAP recommends more research, both in the United States and internationally, on measures of race, ethnicity, and SES and how these complex constructs affect health care and health outcomes throughout the life course.
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Waterston T, Yilmaz G. Child Rights and Health Care: International Society for Social Pediatrics and Child Health (ISSOP) Position Statement. Child Care Health Dev 2014; 40:1-3. [PMID: 24588351 DOI: 10.1111/cch.12118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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49
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Webb E. Commentary on the ISSOP policy statement on the UNCRC and health. Child Care Health Dev 2014; 40:4-6. [PMID: 24588352 DOI: 10.1111/cch.12115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 11/29/2022]
Affiliation(s)
- E Webb
- IMEM, School of Medicine, Cardiff University, Cardiff, Wales, UK
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50
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Wolfe I. Disproportionate disadvantage of the young: Britain, the Unicef report on child well-being, and political choices. Arch Dis Child 2014; 99:6-9. [PMID: 24162009 DOI: 10.1136/archdischild-2013-304437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ingrid Wolfe
- Health Services Research and Policy, London School of Hygiene and Tropical Medicine, and Evelina London Children's Hospital, , London, UK
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