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1 PART I The Field of Pediatrics Since the late 19th century, pediatrics has been the only discipline dedi- cated to all aspects of the care and well-being of infants, children, and adolescents, including their health—their physical, mental, social, and psychologic growth and development—and their ability to achieve f... |
health issues transcend communicable disease and are influenced by global events, such as war, ethnic wars, mass shootings, bioterrorism, the burning of the Amazon rainforest, and the growing severity of wildfires, storms, drought, and hurricanes brought about by climate change to very specific events, such as the eart... |
stage of industrialization and urbanization, (7) gene frequencies for certain disorders, (8) the ecology of infectious agents and their hosts, (9) social stability, and (10) political focus and stability. Although genetics, biology, and access to affordable and quality healthcare are important determinants, social and ... |
The causes of infant and under-5 mortality differ greatly between developed and developing nations. The leading causes of under-5 mortality are preterm birth and birth-related asphyxia/ trauma, pneumonia, diarrhea, and malaria (Fig. 1.1). As compared with higher-resourced countries, more children less than 5 years ... |
ing illness and maintaining health. In the United States, Canada, and parts of Europe, new and continuing discoveries in these areas led to establishment of publicly funded well-child clinics for low-income families. Although the timing of infectious disease control was uneven around the globe, this focus on control ... |
.40 4.86 14.94 17.82 12.41 6.47 9.79 8.76 4.55 6.21 HIV/AIDS Diarrheal diseases Tetanus Measles Meningitis/encephalitis Malaria Acute lower respiratory infections Prematurity Birth asphyxia and birth trauma Sepsis and other infectious conditions Other communicable, perinatal and nutritional conditions Congential anomal... |
use only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved. Chapter 1 u Overview of Pediatrics 3 advances. Five-year survival rates have increased from <10% in the 1960s to >90% in 2023. Cystic fibrosis has shown improvements in survival as well. In the 1960s, most children with cys... |
be lethal, but most children who received timely care improved. As of spring 2023, there were over 766 million cases and nearly 6.9 million deaths from COVID-19, and the United States had the highest number of cases and deaths throughout the world. Chil- dren in the United States accounted for 6 million COVID-19–posi... |
wisqa rs/pdf/leading_causes_of_injury_deaths_highlighting_unintentional_2018-508.pdf. Table 1.3 Ten Leading Causes of Injury Deaths by Age Group Highlighting Violence-Related Injury Deaths, United States – 2018 10 leading causes of injury deaths by age group highlighting violence-related injury deaths, United States... |
pandemic faced unprecedented learning challenges because of widespread school closures and dependence on electronic devices and stable internet connections and widening edu- cational disparities, especially for those in poverty, children of frontline workers and single parents, and those already marginalized. Addition-... |
and environmental factors affecting behav- ior, (2) normal child behavior and development, (3) health behaviors as they pertain to child health, and (4) mild, moderate, and severe behav- ioral and developmental disorders. Accomplishing this would require reconceptualizing professional training, improving clinical commu... |
while each of these interrelated influ- ences are important for optimal health, development, and well-being, the greatest contributions to health outcomes occur in the behavioral, social, and environmental domains—the social and structural influences on health. From 40% to 70% of the relative variation in certain heal... |
1.4). Racism Although racism is known as “America’s Original Sin,” racism and racial discrimination is a worldwide problem (see Chapter 2.1). Racism can occur at the systemic/structural, interpersonal, and internal/psychologic levels. Structural racism is the hierarchical grouping of people based on physical attributes... |
in later life of ischemic heart disease, chronic obstructive pulmonary disease, liver disease, depression, obesity, and cancer. People who suffer ≥6 ACEs die almost 20 years earlier than those who had not experienced ACEs. Although the original conceptualization of ACEs included family- level psychosocial trauma, rece... |
Fig. 1.2). Those assets may be external (e.g., family, community, peers, mentors) or internal (e.g., resilience, posi- tive coping strategies, locus of control). In a healing-centered model of care, the evolution of the question “what’s wrong with you” to “what happened to you” gets further refined to include “what’s ... |
only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved. 6 Part I u The Field of Pediatrics cardiovascular biomarkers (e.g., blood pressure) can occur from chronic stress and result in pathophysiologic conditions associated with chronic diseases. Chronic stress can also have effects a... |
youth with special healthcare needs (CSHCN) are defined by the U.S. Maternal and Child Health Bureau as “those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children... |
- or population-level perspective, with emphasis on identifying and addressing the needs of individuals and families who do not seek regular care or whose care is episodic and suboptimal from a prevention or management standpoint. Effec- tiveness of such a system improves with greater collaboration between healthcare... |
. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved. Chapter 1 u Overview of Pediatrics 7 and quality-of-care–based models, if implemented correctly, may fur- ther advance a population health approach to care. Medical Home The concept of the patient and family–centered medical home ... |
broadening of this concept has been proposed along two separate dimensions. The medical neighborhood expands the medical home concept and refers to coordinated and effi- cient integration between primary care pediatricians and the subspe- cialists, including integrated EHRs, efficient coordinated appointment scheduling... |
these have the potential to achieve what the Institute for Healthcare Improvement calls the “quadruple aim” for healthcare: focusing on care (improving the patient experience with healthcare, quality care, and satisfaction), health (improving the health of populations, including emphasis on equity), provider satisfacti... |
. 8 Part I u The Field of Pediatrics Health and illness are not distributed equally among all members in most societies. Differences exist in historical roots, risk factors, preva- lence and incidence, manifestations, severity, and outcome of health con- ditions, as well as in the availability and quality of healthcare... |
, health- care) or psychosocial factors (e.g., locus of control, adaptive or risky behaviors, stress, social connectedness) that may contribute to dif- ferences in health status. This section will explore several historical social and structural root contributors to health disparities (see also Chapter 2.1). Federal Po... |
sought to control and contain these southern Black Americans. The federal government passed the Housing Act of 1949 to provide funding to cit- ies across the country to clear and redevelop the slums (called “slum clearance”). City leaders and planners used the funds to revitalize their downtown areas to woo suburban Wh... |
The Social Security Administration and the Service- men’s Readjustment Act of 1944 (the GI Bill) were established to cre- ate a middle class. The Social Security system was created to provide income to older adults. However, farmworkers and domestic workers were not included among the professionals that would pay into ... |
are not teaching BIPOC students self-discipline; they are over- punishing and criminalizing these students. • Environmental injustice: There are racial disparities in who suffers the health consequences of climate change. Residential housing segrega- tion and environmental policies have contributed to unequal exposur... |
stress-response systems, changes in levels of inflamma- tory and immune mediators, cardiovascular reactivity, and metabolic and hormone activation. These are normal and adaptive responses to Social Stratification Mechanism Race/ethnicity Environment • Physical • Social Behaviors • Health promoting • Risk taking Suppor... |
gets under the skin” to cause physiologic dysregulation (allostatic load), which over time leads to chronic illnesses that are known to have higher preva- lence in minoritized populations (health disparities). The allostatic load model provides a pathophysiologic mechanism through which negative structural and social d... |
not include temporary immigrant workers who often do not have the same access to resources as do longer-term immigrants. Approximately 18.4 million, or 25% of children in the United States under age 12 years, have at least one immigrant parent. Children of immigrant parents have better health and academic outcomes com... |
conditions Black > White > Hispanic > Asian Poor > Not Poor Asthma Mainland Puerto Rican > Black > White and Mexican American Poor > Not Poor Urban > Rural Obesity Hispanic and Black > White and Asian Poor > Not Poor Rural > Urban Infant mortality Black > Hispanic > White Poor > Not Poor Low birthweight (<2,500 g) Blac... |
) Black > Hispanic > White AIDS, Acquired immunodeficiency syndrome; ODD, oppositional defiant disorder. Downloaded for mohamed ahmed (dr.mms2020@gmail.com) at University of Southern California from ClinicalKey.com by Elsevier on April 20, 2024. For personal use only. No other uses without permission. Copyright ©2024. ... |
Hispanic children (25.6%) and non-Hispanic Black children (24.2%). The prevalence of obesity was 16.1% among non-Hispanic White children and 8.7% among non-Hispanic Asian children. The obesity prevalence among Indigenous Nation/Alaskan Native adolescents is 11.0% and among Native Hawaiian/Pacific Islanders is 26.7%.... |
Hispanic Boys: Black and Hispanic > White HPV, Human papillomavirus. 100 50 40 30 20 10 0 Percent 1999– 2002 2003– 2006 2007– 2010 Total White, non-Hispanic Asian, non-Hispanic Mexican American Black, non-Hispanic 2011– 2014 2015– 2018 Fig. 2.4 Percentage of children ages 6-17 with obesity by race and Hispanic origin,... |
births, with the leading causes of death (in order of frequency) being congeni- tal malformations, low birthweight, maternal complications, and unin- tended injuries. The Asian American population was not disaggregated by country of origin, so granular details regarding this heterogenous American population were not av... |
years) to be 17.7% for Hispanic Americans, 16.2% for Black Americans, 15.8% for Asian Americans, 12.1% for White Americans, and 13.2% for other non-Hispanic Americans. The prevalence of oral health problems in this 2019-2020 NSCH were found to be highest among children who live in households with incomes below the fe... |
. Preventive oral healthcare may improve rates of caries and treat caries before further impairment ensues. Data from the 2014 Medical Expenditure Panel Survey revealed that being poor and lacking health insurance were the main reasons for not receiving preventive dental care. Hearing Care No data suggest that the prev... |
Although vaccination rates have improved, the 2018–2020 CDC National Immunization Survey— Child study found income, geographic, and racial disparities in infant vaccination rates. Vaccination rates were lower among infants living in households with an income below the federal poverty level and infants who lacked health... |
of poverty. Additionally, it is the “criminaliza- tion” of poverty that increases the risk of poor people being reported for abuse and neglect compared to their more affluent counterparts. However, despite the fact that Black children are overrepresented in the child wel- fare system in the United States, race itself s... |
Asian American children were the least likely to receive any type of treatment for ADHD. Depression and Anxiety Disorders According to the 2020 National Survey of Drug Use and Health, from 2004 to 2019, the reported prevalence of major depression episodes increased among all U.S. adolescents. In 2019, those with the hi... |
adultification of Black child behavior. Adults often view Black children as older, less innocent, and in less need of protection than same-age peers of other racial groups. In fact, studies have found that physicians with negative implicit racial bias are more likely to overpathologize Black child behavior and overdia... |
the federal poverty level (70.0%). Child Healthcare Disparities In almost all areas, Black, Hispanic, and Indigenous Nation/Alaskan Native children have been identified as having worse access to needed healthcare, including receipt of any type of medical care within the past 12 months, well-child or preventive visits,... |
, family centered, continuous, comprehensive, compassionate, coordinated, and culturally effective. The use of care coordinators and using community-based health navigators are effec- tive tools in helping to break down the multiple social and health sys- tem barriers that contribute to disparities. Community engageme... |
contribute to disparities and help guide interventions that are tailored to the local setting. Health disparities are a consequence of social and structural deter- minants of health that often have developed based on historically rac- ist policies and other practices and traditions that led to the social stratification... |
, influenced heavily by disparities starting at birth (Table 2.3). The infant mortality rate (IMR), arguably the most important measure of national health, has shown a persistent Black- White gap despite a substantial decline in U.S. IMR for all racial/eth- nic groups (see Fig. 2.5). NCHS data in 2022 showed a double-... |
such as maternal obesity do not capture the root causes of early childhood health inequi- ties, social determinants of health, which present intervention points for achieving health equity. Achieving health equity requires examining equity in outcomes and also equity in process. Causes and interventions to address heal... |
. This inequitable distribution is largely driven by racist policies and practices affecting exposures to small- and large-scale environmental hazards (see Chapter 2). The effects of per- sistent racism are stressful and toxic to the body, with the experience of discrimination across leading to biologic changes that ... |
) 5.7 4.6 3.9 for Asians only; 9.4 for Native Hawaiian and other Pacific Islander 4.9 10.8 8.2 Preterm Birth: proportion of singleton births before 37 wk gestation (2018) 8.2% 7.2% 7.1% 8.4% 11.9% 10.2% Maternal mortality, deaths per 100,000 live births (2018) 17.4 14.9 NR 11.8 37.3 NR Proportion of children <18 yr rep... |
24; serious psychologic distress ≥13). NR, Not reported. Sources: Wealth data taken from the U.S. Census; poverty data for adults taken from the Kaiser Family Foundation, and poverty data for children taken from the National Center for Education Statistics; unemployment data taken from the U.S. Bureau of Labor Statist... |
i- ties are seen across almost all health indicators, with most relative gaps remaining stagnant or worsening over the past two decades. Compared with White children, Black children are about twice as likely to be diagnosed with asthma, more likely to be hospitalized for its treatment, and more likely to have fatal att... |
. Census identified Mexicans and Puerto Ricans as “White” even as racial classification varied by geography. All states collected birth records by 1919, but there was little uniformity on how race was col- lected, if at all, across states. It was not until 1989, when the National Center for Health Statistics (NCHS) rec... |
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