The impact of adverse childhood events on service support and educational outcomes of children who are autistic: A theory-guided analysis using structural equation modeling.

Autistic children who have experienced adverse childhood experiences (ACEs) may have barriers to receiving special education or other developmental services-thus, impacting educational outcomes. Our objective was to model such a pathway using the 2016-2021 National Survey of Children's Health datasets. We extracted data for school outcomes, use of special education and autism-related specialty services and sociodemographic characteristics among autistic children within the data. Associations between sociodemographics and ACEs (categorized as 0, 1-3, and 4+) were tested using design-based X2 tests. We then used structural equation modeling to map the quasi-causal pathways. The sample for our analysis included 4717 autistic children-38.94% were aged 6-10 years, 35.73% of children aged 11-14 years, and 25.32% were between 15 and 17 years-with 88.70% living in metropolitan areas. The X2 showed significant relationships between ACEs and age, ethnoracial groups, and urbanicity among others. The SEM showed ACEs were directly associated with poorer school outcomes (ß = -0.14 (0.04), p = 0.002) and through their inverse relationship with support services (ß = -0.08 (0.04), p = 0.023)- when support services were increased, school outcomes improved (ß = 0.62, p < 0.001). Findings suggested ACEs have a significant direct and indirect impact on school outcomes of autistic children, and 10.76% of children who are autistic have experienced four or more ACEs-which were more likely to occur with severe autism symptomatology and in rural areas. Results highlight the need for communities to recognize the potential long-term impact of ACEs on the academic outcomes of autistic children.

A scoping review of health inequities in alcohol use disorder.

Background: Alcohol Use Disorder (AUD) poses a significant health burden on individuals. The burden occurs more frequently in the medically underserved, as well as racial and sexual minority populations. Ameliorating health inequities is vital to improving patient-centered care.Objectives: The objective of this scoping review is to chart the existing evidence on health inequities related to AUD and identify existing knowledge gaps to guide future equity-centered research.Methods: We performed a literature search using the Ovid (Embase) and MEDLINE (PubMed) databases for articles on AUD that were published in the 5-year period spanning from 2017 to 2021 and written in English. The frequencies of each health inequity examined were analyzed, and findings from each included study were summarized.Results: Our sample consisted of 55 studies for analysis. The most common inequity examined was by race/ethnicity followed by sex or gender. The least reported inequities examined were rural under-resourced areas and occupational status. Our findings indicate that significant research gaps exist in education, rural under-resourced populations, and LGBTQ+ communities with AUD.Conclusions: This scoping review highlights the gaps in research on inequities in AUD. To bridge the current gaps, we recommend research on the following: 1) triage screening tools and the use of telemedicine for rural, under-resourced populations; 2) interventions to increase treatment engagement and retention for women; and 3) community-based participatory methodologies for the LGBTQ+ communities.

Associations of social determinants of health and childhood obesity: a cross-sectional analysis of the 2021 National Survey of Children's Health.

CONTEXT: Childhood obesity is a growing health problem in the United States, with those affected having an increased likelihood of developing chronic diseases at a younger age. Social determinants of health (SDOH) are known to influence overall health. Families who are of low socioeconomic status (SES) have also been shown to be more likely to experience food insecurity. OBJECTIVES: Our primary objective was to utilize the National Survey of Children's Health (NSCH) 2021 data to determine the current associations between childhood obesity and SDOH. Secondarily, we estimated the prevalence of select SDOH among children with obesity. METHODS: We conducted a cross-sectional analysis of 2021 NSCH to extract data related to the SDOH domains. We extracted sociodemographic variables to utilize as controls and constructed logistic regression models to determine associations, via odds ratios, between SDOH and childhood obesity. RESULTS: Within the binary regression models, children with obesity (≥95th percentile) were more likely than children without obesity to experience SDOH in all domains. After controlling for sociodemographic variables, children with obesity were significantly more likely to experience food insecurity when compared to children without obesity (adjusted odds ratio [AOR]=1.39; 95 % confidence interval [CI]: 1.13-1.17). CONCLUSIONS: In line with the current American Academy of Pediatrics (AAP) Clinical Practice Guidelines (CPG), improving policies for nutrition programs and addressing the lack of access to nutritious foods may alleviate some food insecurity. Ensuring that children have access to sufficient nutritious foods is critical in addressing childhood obesity and thus decreasing risk of chronic disease.

Disparities in Pediatric Medical and Childcare Disruption Due to COVID-19.

This cross-sectional study uses National Survey of Children's Health data to assess demographic disparities in medical and childcare disruptions during the COVID-19 pandemic.

Health inequities in mammography: A scoping review.

OBJECTIVE: The objective of this scoping review is to chart the existing evidence on health inequities related to mammography and identify existing knowledge gaps to guide future research. METHODS: This scoping review followed guidelines from the Joanna Briggs Institute and the PRISMA extension for scoping reviews. In July 2022, we searched PubMed and Ovid Embase for published articles on mammography screening, published between 2011 and 2021, written in English, and examining at least one health inequity as defined by the NIH. Screening and charting were both performed in a masked, duplicate manner. Frequencies of each health inequity examined were analyzed and main findings from each included study were summarized. RESULTS: Following screening, our sample consisted of 128 studies. Our findings indicate that mammography screening was less likely in historically marginalized groups, patients who live in rural areas, and in women with low income status and education level. Significant research gaps were observed regarding the LGBTQ + community and sex and gender. No trends between inequities investigated over time were identified. DISCUSSION: This scoping review highlights the gaps in inequities research regarding mammography, as well as the limited consensus across findings. To bridge existing research gaps, we recommend research into the following: 1) assessments of physician knowledge on the LGBTQ + community guidelines, 2) tools for health literacy, and 3) culturally competent screening models.

Equity Reporting in Systematic Reviews of Opioid Treatment of Chronic Non-Cancer Pain with Patient-Reported Outcomes.

Chronic non-cancer pain can affect a patient's social life, ability to work, and overall quality of life (QoL). Opioid therapy is often prescribed as therapeutic treatment in chronic pain. Systematic reviews (SRs)-the pinnacle of research quality-are often used in guideline development; however, pain may differ across cultures and communities. Thus, examination of equity reporting in such SR is necessary. This study examines reporting using the PROGRESS (Place of resident, Race, Occupation, Gender, Religion, Education, Socioeconomic status, Social capital)-Plus framework to examine equity within SRs with patient reported outcomes of chronic, non-cancer pain. A systematic search for SRs was conducted, which were evaluated for PROGRESS-Plus items and study characteristics were extracted. Among the 46 included SRs, seven did not include any PROGRESS-Plus items. The most commonly reported items were age, included within 34 SRs, followed by gender (30/46), and duration of pain (14/46). All other items were reported in five or less studies. Our investigation revealed a deficiency in SR's reporting of equity measures for opioid treatment of chronic non-cancer pain. Given the need to address healthcare disparities among minorities, implementing the PROGRESS-Plus framework may influence QoL and patient-centered care.

Evaluating The Reporting of Patient-Reported Outcomes in Surgical Management of Stress Urinary Incontinence in Women: An Analysis of Randomized Controlled Trials.

BACKGROUND: Stress urinary incontinence (SUI) significantly reduces women's quality of life (QoL). Use of patient-reported outcomes (PROs) is increasing in randomized controlled trials (RCTs), thus standardization is important to ensure reporting completeness. We aim to evaluate completeness of reporting of RCTs for surgical management of SUI in women based on an adaptation of the Consolidated Standards of Reporting Trials statement with PRO extension (CONSORT-PRO). STUDY DESIGN: A literature search was conducted and all RCTs meeting inclusion criteria were evaluated using the CONSORT-PRO adapted checklist and the Cochrane Collaboration risk of bias assessment tool (RoB). We calculated a completion percentage score for each trial's adherence to the CONSORT-PRO adapted checklist and used bivariate regression analysis to examine associations between trial characteristics and completion percentage scores. RESULTS: Forty-three RCTs underwent data extraction and analysis. Mean completion percentage of the CONSORT-PRO was 50.53% (SD = 15.63). A total of 38 (of 43; 88.37%) RCTs received an RoB 2.0 rating of "some concern." RCTs with follow-up longer than 3 months had statistically significantly higher CONSORT-PRO completion: 3-6 months (p = .049), 6-12 months (p = .009), more than 12 months (p = .021). Compared with studies without a conflict of interest statement, studies reporting a conflict of interest (p < .001) or reporting no conflict of interest (p = .048) had higher reporting completeness. CONCLUSIONS: Our results suggest many RCTs addressing surgical management of SUI in women have poor adherence to CONSORT-PRO reporting guidelines. Improving reporting completeness through adherence to the CONSORT-PRO checklist can better inform clinical decision making and improve QoL.

The evaluation of reporting of patient-reported outcomes in MDD: A meta-epidemiological study of clinical trials.

Major depressive disorder (MDD) is a multifaceted disease that profoundly affects quality of life. Patient reported outcomes (PROs) are used in randomized controlled trials (RCTs) to better understand patient perspectives on interventions. Therefore, we sought to assess the completeness of reporting PROs in RCTs addressing MDD. We identified RCTs evaluating MDD containing a PRO measure published between 2016 and 2020 from MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. Inclusion of studies was performed in duplicate. The completion of reporting of RCTs was assessed using the Consolidated Standards of Reporting Trials (CONSORT-PRO) adaptation. Bivariate regression analyses were used to evaluate reporting completeness and trial characteristics. A total of 49 RCTs were included in our analysis, with a mean CONSORT-PRO completion score of 56.7% (SD = 17.3).Our findings show a significant association with completeness of reporting and the following: secondary PRO trials were less completely reported as compared to primary PRO trials (t = -3.19, p = .003); studies with a follow-up period between six months and year were more completely reported as compared to three months or less (6 months to a year, t = 2.34, p = .024); and increased trial sample size was associated with more completeness of reporting (t = 3.17, p = .003). As compared to brain stimulation, the intervention types classified as combination, other, and psychotherapy had greater completeness of reporting (combination, t = 2.35, p = .024; other, t = 3.13, p = .003; psychotherapy, t = 3.41, p = .001). There were no other significant findings. Our study found the completeness of PRO reporting to be inconsistent in RCTs regarding MDD. Moreover, we advocate for the need to establish a core outcome set relevant to the management of adults diagnosed with MDD and facilitate training on the application of PRO data.

An Analysis of the Evidence Underpinning the American Academy Orthopaedic Surgery Pediatrics Clinical Practice Guidelines.

BACKGROUND: Randomized control trials (RCTs) serve as evidentiary support for recommendations underpinning clinical practice guidelines (CPGs) with the goal of optimizing patient care. A knowledge gap exists within scientific literature when evaluating the quality of RCTs used as evidence in the American Academy of Orthopaedic Surgery (AAOS) pediatric CPGs. We aim to evaluate the reporting quality and risk of bias in RCTs underlying AAOS Pediatric CPG recommendations. METHODS: We located all AAOS Pediatric CPGs. We then extracted all RCTs from the CPG reference sections. All included RCTs were evaluated using the Consolidated Standards of Reporting Trials (CONSORT) checklist and Cochrane Collaboration risk of bias assessment tool (RoB 2.0). Descriptive statistics were recorded, and bivariate analysis was used to account for variance in CONSORT scores. A Mann-Whitney U test was completed to compare CONSORT studies published before and after 2010. RESULTS: Three CPGs and 23 RCTs met inclusion criteria. Mean CONSORT adherence was 69.8% (21.6/31). The lowest adhered to CONSORT items were 10, 23, and 24, while items 2a, 13a, and 18 displayed the highest adherence. Ten RCTs (43.5%, 10/23) had "low" risk of bias, 5 RCTs (21.7%, 5/23) were of "some concerns," and 8 RCTs (34.8%, 8/23) received a "high" designation for risk of bias. There were no statistically significant associations in the bivariate regression analysis or Mann-Whitney U test. CONCLUSIONS: Our results suggest that CONSORT adherence within RCTs used as evidence in AAOS Pediatric CPGs is substandard-relying on evidence that, in some cases, is >20 years old. Many of the RCTs cited as supporting evidence have a "high" risk of bias. Altogether, these CPGs may need to be updated or expanded to include more recent evidence relevant to pediatric orthopaedic surgery.