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Woo Baidal J, Finkel MA, Kelman E, Duong N, Bien-Aime C, Goldsmith J, Albrecht SS, Hulse E, Rosenthal A, Reiss J, Schwartz R, Meyer D. Longitudinal Associations of Food Security with Health and Dietary Factors among Food FARMacy Participants during COVID-19 in New York City. Nutrients 2024; 16:434. [PMID: 38337718 PMCID: PMC10857290 DOI: 10.3390/nu16030434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
In cross-sectional studies, food insecurity is associated with adverse health and dietary outcomes. Whether self-reported health and dietary outcomes change in response to improvements in food security has not been examined. We sought to examine how increases in food security are related to changes in health and dietary factors. In this longitudinal, observational study, we included adult participants in a clinical-community emergency food assistance program in New York City from July 2020 to November 2021. Program staff measured food security with a validated six-item measure at program enrollment and six-month re-enrollment. Participants self-reported health and dietary factors (vegetable, fruit, juice, and sugar-sweetened beverage (SSB) consumption frequency). We used multivariable regression to examine associations between change in food security with change in health and dietary factors over six months. Among 310 participants, the mean food security score improved by 1.7 ± 2.3 points over six months. In unadjusted models, each point improvement in food security was associated with increased vegetable (β = 0.10 times; 95% CI: 0.05-0.15); fruit (β = 0.08 times; 95% CI: 0.03-0.14); and juice (β = 0.10 times; 95% CI: 0.05-0.15) consumption. In adjusted models, results remained significant for vegetable and fruit consumption, but not juice. Change in food security was not associated with change in health or SSB outcomes. In this cohort during COVID-19, improved food security was associated with improved vegetable and fruit consumption. Randomized trials that examine the effectiveness of clinical-community partnerships focused on improving food security and nutrition are warranted.
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Affiliation(s)
- Jennifer Woo Baidal
- Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032, USA; (M.A.F.); (N.D.); (C.B.-A.); (D.M.)
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY 10032, USA
| | - Morgan A. Finkel
- Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032, USA; (M.A.F.); (N.D.); (C.B.-A.); (D.M.)
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY 10032, USA
| | - Elizabeth Kelman
- Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032, USA; (M.A.F.); (N.D.); (C.B.-A.); (D.M.)
| | - Ngoc Duong
- Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032, USA; (M.A.F.); (N.D.); (C.B.-A.); (D.M.)
| | - Celine Bien-Aime
- Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032, USA; (M.A.F.); (N.D.); (C.B.-A.); (D.M.)
| | - Jeff Goldsmith
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY 10032, USA;
| | - Sandra S. Albrecht
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA;
| | - Emma Hulse
- Division of Community and Population Health, New York Presbyterian Hospital, New York, NY 10032, USA;
| | | | - Jeremy Reiss
- Henry Street Settlement, New York, NY 10002, USA;
| | | | - Dodi Meyer
- Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032, USA; (M.A.F.); (N.D.); (C.B.-A.); (D.M.)
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY 10032, USA
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Dumitriu D, Lavallée A, Riggs JL, Frosch CA, Barker TV, Best DL, Blasingame B, Bushar J, Charlot-Swilley D, Erickson E, Finkel MA, Fortune B, Gillen L, Martinez M, Ramachandran U, Sanders LM, Willis DW, Shearman N. Advancing early relational health: a collaborative exploration of a research agenda. Front Pediatr 2023; 11:1259022. [PMID: 38143537 PMCID: PMC10748603 DOI: 10.3389/fped.2023.1259022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/07/2023] [Indexed: 12/26/2023] Open
Abstract
Here, we introduce the Early Relational Health (ERH) Learning Community's bold, large-scale, collaborative, data-driven and practice-informed research agenda focused on furthering our mechanistic understanding of ERH and identifying feasible and effective practices for making ERH promotion a routine and integrated component of pediatric primary care. The ERH Learning Community, formed by a team of parent/caregiver leaders, pediatric care clinicians, researchers, and early childhood development specialists, is a workgroup of Nurture Connection-a hub geared toward promoting ERH, i.e., the positive and nurturing relationship between young children and their parent(s)/caregiver(s), in families and communities nationwide. In response to the current child mental health crisis and the American Academy of Pediatrics (AAP) policy statement promoting ERH, the ERH Learning Community held an in-person meeting at the AAP national headquarters in December 2022 where members collaboratively designed an integrated research agenda to advance ERH. This agenda weaves together community partners, clinicians, and academics, melding the principles of participatory engagement and human-centered design, such as early engagement, co-design, iterative feedback, and cultural humility. Here, we present gaps in the ERH literature that prompted this initiative and the co-design activity that led to this novel and iterative community-focused research agenda, with parents/caregivers at the core, and in close collaboration with pediatric clinicians for real-world promotion of ERH in the pediatric primary care setting.
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Affiliation(s)
- Dani Dumitriu
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, United States
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Andréane Lavallée
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, United States
| | - Jessica L. Riggs
- Department of Psychiatry, The University of Michigan, Ann Arbor, MI, United States
| | - Cynthia A. Frosch
- Department of Human Development and Family Science, Auburn University, Auburn, AL, United States
| | - Tyson V. Barker
- Science and Innovation Strategy, Institute for Child Success, Greenville, SC, United States
| | - Debra L. Best
- Department of Pediatrics, Division of General Pediatrics and Adolescent Health, Duke University School of Medicine, Durham, NC, United States
| | | | - Jessica Bushar
- HealthySteps, ZERO TO THREE, Washington, DC, United States
| | | | - Elizabeth Erickson
- Department of Pediatrics, Division of General Pediatrics and Adolescent Health, Duke University School of Medicine, Durham, NC, United States
| | - Morgan A. Finkel
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, United States
| | - Bryn Fortune
- Fortune Consulting, Early Relational Health-Family Network Collaborative, Royal Oak, MI, United States
| | - Leah Gillen
- Department of Research and Innovation, Reach out and Read, Boston, MA, United States
| | - Marty Martinez
- Chief Executive Officer, Reach Out and Read, Boston, MA, United States
| | - Usha Ramachandran
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, United States
| | - Lee M. Sanders
- Department of Pediatrics, Division of General Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - David W. Willis
- Center for the Study of Social Policy, Washington, DC, United States
| | - Nikki Shearman
- Department of Research and Innovation, Reach out and Read, Boston, MA, United States
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Finkel MA, Barrios D, Partida I, Kelman E, Hulse E, Rosenthal A, Reiss J, Schwartz R, Meyer D, Woo Baidal JA. Participant and Stakeholder Perceptions of the Food FARMacy Emergency Food Assistance Program for the Coronavirus Disease 2019 Pandemic: A Qualitative Study. J Acad Nutr Diet 2023:S2212-2672(23)01638-6. [PMID: 37926236 PMCID: PMC11068857 DOI: 10.1016/j.jand.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Food FARMacy is a clinical-community emergency food assistance program developed in response to food insecurity during the COVID-19 pandemic. Few qualitative studies have examined participant, and clinical and community stakeholder experiences with these food assistance programs. OBJECTIVE To examine the motivations, experiences, and perceptions of Food FARMacy participants and program stakeholders. DESIGN A qualitative study using in-depth interviews between March 2021 and July 2021. PARTICIPANTS AND SETTING Twenty-four Food FARMacy participants and 10 program stakeholders in New York, NY (Manhattan, Brooklyn, and Queens) older than age 18 years were interviewed. STATISTICAL ANALYSES PERFORMED Interviews were recorded, transcribed, translated, and analyzed using thematic analysis. Participant and program stakeholder interviews were analyzed separately. Themes that were salient in both groups were combined for reporting. RESULTS Both program participants and stakeholders perceived: pandemic-related demands combined with reduced resources motivated participation; convenience, safety, and ease of access facilitated program retention; participants valued fresh produce and diversity of foods; the program improved diet and health; minimizing food waste was a priority; and social cohesion was an unexpected program benefit. Two additional themes among only program stakeholders also were identified: aligned values, flexibility, and communication were key to successful partnerships; and trust between community partners and community members drove programmatic success. CONCLUSIONS Results suggest that a multisite clinical-community partnership to provide emergency food assistance in New York City can be leveraged to reduce barriers to healthy food access and address food insecurity during crises.
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Affiliation(s)
- Morgan A Finkel
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Daniela Barrios
- Clinical Patient Coordinator, Union Square Practice, New York, New York
| | - Ivette Partida
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | | | - Emma Hulse
- CHALK Program, New York Presbyterian Hospital, New York, New York
| | | | | | | | - Dodi Meyer
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York; NewYork-Presbyterian Division of Community and Population Health/Columbia Campus, New York, New York
| | - Jennifer A Woo Baidal
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York.
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Finkel MA, Bryan A, Partida I, Raaen L, Duong N, Goldsmith J, Woo Baidal JA. Longitudinal trends in parent-reported child sleep, physical activity, and screen use during the COVID-19 pandemic in New York City. SAGE Open Med 2023; 11:20503121221147851. [PMID: 36660110 PMCID: PMC9845847 DOI: 10.1177/20503121221147851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/09/2022] [Indexed: 01/17/2023] Open
Abstract
Objective To examine trends in child sleep, physical activity, and screen use during the COVID-19 pandemic in New York City with a prospective, longitudinal online survey of parents recruited from a large medical center. Methods Data was collected Spring 2020 ("Complete Shutdown") and Fall 2020 ("Partial Shutdown"). Outcomes were parental perceptions about changes in child sleep, physical activity, and screen time compared to before COVID-19; and contemporaneous measures of these child behaviors. We report contemporaneous responses and paired analyses to describe longitudinal changes. Results Two hundred seventy-seven participants were surveyed during Complete Shutdown and 227 (81.9%) filled out a follow-up survey during Partial Shutdown. The largest percentage of parents at both time points perceived no change in child sleep, decreases in child exercise, and increases in child screen time. In paired analyses, perceptions shifted toward less sleep, more physical activity and less screen time from Complete Shutdown to Partial Shutdown. Conclusion COVID-19 had negative impacts on child health behaviors that did not resolve over a 6-month period despite partial reopenings.
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Affiliation(s)
- Morgan A Finkel
- Department of Pediatrics, Columbia
University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Alexis Bryan
- Department of Epidemiology, Columbia
University Mailman School of Public Health, New York, NY, USA
| | - Ivette Partida
- Department of Pediatrics, Columbia
University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Laura Raaen
- Department of Nutrition, Teachers
College, Columbia University, New York, NY, USA
| | - Ngoc Duong
- Department of Pediatrics, Columbia
University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jeff Goldsmith
- Department of Biostatistics, Columbia
University Mailman School of Public Health, New York, NY, USA
| | - Jennifer A Woo Baidal
- Department of Pediatrics, Columbia
University Vagelos College of Physicians and Surgeons, New York, NY, USA,Jennifer A. Woo Baidal, Division of
Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics,
Columbia University Vagelos College of Physicians and Surgeons,
NewYork-Presbyterian, 622 West 168th St, PH-17, New York, NY 10032, USA.
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Woo Baidal JA, Nichols K, Charles N, Chernick L, Duong N, Finkel MA, Falbe J, Valeri L. Text Messages to Curb Sugar-Sweetened Beverage Consumption among Pregnant Women and Mothers: A Mobile Health Randomized Controlled Trial. Nutrients 2021; 13:nu13124367. [PMID: 34959919 PMCID: PMC8703966 DOI: 10.3390/nu13124367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
Racial, ethnic, and socioeconomic disparities in childhood obesity in the United States (U.S.) originate in early life. Maternal sugar-sweetened beverage (SSB) consumption is an early life risk factor for later offspring obesity. The goal of this study was to test the effects of policy-relevant messages delivered by text messages mobile devices (mHealth) on maternal SSB consumption. In this three-arm 1-month randomized controlled trial (RCT), pregnant women or mothers of infants in predominantly Hispanic/Latino New York City neighborhoods were randomized to receive one of three text message sets: graphic beverage health warning labels, beverage sugar content information, or attention control. The main outcome was change in maternal self-reporting of average daily SSB consumption from baseline to one month. Among 262 participants, maternal SSB consumption declined over the 1-month period in all three arms. No intervention effect was detected in primary analyses. In sensitivity analyses accounting for outliers, graphic health warning labels reduced maternal SSB consumption by 28 kcal daily (95% CI: −56, −1). In this mHealth RCT among pregnant women and mothers of infants, graphic health warning labels and beverage sugar content information did not reduce maternal SSB consumption.
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Affiliation(s)
- Jennifer A. Woo Baidal
- Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY 10032, USA; (K.N.); (N.D.); (M.A.F.)
- Correspondence: ; Tel.: +1-(212)-305-5903
| | - Kelsey Nichols
- Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY 10032, USA; (K.N.); (N.D.); (M.A.F.)
| | - Nalini Charles
- New York Presbyterian Hospital Special Supplemental Nutrition Program for Women, Infants and Children, 622 W. 168th Street, New York, NY 10032, USA;
| | - Lauren Chernick
- Department of Emergency Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY 10032, USA;
| | - Ngoc Duong
- Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY 10032, USA; (K.N.); (N.D.); (M.A.F.)
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY 10032, USA;
| | - Morgan A. Finkel
- Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY 10032, USA; (K.N.); (N.D.); (M.A.F.)
| | - Jennifer Falbe
- Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis, CA 95616, USA;
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY 10032, USA;
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Costich M, Finkel MA, Friedman S, Catallozzi M, Gordon RJ. Transition-to-residency: pilot innovative, online case-based curriculum for medical students preparing for pediatric internships. Med Educ Online 2021; 26:1892569. [PMID: 33618622 PMCID: PMC7906614 DOI: 10.1080/10872981.2021.1892569] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 06/09/2023]
Abstract
Background: There is increasing recognition in medical education that greater emphasis must be placed on preparing graduating medical students for their new roles as interns. Few publications in the literature have described transition-to-residency curricula specifically for students interested in pediatrics or pediatric-related fieldsApproach: We developed novel online pediatric cases, embedded within an innovative, hybrid transition-to-residency course, to address high yield, multi-disciplinary topics within the context of several of the AAMC's identified Entrustable Professional ActivitiesEvaluation: The pilot cases were evaluated over two academic years (2018, 2019) at a single academic medical center as part of routine student course evaluation (N = 18/35) with the 2019 evaluation containing additional retrospective pre-post survey questions (N = 9/18) assessing self-reported changes in knowledge. Almost all students were very satisfied or satisfied with the modules overall (94%), the quality of the resources provided (100%), and the structure and clarity of the presentation of the material (100%). Among the students who completed the retrospective pre-post survey after participation in the online modules, significant self-reported improvements were noted in writing orders to the pediatrics floor (Z = -2.07, p = 0.04), providing anticipatory guidance (Z = -2.0,p = 0.046), formulating a differential diagnosis for common pediatric conditions (Z = -2.24, P = 0.03), and preparedness for managing common pediatric floor emergencies (Z = -2.33, P = 0.02).Reflection: We demonstrated feasibility of implementation of an interactive, online case-based curriculum, medical student satisfaction with content and delivery, and increased self-reported knowledge after completion of the pilot pediatric cases on the online, asynchronous learning platform.
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Affiliation(s)
- Marguerite Costich
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Morgan A. Finkel
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Suzanne Friedman
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Marina Catallozzi
- Departments of Pediatrics and Population and Family Health, Columbia University Medical Center, New York, NY, USA
| | - Rachel J. Gordon
- Departments Medicine and Epidemiology, Columbia University Medical Center, New York, NY, USA
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Finkel MA, Cooper BT, Li X, Fenton-Kerimian M, Goldberg JD, Formenti SC. Quality of Life in Women Undergoing Breast Irradiation in a Randomized, Controlled Clinical Trial Evaluating Different Tumor Bed Boost Fractionations. Int J Radiat Oncol Biol Phys 2016; 95:579-89. [DOI: 10.1016/j.ijrobp.2016.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/09/2015] [Accepted: 02/01/2016] [Indexed: 01/22/2023]
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Finkel MA, Nadel ES, Brown DF. Respiratory distress and hypertension in pregnancy. J Emerg Med 1999; 17:1039-43. [PMID: 10595893 DOI: 10.1016/s0736-4679(99)00140-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M A Finkel
- Division of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
OBJECTIVE Because physicians customarily obtain histories before examining children in cases of possible sexual abuse, and because the resulting diagnostic opinions can influence important social and legal decisions, we investigated whether clinical histories influence physicians' interpretations of girls' genital findings. DESIGN In mailed questionnaires, 1387 randomly selected Fellows of the American Academy of Pediatrics and all 802 members of four professional groups concerned with child abuse or pediatric gynecology were asked to interpret seven simulated cases. Respondents were asked to interpret seven additional cases in separate questionnaires mailed 4 months later. Both sets of cases involved the same seven photographs of girls' external genitalia. However, in six of the seven case pairs, the histories in the two questionnaires differed in the extent to which they suggested sexual abuse. In the remaining (control) pair, the same history was presented in both questionnaires. RESULTS Of 2189 physicians, 1114 (50.9%) responded. Responses from 604 physicians (54.2%) were eligible for analysis. Overall, the genital findings were interpreted most consistently by the most experienced physicians and least consistently by the least experienced physicians. The proportion of physicians whose interpretations of a photograph reversed in the direction suggested by the change in the associated history from "no indication of abuse" to "probable abuse," or vice versa, ranged for experienced physicians from none to 5.6%; for moderately experienced physicians from 1.6% to 19.8%; and for inexperienced physicians from 3.6% to 27.2%. This difference between the experience groups was statistically significant in four case pairs. Mean interpretation scores for genital findings changed significantly when the histories changed in two case pairs for the experienced physicians, in five pairs for the moderately experienced physicians, and in all six pairs for the inexperienced physicians. CONCLUSIONS In some cases and especially for less experienced physicians, diagnostic expectation appears likely to influence physicians' interpretations of girls' genital findings. Physicians should be alert to the possibility of diagnostic expectation bias and its potentially serious social and legal consequences.
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Affiliation(s)
- J E Paradise
- Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston Massachusetts, USA.
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Abstract
At its root, medical professionalism is service delivered according to patient's interest. It is essential to reinforce this notion because financial pressures threaten the integrity of the patient-physician relationship. Excessive commercialism directly contrasts the ideals of medical professionalism. This fact necessitates re-examination and reaffirmation of professional behavior. If historical standards of professionalism give way to market-driven incentives, the provision of medical care will become a commodity and the practitioners will be only agents of service delivery. Such a model not only threatens the the physician's identity, but also threatens the patient's interests. Medicine can never succeed as a transaction; it can only succeed as a partnership, a trusting exchange with patients, which is the hallmark of professionalism.
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Affiliation(s)
- M A Finkel
- Harvard Affiliated Emergency Medicine Residency, Boston, Massachusetts, USA
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Affiliation(s)
- M A Finkel
- Center for Children's Support, School of Osteopathic Medicine, University of Medicine and Dentistry of New Jersey, Stratford 08084, USA
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Paradise JE, Finkel MA, Beiser AS, Berenson AB, Greenberg DB, Winter MR. Assessments of girl's genital findings and the likelihood of sexual abuse: agreement among physicians self-rated as skilled. Arch Pediatr Adolesc Med 1997; 151:883-91. [PMID: 9308865 DOI: 10.1001/archpedi.1997.02170460021004] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To measure agreement about genital examination findings among physicians who rate themselves as skilled in evaluating children for suspected sexual abuse, to compare these physicians' descriptions and interpretations with consensus standards developed by an expert panel, and to investigate the effects of physician and case characteristics on agreement. STUDY DESIGN Questionnaires including 7 simulated cases, each consisting of a brief history and 1 photograph of a girl's genitalia, were mailed to random samples of 2 groups: the members of 4 physician organizations concerned with child abuse or pediatric gynecology, and pediatricians at large. Among the surveyed physicians who rated their own skill in evaluating cases of suspected sexual abuse as higher than average, we measured agreement, both overall and between those with the most and with less clinical experience, and assessed their conformity with consensus standard descriptions and interpretations. RESULTS We received responses from 548 (50.9%) of 1076 physicians; 414 responses (75.5%) were analyzable. Two hundred six physicians (50%) rated themselves as skilled in assessing children for sexual abuse. On average, 45% of these physicians' descriptions and 72.6% of their interpretations conformed with the consensus standards. In 4 cases, between 5% and 20.7% of these physicians described genital findings that the expert panel had considered absent from the photographs. Conformity with standard interpretations tended to be higher in cases with photographs concordant with the accompanying, unambiguous histories (P=.06). The most experienced physicians resembled the expert panel more closely than did the less experienced self-rated skilled physicians in interpreting 3 simulated cases (P< or =.001). CONCLUSIONS Assessments of girls' genital findings by physicians who rate themselves as skilled in examining children for suspected sexual abuse often differ. In some cases, among physicians who all rate themselves as skilled, assessments made by very experienced physicians may conform more closely to consensus standards than do assessments made by less experienced physicians.
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Affiliation(s)
- J E Paradise
- Department of Pediatrics, Boston University School of Medicine, Mass, USA
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14
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De Jong AR, Finkel MA. Sexual abuse of children. Curr Probl Pediatr 1990; 20:489-567. [PMID: 2225923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- A R De Jong
- Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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Finkel MA. Child sexual abuse: a physician's introduction to historical and medical validation. J Am Osteopath Assoc 1989; 89:1143-9. [PMID: 2793536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The investigation and validation of an allegation of child sexual abuse is difficult and time-consuming. In sexual abuse cases, the usual indications of physical maltreatment--bruises, abrasions, and lacerations--are generally not present. Thus, to adequately evaluate allegations of sexual abuse, the physician needs a different set of skills. In this paper, I present an introduction to the historical and medical validation of child abuse and provide a clinical approach to the child victim. This article will serve as an introduction to (1) understanding victimization and historical documentation, (2) preparing the child victim for an examination, (3) the forensic medical examination, (4) sexually transmitted diseases in victims and, (5) formulating a conclusion. The selected bibliography supplements this introduction.
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Finkel MA. Anogenital trauma in sexually abused children. Pediatrics 1989; 84:317-22. [PMID: 2748261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Physical findings, when identified, lend powerful support to the validation and prosecution in child sexual abuse cases. Because of the frequent delay between the alleged molestation, disclosure, and examination, there is a need for a systematic method of identifying and interpreting the residual of anal and genital trauma after the acute signs have disappeared. The case findings of seven children who experienced acute genital and anal trauma and were observed until their injuries healed are reported.
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Affiliation(s)
- M A Finkel
- Department of Pediatrics, University of Medicine and Dentistry of New Jersey, School of Osteopathic Medicine, Stratford 08084-1504
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Musci MN, Clark MJ, Ayres RE, Finkel MA. Management of dystocia caused by a large sacrococcygeal teratoma. Obstet Gynecol 1983; 62:10s-12s. [PMID: 6877701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Sacrococcygeal teratoma is a rare cause of dystocia. Reported management strategies to date have yielded few viable infants. In this case report, the infant was partially delivered when extraction was halted. The infant was intubated and resuscitated while preparations for emergency cesarean section were being made. The infant was subsequently delivered abdominally and three years later is normal. Despite absent thoracic cage movement during resuscitation, adequate oxygenation was possible. Increasing use of prenatal ultrasonography should allow early detection, and thus avoid such unanticipated dystocias.
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18
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Sotos JF, Cutler EA, Finkel MA, Doody D. Hypocalcemic coma following two pediatric phosphate enemas. Pediatrics 1977; 60:305-7. [PMID: 896360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Coma, tetany, dehydration, hypotension, tachycardia, and hyperpyrexia developed in a 2 1/2-year-old girl following two hypertonic phosphate pediatric enemas. She had marked hyperphosphatemia, hypocalcemia, hypernatremia, and acidosis. Hypocalcemia due to hyperphosphatemia can explain all of these findings. Calculations indicate that about one third of the phosphorus and sodium contents of the enema were absorbed. Physicians should be aware of the potentially lethal complication of this treatment, which is part of everyday practice.
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