Jacobs Institute of Women's Health
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The Child Opportunity Index and Children\u27s Health: A Meta-Analysis
No full textCONTEXT: Quantifying the impact of place on pediatric health is difficult given the diverse methodologies used to measure place-based social determinants. However, the Child Opportunity Index (COI) is increasingly used to study these relationships. OBJECTIVE: To synthesize associations between the COI and pediatric health. DATA SOURCES: Fifteen databases, 4 gray literature sources, and diversitydatakids.org searched from 2014 to 2024. STUDY SELECTION: US-based observational studies that evaluated children, the COI, and at least 1 pediatric health outcome. DATA EXTRACTION: Protocol registered with PROSPERO (CRD42023418407). Random-effects models created pooled odds ratios (ORs) comparing very low/low COI to high/very high COI for mortality, emergency department (ED) use, and hospital use. Clinically relevant subgroups were explored. RESULTS: Most studies (n = 61 of 85; 72%) reported inverse associations between the COI and an adverse outcome. Lower COI was associated with higher odds of mortality (OR, 1.50; 95% CI, 1.31-1.94; tau squared [τ2] = 0.045; 15 associations from 13 studies). Overall, ED visits were similar (OR, 1.38; 95% CI, 0.97-1.95; τ2 = 0.312; 10 associations from 6 studies), but the subgroup of all-cause ED visits were significantly higher among children with lower COI (OR, 1.66; 95% CI, 1.19-2.31; τ2 = 0.198; 7 associations from 5 studies). Select hospitalization subgroups (medical, surgical/trauma, and \u3e30-day rehospitalizations) were significantly associated with COI, but not overall hospitalizations (OR, 1.15; 95% CI, 0.96-1.36; τ2 = 0.090; 12 studies). LIMITATIONS: Meta-analyses were unadjusted. CONCLUSIONS: Place is a risk factor for children\u27s mortality and select measures of health care use. Shifting the focus from identifying place-based disparities to cocreating community-engaged strategies that mitigate disparities may effectively advance children\u27s health equity
Fetal Callosal Anomalies: A Narrative Review and Practical Recommendations for Pediatric Neurologists
No full textAgenesis of the corpus callosum is a common indication for fetal neurology consultation, increasingly identified through advances in fetal sonography and fetal magnetic resonance imaging. Despite improvements in diagnostic accuracy, prognostic counseling is challenging due to highly variable neurodevelopmental outcomes. Several factors contribute to neurodevelopmental outcome variability, including associated anomalies and etiologic considerations such as genetic, acquired, and environmental factors. This narrative review discusses existing literature on prenatal findings, postnatal outcomes, and comorbidities to provide practical guidelines for prenatal diagnosis, counseling, and postnatal management. Additionally, practice and research gaps are identified to advocate for guidelines to improve counseling, management, and optimization of outcomes for affected children and families
Prediction of Hepatitis C Virus Perinatal Transmission in Pregnant Individuals With Hepatitis C Virus Infection
No full textOur objective was to develop a prediction model for hepatitis C virus (HCV) infection perinatal transmission to improve triage for neonatal follow-up. This was a secondary analysis of HCV antibody-positive participants who were enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network multicenter observational study of HCV infection in pregnancy. Among 432 participants, the perinatal transmission rate was 6.0% (95% CI, 4.0-8.7%). The prediction model was developed and included two factors: maternal HCV RNA titer greater than 10 6 international units/mL and having had any antepartum bleeding. Using this model, the area under the curve for perinatal transmission was 0.76 (95% CI, 0.67-0.86). Probabilities of perinatal transmission of HCV infection ranged from 1.5% (a pregnant individual with HCV RNA 10 6 international units/mL or less and no antepartum bleeding) to 28.5% (a pregnant individual with an HCV RNA titer greater than 10 6 international units/mL and antepartum bleeding). Our results provide data to aid in clinical counseling of pregnant individuals with positive HCV antibodies. Additional research is needed to externally validate this prediction model
Problematic Social Media Use or Social Media Addiction in Pediatric Populations
No full textWith the advent of smartphones and the popularization of social media sites at the beginning of the twenty-first century, children and adolescents have been exposed to a world of virtual interactions in social networking sites that are designed to increase engagement of the user for profit. In this article, we review the epidemiology of use of social media, its addictive features, and potential negative consequences of problematic use, and the research on current interventions known to reduce use. We also give recommendations spanning from the policy to the individual level for children to build a healthier relationship with these sites
Evaluating Avoidable Transfers of Pediatric Forearm Fractures to the Emergency Department
No full textBackground Forearm fractures represent approximately 20% of pediatric fractures and are commonly managed in emergency departments (EDs). While minimally displaced fractures require immobilization, displaced fractures necessitate reduction. Many non-pediatric facilities lack the resources to manage these fractures, leading to frequent transfers to pediatric emergency departments (PEDs). This study aims to evaluate the rate of avoidable transfers of pediatric forearm fractures to a PED and identify risk factors contributing to unnecessary transfers. Methods A retrospective cross-sectional study was conducted at a single tertiary pediatric hospital from July 1, 2022, to June 30, 2023. Patients aged 0-17 years treated for forearm fractures were identified using ICD-10 codes. Exclusion criteria included patients not transferred, incomplete treatment data, or missing initial radiographs. Collected variables encompassed demographics, fracture characteristics, transfer details, and treatments performed. Statistical analyses included chi-square tests for categorical variables and Mann-Whitney U tests for continuous variables, with significance set at p \u3c 0.05. Results Out of 445 patients identified, 161 met the inclusion criteria. The mean age was 8.0 years (SD 3.9); 70.8% were male, and 31.7% were African Americans. Avoidable transfers, defined as patients who did not require reduction or surgical intervention, accounted for 38 cases (23.6%). Non-displaced fractures were significantly associated with avoidable transfers (p \u3c 0.001). Race was also significant, with higher rates of avoidable transfer among African American patients (42.1%) and patients of other races (47.4%) compared to Caucasian patients (10.5%) (p = 0.006). There was a statistically significant association between the source of appropriate and avoidable transfers (p = 0.012), with cases originating from clinics (n = 7), outside hospitals (n = 24), and urgent care centers (n = 7). Multivariate logistic regression identified younger age as the only significant factor associated with avoidable transfer (p = 0.047, OR: 0.74, CI: 0.5-0.98). Conclusions A significant proportion of pediatric forearm fracture transfers to the PED were avoidable, primarily due to patients not requiring reduction or surgical intervention. Younger age was a significant factor associated with unnecessary transfers. Enhancing education on pediatric fracture management and establishing clear guidelines may reduce unnecessary transfers, optimize resource utilization, and alleviate burdens on specialized centers
Poorly quantified trends in ammonium nitrate remain critical to understand future urban aerosol control strategies
No full textDespite decades of progress in reducing nitrogen oxide (NO) emissions, ammonium nitrate (AN) remains the primary inorganic component of particulate matter (PM) in Los Angeles (LA). Using aerosol mass spectrometry over multiple years in LA illustrates the controlling dynamics of AN and their evolution over the past decades. These data suggest that much of the nitric acid (HNO) production required to produce AN in LA occurs during the nighttime via heterogeneous hydrolysis of NO. Further, we show that US Environmental Protection Agency-codified techniques for measuring total PM fail to quantify the AN component, while low-cost optical sensors demonstrate good agreement. While previous studies suggest that declining NO has reduced AN, we show that HNO formation is still substantial and leads to the formation of many tens of micrograms per cubic meter of AN aerosol. Continued focus on reductions in NO will help meet the PM standards in the LA basin and many other regions
Hand swelling and other non-Raynaud\u27s symptoms as the initial presentation of systemic sclerosis: prevalence and clinical associations in two U.S. cohorts
No full textOBJECTIVE: Raynaud\u27s phenomenon (RP) is often the initial clinical manifestation of systemic sclerosis (SSc), but some patients develop other manifestations first. To help elucidate the diversity of SSc presentation in its early stages, we describe the initial clinical manifestations and antinuclear antibody (ANA) profiles of patients in two early SSc cohorts. METHODS: All patient data in the GENISOS and CONQUER cohorts were reviewed. Both studies enrolled patients within five years of the first non-RP symptom. RESULTS: 194/439 (44.2%), and 292/938 (31.1%) patients in GENISOS and CONQUER, respectively, had a non-RP initial symptom, most commonly puffy fingers/hands. Black patients had a non-RP symptom prior to RP more commonly than other race and ethnicity categories. Non-RP first patients were more likely than RP first patients to have diffuse cutaneous involvement and joint contractures at enrollment and had a higher prevalence of RNA Polymerase III antibody positivity. CONCLUSION: In two large U.S. cohorts, \u3e30% of patients began to manifest SSc with puffy fingers/hands or other symptoms, without the warning sign of RP as their initial symptom. These patients presented with more severe skin and musculoskeletal disease on average, highlighting the importance of early recognition. The most common autoantibody associated with this presentation was RNA Polymerase III. These results should be considered in efforts to recognize SSc in its earliest stages. Puffy fingers/hands, even in the absence of RP, should prompt consideration of early SSc and testing for ANA and SSc-associated autoantibodies including RNA Polymerase III
Skin Clearance, Duration of Treatment-free Interval, and Safety of Tapinarof Cream 1% Once Daily: Results from ADORING 3, a 48-week Phase 3 Open-label Extension Trial in Adults and Children Down to 2 Years of Age with Atopic Dermatitis
No full textBACKGROUND: In two pivotal phase 3 trials, tapinarof demonstrated significant efficacy and was well tolerated in patients down to age 2 years with atopic dermatitis. OBJECTIVE: Assess skin clearance rates, duration of treatment-free intervals, and safety of tapinarof in a phase 3 open-label extension trial. METHODS: Patients from the ADORING 1 and 2 pivotal phase 3 trials, a 4-week maximal usage pharmacokinetics trial, and tapinarof-naive patients received tapinarof for up to 48 weeks. Treatment was based on Validated Investigator Global Assessment for Atopic Dermatitis™ (vIGA-AD™) score. Patients with vIGA-AD™≥1 received tapinarof until vIGA-AD™=0. Patients achieving vIGA-AD™=0 discontinued tapinarof and were monitored for treatment-free interval. Patients with vIGA-AD™≥2 were re-treated until vIGA-AD™=0. RESULTS: 728 patients enrolled. Overall, 51.9% achieved vIGA-AD™=0, and 81.6% achieved vIGA-AD™=0 or 1 at least once. After first achieving complete clearance and discontinuing treatment, the mean first treatment-free interval was 79.8 consecutive days. Tapinarof was well tolerated, with no new safety signals. Most-frequent adverse events were folliculitis (12.1%), nasopharyngitis (6.9%), and upper respiratory tract infection (6.9%). LIMITATIONS: Open-label; treatment-free interval potentially underestimated. CONCLUSION: Tapinarof was well tolerated and resulted in high skin clearance rates that were maintained off-therapy and consistent safety in patients down to age 2 years
Adapting a brief smoke-free homes intervention for communities in Armenia and Georgia
No full textEvidence-based interventions (EBIs) often require adaptation to be effective for new communities and/or cultural contexts. This paper describes the process for adapting an evidence-based smoke-free homes (SFHs) intervention to be culturally appropriate for households in Armenia and Georgia. The intervention, including three mailed packages ( mailings ) and a coaching call, was adapted using a systematic multi-step adaptation process involving: (i) focus groups (n = 8) among adults in Armenia and Georgia, who smoked cigarettes or lived in a household with someone who smoked; (ii) consulting with in-country research team experts and local community leaders; and (iii) collaboratively deciding on critical adaptations, which differed slightly by country. Adaptations spanned across intervention components. While adaptations were largely surface-level (e.g. Armenia- and Georgia-relevant facts, color themes, imagery of individuals, homes, and settings), the process identified needed deep structure changes. For example, the nature of the challenges and solutions addressed, the narratives used for role modeling, and the imagery were adapted to better reflect the smoking-related social norms and dynamics (e.g. greater smoking prevalence among men vs. women, difficulty asking guests/elders to smoke outside), household composition (i.e. multigenerational), types of homes (e.g. ease of access to outdoor spaces), and types of tobacco used (i.e. heated tobacco products). The adapted interventions maintained the core elements and underlying theoretical approach but included adaptations to ensure cultural appropriateness and relevance. This should yield an effective intervention, which will be assessed next. The description of this multi-step adaptation process could inform future efforts to disseminate and implement EBIs across settings globally
Posttraumatic stress disorder mitigation in trauma patients: An evidence-based systematic review from the Eastern Association for the Surgery of Trauma
No full textBACKGROUND: Because of advances in trauma care, there has been increased survival among trauma patients. However, less progress has been made to address posttraumatic psychological disorders. Many trauma patients (19-42%) report emotional or psychological distress after injury, and over one in five will develop posttraumatic stress disorder (PTSD) and/or depression within the first postinjury year. We aim to establish a practice management guideline using a systematic review to provide guidance on early identification of individuals at risk for PTSD and evidence-based treatment options to assist our patients to mitigate the development of PTSD. METHODS: Clinically relevant questions regarding screening of and intervention for PTSD in adult trauma patients with clearly defined patient Population(s), Intervention(s), Comparison(s), and appropriately selected Outcomes were determined. A systematic literature review was conducted for the period of January 1, 1996, to September 9, 2023. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation methodology. The working group reached consensus on the final evidence-based recommendations. RESULTS: The literature search yielded 9,387 studies, of which 25 met the criteria for inclusion. Screening and interventions were mostly successful in the identification and management of acute stress disorder/PTSD. The use of cognitive behavioral therapy was the most successful therapy, especially when used with high-risk individuals. CONCLUSION: We conditionally recommend screening to identify patients at risk for PTSD during their initial hospitalization. We strongly recommend the use of cognitive behavioral therapy for mitigation of PTSD. LEVEL OF EVIDENCE: Systematic Review/Meta-analysis; Level II