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Mekhail KT, Burström B, Marttila A, Wångdahl J, Lindberg L. Parents' comprehensive health literacy and child health after attending extended home visiting in Swedish multicultural settings-A case-comparison study. Scand J Caring Sci 2024. [PMID: 39101312 DOI: 10.1111/scs.13292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/16/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Parents' low health literacy (HL) has negative impacts on child health. Parental interventions may improve parents' HL and thus impact child health positively. OBJECTIVES This study aimed to gain knowledge about associations between parents' comprehensive HL (CHL) and child health after an extended postnatal home visiting program in Swedish multicultural, disadvantaged settings compared to parents receiving regular child healthcare (CHC). MATERIALS AND METHODS This quasi-experimental study used a case-control sampling method to recruit first-time parents through two CHC centres in Stockholm (2017-2020). Participants (N = 151) were interviewed twice through structured questionnaires when their child was <2 months and 15-18 months old. HLS-EU-Q16 assessed parents' CHL. Children's medical records (0-18 months) were reviewed regarding breastfeeding, children's exposure to smoking, language development and healthcare utilisation. Data were analysed with regression models and non-parametric tests. RESULTS No significant association was found between parents' CHL and child health. However, significantly fewer unplanned visits to the CHC centre were observed among children (0-18 months) in the intervention group irrespective of CHL, compared with children to parents with improved CHL in the comparison group (F = 3.856, p = 0.011). CONCLUSIONS Postnatal home visiting interventions practicing proportional universalism and family-centred care may reduce unplanned visits within CHC in disadvantaged settings despite parents' CHL. Further studies with long-term follow-up are suggested to explore associations between parents' CHL and child health. TRIAL REGISTRATION As a clinical study (not a clinical trial) with appropriate ethical permission with participants' consents, this study was retrospectively registered (18 February 2020) in the ISRCTN registry (ISRCTN10336603).
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Affiliation(s)
- Kirsi Tiitinen Mekhail
- Department of Global Public Health, K9, Karolinska Institute, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Bo Burström
- Department of Global Public Health, K9, Karolinska Institute, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Anneli Marttila
- Department of Global Public Health, K9, Karolinska Institute, Stockholm, Sweden
- Department of Social Work, Criminology and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Josefin Wångdahl
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Solna, Sweden
| | - Lene Lindberg
- Department of Global Public Health, K9, Karolinska Institute, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Stockholm, Sweden
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Kim HA, Yu AG, Kim NP, Iqbal MS, Butts R. Lower opportunity ZIP code is associated with worse outcomes after listing in pediatric heart transplantation. J Heart Lung Transplant 2024; 43:1298-1307. [PMID: 38704128 DOI: 10.1016/j.healun.2024.04.059] [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: 10/16/2023] [Revised: 03/14/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The Child Opportunity Index (COI) comprehensively measures children's social determinants of health. We describe association between COI and outcomes after listing for heart transplantation. METHODS We conducted a retrospective review of the United Network for Organ Sharing (UNOS) database for U.S. children listed for heart transplant between 2012 and 2020. ZIP codes were utilized to assign COI. Primary outcome was survival from time of listing. Secondary outcomes included waitlist survival, 1-year post-transplant survival, and conditional 1-year post-transplant survival. Cox regression was performed adjusting for payor, age, race, diagnosis, and support at listing for all outcomes except waitlist survival, for which Fine-Gray competing risk analysis was performed. RESULTS Of 5,723 children listed, 109 were excluded due to missing ZIP codes. Race/ethnicity and payor were associated with COI (p < 0.001). Patients living in very low COI ZIP codes compared to all others had increased mortality from time of listing (HR 1.16, CI 1.03-1.32, p = 0.02) with 1-, 5-, and 9-year survival of 79.3% vs 82.2%, 66.5% vs 73.0%, and 53.6% vs 64.7% respectively, were more likely to be removed from the waitlist due to death or being too sick (subdistribution HR 1.26, 95% CI 1.10-1.42), and had increased mortality conditional on one-year post-transplant survival (HR 1.38, 1.09-1.74, p = 0.008) with 1-, 3-, and 5- year survival of 94.7% vs 97.3%, 87.0% vs 93.1%, and 78.6% vs 86.9%. CONCLUSIONS Children living in lower opportunity ZIP codes had poorer survival from time of listing, poorer waitlist survival, and poorer conditional one-year post-transplant survival.
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Affiliation(s)
- Heidi A Kim
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas
| | - Andrew G Yu
- Division of Hospital Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas
| | - Nicole P Kim
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas
| | - Mehreen S Iqbal
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas
| | - Ryan Butts
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas.
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Coelho C, Pinho J, Pinto M, Pedrosa C, Costa H, Romariz J, Carvalho MI. Pediatric asthma knowledge: Insights from a Portuguese central hospital study. Pediatr Pulmonol 2024. [PMID: 39073035 DOI: 10.1002/ppul.27196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 06/12/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Asthma is a common chronic condition in children, with parental and child health literacy affecting health outcomes and asthma control. This study examined pediatric asthma knowledge at a Portuguese central hospital and its determinants. METHODS We conducted a comparative cross-sectional study, applying the Asthma Knowledge Questionnaire (QCSA), answered by adolescents and/or caregivers. The sample was categorized into two groups based on the presence or absence of respiratory conditions, such as asthma or recurrent wheezing, in children. Those with such conditions (Group A) were further divided into two subgroups: those receiving general pediatric care (Group A2) and those receiving specialized care, followed in pulmonology or allergology consultations (Group A1). RESULTS The study involved 154 participants, predominantly female (74%) with an average age of 31.2 years ( ± 13.4). The average QCSA score was 14.8 ( ± 3.2), and Group A exhibited a statistically higher score, 15.5 points ±3.2 versus Group B, 14.2 points ± 3.2, p = .034. Group A1 achieved significantly better scores (16 points: range 4-21) than Group A2 (14 points: range 9-21) (p = .029). Scores were correlated positively with the duration of specialized follow-up (ρ = .326; p = .027). Asthma knowledge was correlated with the level of education (r = .468; p < .001). The number of wheezing episodes (r = -.466; p < .001) within the past year were associated to QCSA scores. CONCLUSION In summary, the presence of respiratory condition, the follow-up in specialized appointments and higher levels of education were associated with greater asthma knowledge.
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Affiliation(s)
- Cristina Coelho
- Department of Immunology and Allergology, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Joana Pinho
- Department of Pediatrics, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Mariana Pinto
- Department of Pediatrics, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Cláudia Pedrosa
- Department of Pediatrics, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
- Pediatric Allergology and Pulmonology Unit, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Herculano Costa
- Department of Pediatrics, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
- Pediatric Allergology and Pulmonology Unit, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Jorge Romariz
- Department of Pediatrics, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
- Pediatric Allergology and Pulmonology Unit, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Maria I Carvalho
- Department of Pediatrics, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
- Pediatric Allergology and Pulmonology Unit, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
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Lepe A, Muhamed TAS, Reijneveld SA, de Kroon MLA. Mediation by parent health literacy and behaviour of socioeconomic inequality in child overweight. Pediatr Obes 2024:e13156. [PMID: 39075886 DOI: 10.1111/ijpo.13156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 06/14/2024] [Accepted: 07/10/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Socioeconomic inequalities contribute to childhood overweight. Identifying mediators could help reduce these inequalities. OBJECTIVE We assessed to what extent and how parental health literacy and health behaviours mediate the relationship between parental socioeconomic status and childhood overweight. METHODS Data were taken from the multigenerational prospective Dutch Lifelines Cohort Study. We included 6683 children, baseline age 9.8 years (SD = 2.6), with an average follow-up of 36.2 months (SD = 9.3). Overweight was defined using age- and sex-specific cut-offs. Three indicators of socioeconomic status were included: education, income and occupation. We assessed the mediating role of parental health literacy and health behaviours (smoking, diet, physical activity and alcohol) using causal mediation. RESULTS Four additional years of education and an SD-increase in both income and occupation decreased the odds of childhood overweight by 42%, 12% and 20%, respectively. Only parental smoking independently mediated the relationship of both education (6.6%) and occupation (5.7%) with overweight. Parental health behaviours jointly explained 8.4% (education), 19.4% (income) and 9.8% (occupation) per relationship. Lastly, adding parental health literacy explained 10.8% (education), 27.4% (income) and 13.3% (occupation) of these relationships. CONCLUSIONS We found large socioeconomic inequalities in childhood overweight. Remarkably, parental smoking was a key mediator. Therefore, prevention targeting smoking may reduce socioeconomic inequalities in childhood overweight.
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Affiliation(s)
- Alexander Lepe
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tamool A S Muhamed
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marlou L A de Kroon
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Zhong X, He M, Lei L, Li X, Pan C, Wang B, Pen L, Li X. Validation of the Chinese version of the autism spectrum knowledge scale general population version (ASKSG) with a parent sample. J Pediatr Nurs 2024:S0882-5963(24)00271-9. [PMID: 39048480 DOI: 10.1016/j.pedn.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND The early detection and diagnosis of autism spectrum disorder (ASD) in children are a first step in determining follow-up assessments and personalized treatment plans. Parents play an extremely crucial role in children's development; therefore, it is essential to identify a valid and reliable instrument to evaluate the knowledge of parents about ASD. The aim of this study was to translate and determine the psychometric properties of the Autism Spectrum Knowledge Scale General Population Version (ASKSG) with a parent sample. DESIGN AND METHODS A cross-sectional study was conducted with 858 parents of children aged 0-14 years in China. The demographic characteristics form and ASKSG were used for data collection. The psychometric properties of the ASKSG were evaluated by examining reliability, exploratory factor analysis (EFA), categorical confirmatory factor analysis (CCFA), unidimensionality, person and item reliability, item fit and item difficulty, and item-person mapping. RESULTS The Cronbach's alpha coefficient of the ASKSG was 0.865. In terms of EFA, principal component analysis revealed a fixed number of five factors, explaining 41.642% of the total variance. For the CCFA, the structure of the thematically derived five-factor model was observed to be a marginal fit to the data. The eigenvalue was 31.00, with a variance of 62.7%. The person reliability was 0.85, and the person separation was 2.38. The item reliability was 1.00, and the item separation was 15.02. The infit and outfit statistical analysis fell within acceptable ranges from 0.75 to 1.35, and the item difficulty ranged from -2.43 to 2.44. An item-person map with excellent targeting would be symmetric along the vertical axis from more difficult endorsement at the top (question 1 and question 20) to easier endorsement at the bottom (question 1). Some items do appear to function differently across sexes, and they assess the latent trait unequally across both sexes. CONCLUSIONS The Chinese version of the ASKSG is a reliable and valid tool for assessing knowledge of parents about ASD. PRACTICE IMPLICATIONS Chinese ASKSG now offers medical professionals and teachers a robust means of assessing parental knowledge about ASD. Therefore, professionals may use the scale to help them screen or identify parents who are in need of additional support or advice.
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Affiliation(s)
- Xiaoying Zhong
- Department of Nursing, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
| | - Mei He
- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Lei Lei
- Department of Nursing, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China; Philippines Women's University, Manila, Philippines
| | - Xixi Li
- Department of Nursing, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
| | - Changqing Pan
- Gynecology and obstetrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
| | - Bangjun Wang
- Department of Nursing, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
| | - Lin Pen
- Department of Nursing, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Xiaoyu Li
- Department of Nursing, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
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Meyers N, Costich M, Abrams MA, Friedman S, Gupta A, Morrison A, Wood M, Solano J. Prioritizing Health Literacy Educational Objectives for Pediatric Residents - A Delphi Study. Acad Pediatr 2024:S1876-2859(24)00234-1. [PMID: 38959997 DOI: 10.1016/j.acap.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/04/2024] [Accepted: 06/21/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE Children of caregivers with limited health literacy are at risk of poorer health outcomes. Thus, health literacy-informed communication tools are critical to achieving a more equitable health system. However, there is no agreement on the health literacy skills pediatric residents should attain. We used Delphi methodology to establish consensus on health literacy objectives to inform development of a pediatric resident curriculum. METHODS Our Delphi panel participated in three rounds of anonymous surveys to rank the importance of health literacy objectives in pediatric resident education. Consensus was defined as ≥70% of panelists identifying an objective as essential or 100% agreeing an objective was recommended or essential. RESULTS Thirteen pediatric health literacy experts comprised a racially, geographically, and professionally-diverse panel. After three survey rounds, 27 of the initial 65 objectives met consensus. All final objectives aligned with Accreditation Council for Graduate Medical Education (ACGME) core competencies. CONCLUSIONS A panel of pediatric health literacy experts established consensus on health literacy objectives specific to pediatric resident training. These prioritized objectives align with ACGME core competencies, as well as evidence-based strategies like teach-back, and newer considerations like addressing organizational health literacy. They should inform future health literacy curricula and assessment within pediatric residency programs.
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Affiliation(s)
- Nicole Meyers
- New York-Presbyterian/Columbia University Irving Medical Center (N Meyers), Department of Pediatrics, New York, NY.
| | - Marguerite Costich
- Columbia University Irving Medical Center (M Costich and S Friedman), Department of Pediatrics, New York, NY
| | - Mary Ann Abrams
- The Ohio State University College of Medicine (MA Abrams), Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Suzanne Friedman
- Columbia University Irving Medical Center (M Costich and S Friedman), Department of Pediatrics, New York, NY
| | - Aditi Gupta
- Baylor College of Medicine (A Gupta and M Wood), Department of Pediatrics, Houston, Tex
| | - Andrea Morrison
- North Valley Emergency Specialists, Glendale, AZ and CommunicateMD (A Morrison), Phoenix, AZ
| | - Margaret Wood
- Baylor College of Medicine (A Gupta and M Wood), Department of Pediatrics, Houston, Tex
| | - Joy Solano
- Children's Mercy Kansas City (J Solano), Department of Pediatrics, Kansas City, Mo
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Coffin A, Elder B, Luercio M, Ahuja N, Barber R, DeCamp LR, Encalada K, Fan AL, Farkas JS, Jain P, Johnson TM, Mallick N, Wilder JL, Yang TJ, Yin HS, Lion KC, Khan A. Creating Culturally Adapted Multilingual Materials for Research. Pediatrics 2024; 154:e2023063988. [PMID: 38860305 DOI: 10.1542/peds.2023-063988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 06/12/2024] Open
Abstract
Patients who speak languages other than English are frequently excluded from research. This exclusion exacerbates inequities, biases results, and may violate federal regulations and research ethics. Language justice is the right to communicate in an individual's preferred language to address power imbalances and promote equity. To promote language justice in research, we propose a method to translate and culturally-adapt multifaceted research materials into multiple languages simultaneously. Our method involves a multistep approach, including professional translation, review by bilingual expert panels to refine and reach consensus, and piloting or cognitive interviews with patients and families. Key differences from other translation approaches (eg, the World Health Organization) include omitting back-translation, given its limited utility in identifying translation challenges, and limiting expert panelist and piloting-participant numbers for feasibility. We detail a step-by-step approach to operationalizing this method and outline key considerations learned after utilizing this method to translate materials into 8 languages other than English for an ongoing multicenter pediatric research study on family safety-reporting. Materials included family brochures, surveys, and intervention materials. This approach took ∼6 months overall at a cost of <$2000 per language (not including study personnel costs). Key themes across the project included (1) tailor scope to timeline, budget, and resources, (2) thoughtfully design English source materials, (3) identify and apply guiding principles throughout the translation and editing process, and (4) carefully review content and formatting to account for nuances across multiple languages. This method balances feasibility and rigor in translating participant-facing materials into multiple languages simultaneously, advancing language justice in research.
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Affiliation(s)
- Alyssa Coffin
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Brynn Elder
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Marcella Luercio
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Namrata Ahuja
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Rebecca Barber
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California
| | - Lisa Ross DeCamp
- Department of Pediatrics, University of Colorado School of Medicine Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, Colorado
- Latino Research and Policy Center, Anschutz Medical Campus, Aurora, Colorado
| | - Karen Encalada
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York
| | - Angela L Fan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Jonathan S Farkas
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York
- Department of Pediatrics, New York University Langone Health and Bellevue Hospital Center, New York, New York
| | - Pia Jain
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Tyler M Johnson
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Nandini Mallick
- Family Advisory Council, Boston Children's Hospital, Boston, Massachusetts
| | - Jayme L Wilder
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Tracy J Yang
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - H Shonna Yin
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - K Casey Lion
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington School of Medicine, Seattle Washington
| | - Alisa Khan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Soliman L, Soliman P, Gallo Marin B, Sobti N, Woo AS. Craniosynostosis: Are Online Resources Readable? Cleft Palate Craniofac J 2024; 61:1228-1232. [PMID: 36744419 DOI: 10.1177/10556656231154843] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE This study aims to analyze the readability of online craniosynostosis materials from the perspective of a caregiver, and to assess if readability levels conform to recommendations by the American Medical Association (AMA) and National Institutes of Health (NIH). DESIGN This is a cross-sectional investigation in which an internet search was conducted simulating the search terms of a caregiver of a patient with craniosynostosis. The first three pages of resulting records were calculated for comprehension ease using validated readability indices. Records were also classified by author type, including hospital system, national health organization, academic journal, and other. MAIN OUTCOME MEASURES Flesch-Kincaid Reading Grade Level, Gunning fog Index, SMOG Index, and Coleman Liau Index. RESULTS Thirty records were identified for which the mean readability level was 12.8 ± 2.6 grade levels (range, 7.6-15.9). There were no significant differences in mean readability across readability indices or author type. None of the thirty records met levels recommended by the AMA or NIH and were 6.8 grade levels above these guidelines on average. CONCLUSIONS Online material pertaining to craniosynostosis is written, on average, at the reading level of a first-year undergraduate student. The AMA and NIH recommend that articles be written at approximately a sixth-grade reading level to promote comprehension. Therefore, there is significant room for improvement of current online materials. Authors should consider consulting publicly available guides in preparing future resources.
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Affiliation(s)
- Luke Soliman
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Paul Soliman
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Benjamin Gallo Marin
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nikhil Sobti
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Albert S Woo
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Doğan Y, Karaca NB, Buran S, Atabey Gerlegiz EN, Aliyev E, Bayındır Y, Bilginer Y, Ünal E, Özen S. Health Literacy Levels of Patients With Juvenile Idiopathic Arthritis and Their Parents. Health Expect 2024; 27:e14117. [PMID: 38879783 PMCID: PMC11180293 DOI: 10.1111/hex.14117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/26/2024] [Accepted: 06/01/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND The aim of this study was to reveal the relationship between the health literacy (HL) levels of children with juvenile idiopathic arthritis (JIA) and their parents, and the general health status and physical performance of the children. METHODS This study included 79 children aged 9-18 years with a diagnosis of JIA and one of their parents. HL levels were evaluated with the Turkish version of the Health Literacy for School-Aged Children and Turkish Health Literacy-32 (THL-32) for children and Adult Health Literacy Scale (AHLS) for their parents. The Childhood Health Assessment Questionnaire (CHAQ), 6-minute walk test (6-MWT), 10-meter walking test (10-MWT) and 10-stair climbing test (10-SCT) was used to evaluate the children. Juvenile Arthritis Biopsychosocial Questionnaire (JAB-Q) was used to assess the children's and parents' psychosocial status and perception of health. RESULTS HL levels of patients with JIA were 16.5% low HL, %55.7 moderate HL and 27.8% high HL. According to THL-32 scale score, HL level of parents were as follows: inadequate, 3.8%; problematic, 22.8%; sufficient, 34.2%; and excellent, 39.2%. Children's HL levels increase positively as they get older, and no significant relationship was found with other parameters. The AHLS, CHAQ and JAB-Q scores were better in the group with higher education levels of the parents. No statistically significant association was found between the HL of the children and that of the parents. CONCLUSION In our study, it was found that the high education levels of the parents positively affected the quality of life and physical condition of their children and parental HL levels. In addition, it was shown that the HL levels of children with JIA were not statistically related to other parameters. PATIENT OR PUBLIC CONTRIBUTION Children diagnosed with JIA and one of their parents actively participated in the study. Feedback from children and families provided important information about obtaining and using HL information before and during the study. The importance of therapy programs and information focusing on the patient and their family, as well as the inter-multidisciplinary approach, in combating a chronic disease at an early age was reinforced by the feedback received from patients and their families.
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Affiliation(s)
- Yahya Doğan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Nur Banu Karaca
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Sinan Buran
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ege Nur Atabey Gerlegiz
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Emil Aliyev
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yağmur Bayındır
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yelda Bilginer
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Edibe Ünal
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Seza Özen
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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10
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Denny A, Day AS, Vernon-Roberts A. Association between Paediatric Complementary and Alternative Medicine Use and Parental Health Literacy, Child Health, and Socio-Economic Variables: A Prospective Study. Pediatr Rep 2024; 16:368-384. [PMID: 38804375 PMCID: PMC11130825 DOI: 10.3390/pediatric16020032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024] Open
Abstract
Complementary and Alternative Medicines (CAMs) constitute products and practices not considered allopathic medicine. CAM use is high in children, but little is known about factors that may influence parents using CAM with their child. This study aimed to determine the variables associated with CAM use in children with a prospective study among children and their parents attending a tertiary care hospital in New Zealand (NZ). Outcomes included current CAM use, parental opinions on CAM, parental health literacy and child well-being. This study was completed by 130 parents (85% female), and the mean child age was 6.7 years. CAM use was reported for 59 (45%) children, the most common being oral supplements and body manipulation. Children were more likely to use CAM if their parent had higher health literacy (p = 0.001), and if they had previously attended the emergency department within 12 months (p = 0.03). There was no association between child well-being and CAM use. Parental opinion of using CAM only if a doctor recommended it was associated with CAM use for their child (p = 0.01). Only 40% of parents disclosed their child's CAM use to the medical team. This study highlights that parental health literacy influences the use of CAM for children in NZ, providing insight for translational research to improve CAM safety and disclosure rates in NZ.
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Affiliation(s)
- Abida Denny
- Otago Medical School, University of Otago, Dunedin 9016, New Zealand
| | - Andrew S. Day
- Department of Paediatrics, University of Otago, Christchurch 8011, New Zealand;
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11
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Han YY, Gutwein A, Apter A, Celedón JC. Health literacy and asthma: An update. J Allergy Clin Immunol 2024; 153:1241-1251. [PMID: 38135010 PMCID: PMC11070295 DOI: 10.1016/j.jaci.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
The US Department of Health and Human Services has defined health literacy (HL) as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Structural and social determinants of health lead to low HL in approximately 36% of adults in the United States, where this condition is most prevalent in racial and ethnic minorities, economically disadvantaged communities, and immigrants with limited English proficiency. In turn, low HL can worsen asthma outcomes through direct effects (eg, nonadherence to or incorrect use of medications) and indirect effects (eg, an unhealthy diet leading to obesity, a risk factor for asthma morbidity). The purpose of this update is to examine evidence from studies on low HL and health and asthma outcomes published in the last 12 years, identify approaches to improve HL and reduce health disparities in asthma, and discuss future directions for research in this area under the conceptual framework of a socioecological model that illustrates the multifactorial and interconnected complexity of this public health issue at different levels.
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Affiliation(s)
- Yueh-Ying Han
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Amanda Gutwein
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Andrea Apter
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pa
| | - Juan C Celedón
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa.
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12
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Aljahany M, Doumi R, Alhuthail RA, Alshangiti HY, Alsugair RA, Aldokhail LS, Aljohani LH, Alqasimi NA, Alotaibi EM, Alaradi LM, Alabdullah NA, Alkelabi NS, Aleyeidi NA, Fayed A. Public Health Literacy and Emergency Department Utilization in Saudi Arabia: A Cross-Sectional Study. Risk Manag Healthc Policy 2024; 17:995-1004. [PMID: 38680480 PMCID: PMC11055523 DOI: 10.2147/rmhp.s440872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/11/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose Health literacy (HL) is the degree in which individuals are able to access, comprehend, and use publicly available health resources and services. A previous study was done in the Kingdom of Saudi Arabia (KSA) assessing the prevalence of HL, the study shows that almost half of KSA residents had limited HL. Most studies that show the level of HL and its relationship to emergency department (ED) utilization were conducted outside KSA. This study aims to assess the association between HL and utilization of ED services and to estimate the prevalence, factors, and outcomes of low HL in KSA. Patients and methods A cross-sectional study was conducted among 903 participants in KSA over a period of 2 months (April and May 2023) using an online survey. Participants were asked about sociodemographic characteristics (age, sex, nationality, marital status, education, work status, income), associated factors (chronic diseases, psychiatric disorders, Covid-19 infection, Covid-19 vaccination, ED visits), and Health Literacy (read, access, understand, evaluation, decision). A health literacy instrument for adults (HELIA), which consists of the previously mentioned five subscales, was used to estimate the level of HL and its association with the risk factors. Results Almost 529 (58.58%) and 374 (41.42%) had limited HL and adequate HL, respectively. Participants with limited HL were mostly aged 35-45 years (61.7%), men (p < 0.05) (68.9%), divorced (65.9%), non-Saudi (69.6%), and had elementary level of education (66.7%). Participants with adequate HL had master's and PhD degree (48.1%), were healthcare students or graduates (62.8%, p < 0.05), had an income >30 thousand riyals (55.6%, p < 0.05), were previously infected with COVID-19 (43%), and did not visit ED in the preceding year (42.3%). Conclusion A high prevalence of low HL among KSA residents was observed. There was no significant difference in ED utilization between participants who had adequate and limited HL.
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Affiliation(s)
- Muna Aljahany
- Department of Internal Medicine, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Rasha Doumi
- Family and Community Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ruba Adel Alhuthail
- Family and Community Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hind Yahiya Alshangiti
- Family and Community Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Reem Abdullah Alsugair
- Family and Community Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Laila Salah Aldokhail
- Family and Community Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Lujain Hatim Aljohani
- Family and Community Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Nuwayyir Abdullah Alqasimi
- Family and Community Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Enar Mohammed Alotaibi
- Family and Community Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Lujain Mohamed Alaradi
- Family and Community Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Norah Abdulaziz Alabdullah
- Family and Community Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Nadeen Saad Alkelabi
- Family and Community Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Nouran A Aleyeidi
- Family and Community Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Amel Fayed
- Family and Community Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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13
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Jeon KH, Shin DW, Lee JW, Baek HJ, Chung NG, Sung KW, Song YM. Parent caregivers' preferences and satisfaction with currently provided childhood cancer survivorship care. J Cancer Surviv 2024; 18:617-630. [PMID: 36396908 DOI: 10.1007/s11764-022-01287-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to investigate the level of satisfaction of parent caregivers of childhood cancer survivors (CCSs) with currently provided survivorship care and their preferences for survivorship care provider. METHODS Study subjects were parent caregivers recruited at three hospitals in Korea. Study data were collected from self-administered questionnaires and medical records. We assessed parent caregivers' levels of satisfaction with specific survivorship care contents and preferred types of survivorship care provider among oncologists, primary care physicians (PCPs), and institutional general physicians (IGPs). Factors associated with parent caregivers' preferences for survivorship care provider were evaluated by multiple logistic regression analysis. RESULTS 680 parent caregivers (mother 62.1% and father 37.9%) of 487 CCSs (mean age at diagnosis: 6.9 ± 5.1 years; mean time since treatment completion 5.4 ± 4.4 years) were included. Parent caregivers' dissatisfaction was the highest with screening for second primary cancer, followed by psychosocial problem management. Higher educational level of parent caregiver, parent caregiver's higher level of dissatisfaction with currently provided care, higher age of CCSs at cancer diagnosis, history of receiving hematopoietic stem cell transplant, and longer time lapse after cancer treatment were significantly associated with parent caregivers' higher preference for PCPs or IGPs than oncologists. Parent caregiver's multiple comorbidities and higher fear of cancer recurrence were associated with parent caregivers' higher preference for oncologists than PCPs or IGPs. Around 80% of parent caregivers recognized that a shared care system was helpful for promoting the health of CCSs. CONCLUSION Parent caregivers were substantially dissatisfied with currently provided care, especially regarding the health issues not directly associated with the primary cancer. Parent caregivers' preferences for survivorship care provider is influenced by multiple factors, including age and survival time of CCSs, characteristics of parent caregivers, satisfaction level with care, and specific survivorship care contents. IMPLICATIONS FOR CANCER SURVIVORS The findings of our study suggest that shared survivorship care for CCSs with consideration of specific care contents can complement the current oncologist-led survivorship care system.
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Affiliation(s)
- Keun Hye Jeon
- Department of Family Medicine, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Jo Baek
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Donggu, Gwangju, Republic of Korea
| | - Nack-Gyun Chung
- Department of Pediatrics, the Catholic University of Korea School of Medicine, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yun-Mi Song
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
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14
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von Sommoggy J, Skiba EM, Lander J, Apfelbacher C, Curbach J, Brandstetter S. Health Literacy in Pediatric Consultations on Allergy Prevention. Health Lit Res Pract 2024; 8:e47-e61. [PMID: 38599576 PMCID: PMC11006282 DOI: 10.3928/24748307-20240320-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/31/2023] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND The first 3 years of life offer an opportunity to prevent allergic diseases. Pediatricians are an important source of health information for parents. However, a certain degree of health literacy is necessary to understand, appraise, and apply preventive behavior, which can be supported by health literacy (HL) sensitive consultations and a HL friendly environment. OBJECTIVE In this study, we want to shed light on how pediatricians in outpatient care in Germany advise on early childhood allergy prevention (ECAP) and how they consider parental HL. METHODS We conducted 19 semi-standardized telephone interviews with pediatricians from North-Rhine-Westphalia and Bavaria. The interviews were audio-recorded, transcribed, pseudonymized, and subjected to content analysis. KEY RESULTS Current ECAP recommendations were well known among our sample. Despite the shift of evidence from avoidance of allergens toward early exposure, providing advice on ECAP was considered non-controversial and it was widely assumed that recommendations were easy to understand and apply for parents. However, ECAP was treated as an implicit topic resonating among others like infant nutrition and hygiene. Regarding HL, our interview partners were not aware of HL as a concept. However, they deemed it necessary to somehow assess parental information level and ability to understand provided information. Formal HL screening was not applied, but implicit strategies based on intuition and experience. Concerning effective HL-sensitive communication techniques, interviewees named the adaptation of language and visual support of explanations. More advanced techniques like Teach Back were considered too time-consuming. Medical assistants were considered important in providing an HL-sensitive environment. Time constraints and the high amount of information were considered major barriers regarding HL-sensitive ECAP counseling. CONCLUSION It seems warranted to enhance professional education and training for pediatricians in HL and HL-sensitive communication, to reach all parents with HL-sensitive ECAP counseling. [HLRP: Health Literacy Research and Practice. 2024;8(2):e47-e61.].
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Affiliation(s)
- Julia von Sommoggy
- Address correspondence to Julia von Sommoggy, Ph.D., University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, Steinmetzstr. 1–3, 93049 Regensburg;
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15
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Mullin K, Rentea RM, Appleby M, Reeves PT. Gastrointestinal Ostomies in Children: A Primer for the Pediatrician. Pediatr Rev 2024; 45:210-224. [PMID: 38556505 DOI: 10.1542/pir.2023-006195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Despite the advancement of medical therapies in the care of the preterm neonate, in the management of short bowel syndrome and the control of pediatric inflammatory bowel disease, the need to create fecal ostomies remains a common, advantageous treatment option for many medically complex children.
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Affiliation(s)
- Kaitlyn Mullin
- Pediatric Colorectal Center, Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Rebecca M Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital-Kansas City, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | | | - Patrick T Reeves
- Pediatric Colorectal Center, Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
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16
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Hayward M, Critcher J. Adultification: risk factors, harmful effects and implications for nursing practice. Nurs Child Young People 2024; 36:14-20. [PMID: 37779324 DOI: 10.7748/ncyp.2023.e1488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 10/03/2023]
Abstract
Adultification, whereby children and young people are perceived as older or more mature than they actually are, disproportionately affects those from minority ethnic backgrounds. It can also occur in other contexts, for example when children and young people are placed in a position of adult responsibility. Nurses have a duty to support and protect children and young people, which includes protecting them from adultification and the negative effects it can have on health and well-being. This article discusses strategies nurses can use to prevent adultification - such as developing awareness, avoiding adultifying language and listening to children and young people - and actions to take when suspecting adultification from colleagues.
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Affiliation(s)
- Melanie Hayward
- Institute for Health and Social Care, Buckinghamshire New University, High Wycombe, England
| | - Julie Critcher
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Medway, England
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17
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Kemp KM, Nagaraj PK, Orihuela CA, Lorenz RG, Maynard CL, Pollock JS, Jester T. Racial and ethnic differences in diagnosis age and blood biomarkers in a pediatric inflammatory bowel disease cohort. J Pediatr Gastroenterol Nutr 2024; 78:634-643. [PMID: 38284647 PMCID: PMC11181309 DOI: 10.1002/jpn3.12131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/11/2023] [Accepted: 10/04/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Prompt diagnosis of pediatric-onset inflammatory bowel disease (IBD) is crucial for preventing a complicated disease course; however, it is not well understood how social determinants of health might affect pediatric IBD diagnosis. This study examined differences in diagnosis age, biomarkers of disease severity, and anthropometrics with sociodemographic factors in a pediatric IBD cohort. METHODS Pediatric IBD patients (n = 114) and their parents/caregivers were enrolled from the Children's of Alabama Pediatric IBD Clinic in Birmingham, Alabama. Primary analyses examined associations of child race and ethnicity, parental income, parental education, single-parent household status, insurance type, and distance to a tertiary pediatric gastroenterology referral center with diagnosis age. Secondary analyses examined differences in biomarker levels, height, and body mass index at the time of diagnosis. RESULTS Racial and ethnic minority children were diagnosed at an older age compared to Non-Hispanic White children (14.4 ± 0.40 vs. 11.7 ± 0.38 years; p < 0.001), and this trend was robust to adjustment with other sociodemographic variables. Parental attainment of a college education attenuated the link between minority race and ethnicity and the likelihood of older age at diagnosis, while other sociodemographic variables had no moderating effect. Racial and ethnic minority children were 5.7 times more likely to have clinically elevated erythrocyte sedimentation rate at diagnosis compared to Non-Hispanic White children (p = .024). CONCLUSIONS These results suggest that child race and ethnicity may exert a primary effect on the age at diagnosis with pediatric-onset IBD. This study highlights the need for further research on racial and ethnic disparities to promote health equity in pediatric-onset IBD.
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Affiliation(s)
- Keri M. Kemp
- Cardio-Renal Physiology and Medicine Section, Division of Nephrology, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pooja K. Nagaraj
- Department of Pediatrics, Division of Gastroenterology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Catheryn A. Orihuela
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robin G. Lorenz
- Department of Research Pathology, Genentech, South San Francisco, California, USA
| | - Craig L. Maynard
- Department of Pathology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer S. Pollock
- Cardio-Renal Physiology and Medicine Section, Division of Nephrology, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Traci Jester
- Department of Pediatrics, Division of Gastroenterology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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18
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Tahan L, Habchy P, Moussi C, Khadra T, Jawich M, Njeim A, Kattan O, Abou Habib L, El Bitar W, El Asmar B, Chahine MN. A National School Health Campaign in Lebanon on Children Aged between 3 and 12 Years Old: Concordance Level between Parents' Reports and Medical Visit Findings about Physical and Mental Health. CHILDREN (BASEL, SWITZERLAND) 2024; 11:214. [PMID: 38397326 PMCID: PMC10887313 DOI: 10.3390/children11020214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/27/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
A school's commitment to promoting health extends beyond students' efforts to encompass parental involvement and must recognize the critical role of parents in enhancing overall student well-being. This study, conducted in 27 schools across Lebanon, assessed parents' awareness of their children's physical and mental health. A school health campaign involved direct medical interventions on 7184 students, followed by phone interviews with 3880 parents to compare their responses with the medical findings. Discordances ranged from extreme mismatches (≥50%) to mild mismatches (<15%), with notable disparities in incomplete vaccination (67.8%), BMI (59%), and mental health indicators (expressions of sadness (69.1%), loneliness (61.0%), and anxiety (53.4%)). Factors such as school type, child's age, governorate, family income, parents' occupation, education level, and marital status significantly influenced discordance rates. Notably, mental health aspects exhibited higher disparities, emphasizing the need for improved communication between parents, physicians, and children. Bridging these gaps could empower parents with better knowledge, fostering environments conducive to lifelong healthy behaviors in children. The study underscores the urgency for enhanced communication strategies to bridge discrepancies and ensure a more comprehensive understanding of children's physical and mental well-being.
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Affiliation(s)
- Léa Tahan
- Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon; (L.T.); (P.H.); (C.M.); (T.K.); (M.J.); (A.N.); (O.K.)
| | - Peter Habchy
- Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon; (L.T.); (P.H.); (C.M.); (T.K.); (M.J.); (A.N.); (O.K.)
| | - Charbel Moussi
- Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon; (L.T.); (P.H.); (C.M.); (T.K.); (M.J.); (A.N.); (O.K.)
| | - Tia Khadra
- Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon; (L.T.); (P.H.); (C.M.); (T.K.); (M.J.); (A.N.); (O.K.)
| | - Melissa Jawich
- Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon; (L.T.); (P.H.); (C.M.); (T.K.); (M.J.); (A.N.); (O.K.)
| | - Alain Njeim
- Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon; (L.T.); (P.H.); (C.M.); (T.K.); (M.J.); (A.N.); (O.K.)
| | - Ogarite Kattan
- Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon; (L.T.); (P.H.); (C.M.); (T.K.); (M.J.); (A.N.); (O.K.)
| | - Leila Abou Habib
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
| | - Wassim El Bitar
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
- Department of Pediatrics, Bellevue Medical Center University Hospital, Mansourieh P.O. Box 295, Lebanon
| | - Béchara El Asmar
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
- Faculty of Medicine, Saint Joseph University, Beirut P.O. Box 17-5208, Lebanon
- Department of Cardiology, Hotel-Dieu de France Hospital, Achrafieh, Beirut P.O. Box 11-5190, Lebanon
| | - Mirna N. Chahine
- Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon; (L.T.); (P.H.); (C.M.); (T.K.); (M.J.); (A.N.); (O.K.)
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
- Basic Sciences Department, Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon
- Foundation-Medical Research Institutes (F-MRI®), Achrafieh, Beirut P.O. Box 64, Lebanon
- Foundation-Medical Research Institutes (F-MRI®), 1211 Geneva, Switzerland
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Nacht CL, Jacobson N, Shiyanbola O, Smith CA, Hoonakker PL, Coller RJ, Dean SM, Sklansky DJ, Smith W, Sprackling CM, Kelly MM. Perception of Physicians' Notes Among Parents of Different Health Literacy Levels. Hosp Pediatr 2024; 14:108-115. [PMID: 38173406 PMCID: PMC10823185 DOI: 10.1542/hpeds.2023-007240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To explore the benefits and challenges of accessing physicians' notes during pediatric hospitalization across parents of different health literacy levels. METHODS For this secondary analysis, we used semi-structured interviews conducted with 28 parents on their impressions of having access to their child's care team notes on a bedside table. Three researchers used thematic analysis to develop a codebook, coded interview data, and identified themes. Parent interviews and respective themes were then dichotomized into proficient or limited health literacy groups and compared. RESULTS Nine themes were identified in this secondary analysis: 6 benefits and 3 challenges. All parents identified more benefits than challenges, including that the notes served as a recap of information and memory aid and increased autonomy, empowerment, and advocacy for their child. Both groups disliked receiving bad news in notes before face-to-face communication. Parents with proficient literacy reported that notes allowed them to check information accuracy, but that notes may not be as beneficial for parents with lower health literacy. Parents with limited literacy uniquely identified limited comprehension of medical terms but indicated that notes facilitated their understanding of their child's condition, increased their appreciation for their health care team, and decreased their anxiety, stress, and worry. CONCLUSIONS Parents with limited health literacy uniquely reported that notes improved their understanding of their child's care and decreased (rather than increased) worry. Reducing medical terminology may be one equitable way to increase note accessibility for parents across the health literacy spectrum.
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Affiliation(s)
- Carrie L. Nacht
- School of Public Health, San Diego State University, San Diego, California
| | - Nora Jacobson
- Institute for Clinical and Translational Research and School of Nursing
| | | | | | - Peter L.T. Hoonakker
- Wisconsin Institute for Health Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Ryan J. Coller
- Department of Pediatrics, University of WisconsinSchool of Medicine and Public Health, Madison, Wisconsin
| | | | - Daniel J. Sklansky
- Department of Pediatrics, University of WisconsinSchool of Medicine and Public Health, Madison, Wisconsin
| | | | - Carley M. Sprackling
- Department of Pediatrics, University of WisconsinSchool of Medicine and Public Health, Madison, Wisconsin
| | - Michelle M. Kelly
- Department of Pediatrics, University of WisconsinSchool of Medicine and Public Health, Madison, Wisconsin
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Perry TT, Marko A, Russell AF, Cooke AT, Bingemann TA, Ross KR, Young MC. How Schools Can Help Address Social Determinants of Health in Asthma Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:316-326. [PMID: 37839577 DOI: 10.1016/j.jaip.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
Schools are in a unique position to address social determinants of health (SDOHs) in pediatric asthma management because of their potential to provide resources and facilitate collaboration with health care providers and services for children at risk within their community. SDOHs include economic factors, educational attainment and health literacy, neighborhood factors and the built environment, social and community aspects including discrimination and racism, and health care access and quality. These factors have a significant impact on asthma health in children, and certain populations such as minoritzed populations and those living in high-poverty environments have been shown to be at greater risk for adverse effects of SDOHs on asthma outcomes. School-based asthma programs address several SDOHs including health literacy, the built environment, and health care quality and access and have been shown to improve asthma outcomes. Key components include connection between the school and the health care team, self-management education, and directly observed therapy. School nurses play a key role in directing and managing effective programs because they can evaluate and support a student's health while considering the effect of SDOHs at interpersonal, institutional, community, and policy levels.
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Affiliation(s)
- Tamara T Perry
- Division of Allergy and Immunology, College of Medicine, Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Angela Marko
- Division of Pediatric Pulmonology and Sleep Medicine, UH Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio.
| | - Anne F Russell
- School of Nursing and Health Sciences, Spring Arbor University, Spring Arbor, Mich; Food Allergy and Anaphylaxis Michigan Association, Ann Arbor, Mich
| | - Abigail T Cooke
- Allergy and Asthma Specialists, Durango, Colo; Colorado State University-Pueblo: Graduate School of Nursing, Pueblo, Colo
| | - Theresa A Bingemann
- Departments of Allergy, Immunology and Rheumatology and Pediatric Allergy and Immunology, University of Rochester School of Medicine, Rochester, NY
| | - Kristie R Ross
- Division of Pediatric Pulmonology and Sleep Medicine, UH Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Michael C Young
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
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Koole D, Lans A, Lang JH, de Groot TM, Borkhetaria P, Verlaan JJ, Schwab JH, Tobert DG. Limited health literacy results in lower health-related quality of life in spine patients. Spine J 2024; 24:263-272. [PMID: 37774984 DOI: 10.1016/j.spinee.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/15/2023] [Accepted: 09/23/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND CONTEXT Spinal conditions impact health-related quality of life (HRQoL). Patient education and counseling improve HRQoL, yet the effects may be limited for patients with inadequate health literacy (HL). Despite the established relationship between HRQoL and HL in other fields, research in the orthopedic spine population is lacking. PURPOSE To investigate if limited HL results in lower HRQoL and to evaluate factors are associated with HRQoL in patients seen at an outpatient orthopedic spine center. STUDY DESIGN/SETTING Prospective single-center cross-sectional study. PATIENT SAMPLE Patients 18 years of age or older seen at a tertiary urban academic hospital- based multi-surgeon outpatient spine center. OUTCOME MEASURES EQ-5D-5L health-related quality of life (HRQoL) questionnaire, and the Newest Vital Sign (NVS) HL assessment tool. METHODS Between October 2022 and February 2023, consecutive English-speaking patients over the age of 18 and new to the outpatient spine clinic were approached for participation in this cross-sectional survey study. Patients completed a sociodemographic survey, EQ-5D-5L HRQoL questionnaire, and Newest Vital Sign (NVS) HL assessment tool. The EQ-5D-5L yields two continuous outcomes: an index score ranging from below 0 to 1 and a visual analog scale (EQ-VAS) score ranging from 0 to 100. The NVS scores were divided into limited (0-3) and adequate (4-6) HL. Multivariate linear regression with purposeful selection of variables was performed to identify independent factors associated with HRQoL. RESULTS Out of 397 eligible patients, 348 (88%) agreed to participate and were included in statistical analysis. Limited HL was independently associated with lower EQ-5D-5L index scores (B=1.07 [95% CI 1.00-1.15], p=.049. Other factors associated with lower EQ-5D-5L index scores were being obese (BMI≥30), having housing concerns, and being an active smoker. Factors associated with lower EQ-VAS scores were being underweight (BMI<18.5), obese, having housing concerns, and higher updated Charlson comorbidity index (uCCI) scores. Being married was associated with higher EQ-VAS scores. CONCLUSIONS Limited HL is associated with lower EQ-5D-5L index scores in spine patients, indicating lower HRQoL. To effectively apply HL-related interventions in this population, a better understanding of the complex interactions between patient characteristics, social determinants of health, and HRQoL outcomes is required. Further research should focus on interventions to improve HRQoL in patients with limited HL and how to accurately identify these patients. LEVEL OF EVIDENCE Level II prognostic.
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Affiliation(s)
- Dylan Koole
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA; Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden University, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Amanda Lans
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA; Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands.
| | - Julian H Lang
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Tom M de Groot
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Pranati Borkhetaria
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Jorrit-Jan Verlaan
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Daniel G Tobert
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
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Nakajima R, Komoriya M, Watanabe F. Is health literacy of adolescent athletes' parents whose children belonged to sports clubs related to their children's intention to receive medications, vaccines, supplements, and energy drinks? A cross-sectional study. BMC Public Health 2024; 24:257. [PMID: 38254028 PMCID: PMC10804555 DOI: 10.1186/s12889-024-17746-0] [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: 05/02/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Adolescent athletes' values regarding health behaviors, including their attitudes toward doping, are largely derived from those of their parents. Therefore, clarifying the factors that affect parents' intentions regarding their children's medicine intake and nutrition can help elucidate the process of forming values of healthy behaviors in young athletes. METHODS Between March 8 and March 9, 2021, an online questionnaire survey was conducted via an Internet research company; data from 2,000 residents in Japan were collected. Participants were male and female residents aged 30-59 years with children in elementary or high school and belonging to sports clubs. The survey items included respondent's and child's basic information, respondent's health literacy, and level of sports in which the respondent and child were (or are) engaged. Respondents were also asked if they would like their children to receive prescription drugs, over-the-counter drugs, herbal medicines, vaccines, supplements, or energy drinks. Logistic regression analysis was performed to analyze the relationship between respondents' basic information and health literacy and their intention to receive prescription and over-the-counter drugs, herbal medicines, vaccines, supplements, and energy drinks. RESULTS Higher parental health literacy was associated with higher children's willingness to receive prescription drugs (odds ratio [OR] = 1.025, 95% confidence interval [CI]: 1.016-1.035), over-the-counter drugs (OR = 1.012, 95% CI: 1.003-1.021), prescription herbal medicines (OR = 1.021, 95% CI: 1.021-1.030), over-the-counter herbal medicines (OR = 1.012, 95% CI: 1.003-1.021), and vaccines (OR = 1.025, 95% CI: 1.016-1.035). Conversely, the children's intention to receive energy drinks (OR = 0.990, 95% CI: 0.980-1.000) decreased significantly. As the child's athletic level increased, parents' willingness for their children to receive oral prescription medicines decreased (OR = 0.886, 95% CI: 0.791-0.992) and that to receive supplements (OR = 1.492, 95% CI: 1.330-1.673) and energy drinks significantly increased (OR = 1.480, 95% CI: 1.307-1.676). CONCLUSION Health literacy of adolescent athletes' parents is associated with their children's willingness to receive medicines. Healthcare providers should counsel parents of adolescent athletes to allow their children to receive necessary drug treatments and prevent doping violations caused by supplement intake.
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Affiliation(s)
- Rie Nakajima
- Department of Pharmacy Practice in Primary Care, Nihon University School of Pharmacy, 7-7-1 Narashinodai, 274-8555, Funabashi-shi, Chiba, Japan.
| | - Michihiro Komoriya
- Department of Pharmacy Practice in Primary Care, Nihon University School of Pharmacy, 7-7-1 Narashinodai, 274-8555, Funabashi-shi, Chiba, Japan
| | - Fumiyuki Watanabe
- Department of Pharmacy Practice in Primary Care, Nihon University School of Pharmacy, 7-7-1 Narashinodai, 274-8555, Funabashi-shi, Chiba, Japan
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Tiong K, Palmer GM, Jaaniste T. Attrition from Face-to-Face Pediatric Outpatient Chronic Pain Interventions: A Narrative Review and Theoretical Model. CHILDREN (BASEL, SWITZERLAND) 2024; 11:126. [PMID: 38275436 PMCID: PMC10814025 DOI: 10.3390/children11010126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
There is limited understanding of attrition (premature treatment withdrawal and non-completion) from pediatric chronic pain services. This narrative review aimed to summarize attrition prevalence from face-to-face pediatric outpatient chronic pain interventions, identify associated factors and develop a theoretical model to account for attrition in this setting. A comprehensive search of the published literature revealed massive variability (0-100%) in the reported attrition rates from pediatric chronic pain interventions that varied in type and format (individual vs. group, single discipline vs. interdisciplinary, psychological only vs. multiple combined interventions, of different durations). The factors associated with attrition from pediatric chronic pain programs varied between the studies: some have assessed patient sex, psychological and other comorbidities, avoidance strategies, missed schooling, family composition/tensions, caregiver catastrophizing, scheduling, caregiver leave and clinic access. A theoretical model is presented depicting youth, caregiver and service factors that may impact attrition from pediatric chronic pain interventions. Where available, literature is drawn from the pediatric chronic pain context, but also from adult chronic pain and pediatric weight management fields. The implications for research and clinical practice are discussed, including improved reporting, patient screening and targeted supports to promote intervention completion. This review contributes to a better understanding of attrition, which is crucial for optimizing pediatric chronic pain service outcomes.
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Affiliation(s)
- Kristen Tiong
- School of Clinical Medicine, University of New South Wales, Kensington, NSW 2052, Australia;
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Greta M. Palmer
- Children’s Pain Management Service, Department of Anaesthesia and Pain Management, Royal Children’s Hospital, Melbourne, VIC 3052, Australia;
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Tiina Jaaniste
- School of Clinical Medicine, University of New South Wales, Kensington, NSW 2052, Australia;
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
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Chaker SC, Hung YC, Saad M, Golinko MS, Galdyn IA. Easing the Burden on Caregivers- Applications of Artificial Intelligence for Physicians and Caregivers of Children with Cleft Lip and Palate. Cleft Palate Craniofac J 2024:10556656231223596. [PMID: 38178785 DOI: 10.1177/10556656231223596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVE Many caregivers of children with cleft lip and palate experience a high level of anxiety throughout their child's medical and surgical care. We aim to evaluate artificial intelligence (AI) as a tool to mitigate these feelings and can aid clinicians in the development of robust pediatric educational materials for caregivers and families. DESIGN Thirteen of the most common postoperative questions following cleft lip and/or palate repair were developed by an expert panel of senior Pediatric Plastic Surgeons and were posed to ChatGPT. Professional answers from the expert panel were provided and compared to responses from ChatGPT. A literature review was also conducted to generate a new support model for caregivers with children undergoing a surgical procedure. SETTING Department of Pediatric Plastic Surgery at a metropolitan Children's Hospital. PARTICIPANTS Senior Pediatric Plastic Surgeons at a metropolitan Children's Hospital. INTERVENTIONS None. MAIN OUTCOME MEASURE The primary outcome was to determine the ability of ChatGPT to respond to common postoperative questions and to develop a model for AI assistance in family-centered perioperative care. RESULTS ChatGPT had a postoperative question response accuracy rate of 69% when compared with subject matter expert responses, with its greatest errors being information errors. An extensive literature search revealed that AI can assist in multiple traditional perioperative strategies to reduce caregivers and patient anxiety. CONCLUSIONS Artificial Intelligence can help to reduce the burden of generating patient education materials as well as support caregivers in multiple aspects and perioperative care.
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Affiliation(s)
- Sara C Chaker
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ya-Ching Hung
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of General Surgery, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Mariam Saad
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael S Golinko
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Pediatric Plastic Surgery, Cleft and Craniofacial Program, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Izabela A Galdyn
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Pediatric Plastic Surgery, Cleft and Craniofacial Program, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
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Carroll AR, Johnson JA, Stassun JC, Greevy RA, Mixon AS, Williams DJ. Health Literacy-Informed Communication to Reduce Discharge Medication Errors in Hospitalized Children: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2350969. [PMID: 38227315 DOI: 10.1001/jamanetworkopen.2023.50969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
Importance Inadequate communication between caregivers and clinicians at hospital discharge contributes to medication dosing errors in children. Health literacy-informed communication strategies during medication counseling can reduce dosing errors but have not been tested in the pediatric hospital setting. Objective To test a health literacy-informed communication intervention to decrease liquid medication dosing errors compared with standard counseling in hospitalized children. Design, Setting, and Participants This parallel, randomized clinical trial was performed from June 22, 2021, to August 20, 2022, at a tertiary care, US children's hospital. English- and Spanish-speaking caregivers of hospitalized children 6 years or younger prescribed a new, scheduled liquid medication at discharge were included in the analysis. Interventions Permuted block (n = 4) randomization (1:1) to a health literacy-informed discharge medication communication bundle (n = 99) compared with standard counseling (n = 99). A study team member delivered the intervention consisting of a written, pictogram-based medication instruction sheet, teach back (caregivers state information taught), and demonstration of dosing with show back (caregivers show how they would draw the liquid medication in the syringe). Main Outcome and Measures Observed dosing errors, assessed using a caregiver-submitted photograph of their child's medication-filled syringe and expressed as the percentage difference from the prescribed dose. Secondary outcomes included caregiver-reported medication knowledge. Outcome measurements were blinded to participant group assignment. Results Among 198 caregivers randomized (mean [SD] age, 31.4 [6.5] years; 186 women [93.9%]; 36 [18.2%] Hispanic or Latino and 158 [79.8%] White), the primary outcome was available for 151 (76.3%). The observed mean (SD) percentage dosing error was 1.0% (2.2 percentage points) among the intervention group and 3.3% (5.1 percentage points) among the standard counseling group (absolute difference, 2.3 [95% CI, 1.0-3.6] percentage points; P < .001). Twenty-four of 79 caregivers in the intervention group (30.4%) measured an incorrect dose compared with 39 of 72 (54.2%) in the standard counseling group (P = .003). The intervention enhanced caregiver-reported medication knowledge compared with the standard counseling group for medication dose (71 of 76 [93.4%] vs 55 of 69 [79.7%]; P = .03), duration of administration (65 of 76 [85.5%] vs 49 of 69 [71.0%]; P = .04), and correct reporting of 2 or more medication adverse effects (60 of 76 [78.9%] vs 13 of 69 [18.8%]; P < .001). There were no differences in knowledge of medication name, indication, frequency, or storage. Conclusions and Relevance A health literacy-informed discharge medication communication bundle reduced home liquid medication administration errors and enhanced caregiver medication knowledge compared with standard counseling. Routine use of these standardized strategies can promote patient safety following hospital discharge. Trial Registration ClinicalTrials.gov Identifier: NCT05143047.
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Affiliation(s)
- Alison R Carroll
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jakobi A Johnson
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Justine C Stassun
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Amanda S Mixon
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Internal Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Derek J Williams
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
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Panagi L, White SR, Howdle C, Bennett S, Heyman I, Shafran R, Ford T. Predictors of contact with services for mental health problems among children with comorbid long-term physical health conditions: a follow-up study. Eur Child Adolesc Psychiatry 2024; 33:21-31. [PMID: 36357554 PMCID: PMC10807016 DOI: 10.1007/s00787-022-02105-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/26/2022] [Indexed: 11/12/2022]
Abstract
Children with long-term physical health conditions (pLTCs) are at increased risk of developing mental health comorbidities, although most do not access services for their mental health. No previous studies have examined the determinants of contact with services for mental health concerns among this group of children. This 3-year longitudinal study involved a population-based sample of children aged 5-16 years from the British Child and Adolescent Mental Health Surveys conducted in 1999 and 2004. In children with comorbid pLTCs and mental health disorders at baseline (N = 397), we examined associations between several child-, family- and service-related factors and (a) contact with primary health care, (b) contact with paediatrics and (c) contact with child and adolescent mental health services over 3-year follow-up (2002 and 2007). Separate multivariable binary logistic regressions were conducted for each service. The impact of mental health difficulties on the child and contact with the teacher predicted contact with all three services. Adolescent age, female gender, larger family size, some or marked academic difficulties, and having parents with educational qualification(s) were specific predictors of contact with primary health care. Male gender, stressful life events, and contact with primary health care were specific predictors of contact with child and adolescent mental health services. No other factors predicted contact with paediatrics. Our findings highlight the role of child-, family-, and service-related factors in accessing mental health care in children with comorbid pLTCs and mental health disorders which could inform planning and provision of services to reduce unmet mental health needs.
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Affiliation(s)
- Laura Panagi
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Innovation Hub/Bay 13, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK.
| | - Simon R White
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Innovation Hub/Bay 13, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK
| | - Charlotte Howdle
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP, UK
| | - Sophie Bennett
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Innovation Hub/Bay 13, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK
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Reddy AR, Doshi AK, Mak A, Shea JA, Fardad JT, Moon J, Hu P, Garcia-Marcinkiewicz AG. Assessing the health literacy of caregivers in the pediatric intensive care unit: a mixed-methods study. Front Pediatr 2023; 11:1308673. [PMID: 38188919 PMCID: PMC10771288 DOI: 10.3389/fped.2023.1308673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024] Open
Abstract
Background Limited health literacy is associated with increased hospitalizations, emergency visits, health care costs, and mortality. The health literacy levels of caregivers of critically ill children are unknown. This mixed-methods study aims to quantitatively assess the health literacy of caregivers of children admitted to the pediatric intensive care unit (PICU) and qualitatively describe facilitators and barriers to implementing health literacy screening from the provider perspective. Methods Caregivers of patients admitted to our large, academic PICU (between August 12, 2022 and March 31, 2023) were approached to complete a survey with the Newest Vital Sign (NVS), which is a validated health literacy screener offered in English and Spanish. We additionally conducted focus groups of interdisciplinary PICU providers to identify factors which may influence implementation of health literacy screening using the Consolidated Framework for Implementation Research (CFIR) framework. Results Among 48 surveyed caregivers, 79% demonstrated adequate health literacy using the Newest Vital Sign screener. The majority of caregivers spoke English (96%), were mothers (85%), and identified as White (75%). 83% of caregivers were able to attend rounds at least once and 98% believed attending rounds was helpful. Within the PICU provider focus groups, there were 11 participants (3 attendings, 3 fellows, 2 nurse practitioners, 1 hospitalist, 2 research assistants). Focus group participants described facilitators and barriers to implementation, which were mapped to CFIR domains. Timing of screening and person administering screening were identified as modifiable factors to improve future implementation. Conclusion We found the health literacy levels of PICU caregivers in our setting is similar to prior assessments of parental health literacy. Participation in morning rounds was helpful for developing understanding of their child's illness, regardless of health literacy status. Qualitative feedback from providers identified barriers across all CFIR domains, with timing of screening and person administering screening as modifiable factors to improve future implementation.
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Affiliation(s)
- Anireddy R. Reddy
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Anushree K. Doshi
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Allison Mak
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
- Department of General Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Judy A. Shea
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medicine, Perelman School of Medicine and University of Pennsylvania, Philadelphia, PA, United States
| | - Joana T. Fardad
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jiwon Moon
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Paula Hu
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Annery G. Garcia-Marcinkiewicz
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Kim S, Kang SJ. Mothers' experiences of caring for their children with liver transplantation: From sorrow to new determination. J Child Health Care 2023:13674935231223767. [PMID: 38113827 DOI: 10.1177/13674935231223767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
This study aims to understand mothers' dynamic experiences of caring for their children with liver transplant. A descriptive phenomenological qualitative approach was applied to this study. A total of seven mothers participated in this study. Data were collected from April 2020 to June 2020 through face-to-face interviews. Data analysis was performed using Giorgi's phenomenological method. By grouping general meaning units, 8 themes and 19 subthemes were derived. Eight themes are as follows: sorrow and distress of accepting a child's diagnosis; difficulties in deciding to undergo liver transplantation; negative emotions before and after transplant; the support system before and after liver transplantation; achieving a sense of trust toward healthcare providers; new concerns about the child's life after undergoing liver transplantation; appreciation of the experience; and new determination and expectations for future life. This study can contribute to the guideline that describes the role and daily life experiences of caregiving for other parents whose children undergo liver transplantation and nurses who work with impacted families. Healthcare providers can refer to the results to provide liver transplantation childcare and hospital-based support groups for child's family to improve nurses' communication skills.
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Affiliation(s)
- Sooyoung Kim
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Sook Jung Kang
- College of Nursing, Ewha Womans University, Seoul, Korea
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Chou AK, Liao CH, Chen DR. Measuring adolescent health literacy in Taiwan: validation of the health literacy assessment scale for adolescents. BMC Public Health 2023; 23:2409. [PMID: 38049759 PMCID: PMC10696858 DOI: 10.1186/s12889-023-17167-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/06/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND This study aimed to validate the Chinese version of the Health Literacy Assessment Scale for Adolescents (HAS-A) and conduct a comparative analysis of adolescent health literacy between Taiwan and other countries. METHODS The Chinese version of the HAS-A was completed by 2,312 adolescents in the fifth and sixth grades of a primary school. Psychometric properties were examined using consistent internal reliability and confirmatory factor analysis. These assessments were compared with the results from different regions to explore health literacy inequality. RESULTS Construct validity was good, and internal consistency was acceptable. The scale, particularly regarding communication health literacy, was associated with parents' socioeconomic status, and family income had a more significant impact on children's health literacy than community income. Health literacy disparities appear in different countries, with Taiwan exhibiting the lowest level of communication health literacy. CONCLUSION The results indicate that the HAS-A is a valuable tool for assessing the health literacy of 10-11-year-old adolescents and can uncover health literacy inequality among different regions.
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Affiliation(s)
- An-Kuo Chou
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, 30059, Hsinchu, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, 10055, Taipei, Taiwan
| | - Chun-Hua Liao
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, 30059, Hsinchu, Taiwan
| | - Duan-Rung Chen
- Population Health Research Center, National Taiwan University, 10055, Taipei, Taiwan.
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Rd., Taipei, 10055, Taiwan.
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Brewer SE, DeCamp LR, Reedy J, Armstrong R, DeKeyser HH, Federico MJ, McFarlane A, Figlio G, Huebschmann AG, Szefler SJ, Cicutto L. Developing a Social Determinants of Health Needs Assessment for Colorado Kids (SNACK) Tool for a School-Based Asthma Program: Findings from a Pilot Study. Ethn Dis 2023; DECIPHeR:126-131. [PMID: 38846737 PMCID: PMC11099530 DOI: 10.18865/ed.decipher.126] [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] [Indexed: 06/09/2024] Open
Abstract
Background School-based asthma programs effectively address poorly controlled asthma and asthma disparities, especially when coupled with screening for and addressing social determinants of health (SDOH) needs. Existing screening tools are tailored to clinical settings; therefore, we sought to develop a community-based SDOH screening tool. Design/Methods We used a four-phase iterative design process to develop and pilot a community-based screening tool. We used a modified Delphi process to identify screening tool domains, identified validated items for inclusion, and developed an appropriate tool layout for populations with limited health/general literacy. Community advisory boards reviewed and refined a draft tool. Next, we conducted a qualitative pilot test of acceptability to parents and feasibility for staff in a community health center. Results Six domains are included in our SDOH screening tool: health care access, transportation, food insecurity, public benefits, housing, and utilities. In the pilot test, 41 screenings were completed, and 36 parents (16.7% Spanish speaking) provided feedback. Most families understood the purpose of the screening; felt that the questions were clear, appropriate, and quick to complete; and liked the pictures. The clinic's care coordinator expressed a preference for the pilot tool compared to their existing screening tool and recommended improvements to encourage honest reporting by patients. Conclusion This community-based screening tool addresses key SDOH needs that impact asthma and is acceptable to families. The next steps are to implement the tool in school-based asthma programs to support improvements in asthma outcomes and disparities by identifying and addressing families' unmet SDOH needs.
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Affiliation(s)
- Sarah E. Brewer
- Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, CO
- University of Colorado School of Medicine, Department of Family Medicine, Aurora, CO
| | - Lisa R. DeCamp
- Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, CO
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO
| | - Julia Reedy
- Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, CO
| | - Rachel Armstrong
- Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, CO
| | - Heather H. DeKeyser
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO
- Breathing Institute, Children’s Hospital Colorado, Aurora, CO
| | - Monica J. Federico
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO
- Breathing Institute, Children’s Hospital Colorado, Aurora, CO
| | | | - Gino Figlio
- High Plains Community Health Center, Lamar, CO
| | - Amy G. Huebschmann
- Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, CO
- University of Colorado School of Medicine, Division of General Internal Medicine, Aurora, CO
- Ludeman Family Center for Women’s Health Research, Aurora, CO
| | - Stanley J. Szefler
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO
- Breathing Institute, Children’s Hospital Colorado, Aurora, CO
| | - Lisa Cicutto
- National Jewish Health and University of Colorado College of Nursing and Clinical Science, Denver, CO
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Bushuven S, Bentele M, Bentele S, Gerber B, Bansbach J, Ganter J, Trifunovic-Koenig M, Ranisch R. "ChatGPT, Can You Help Me Save My Child's Life?" - Diagnostic Accuracy and Supportive Capabilities to Lay Rescuers by ChatGPT in Prehospital Basic Life Support and Paediatric Advanced Life Support Cases - An In-silico Analysis. J Med Syst 2023; 47:123. [PMID: 37987870 PMCID: PMC10663183 DOI: 10.1007/s10916-023-02019-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Paediatric emergencies are challenging for healthcare workers, first aiders, and parents waiting for emergency medical services to arrive. With the expected rise of virtual assistants, people will likely seek help from such digital AI tools, especially in regions lacking emergency medical services. Large Language Models like ChatGPT proved effective in providing health-related information and are competent in medical exams but are questioned regarding patient safety. Currently, there is no information on ChatGPT's performance in supporting parents in paediatric emergencies requiring help from emergency medical services. This study aimed to test 20 paediatric and two basic life support case vignettes for ChatGPT and GPT-4 performance and safety in children. METHODS We provided the cases three times each to two models, ChatGPT and GPT-4, and assessed the diagnostic accuracy, emergency call advice, and the validity of advice given to parents. RESULTS Both models recognized the emergency in the cases, except for septic shock and pulmonary embolism, and identified the correct diagnosis in 94%. However, ChatGPT/GPT-4 reliably advised to call emergency services only in 12 of 22 cases (54%), gave correct first aid instructions in 9 cases (45%) and incorrectly advised advanced life support techniques to parents in 3 of 22 cases (13.6%). CONCLUSION Considering these results of the recent ChatGPT versions, the validity, reliability and thus safety of ChatGPT/GPT-4 as an emergency support tool is questionable. However, whether humans would perform better in the same situation is uncertain. Moreover, other studies have shown that human emergency call operators are also inaccurate, partly with worse performance than ChatGPT/GPT-4 in our study. However, one of the main limitations of the study is that we used prototypical cases, and the management may differ from urban to rural areas and between different countries, indicating the need for further evaluation of the context sensitivity and adaptability of the model. Nevertheless, ChatGPT and the new versions under development may be promising tools for assisting lay first responders, operators, and professionals in diagnosing a paediatric emergency. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Stefan Bushuven
- Training Center for Emergency Medicine (NOTIS e.V), Breite Strasse 7, Engen, 78234, Germany.
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany.
| | - Michael Bentele
- Training Center for Emergency Medicine (NOTIS e.V), Breite Strasse 7, Engen, 78234, Germany
| | - Stefanie Bentele
- Training Center for Emergency Medicine (NOTIS e.V), Breite Strasse 7, Engen, 78234, Germany
| | - Bianka Gerber
- Training Center for Emergency Medicine (NOTIS e.V), Breite Strasse 7, Engen, 78234, Germany
| | - Joachim Bansbach
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julian Ganter
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Robert Ranisch
- Faculty for Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
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Aygun O, Topcu M. The relationship between parental health literacy levels and anthropometric measurements of children in Turkey. BMC Pediatr 2023; 23:559. [PMID: 37946149 PMCID: PMC10636928 DOI: 10.1186/s12887-023-04385-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE The aim of this study was to identify the relationship between parental health literacy levels and anthropometric measurements of children in Turkey. METHODS The research was of cross-sectional/correlational design and carried out with 378 consenting parents registered at a Family Health Center. A Sociodemographic Data Form and the Health Literacy Scale for Turkey-32 was used to collect the study data. Data collection was completed at face-to-face interviews held in the consultation department of the family health center. The data were analyzed with the chi-square test and Ordinal Logistic Regression Analysis. RESULTS It was determined that parental health literacy levels were associated with level of education, income status and the state of the parents' employment (p < .05). A relationship was also found between adequate levels of parental health literacy and the health status, weight and height standard deviation scores by age of the parents' children (p < .05). CONCLUSION This study found that adequate levels of parental health literacy were significantly lower than the European average. The study found that adequate parental health literacy had a positive effect on children's anthropometric measurements. Health institutions and health professionals should plan training programs to improve the health literacy of parents when they apply to health institutions.
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Affiliation(s)
- Ozcan Aygun
- Fethiye Health Science Faculty, Public Health Nursing Department, Mugla Sitki Kocman University, Calica Mevkii/Karaculha Fethiye, Mugla, Turkey.
| | - Mine Topcu
- Department of Nursing, Public Health Nursing Master's Program, Institute of Health Sciences, Mugla, Turkey
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Pivac I, Markić J, Poklepović Peričić T, Aranza D, Marušić A. Evaluating health claim assessment skills of parents with preschool children: A cross-sectional study using Informed Health Choices Claim Evaluation Tool. J Glob Health 2023; 13:04156. [PMID: 37917876 PMCID: PMC10622117 DOI: 10.7189/jogh.13.04156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Background Health literacy is a global problem and is particularly relevant when making health care decisions about small children. We analysed how parents of preschool children assess health claims and explored the predictors of their assessment skill. Methods We conducted a survey with questions from the Claim Evaluation Tools (CET) database, part of the Informed Health Choices (IHC) project, in ten paediatric primary care practices of the Split-Dalmatia County Health Center, Split, Croatia, from 1 February to 31 March 2023. Eligible participants were parents accompanying preschool-aged children for check-ups. We also collected data on parents' and children's demographic and health characteristics (including the presence of any chronic illness in the child), visits to paediatric emergency service, hospitalisations, vaccination status, the presence of chronic illness of parents or relatives, and whether parents had to made treatment decisions for themselves and/or their family member. Results Overall, 402 parents of preschool children (median age 35 years (interquartile range (IQR) = 31.0-38.3)) had a median IHC CET test score of 10.0 (IQR = 8.0-11.0) out of 12 questions. The multiple regression analysis showed that female gender, higher level of education, being employed, and having a history of a visit to paediatric emergency service were significant predictors of the test score, explaining 21.9% of the variance. Conclusions Parents of preschool children have a very good ability for critical assessment of health-related statements in a complex health care system and an environment of generally unsatisfactory health literacy. Further studies should explore how parents understand health claims in different geographical, socio-economic and cultural setting, and explore educational interventions to increase critical thinking abilities and informed decision-making, especially among fathers, unemployed parents and those with lower levels of education.
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Affiliation(s)
- Ivan Pivac
- University of Split School of Medicine, Split, Croatia
| | - Joško Markić
- University of Split School of Medicine, Split, Croatia
- Department of Pediatrics, University Hospital of Split, Split, Croatia
| | | | - Diana Aranza
- University Department of Health Studies, University of Split, Split, Croatia
| | - Ana Marušić
- University of Split School of Medicine, Split, Croatia
- Center for Evidence-based Medicine, University of Split School of Medicine, Split, Croatia
- Department for Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
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Portela-Pino I, Hernaiz-Sanchez A, Lomba-Portela L. Evaluation of health literacy and its predictive formative factors among Spanish military personnel. MILITARY PSYCHOLOGY 2023:1-8. [PMID: 37921646 DOI: 10.1080/08995605.2023.2274755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023]
Abstract
Health literacy (HL) is an aspect that has been widely studied. However, in the military population there are hardly any studies on the influence of educational variables. Knowing the level of health literacy of military professionals is important as it has an impact on adequate health decision making, avoids the abuse of health services and makes it possible to ask for help when needed, especially in aspects related to mental health. The aim of this study was to measure the level of literacy, as well as its association with other training variables in a sample of military personnel. The study was carried out in 695 military personnel of the Spanish Army. A cross-sectional observational design was used, using a survey with the HLS-EU-Q47 scale. Among the results, it stands out that the level of health literacy of the military is high compared to the rest of the population. The results showed that the level of HL does not seem to be influenced by the level of languages, nor by the degree they hold, nor by experiences abroad. On the other hand, it was observed that the performance of professional internships and work in multidisciplinary teams, extracurricular training, does influence the level of HL, especially in the dimension related to health promotion. This fact seems to mean that the military have learned during these experiences to keep abreast of health-related issues, to understand, to value and to form a considered opinion on health-related information.
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Affiliation(s)
- Iago Portela-Pino
- Department of Health Sciences, Faculty of Health Sciences, Isabel I University, Burgos, Spain
| | | | - Lucía Lomba-Portela
- Department of Didactics, School Organisation and Research, University of Vigo, Vigo, Spain
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Glick AF, Farkas JS, Magro J, Shah AV, Taye M, Zavodovsky V, Rodriguez RH, Modi AC, Dreyer BP, Famiglietti H, Yin HS. Management of Discharge Instructions for Children With Medical Complexity: A Systematic Review. Pediatrics 2023; 152:e2023061572. [PMID: 37846504 PMCID: PMC10598634 DOI: 10.1542/peds.2023-061572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 10/18/2023] Open
Abstract
CONTEXT Children with medical complexity (CMC) are at risk for adverse outcomes after discharge. Difficulties with comprehension of and adherence to discharge instructions contribute to these errors. Comprehensive reviews of patient-, caregiver-, provider-, and system-level characteristics and interventions associated with discharge instruction comprehension and adherence for CMC are lacking. OBJECTIVE To systematically review the literature related to factors associated with comprehension of and adherence to discharge instructions for CMC. DATA SOURCES PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, Web of Science (database initiation until March 2023), and OAIster (gray literature) were searched. STUDY SELECTION Original studies examining caregiver comprehension of and adherence to discharge instructions for CMC (Patient Medical Complexity Algorithm) were evaluated. DATA EXTRACTION Two authors independently screened titles/abstracts and reviewed full-text articles. Two authors extracted data related to study characteristics, methodology, subjects, and results. RESULTS Fifty-one studies were included. More than half were qualitative or mixed methods studies. Few interventional studies examined objective outcomes. More than half of studies examined instructions for equipment (eg, tracheostomies). Common issues related to access, care coordination, and stress/anxiety. Facilitators included accounting for family context and using health literacy-informed strategies. LIMITATIONS No randomized trials met inclusion criteria. Several groups (eg, oncologic diagnoses, NICU patients) were not examined in this review. CONCLUSIONS Multiple factors affect comprehension of and adherence to discharge instructions for CMC. Several areas (eg, appointments, feeding tubes) were understudied. Future work should focus on design of interventions to optimize transitions.
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Affiliation(s)
| | | | - Juliana Magro
- Health Sciences Libraries, NYU Langone Health, New York, New York
| | | | | | | | | | - Avani C. Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | | | - H. Shonna Yin
- Department of Pediatrics
- Department of Population Health, NYU Langone Health, New York, New York
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Ikediashi BG, Ehrmann C, Gomez S, Michel G. Disease knowledge and health literacy in parents of children with sickle cell disease. EJHAEM 2023; 4:956-962. [PMID: 38024626 PMCID: PMC10660603 DOI: 10.1002/jha2.762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 12/01/2023]
Abstract
We aimed to (1) describe sickle cell disease (SCD) knowledge and health literacy levels in parents of children with SCD, (2) examine associations with socio-demographic factors and (3) analyse the association with hospital admissions and frequency of occurrence of painful episodes. Parents who presented with their child at routine hospital consultation at the National Sickle Cell Disease Centre in Benin were administered a questionnaire assessing SCD knowledge, health literacy (newest vital sign [NVS]) and socio-demographic and clinical characteristics. In total, 117 parents participated (108, 92.3% females). The predominant SCD genotype was HbSS (79.5%). The average SCD knowledge score was 13.6 (standard deviation [SD] = 2.0). Only 34 (29.1%) participants correctly answered ≥70% of the questions, indicating good knowledge. Health literacy was relatively low (mean NVS score = 3.3; SD = 1.1). SCD knowledge was higher in parents with older children (p = 0.001) and higher education levels (primary, p = 0.010; tertiary, p = 0.036 compared to participants with no formal education). Hospital admissions were more frequent when parents had lower SCD knowledge (p = 0.034) and in parents with younger children (p = 0.039). No associations were found between health literacy and hospital admissions (p = 0.940) and frequency of occurrence of painful episodes (p = 0.224). Continuous disease-specific education for parents of children with SCD may help them better identify and prevent the occurrence of symptoms and decrease the number of hospital admissions.
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Affiliation(s)
| | | | - Selma Gomez
- National Sickle Cell Disease Centre of Benin (New‐Born Screening of Sickle Cell Disease and Comprehensive Clinical Care Programs, CPMI‐NFED)CotonouBenin
| | - Gisela Michel
- Faculty of Health Sciences and Medicine, University of LucerneLucerneSwitzerland
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Rosenfeld LE, McCullagh K, King CJ, Torres M, Litt JS. Organizational Health Literacy as a Tool for Health Equity: Application in a High-Risk Infant Follow-Up Program. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1658. [PMID: 37892321 PMCID: PMC10605611 DOI: 10.3390/children10101658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Healthy People 2030 emphasizes personal health literacy (individual skills) and organizational health literacy-the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. However, research on the latter is in the early stages. METHODS This study describes an organizational health literacy assessment in a U.S. urban academic children's hospital. A variety of evidence-based health literacy assessments were used to assess patient information materials and the environment, including institutional practices, navigation, culture and language, and communication. Trained interviewers and analysts reached consensus for all assessments. RESULTS Information Items: SMOG scores (n = 9) ranged from 7th- to 14th-grade reading level (average = 11.3). PEMAT-P scores (n = 9) ranged from 43.8% to 93.8% understandability and 0% to 80% actionability. CDC CCI scores (literacy demand) (n = 6) ranged from 18.2% to 58.8% (≥90% = excellent). SAM scores (suitability) (n = 6) fell in the "adequate" range (43.2-58.3%). The PMOSE/IKIRSCH scores (complexity) (n = 3) noted low-moderate difficulty. Apter's Hierarchy (n = 4) revealed three numeracy domains (50% = descriptive purposes and decision-making, 100% = interpreting information). Organization-level: Walking interviews highlighted organizational facilitators and barriers related to the pre-visit and visit environments. HLE2 domain scores ranged from 52% to 68%. CONCLUSIONS Organizational health literacy demands far outweigh the average literacy skills of adults in the U.S. (patients and staff). Findings can be used to hone quality improvement and other processes to focus on structural solutions to increase health equity.
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Affiliation(s)
- Lindsay E. Rosenfeld
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Boston Children’s Hospital, Boston, MA 02115, USA; (K.M.); (C.J.K.)
- Heller School for Social Policy & Management, Brandeis University, Waltham, MA 02453, USA
| | - Kelly McCullagh
- Boston Children’s Hospital, Boston, MA 02115, USA; (K.M.); (C.J.K.)
| | - Carolyn J. King
- Boston Children’s Hospital, Boston, MA 02115, USA; (K.M.); (C.J.K.)
| | - Micaela Torres
- Charles R. Drew, UCLA Medical Education Program, Los Angeles, CA 90059, USA;
- UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Jonathan S. Litt
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Boston Children’s Hospital, Boston, MA 02115, USA; (K.M.); (C.J.K.)
- Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Pergolizzi J, LeQuang JAK, Vasiliu-Feltes I, Breve F, Varrassi G. Brave New Healthcare: A Narrative Review of Digital Healthcare in American Medicine. Cureus 2023; 15:e46489. [PMID: 37927734 PMCID: PMC10623488 DOI: 10.7759/cureus.46489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/30/2023] [Indexed: 11/07/2023] Open
Abstract
The digital revolution has had a profound effect on American and global healthcare, which was accelerated by the pandemic and telehealth applications. Digital health also includes popular and more esoteric forms of wearable monitoring systems and interscatter and other wireless technologies that facilitate their telemetry. The rise in artificial intelligence (AI) and machine learning (ML) may serve to improve interpretation from imaging technologies to electrocardiography or electroencephalographic tracings, and new ML techniques may allow these systems to scan data to discern and contextualize patterns that may have evaded human physicians. The necessity of virtual care during the pandemic has morphed into new treatment paradigms, which have gained patient acceptance but still raise issues with respect to privacy laws and credentialing. Augmented and virtual reality tools can facilitate surgical planning and "hands-on" clinical training activities. Patients are working with new frontiers in digital health in the form of "Dr. Google" and patient support websites to learn or share medical information. Patient-facing digital health information is both a blessing and curse, in that it can be a boon to health-literate patients who seek to be more active in their own care. On the other hand, digital health information can lead to false conclusions, catastrophizing, misunderstandings, and "cyberchondria." The role of blockchain, familiar from cryptocurrency, may play a role in future healthcare information and would serve as a disruptive, decentralizing, and potentially beneficial change. These important changes are both exciting and perplexing as clinicians and their patients learn to navigate this new system and how we address the questions it raises, such as medical privacy in a digital age. The goal of this review is to explore the vast range of digital health and how it may impact the healthcare system.
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Affiliation(s)
| | | | | | - Frank Breve
- Department of Pharmacy, Temple University, Philadelphia, USA
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Wynter K, Watkins V, Kavanagh S, Hosking S, Rasmussen B, Maindal HT, Macdonald J. Health literacy among fathers and fathers-to-be: a multi-country, cross-sectional survey. Health Promot Int 2023; 38:daad131. [PMID: 37851463 PMCID: PMC10583760 DOI: 10.1093/heapro/daad131] [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] [Indexed: 10/19/2023] Open
Abstract
During pregnancy and early fatherhood, men are at higher risk of poor health, exacerbated by low engagement by healthcare services. Yet the transition to fatherhood presents an opportunity for men to improve their health and health behaviours. Health literacy refers to individuals' competence in accessing and applying health information. Poor health literacy is associated with poor health and low help-seeking. The aim of this study was to identify health literacy strengths, needs and profiles among fathers. Men who were expecting a baby ('antenatal') or had become fathers in the past 18 months ('postnatal') were recruited through an international, online paid survey platform. The survey included the nine-scale Health Literacy Questionnaire (HLQ). Of 889 survey respondents (n = 416, 46.5% antenatal; n = 473, 53.5% postnatal), 274 (31.0%) were residing in the USA and 239 (27.0%) in the UK. Relatively higher scores were reported for HLQ scales relating to having sufficient information and finding and understanding this information, as well as social support for health. Relatively lower scores were obtained for scales relating to actively managing one's own health and navigating the health care system. Three scale scores were significantly lower among nulliparous than multiparous men. Seven health literacy profiles were identified. In conclusion, while fathers have some health literacy strengths, they also experience some barriers, particularly first-time fathers. Awareness of diverse health literacy profiles among fathers may assist in developing strategies to strengthen health services' capacity to meet fathers' needs and reduce risks to their health at this critical juncture in families' lives.
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Affiliation(s)
- Karen Wynter
- Department of Psychiatry, School of Clinical Sciences, Monash University, Level 3, P Block, 246 Clayton Road, Clatyon, Victoria, 3168, Australia
- School of Nursing and Midwifery, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Vanessa Watkins
- School of Nursing and Midwifery, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Shane Kavanagh
- School of Health and Social Development, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Sarah Hosking
- The Institute for Mental and Physical Health and Clinical Translation, Deakin University, School of Medicine, 199 Ryrie Street Geelong, Victoria, 3220, Australia
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation (IHT) – Western Health Partnership, Deakin University, Sunshine Hospital, 176 Furlong Road, St Albans, Victoria, 3021, Australia
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, 2200, Denmark
- Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Campusvej 55, Odense, 5230, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health, Aarhus University, Bartholins Alle 2, 2. sal, Aarhus, 8000, Denmark
| | - Jacqui Macdonald
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia
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Abrams MA, Crichton KG, Oberle EJ, Flowers S, Crawford TN, Perry MF, Mahan JD, Reed S. A Refined Teach-back Observation Tool: Validity Evidence in a Pediatric Setting. Health Lit Res Pract 2023; 7:e187-e196. [PMID: 37812909 PMCID: PMC10561624 DOI: 10.3928/24748307-20230919-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/25/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Teach Back (TB) is recommended to assess and ensure patient understanding, thereby promoting safety, quality, and equity. There are many TB trainings, typically lacking assessment tools with validity evidence. We used a pediatric resident competency-based communication curriculum to develop initial validity evidence and refinement recommendations for a Teach-back Observation Tool (T-BOT). OBJECTIVE This study aimed to develop initial validity evidence for a refined T-BOT and provide guidance for further enhancements to improve essential TB skills training among pediatric residents. METHODS After an interactive health literacy (HL) training, residents participated in recorded standardized patient (SP) encounters. Raters developed T-BOT scoring criteria, then scored a gold standard TB video and resident SP encounters. For agreement, Fleiss' Kappa was computed for >2 raters, and Cohen's Kappa for two raters. Percent agreement and intraclass correlation (ICC) were calculated. Statistics were calculated for gold standard (GS) and TB items overall for all six raters, and for five faculty raters. Agreement was based on Kappa: no agreement (≤0), none to slight (0.01-0.20), fair (0.21-0.40), moderate (0.41-0.60), substantial (0.61-0.80), almost perfect (0.81-1.00). KEY RESULTS For six raters, Kappa for the GS was 0.554 (moderate agreement) with 71.4% agreement; ICC = .597; for SP encounters, it was 0.637 (substantial) with 65.4% agreement; ICC = .647. Individual item agreement for SP encounters average was 0.605 (moderate), ranging from 0.142 (slight) to 1 (perfect). For five faculty raters, Kappa for the GS was 0.779 (substantial) with 85.7% agreement; ICC = .824; for resident SP encounters, it was 0.751 (substantial), with 76.9% agreement; ICC = .759. Individual item agreement on SP encounters average was 0.718 (substantial), ranging from 0.156 (slight) to 1 (perfect). CONCLUSION We provide initial validity evidence for a modified T-BOT and recommendations for improvement. With further refinements to increase validity evidence, accompanied by shared understanding of TB and rating criteria, the T-BOT may be useful in strengthening approaches to teaching and improving essential TB skills among health care team members, thereby increasing organizational HL and improving outcomes. [HLRP: Health Literacy Research and Practice. 2023;7(4):e187-e196.].
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Affiliation(s)
- Mary Ann Abrams
- Address correspondence to Mary Ann Abrams, MD, MPH, Center for Child Health Equity and Outcomes Research, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH 43205;
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García-Quintero X, Bastardo Blanco D, Vásquez L, Fuentes-Alabí S, Benites-Majano S, Maza M, Ugaz C, Morales R, Baker JN, McNeil MJ. Health literacy on quality of life for children with cancer: modules on pediatric palliative care. Rev Panam Salud Publica 2023; 47:e134. [PMID: 37750058 PMCID: PMC10516324 DOI: 10.26633/rpsp.2023.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/31/2023] [Indexed: 09/27/2023] Open
Abstract
Objective To describe the development of educational materials for parents and other caregivers of children with cancer, which utilized a culturally sensitive approach to reduce acceptance barriers to palliative care (PC). Methods The Pan American Health Organization (PAHO), St. Jude Children's Research Hospital, and partners in Latin America and the Caribbean collaborated in a three-phase project, beginning with a needs assessment survey of caregivers of children with cancer in Peru. Based on this finding, an interdisciplinary team of pediatric PC experts developed educational content that was designed and validated by an international committee of PC and communication experts. Results The collaboration resulted in the development of an eight-module series that introduces caregivers to key concepts of pediatric PC, including management of pain, quality of life, and end of life care. The series was designed to reduce caregiver stigma associated with PC through culturally sensitive education that addresses the low levels of health literacy among caregivers in Latin America and the Caribbean. In the 15 months since the launch, these modules have been distributed throughout Latin America and were downloaded 2 825 times. Conclusions Educational materials and anticipatory guidance of PC were considered to be a priority for parents and other caregivers of children with cancer throughout Latin America. The materials developed through this project have been widely utilized and are available through the PAHO website and the Together by St. Jude™ online resource.
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Affiliation(s)
- Ximena García-Quintero
- Department of Global Pediatric MedicineSt. Jude Children’s Research HospitalMemphisUnited States of AmericaDepartment of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, United States of America.
| | - Daniel Bastardo Blanco
- Department of Strategic Communication, Education and OutreachSt. Jude Children’s Research HospitalMemphisUnited States of AmericaDepartment of Strategic Communication, Education and Outreach. St. Jude Children’s Research Hospital, Memphis, United States of America.
| | - Liliana Vásquez
- Noncommunicable Diseases UnitPan American Health Organization/World Health OrganizationWashington, DCUnited StatesNoncommunicable Diseases Unit, Pan American Health Organization/World Health Organization, Washington, DC, United States.
| | - Soad Fuentes-Alabí
- Noncommunicable Diseases UnitPan American Health Organization/World Health OrganizationWashington, DCUnited StatesNoncommunicable Diseases Unit, Pan American Health Organization/World Health Organization, Washington, DC, United States.
| | - Sara Benites-Majano
- Noncommunicable Diseases UnitPan American Health Organization/World Health OrganizationWashington, DCUnited StatesNoncommunicable Diseases Unit, Pan American Health Organization/World Health Organization, Washington, DC, United States.
| | - Mauricio Maza
- Noncommunicable Diseases UnitPan American Health Organization/World Health OrganizationWashington, DCUnited StatesNoncommunicable Diseases Unit, Pan American Health Organization/World Health Organization, Washington, DC, United States.
| | - Cecilia Ugaz
- Department of OncologyInstituto Nacional de Enfermedades NeoplásicasLimaPeruDepartment of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru.
| | - Roxana Morales
- Department of OncologyInstituto Nacional de Enfermedades NeoplásicasLimaPeruDepartment of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru.
| | - Justin N Baker
- Department of Global Pediatric MedicineSt. Jude Children’s Research HospitalMemphisUnited States of AmericaDepartment of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, United States of America.
| | - Michael J. McNeil
- Department of Global Pediatric MedicineSt. Jude Children’s Research HospitalMemphisUnited States of AmericaDepartment of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, United States of America.
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Zysset AE, Schwärzler P, Dratva J. Seeking Health in a Digital World: Exploring Immigrant Parents' Quest for Child Health Information-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6804. [PMID: 37835074 PMCID: PMC10572919 DOI: 10.3390/ijerph20196804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/10/2023] [Accepted: 09/16/2023] [Indexed: 10/15/2023]
Abstract
During pregnancy and early parenthood, parents' strong interest in pediatric health information presents a valuable opportunity to positively impact long-term health-seeking behavior and overall child health. In line with the increasing prevalence of digital transformation, a scoping review was conducted to explore two key aspects: (1) information seeking and use of digital health information among immigrant parents, and (2) associated reasons and factors. The literature search covered the period until July 2022, using Web of Science, MEDLINE, and CINAHL Complete databases. Out of 625 articles, 12 were included, comprising six qualitative, five quantitative studies, and one review. The majority of studies focused on immigrants in North America, primarily from Latin America and Asia. The studies varied in topics and methodologies, making it challenging to draw general conclusions. Nevertheless, while most immigrant parents rely on digital information on child health, they often prefer human sources such as family, friends, or healthcare providers. Trustworthiness and accessibility emerged as critical criteria for health resources. Two focus group discussions, derived from the results of the review, confirmed these findings for migrant mothers in Switzerland.
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Affiliation(s)
- Annina E. Zysset
- Departement of Health, Institute of Public Health, ZHAW Zürich University of Applied Sciences, 8401 Winterthur, Switzerland; (A.E.Z.); (P.S.)
| | - Patricia Schwärzler
- Departement of Health, Institute of Public Health, ZHAW Zürich University of Applied Sciences, 8401 Winterthur, Switzerland; (A.E.Z.); (P.S.)
| | - Julia Dratva
- Departement of Health, Institute of Public Health, ZHAW Zürich University of Applied Sciences, 8401 Winterthur, Switzerland; (A.E.Z.); (P.S.)
- Medical Faculty, University of Basel, 4056 Basel, Switzerland
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Nilsson S, Hylén M, Kristensson-Hallström I, Kristjánsdóttir G, Stenström P, Vilhjálmsson R. Parental Access to Healthcare following Paediatric Surgery-The Precarious Role of Parents as Providers of Care in the Home. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1578. [PMID: 37761539 PMCID: PMC10527615 DOI: 10.3390/children10091578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
Access to healthcare can facilitate parents' self-management of their children's care. Healthcare access can be described as consisting of six dimensions: approachability, acceptability, affordability, availability, appropriateness, and aperture. The aim of this study was to analyse these dimensions of healthcare access experienced by parents caring for their children at home following paediatric surgery. The method-directed content analysis, conducted with the six-dimensional framework of access to healthcare as a guide, was used to analyse twenty-two interviews with parents of children treated with paediatric surgery. All six dimensions were represented in the results. Acceptability was the most frequent dimension, followed by appropriateness and approachability. Affordability, availability, and aperture were less represented. Although access to healthcare after paediatric surgery is generally appropriate and approachable, parents may experience insecurity in performing the self-management needed. Complementary forms of information provision, e.g., telemedicine, can be valuable in this regard.
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Affiliation(s)
- Stefan Nilsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Queen Silvia Children’s Hospital, Behandlingsvägen 7, 416 50 Gothenburg, Sweden
| | - Mia Hylén
- Department of Health Sciences, Faculty of Medicine, Lund University, 221 00 Lund, Sweden; (M.H.); (I.K.-H.); (R.V.)
- Department of Intensive and Perioperative Care, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Inger Kristensson-Hallström
- Department of Health Sciences, Faculty of Medicine, Lund University, 221 00 Lund, Sweden; (M.H.); (I.K.-H.); (R.V.)
| | - Gudrún Kristjánsdóttir
- Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Eiriksgötu 34, IS-101 Reykjavik, Iceland;
| | - Pernilla Stenström
- Department of Pediatric Surgery, Skåne University Hospital Lund, Lund University, Lasarettsgatan 48, 221 85 Lund, Sweden;
| | - Runar Vilhjálmsson
- Department of Health Sciences, Faculty of Medicine, Lund University, 221 00 Lund, Sweden; (M.H.); (I.K.-H.); (R.V.)
- Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Eiriksgötu 34, IS-101 Reykjavik, Iceland;
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Bakare O, Akintujoye IA, Gbemudu PE, Mbaezue RN, Akinbolade AO, Olopade S. Medicaid Coverage and Emergency Department Utilization in Southeastern Pennsylvania. Cureus 2023; 15:e45464. [PMID: 37859924 PMCID: PMC10584275 DOI: 10.7759/cureus.45464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Overutilization of the emergency department (ED) is a significant problem in the United States (US), characterized mainly by patients with non-emergent conditions seeking care in a setting designed specifically for acute care. This has significantly increased healthcare costs in the US, a country with one of the most expensive healthcare systems in the world. ED overutilization was also found to be high among people with Medicaid coverage, especially since the Affordable Care Act was enacted with an expansion in Medicaid coverage. Using the 2018 South Eastern Pennsylvania (SEPA) Household Health Survey, we identified a significant bivariate relationship between emergency department visits and the following predictor variables: sex, race, education, employment status, 150% poverty level, and Medicaid recipient. Using a multivariable logistic regression model, Medicaid recipients had higher odds of presenting to the ED than non-Medicaid recipients [odds ratio (OR): 2.863, 95% confidence interval (CI): 2.164, 3.788]. Black people (OR: 1.647, 95% CI: 1.411, 1.923) and Native Americans (OR: 2.985, 95% CI: 1.536, 5.800) had higher odds than Whites. Respondents without a high school diploma had higher odds than college graduates (OR: 1.647, 95% CI: 1.96, 2.273). Respondents below the 150% poverty line had higher odds than those at or above the 150% poverty level (OR: 1.651, 95% CI: 1.386, 1.968). Unemployed respondents had higher odds than full-time employed respondents (OR: 1.703, 95% CI: 1.488, 1.953) or part-time (OR: 1.259, 95% CI: 1.036, 1.529). No difference was observed between the sexes. Addressing ED overutilization should take a multi-faceted approach with the ultimate goal of improving access to primary care.
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Affiliation(s)
- Olusegun Bakare
- Internal Medicine-Pediatrics, Tulane University School of Medicine, New Orleans, USA
| | | | - Paul E Gbemudu
- Internal Medicine-Pediatrics, Tulane University School of Medicine, New Orleans, USA
| | | | | | - Segun Olopade
- Medicine and Surgery, Igbinedion University Teaching Hospital, Okada, NGA
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Dawson AE, Ray Bignall ON, Spencer JD, McLeod DJ. A Call to Comprehensively Understand Our Patients to Provide Equitable Pediatric Urological Care. Urology 2023; 179:126-135. [PMID: 37393019 DOI: 10.1016/j.urology.2023.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/02/2023] [Accepted: 05/16/2023] [Indexed: 07/03/2023]
Affiliation(s)
- Anne E Dawson
- Division of Psychology and Neuropsychology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio; The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, Ohio
| | - O N Ray Bignall
- The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, Ohio; Division of Nephrology and Hypertension, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - John David Spencer
- The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, Ohio; Division of Nephrology and Hypertension, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Daryl J McLeod
- The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, Ohio; Department of Urology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
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Abidin ZZ, Halim RA, Noor E, Nor NSM, Nazari NSM, Zaini AA, Azizi NZ, Soelar SA. Knowledge and Perception of Bidirectional Relationship Between Periodontal Disease and Type 1 Diabetes Mellitus: A Questionnaire Study. J Int Soc Prev Community Dent 2023; 13:416-425. [PMID: 38124724 PMCID: PMC10729881 DOI: 10.4103/jispcd.jispcd_123_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 12/23/2023] Open
Abstract
Aim The bidirectional relationship between type 1 diabetes mellitus (T1DM) and inflammatory periodontal disease (PD) is globally recognized. However, oral health components are often given lower priority, and studies related to knowledge and the bidirectional association are limited. This study assesses the knowledge and perceptions of PD and its associated risk factors among T1DM patients and/or their parents. Materials and Methods Patients under 18 with T1DM at Universiti Teknologi MARA and Universiti Malaya were invited to participate. Structured interviews were conducted to assess participants' knowledge and perceptions of T1DM, and statistical analysis was performed to examine their associations using Pearson's chi-squared test and Fisher's exact test. Results A total of 113 T1DM patients, with a mean age of 11.4 ± 4, completed the interviews. Poor knowledge was observed among parents and T1DM patients (P-value = 0.007) and those who exercised regularly (P-value = 0.047). A significant association with good perception was found among individuals with uncontrolled HbA1c levels (P-value = 0.0018) and those experiencing bleeding symptoms (P-value = 0.021). Conclusions The study highlights the importance of increasing awareness, a key factor in improving oral health knowledge. Interestingly, despite poor control of clinical parameters, the population displayed good perception, suggesting a potential lack of understanding regarding disease control.
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Affiliation(s)
- Zaridah Zainal Abidin
- Centre of Studies for Paediatric Dentistry & Orthodontics, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
| | - Rohaida Abdul Halim
- Centre of Studies for Paediatric Dentistry & Orthodontics, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
| | - Erni Noor
- Centre of Studies for Periodontology, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
| | - Noor Shafina Mohd Nor
- Department of Paediatrics, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
| | - Nor Shafina Mohamed Nazari
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Sungai Buloh, Selangor, Malaysia
| | - Azriyanti Anuar Zaini
- Department of Paediatric, Faculty of Medicine, Universiti Malaya, Sungai Buloh, Selangor, Malaysia
| | - Nurul Zeety Azizi
- Department of Paediatric Dentistry & Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Aiman Soelar
- Clinical Research Centre, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
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Stewart TA, Perrin EM, Yin HS. Addressing Health Literacy in Pediatric Practice: A Health Equity Lens. Pediatr Clin North Am 2023; 70:745-760. [PMID: 37422312 DOI: 10.1016/j.pcl.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
Low health literacy has been linked to worse child health-related knowledge, behaviors, and outcomes across multiple health domains. As low health literacy is highly prevalent and an important mediator of income- and race/ethnicity-associated disparities, provider adoption of health literacy best practices advances health equity. A multidisciplinary effort involving all providers engaged in communication with families should include a universal precautions approach, with clear communication strategies employed with all patients, and advocacy for health system change.
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Affiliation(s)
- Tiffany A Stewart
- Department of Pediatrics, New York University Grossman School of Medicine / Bellevue Hospital Center, 550 First Avenue, NBV 8S4-11, New York, NY 10016, USA
| | - Eliana M Perrin
- Department of Pediatrics, Johns Hopkins School of Medicine / School of Nursing, 200 North Wolfe Street, Rubenstein Building 2071, Baltimore, MD 21287, USA
| | - Hsiang Shonna Yin
- Department of Pediatrics, New York University Grossman School of Medicine / Bellevue Hospital Center, 550 First Avenue, NBV 8S4-11, New York, NY 10016, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
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Abstract
PURPOSE OF REVIEW Health literacy influences how children and families participate in their medical care, use health services, and overall health outcomes. Health literacy is underexplored in pediatric dermatology. In this scoping review, we provide examples of how limited health literacy can be a barrier to patient care in pediatric dermatology and how to mitigate its effects. RECENT FINDINGS Limited health literacy is associated with worse health outcomes, decreased medication adherence, and decreased use of the healthcare system versus those with adequate health literacy. Materials created to help patients understand their medical conditions and treatment options often are written at a reading level far above that of the average patient and caregiver. Given the reading level of patient-facing materials, those with limited health literacy are more susceptible to medication administration errors, with omissions or incorrect dosing being most frequent to occur. There is limited research about how skills related to health literacy, including numeracy and electronic health literacy, can be addressed in pediatric dermatology. SUMMARY Health literacy impacts patient care, treatment, and adherence in pediatric dermatology. This article gives examples of how to address common challenges in the pediatric dermatology clinic and presents areas for further research and improvement.
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Affiliation(s)
| | | | - Carrie C Coughlin
- Division of Dermatology, Departments of Medicine and Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Keith KE, Wadhwa A, York J, Fazeli PL, Bhatia S, Landier W. Health Literacy in Parents of Children Newly Diagnosed With Cancer and Comprehension of Key Concepts Related to Their Child's Care. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:235-244. [PMID: 37063061 DOI: 10.1177/27527530221140076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background: There is a paucity of literature regarding health literacy in pediatric oncology. We sought to understand the relationship between health literacy and comprehension of key new diagnosis education concepts in parents of children newly diagnosed with cancer. Methods: Using data from a study evaluating a structured new diagnosis discharge teaching intervention, we performed a secondary analysis to understand the relationship between parental health literacy (Brief Health Literacy Screener: BHLS) and comprehension of six key concepts (child's diagnosis, primary oncologist, and treatment plan; seeking emergent care; fever definition; re-dosing medication). We also evaluated the association between parents self-reported sociodemographic characteristics, preferred learning style (one-item ordinal assessment) and health literacy. We tested relationships using Fisher's exact tests, independent samples t-tests, and Pearson correlations. Results: Fifty parents participated (age 35.4 ± 8.2 years [M ± SD]; 86% female; 60% non-Hispanic white; 24% with ≤high school education); nine parents (18%) scored in the BHLS low literacy range; 80% correctly responded to all six items on the key concepts questionnaire (100% comprehension). Health literacy was not significantly related to 100% comprehension or to individual key concept responses, with the exception of "child's treatment plan" (correct responses: 55.6% in low vs. 100% in adequate literacy groups; p < .001). Parental sociodemographic characteristics and preferred learning styles were not significantly related to health literacy. Discussion:Despite variability in health literacy levels, 80% of the parents comprehended all key concepts, suggesting that the intervention was effective for most parents, regardless of health literacy level.
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Affiliation(s)
- K Elizabeth Keith
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aman Wadhwa
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jocelyn York
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wendy Landier
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Miles KG, Liu J, Tseng SY, DeFranco EA, Divanovic AA, Jones HN, Ollberding NJ, Cnota JF. Neonatal Depression Is Associated With 1-Year Mortality in Critical Congenital Heart Disease. J Am Heart Assoc 2023; 12:e028774. [PMID: 37260029 PMCID: PMC10381992 DOI: 10.1161/jaha.122.028774] [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: 11/08/2022] [Accepted: 05/03/2023] [Indexed: 06/02/2023]
Abstract
Background Low 5-minute Apgar scores (AS) are predictive of term and preterm neonatal mortality but have not been well studied in the critical congenital heart disease (CCHD) population. We analyzed US national vital statistics data to evaluate the association between neonatal depression (AS 0-3) and 1-year mortality in CCHD. Methods and Results We performed a retrospective cohort study using 2014 to 2018 Centers for Disease Control and Prevention cohort-linked birth certificate and infant death records. Five-minute AS were categorized as ≤3, 4 to 6, or ≥7. We calculated birth rates and associated mortality rates by AS group in infants with and without CCHD. Multivariable logistic regression analyzed neonatal, maternal, and pregnancy-related risk factors for neonatal depression and 1-year mortality. Of 11 642 neonates with CCHD (0.06% of all births), the 5.8% with AS 0 to 3 accounted for 23.3% of all 1-year CCHD mortality, with 69.9% of deaths occurring within 1 month of life. Gestational age at birth, growth restriction, extracardiac defects, race, and low maternal education were associated with an increased odds of AS 0 to 3 in neonates with CCHD relative to those with AS 7 to 10 on multivariable analysis. AS 0 to 3 was associated with 1-year CCHD mortality after adjusting for these factors, prenatal care, and delivery location (adjusted odds ratio, 14.57 [95% CI, 11.73-18.10]). Conclusions The AS is a routine clinical measure providing important prognostic information in CCHD. These findings suggest that prenatal and perinatal factors, beyond those included in current risk stratification tools, are important for CCHD outcomes. Multidisciplinary collaboration to understand the pathophysiology underlying neonatal depression may help identify interventions to improve CCHD mortality rates.
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Affiliation(s)
| | - James Liu
- Division of Maternal‐Fetal Medicine, Department of Obstetrics and GynecologyUniversity of CincinnatiCincinnatiOH
| | | | - Emily A. DeFranco
- Division of Maternal‐Fetal Medicine, Department of Obstetrics and GynecologyUniversity of CincinnatiCincinnatiOH
| | | | - Helen N. Jones
- Department of Physiology and AgingUniversity of FloridaGainesvilleFL
| | - Nicholas J. Ollberding
- Division of Biostatistics and EpidemiologyCincinnati Children’s Hospital Medical CenterCincinnatiOH
| | - James F. Cnota
- The Heart InstituteCincinnati Children’s HospitalCincinnatiOH
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