Dimitri Christakis

Background The efficacy of the BNT162b2 vaccine in pediatrics was assessed by randomized trials before the Omicron variant’s emergence. The long-term durability of vaccine protection in this population during the Omicron period remains limited. Objective To assess the effectiveness of BNT162b2 in preventing infection and severe diseases with various strains of the SARS-CoV-2 virus in previously uninfected children and adolescents. Design Comparative effectiveness research accounting for underreported vaccination in 3 study cohorts: adolescents (12 to 20 years) during the Delta phase and children (5 to 11 years) and adolescents (12 to 20 years) during the Omicron phase. Setting A national collaboration of pediatric health systems (PEDSnet). Participants 77 392 …

Purpose: The goal of this article was to identify demographic differences in receipt of gender dysphoria (GD) diagnosis and access to gender-affirming care (GAC) among adolescents whose gender identity and/or pronouns differed from their sex assigned at birth. Methods: Data were from 2444 patients who were 13–17 years old and had a documented gender identity and/or pronouns that differed from their sex assigned at birth in the electronic health record. Adjusted logistic regression models explored associations between demographic characteristics (sex assigned at birth, gender identity, race and ethnicity, language, insurance type, rural status) and presence of GD diagnosis and having accessed GAC. Results: The average predicted probability (Pr) of having received a GD diagnosis was 0.62 (95% confidence interval [CI] = 0.60–0.63) and of having accessed GAC was 0.48 (95% CI = 0.46–0.50 …

Background: The impact of pre-infection vaccination on the risk of long COVID remains unclear in the pediatric population. Further, it is unknown if such pre-infection vaccination can mitigate the risk of long COVID beyond its established protective benefits against SARS-CoV-2 infection. Objective: To assess the effectiveness of BNT162b2 on long COVID risks with various strains of the SARS-CoV-2 virus in children and adolescents, using comparative effectiveness methods. To disentangle the overall effectiveness of the vaccine on long COVID outcomes into its independent impact and indirect impact via prevention of SARS-CoV-2 infections, using causal mediation analysis. Design: Real-world vaccine effectiveness study and mediation analysis in three independent cohorts: adolescents (12 to 20 years) during the Delta phase, children (5 to 11 years) and adolescents (12 to 20 years) during the Omicron phase. Setting: Twenty health systems in the RECOVER PCORnet electronic health record (EHR) Program. Participants: 112,590 adolescents (88,811 vaccinated) in the Delta period, 188,894 children (101,277 vaccinated), and 84,735 adolescents (37,724 vaccinated) in the Omicron period. Exposures: First dose of the BNT162b2 vaccine vs. no receipt of COVID-19 vaccine. Measurements: Outcomes of interest include conclusive or probable diagnosis of long COVID following a documented SARS-CoV-2 infection, and body-system-specific condition clusters of post-acute sequelae of SARS-CoV-2 infection (PASC), such as cardiac, gastrointestinal, musculoskeletal, respiratory, and syndromic categories. The effectiveness was reported as (1 …

Objectives To characterize the complex interplay between multiple clinical conditions in a time-to-event analysis framework using data from multiple hospitals, we developed two novel one-shot distributed algorithms for competing risk models (ODACoR). By applying our algorithms to the EHR data from eight national children’s hospitals, we quantified the impacts of a wide range of risk factors on the risk of post-acute sequelae of SARS-COV-2 (PASC) among children and adolescents. Materials and Methods Our ODACoR algorithms are effectively executed due to their devised simplicity and communication efficiency. We evaluated our algorithms via extensive simulation studies as applications to quantification of the impacts of risk factors for PASC among children and adolescents using data from eight children’s hospitals including the Children’s Hospital of Philadelphia …

Purpose: To explore transgender and nonbinary (TNB) young adults' (1) interest in receiving gender-affirming medications through telemedicine before age 18 years and (2) willingness to initiate this care with primary care providers (PCPs). Methods: Data were from a survey of TNB young adults who had not received gender-affirming medications before age 18 years. Chi-square and Wald tests identified demographic differences in telemedicine interest and willingness to initiate medications with their PCP as minors. Results: Among 280 respondents, 82.5% indicated interest in telemedicine and 42.0% were willing to initiate medications with their PCP. Black/African American respondents were more likely to indicate interest in telemedicine than White and multiracial respondents. Respondents from rural areas were more likely to indicate willingness to initiate medications with their PCP than those from urban areas …

ObjectiveAssess how child involvement in making rules about screen time relates to age, child prosocial functioning, and amount of screen use among adolescents.MethodsNORC’s AmeriSpeak Panel was used to recruit a nationally representative sample of parents or guardians of school-aged children (age 5–17) in the United States (n = 2084). Parents completed survey that included measures of screen time, child involvement in rule making about screen use, family functioning, and dimensions of child psychosocial functioning.ResultsAcross all age categories, most families had some form of rules about the allowable amount of screen-based digital media for uses other than schoolwork: 86 % of elementary school-aged children (ages 5 to 10), 81 % of middle school-aged children (ages 11–13), and 61 % of high school aged children (ages 14–17). Across all age groups, having rules was associated with …

IntroductionLimited caregiver health literacy has been associated with poorer health outcomes in pediatric patients and may limit caregiver understanding of printed education resources. Postoperative healthcare utilization may be related to confusion about instructions or complications.ObjectiveTo correlate caregiver health literacy and educational video intervention with postoperative healthcare utilization following ambulatory pediatric urologic surgery.Study designFrom July through December 2021, a randomized double-blinded trial assessed postoperative healthcare utilization following pediatric urologic surgery. Caregivers were randomized to receive standardized postoperative counseling and printed instructions (control) or access to English-language educational YouTube® videos with standardized postoperative counseling and printed instructions (intervention). Medical record abstraction was completed …

Purpose of ReviewThe incorporation of digital technologies and their use in youth’s everyday lives has been increasing rapidly over the past several decades with possible impacts on youth development and mental health. This narrative review aimed to consider how the use of digital technologies may be influencing brain development underlying adaptive and maladaptive screen-related behaviors.Recent FindingsTo explore and provide direction for further scientific inquiry, an international group of experts considered what is known, important gaps in knowledge, and how a research agenda might be pursued regarding relationships between screen media activity and neurodevelopment from infancy through childhood and adolescence. While an understanding of brain-behavior relationships involving screen media activity has been emerging, significant gaps exist that have important implications for the health of …

PurposeLittle prior research has explored the experiences of transgender and nonbinary (TNB) individuals seeking gender-affirming medical care in young adulthood. We aimed to understand whether TNB individuals initiating gender-affirming care in young adulthood would have wanted to receive this care prior to age 18, and if so, 1) what types of care they desired, and 2) whether they had discussed this with their parents or guardians who would have needed to provide consent for them to access this care.MethodsWe administered a 42 item cross-sectional, electronic survey in July 2023 to TNB young adults who 1) began seeking gender-affirming care through a national telemedicine platform between the ages of 18-20, and 2) had not received gender-affirming medical care from a licensed provider before age 18. Descriptive statistics were used to characterize the sample (Table 1) and chi2 tests with post-hoc …

Telemedicine may help improve access to gender-affirming care for transgender and gender diverse (TGD) adolescents. Parents or guardians (i.e., caregivers) of TGD adolescents play a critical role in supporting TGD adolescents in accessing this care. The purpose of this study was to explore caregivers’ perspectives regarding their adolescent receiving pediatric gender-affirming care via telemedicine to help providers and health systems optimize this modality for future care delivery. Caregivers (n = 18) of TGD adolescents ages 14–17 participated in semi-structured, individual interviews that were transcribed and analyzed qualitatively. Caregivers cited participating in visits from their home environment, decreased anxiety, COVID safety, ability to have more family members attend, no transportation demands, and effective delivery of care as advantages of telemedicine. Disadvantages included dysphoria or …

The editors of JAMA and the JAMA Network journals have affirmed a steadfast commitment to equity in the conduct of our work and the content that we publish. 1, 2 This commitment includes an intentional strategy to ensure that editorial decision-makers and board members that advise the editors represent the breadth of thought, expertise, experiences, and backgrounds important for the fields of medical science covered by our journals. The strategy also aims to include individuals from groups that have been historically marginalized and excluded from medicine and medical publishing. 2 One aspect of this work is our commitment to reporting on the demographics of editorial teams in ongoing efforts at transparency that are essential to the trust that authors, peer reviewers, and readers place in the journals of the JAMA Network. 1, 2In 2021 the JAMA Network joined the Joint Commitment for Action on Inclusion and …

Background: An electronic consultation (e-consult) platform was implemented to support pediatric primary care providers (PCPs) in providing gender-affirming care to transgender and nonbinary (TNB) adolescents. Following implementation, a study was conducted to (1) explore how access to this e-consult platform impacts PCP confidence and referral patterns, (2) describe the content of questions, and (3) evaluate PCP's perspectives regarding platform usability. Methods: Following each submission, providers completed a 17-item survey. A total of 20 providers submitted 38 e-consults and 26 follow-up surveys between October 2021 and December 2022. Results: All PCPs reported a high overall value and increased confidence caring for TNB adolescents. Nearly one in five (19%) felt it allowed them to avoid submitting a specialty referral. Mean System Usability Scale score was 78.2 indicating good usability …

JAMA Pediatrics is offering a 2-year editorial fellowship position for a qualified individual who will be supported with a small stipend. The fellow will receive hands-on training in the editorial processes and policies of a pediatric journal and will be well prepared to take an editorial role in a pediatric or other peer-reviewed journal at the end of the fellowship and will gain an in-depth appreciation for how journal editorial processes work.As a journal, we are working to become more inclusive in our authorship and readership, to provide a platform for voices that are not sufficiently represented in our field, and to develop relationships with junior academics from underrepresented backgrounds. 1 We believe that one way to effect lasting positive change is by providing opportunities to such academics to advance their careers and become leaders within the field. Therefore, we encourage pediatric researchers from various …

The value of peer review, editorial review, and postpublication enhancements, particularly for those who seek to translate scientific knowledge to practice and policy. The JAMA Network core audience includes scientists who seek timely access to scientific findings to further clinical research, but also clinicians and patients, health policy makers and health system leaders, and the general public, seeking scientific information to better their own health and the health of others. Our editorial process is focused on helping authors and this broad audience not simply with reportage, but also with the interpretation of a scientific finding in the context of other scientific evidence and current clinical and public health practice. This is a dynamic process, continuing right to the final publication of the version of record (and occasionally beyond publication if corrections or clarifications warrant). 2 Articulating appropriate conclusions …

PurposeBoth affirming environments and access to gender-affirming medical care have a positive impact on the mental health of transgender and gender diverse (TGD) youth, however, many TGD youth experience barriers in accessing this care. Pediatric primary care providers (PCPs) can play an important role in expanding access to gender-affirming care for TGD youth; however, few currently provide this care. The purpose of this study was to explore pediatric PCPs' perspectives regarding barriers they experience to providing gender-affirming care in the primary care setting.MethodsPediatric PCPs who had sought out support from the Seattle Children's Gender Clinic were recruited via email to participate in semistructured, one-hour Zoom interviews. All interviews were transcribed and then subsequently analyzed in Dedoose qualitative analysis software using a reflexive thematic analysis framework.Results …

Background: Access to gender-affirming care services for transgender and gender-diverse youths is limited, in part because this care is currently provided primarily by specialists. Telehealth platforms that enable primary care providers (PCPs) to receive education from and consult specialists may help improve the access to such services. However, little is known about PCPs’ preferences regarding receiving this support.Objective: This study aimed to explore pediatric PCPs’ perspectives regarding optimal ways to provide telehealth-based support to facilitate gender-affirming care provision in the primary care setting.Methods: PCPs who had previously requested support from the Seattle Children’s Gender Clinic were recruited to participate in semistructured, 1-hour web-based interviews. Overall, 3 specialist-to-PCP telehealth modalities (tele-education, electronic consultation, and telephonic consultation) were described, and the participants were invited to share their perspectives on the benefits and drawbacks of each modality, which modality would be the most effective, and the most important characteristics or outcomes of a successful platform. Interviews were transcribed and analyzed using a reflexive thematic analysis framework.Results: The interviews were completed with 15 pediatric PCPs. The benefits of the tele-education platform were developing a network with other PCPs to facilitate shared learning, receiving comprehensive didactic and case-based education, having scheduled education sessions, and increasing provider confidence. The drawbacks were requiring a substantial time commitment and not allowing for real-time, patient …

ImportanceSARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termedpostacute sequelae of SARS-CoV-2 infection(PASC), also known aslong COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals.ObjectiveTo develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections.Design, Setting, and ParticipantsProspective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after …

The mission of JAMA Pediatrics is to provide state-of-theart information to individuals and organizations working to advance the health and well-being of infants, children, and adolescents by publishing innovative, clinically relevant research on the health of children and adolescents. Original research reports typically published by JAMA Pediatrics have included randomized clinical trials, cohort and case-control studies, epidemiologic assessments, cross-sectional studies, cost-effectiveness and decision analyses, systemic reviews with meta-analysis, and studies assessing diagnostic or screening tests. JAMA Pediatrics is pleased to announce an expansion of the focus of Original Investigations considered for publication with a new call for manuscripts reporting original and innovative pediatric translational research with significant clinical relevance. The most traditional definition of translational research has focused …

BACKGROUND AND OBJECTIVES Youth with either autism spectrum disorder (ASD) or gender dysphoria (GD) alone have also been shown to be at greater risk for mental health (MH) concerns; however, very little research has considered how cooccurring ASD and GD may exacerbate MH concerns. The purpose of this study was to examine associations between ASD, GD, and MH diagnoses (anxiety, depression, eating disorder, suicidality, and self-harm) among US adolescent populations. METHODS This is a secondary analysis of a large administrative dataset formed by 8 pediatric health system members of the PEDSnet learning health system network. Analyses included descriptive statistics and adjusted mixed logistic regression models testing for associations between combinations of ASD and GD diagnoses and MH diagnoses as recorded in the patient’s electronic medical …

Using an electronic health record–based algorithm, we identified children with Coronavirus disease 2019 (COVID-19) based exclusively on serologic testing between March 2020 and April 2022. Compared with the 131 537 polymerase chain reaction–positive children, the 2714 serology-positive children were more likely to be inpatients (24% vs 2%), to have a chronic condition (37% vs 24%), and to have a diagnosis of multisystem inflammatory syndrome in children (23% vs <1%). Identification of children who could have been asymptomatic or paucisymptomatic and not tested is critical to define the burden of post-acute sequelae of severe acute respiratory syndrome coronavirus 2 infection in children.